Jurnal of Rehabilitation Medicine 2

Journal of ISSN 1650-1969
REHABILITATION
MEDICINE Supplement No. 48
May 2010
Official journal of the
– International Society of Physical and Rehabilitation Medicine (ISPRM)
– UEMS European Board of Physical and Rehabilitation Medicine (EBPRM)
– European Academy of Rehabilitation Medicine (EARM)
Published in association with the
– European Society of Physical and Rehabilitation Medicine (ESPRM)
– Canadian Association of Physical Medicine and Rehabilitation (CAPM&R)
ABStracts
Second Asia–Oceanian
Conference of Physical and
Rehabilitation Medicine
April 29 – may 2, 2010, Taipei, Taiwan
T Rehabilitation Information
www.medicaljournals.se/jrm
Journal of Rehabilitation Medicine
Journal of Rehabilitation Medicine is an international peer-review journal published in English with ten regular
issues per year. It is owned by a Swedish nonprofit organization: Foundation for Rehabilitation Information. Journal of Rehabilita-
tion Medicine was former called Scandinavian Journal of Rehabilitation Medicine, which was founded by Olle Höök in 1968. The
name was changed to Journal of Rehabilitation Medicine in 2001.
Journal of Rehabilitation Medicine aims to be a leading worldwide forum for research in physical and rehabilitation medicine,
aiming to increase knowledge in evidence-based clinical rehabilitation. Contributions from all parts of the world and from differ-
ent professions in rehabilitation are encouraged. Original articles, Reviews (including Educational reviews), Special reports, Short
communications, Case reports, and Letters to the Editor are published. Clinical studies on rehabilitation in various patients groups,
within neurological and musculoskeletal as well as in other relevant rehabilitation areas, reports on physical and behavioural treat-
ment methodology, including rehabilitation technology, development and analysis of methodology for outcome measurements,
epidemiological studies on disability in relation to rehabilitation, and studies on vocational and socio-medical aspects of rehabilita-
tion will be considered for publication. The journal emphasizes the need for randomized controlled studies of various rehabilitation
interventions, the use of the International Classification of Functioning, Disability and Health (ICF) as a background for reports
when appropriate, and the use of modern psychometric methodology in treating and reporting data from ordinal scales.
Editor-in-Chief Jan Lexell, Lund, Sweden

Gunnar Grimby, Göteborg, Sweden Jianan Li, Nanjing, China
Leonard S.W. Li, Hong Kong
Associate Editors Meigen Liu, Tokyo, Japan
Kristian Borg, Stockholm, Sweden Crt Marincek, Ljubljana, Slovenia
Ian Cameron, Sydney, Australia Nancy Mayo, Montreal, Canada
Franco Franchignoni, Veruno, Italy Frans Nollet, Amsterdam, The Netherlands
Björn Gerdle, Linköping, Sweden Jean-Michel Mazaux, Bordeaux, France
Kenneth Ottenbacher, Galveston, USA Chang-il Park, Seoul, Korea
Bengt H. Sjölund, Odense, Denmark Michael Quittan, Vienna, Austria
Henk Stam, Rotterdam, The Netherlands Carol Richards, Quebec, Canada
Gerold Stucki, Nottwil, Switzerland Johan Stanghelle, Oslo, Norway
Katharina Stibrant Sunnerhagen, Göteborg, Sweden
Editorial Board Simon F.T. Tang, Tao-Yuan, Taiwan
Olavi Airaksinen, Kuopio, Finland Robert Teasell, London, Canada
Masami Akai, Saitama, Japan Alan Tennant, Leeds, United Kingdom
Jari Arokoski, Kuopio, Finland Luigi Tesio, Milan, Italy
Aniko Bartfai, Stockholm, Sverige Leanne Togher, Sydney, Australia
Linamara R. Battistella, Sao Paulo, Brazil Lynne Turner-Stokes, London, United Kingdom
Bipin Bhakta, Leeds, United Kingdom Guy Vanderstraeten, Gent, Belgium
Fin Biering-Sørensen, Copenhagen, Denmark Maobin Wang, Beijing, China
Jörgen Borg, Uppsala, Sweden Anthony B. Ward, Stoke on Trent, United Kingdom
Anne Chamberlain, Leeds, United Kingdom Günes Yavuzer, Istanbul, Turkey
Alain Delarque, Marseilles, France
Jean-Pierre Didier, Dijon, France
Jan Ekholm, Stockholm, Sweden Contact persons for the organizations:
Veronika Fialka-Moser, Vienna, Austria International Society of Physical Rehabilitation
Anne Fisher, Umeå, Sweden Medicine (ISPRM): Franco Franchignoni, Veruno, Italy
Martin Grabois, Houston, USA UEMS European Board of Physical and Rehabilitation
Cristoph Gutenbrunner, Hannover, Germany Medicine: Guy Vanderstraeten, Gent, Belgium
Kenji Hachisuka, Kitakyushu, Japan European Academy of Rehabilitation Medicine: Gustaaf
Andrew Haig, Michigan, USA Lankhorst, Amsterdam, The Netherlands
Karin Harms-Ringdahl, Stockholm, Sweden European Society of Physical and Rehabilitation Medicine:
Tessa Hart, Philadelphia, USA Elena Milkova Ilieva, Plovdiv, Bulgaria and Calogero Foti,
Marta Imamura, São Paulo, Brasil Rome, Italy
Alan Jette, Boston, USA Canadian Association of Physical Medicine and
Rehabilitation: Colleen O’Connell, Fredericton, New
Brunswick, Canada
All correspondence concerning manuscripts, editorial matters and subscription should be addressed to:
Editorial Manager: Mrs Agneta Andersson, Editorial assistant: Hanna Bergström, [email protected]
[email protected] For postal address: see inside back cover
Publication information: Journal of Rehabilitation Medicine (ISSN 1650-1977) volume 42 comprises ten regular issues published
in January, February, March, April, May, June, July, September, October and November. Each issue comprises at least 96 pages.
Subscription rates for volume 42:
- for institutions: paper incl. electronic access: EUR 430, electronic only: EUR 370
- for individuals: paper incl. electronic access: EUR 175, electronic only: EUR 145
- for the organizations mentioned above: paper incl. electronic access: EUR 75, electronic only: EUR 50
Indexing: Journal of Rehabilitation Medicine is indexed in Index Medicus/MEDLINE, Excerpta Medica/EMBASE, Biological
Abstracts, Current Contents/Clinical Practice, Allied and Alternative Medicine Database (AMED), Applied Social Sciences
Index & Abstracts, Ergonomic Abstracts, Psychological Abstracts PsycINFO, PSYCLIT DATABASE, Cumulative Index to
Nursing & Allied Health Literature (CINAHL), Developmental Medicine and Child Neurology, Exceptional Child Education
Resources, Periodicals Scanned and Abstracted: Life Sciences Collection, Faxon Finder, Focus On Sports Science & Medicine,
Research Alert, SCISEARCH, SportSearch.
J Rehabil Med 2010; Suppl 48: 1–204
ABStracts
Second Asia–Oceanian Conference of
Physical and Rehabilitation Medicine
April 29–may 2, 2010, Taipei
WELCOME TO TAIPEI
Dear Colleagues,
On behalf of the Organizing Committee, it is our greatest honor to have you here in Taipei to attend the 2nd Asia-
Oceanian Conference of Physical and Rehabilitation Medicine (2nd AOCPRM). The conference will be held from April
29th to May 2nd of 2010 in the Taipei International Convention Center.
The theme of our conference is “Rehabilitation: “From Cell to Society”. We have invited reputable speakers from
all over the globe to cover the hottest topics in modern physical and rehabilitation medicine. Numerous workshops
will be organized to offer hands on practice in soft tissue ultrasound examinations, shockwave therapy, and in the
fabrication of ankle-foot-orthosis.
As you may know, Taipei is famous for its inexpensive but high quality electronic products, and the adventurous
night markets. Taipei is also well known for its 101 building, one of the world’s renowned skyscrapers. Therefore, I
strongly advise you to take the opportunity to tour around Taipei and experience the unique fusion of Chinese - Western
cultural lifestyle that Taipei has to offer.
If you need any further assistance from us, please do not hesitate to let us know. It is our obligation to ensure that
your stay in Taipei will be an enjoyable one. Thank you very much!
Sincerely yours,
Simon FT Tang
Chairman of the Organizing Committee
The 2nd AOCPRM Meeting in Taipei, 2010
© 2008 Foundation of Rehabilitation Information. ISSN 1650-1977

doi: 10.2340/16501977-0563 J Rehabil Med Suppl 48
2
Thursday, April 29, 2010

09.00–17.00
ESPRM-AOSPRM Collaborative Program of ICF – International Classification of Functioning,
Disability and Health
Implementation of ICF in Rehabilitation Medicine from the ISPRM Perspective Gerold Stucki
Measurement Tools Alarcos Cieza
Overview and Updates on ICF Core Set Development Alarcos Cieza
ICF-based Strategy for Return-to-work after Medical Rehabilitation Christoph
Gutenbrunner
The Study of ICF Core-set Validation in Twelve Diseases in China Tao Xu
ICF and the Evaluation of Persons with Walking Abnormalities in Clinical Settings Alain Delarque
The European Experience of Using ICF in Research Alarcos Cieza
Asian-European Interaction: ICF and AOCPRM-ESPRM Cooperation Alessandro Giustini
Friday, April 30, 2010

08.30–10.00
Keynote Speech
The Philosophy of Rehabilitation, from Cell to Society Gerold Stucki KS 01-01
Complex Regional Pain Syndrome (CRPS): Evaluation and Treatment Martin Grabois KS 01-02
10.30–17.00
Musculoskeletal Disoders: Musculoskeletal Ultrasonography
Role of Elastography in Neuromusculoskeletal Ultrasound Gi-Young Park 0430A1
Elastography of Plantar Soft Tissue Properties Chih-Chin Hsu 0430A2
Application of Ultrasound in Sports Injuries Yi-Pin Chiang 0430A3
Non-invasive Measurement of Vessels Mechanical Properties Yio-Wha Shau 0430A4
Rehabilitation Potentials Following Foot Drop Among Leprosy Cured Patients Ajit Kumar Varma 0430E1FP
The Prevalence of Musculoskeletal Disorders in the Textile Occupation, Thailand Petcharat Keawduangdee 0430E2FP
Functional Outcomes of Major Lower Limb Amputation 1994–2006: A Modern Series Jane Wu 0430E3FP
Effects of Disc Degeneration and Muscle Dysfunction on the Cervical Spine Stability: From in Chih-Hsiu Cheng 0430E4FP
Vitro Study Using Porcine Model
Nitric Oxide Concentrations in CSF are Possible Predictors of Postoperative ADL Improvement in Shinji Kimura 0430E5FP
Lumbar Canal Stenosis
Paradigm Shift in the Management of Back Pain M. Taslim Uddin 0430E6FP
Effect of Taping for Patients with Lateral Epicondylitis and Motion Tracking on Elbow Tissue Pei-Chun Hsieh 0430E7FP
from Ultrasonic Image Sequence
Ultrasound-guided Injection Therapy for Frozen Shoulder Sheng Bi 0430E8FP
Comparison of Elastography and Gray-scale Ultrasonography in Diagnosing Small Full-thick- Giyoung Park 0430E9FP
ness Supraspinatus Tendon Tear
15.30–17.00
Interventional Rehabilitation
An interventional PM&R Approach to Spinal Pain: Evidence-based Approach and Beyond David Cifu 0430J1
Ultrasound Diagnosis and New Treatment in Adhesive Capsulitis (Frozen Shoulder) Gi-Young Park 0430J2
Ultrasound Guided Injection Treatments in Rehabilitation Medicine Carl PC Chen 0430J3
New Advances in Therapeutic Ultrasound Wen-Shiang Chen 0430J4
Extracorpal Shock Wave Therapy on Rehabilitation of Tendinopathy Mao-Hsiung Huang 0430J5
The Science of Intravascular Laser Irradiation of Blood (ILIB) and Its Applications Tien-Yow Chuang 0430J6
10.30–12.00
Brain Disoders: Traumatic Brain Injury
Event-related Potentials and Dual Sensory Impairment (DSI) in TBI Henry Lew 0430B1
Traumatic Brain Injury (TBI) Research in Taiwan Wen-Ta Chiu 0430B2
J Rehabil Med Suppl 48

3
Neuroprotection Strategies in Experimental Traumatic Brain Injury Szu-Fu Chen 0430B3

Effect of Noise on Retention and Transfer of a Spatial Memory Task in Unequal Context in Mohammad Ali Gheraat 0430B4FP
Male Rats: A Behavioral Review
Effect of Hyperbaric Oxygenation (HBO) on Unilateral Spatial Neglect (USN) Induced by Jinglong Liu 0430B5FP
Traumatic Brain Injury
Analysis of Influence Factors of Cognitive Impairment Following First Onset of Stroke Xiquan Hu 0430B6FP
13.30–15.00
Brain Disorders: Neural Plasticity & Cognition
Cognitive Component of Tai Chi Chuan: A fMRI Study Chetwyn Chan 0430F1
How Valid is the Broken Mirror Theory of Autism Ya-Wei Cheng 0430F2
Cognitive and Neuroimage Assessment and Human Cognitive Rehabilitation Yuejia Luo 0430F3
Representation of Tactile Motion in the Primary Somatosensory Cortex: A Psychophysical and Yu-Cheng Pei 0430F4
Neurophysiological Study
Reveal the Neural Mechanism and the Property of Pure Alexia for Chinese Characters by Us- Chunlei Shan 0430F5FP
ing Neuroimaging Techniques and Cognitive Neuropsychological Tests
The Effects of Basal Ganglia Stroke on Implicit Learning Zhongli Jiang 0430F6FP
Cognitive Flexibility in Children with Learning Disability H.S. Somashekara 0430F7FP
15.30–16.00
Development of Physical and Rehabilitation Medicine in Aisan and Oceanian Region
Development of Physical and Rehabilitation Medicine in Taiwan Simon Fuk-Tan Tang 0430K1
The Development of Rehabilitation Medicine in the Philippines: Our Work, Mission and Vision Reynaldo Rey Matias 0430K2
Development of Physical and Rehabilitation Medicine in Mongolia Baljinnyam Avirmed 0430K3
History of Development of ISPRM: Review of the Challenges John Melvin 0430K4
10.30–17.00
Brain Disorders: Stroke
Depression and Anxiety in the Hemiplegic Jorge Lains 0430C1
Mirror Neuron System in the Pre-motor Cortical Area: A RCT in the Post-acute Stroke Arm Marco Franceschini 0430C2
Rehabilitation. Preliminary Report
Effectiveness of Ultrasound Guided Botox Injection on Balance in Post-stroke Patients with Zulin Dou 0430C3
Lower Extremities Spasticity
Massage Therapy in Depressed People: A Meta-Analysis of Clinical Trials Wen-Hsuan Hou 0430C4
Power Rehabilitation, Principle and Method Tkahito Takeuchi 0430G1
Functional Electrical Stimulation Improves Functional Recovery of the Upper Extremity of Tiebin Yan 0430G2
Subjects with Acute Stroke: A 6 Months Follow-up Study
Evidence-based Stroke Rehabilitation? Keh-Chung Lin 0430G3
Facilitating Motor Performance Through External Cueing for People with Parkinson’s Disease Hui-Ing Ma 0430G4
Physical Findings, Sonography and Shoulder Pain of Hemiplegic Shoulders in Acute Stroke Yu-Chi Huang 0430G5
Patients during Rehabilitation
Effects of Motion Control Shoe on the Kinematic, Kinetic and Motor Control of the Leg During Gabriel Y.F. Ng 0430L1
Running
The Role of Imagery in Constraint-induced Movement Therapy Karen Liu 0430L2
Use of Proprioceptive Stimulation in Stroke Rehabilitation Sang-I Lin 0430L3
Cortical Reorganization Induced by Body Weight-supported Treadmill Training in Individuals Ray-Yau Wang 0430L4
with Stroke
Integrity of the Corticospinal Tract Predicts Motor Recovery in Stroke: Diffusion Spectrum Pei-Fang Tang 0430L5
Imaging Studies
Telerehabilitation in Subjects with Subacute Stroke Kwan-Hwa Lin 0430L6
Effects of Sit-Stand-Sit Strategies on Postural Stability in Stroke Patients Ta-Sen Wei 0430D1
Robotic-assisted Therapy of Paretic Upper Limb for Chronic Stroke Pai-Yin Chen 0430D2FP
Correlation Factors of the Health-related Quality of Life in Patients with Chronic Aphasia Due Lochia Chang 0430D3FP
to Stroke
Correlation of Stroke-onset Severity with Health Status, Quality of Life and Family Impact in Ru-Lan Hsieh 0430D4FP
Patients with Ischemic Stroke
Comparison of Intramuscular Botulinum Toxin Type A Injection and Percutaneous Muscular Jau-Jia Lin 0430D5FP
Branch Block of the Tibial Nerve for Reducing Ankle Plantarflexor Spastcitiy: A Randomized
Clinical Trial

4
That Using Computer Exercise Upper Limb of the Ischemic Stroke Patients Observe the Jin Chen 0430D6FP
Changes of Brain Functional Magnetic Resonance Imaging
The Effect of Rehabilitative Training on Brain Functional Reorganization in Patients with Xiquan Hu 0430D7FP
Cerebral Infarction by fMrI: A Longitudinal Study
13.30–17.00
Cardiopulmonary Rehabilitation and Obesity
Schedule of Cardiac Rehabilitation Farzaneh Torkan 0430H1
Exercise Prescription and Thrombogenesis Jong Shyan Wang 0430H2
Benefits of Phase 2 Cardiac Rehabilitation in Patients with Myocardial Infarction Ssu-Yuan Chen 0430H3
CARES THAI Actions: Preventive and Rehabilitative Program for Cardiac and High Risk Piyanuj Ruckpanich 0430H4
Factors Patients
To Facilitate Return to Work Through Cardiac Rehabilitation Leonard S.W. Li 0430H5
Phase 2 Cardiac Rehabilitation Improves Aerobic Capacity of Heart Transplantation Recipi- Ssu-Yuan Chen 0430M1FP
ents at One Year After Surgery
Study of Physiological Ischemic Exercise Training on Circulating Epcs and Neovasculation in Chun-Xiao Wan 0430M2FP
Pathological Myocardial Ischemia Animals in Vivo
Electrical Stimulation in Patients with Severe Chronic Heart Failure. Masahiro Kohzuki 0430M3FP
The Effects of Phase 2 Cardiac Rehabilitation Program on Health-related Quality of Life Chen-Jung Hsu 0430M4FP
Among Heart Transplantation Recipients
The Effect of Isometric Exercise on Human Coronary Collateral Function During Acute Coro- Xiao Lu 0430M5FP
nary Occlusions
Is Horseback Riding More Effecitve Than Horse Riding Robot for Physical Exercise?: Heart Naohisa Kikuchi 0430M6FP
Rate Monitoring, Caloric Consumption, 2D Motion Analysis and Surface EMG Monitoring
Effectiveness of Breathemax Breathing Device on Airway Secretion Clearance in Patients Sujittra Kluayhomthong 0430M7FP
Dependent on Mechanical Ventilation
Effect of Phase Ii Cardiac Rehabilitation After Coronary Artery Bypass Graft: A Comparison Po-Chin Strong 0430M8FP
of Quality of Life, Peak V2 and Functional Aerobic Impairment.
Nos-3 Effected on the Pulmonary Arterial Pressure and Alleviated the Pulmonary Small Arte- Xiaotong Wang 0430M9FP
rial Remodeling in Chronic Hypoxic Hypercapnic Rats by Kallikrein
13.30–17.00
Cross-Strait Session
Development of Rehabilitation Services for Child Cerebral Palsy in China Xiaojie Li 0430I1
Neural Function Information Detection and Rehabilitation Engineering Jue Wang 0430I2
The Theory and Approach of Disability Classification and Evaluation Based on ICF model Zhuoying Qiu 0430I3
Analyses of Clinical Assessment of Unilateral Neglect after Stroke Weiqun Song 0430I4
Applied Research of Exercise Therapy in Complications of Diabetes Zhongli Jiang 0430I5
The Effects of Angelica Sinensis Injection on the Neuronal Metabolites and Blood Flow Speed Wei-Jing Liao 0430I6
within Reperfusion Following the Ischemic Cerebral Injury in Rats
Mental Health Status of the Parents of Cerebral Palsy Children and its Relationship with Zhihai Lu 0430N1FP
Personality Traits
CCK-8 Prevents Glutamate-Induced Apoptosis in Cultured Cortical Neurons Via Up-regula- Jiangbao Zhou 0430N2FP
tion of Bcl-2/Bax Ratio and Down-Regulation of Caspase-3
Protective Effect of BDNF to Newborn Rats with Hypoxie-ischemic Brain Damage Jiangbao Zhou 0430N3FP
Morphine Preconditioning Induces Delayed Neuroprotection Against Glutamate-Induced Qing Shang 0430N4FP
Excitotoxicity
Clinical Comparative Study on Acupuncture and Swallowing Trainning for Treating Dysphag- Pande Zhang 0430N5FP
ic Patients with Stroke
Application of Network Thinking and Network Analysis on Meridian Researches Feng Lin 0430N6FP
Postischemic Wheel Running Increased Neurogenesis in the Subventricular Zone of Adult Xiquan Hu 0430N7FP
Rats With Local Cerebral Infarction
Study on Auditory Semantic Priming Effects in Aphasia Patients Zhongli Jiang 0430N8FP
Dysfunction of the Mitochondria in the Cerebrum of Mice Induced by Chronic Hypoxic Hy- Xiaotong Wang 0430N9FP
percapnia
Study on the Therapeutic Effects of Chinese Traditional Manipulation Combined with Lumbo- Zhang Hong 0430N10FP
Dorsal and Abdominal Muscle Exercise in Treating Waist Sports Injuries

5
saturday, may 1, 2010

08.30–10.00
Keynote Speech
Postural Motor Control: What We Learned from Animal Model and Its Relevance for Human Tatian Deliagina KS 02-01
Application of rTMS and tDCS in Rehabilitation after Brain Damage Yung-Zu Huang KS 02-02
John Rothwell
10.30–17.00
Brain Disorders: Sensory-Motor Control
Biophysics of Assessment of Human Motor Control by Surface Polyelectromyography Art Sherwood 0501A1
Motor Control Modification in Humans after SCI Barry McKay 0501A2
Correlation of Motor Control in the Supine Position and Assistive Device Used for Ambula- Simon Fuk-Tan Tang 0501A3
tion in Chronic Incomplete Spinal Cord-injured Persons
Neurophysiology of the Human Spinal Cord Tested by Lumbosacral Evoked Potentials, the Karen Minassian 0501A4
H reflex and Posterior Root-muscle Reflexes
Human Neural Control of Posture: Modifications of Lumbar Posterior Root-muscle Reflexes Ursula Hofstoetter 0501D1
Neuroimaging Assessment of Human Spinal Cord White and Grey Matter Spyros Kolias 0501D2
Transitory Human Paraplegia Vedran Deletis 0501D3
The Neurophysiology of Human Locomotor Training Keith E Tansey 0501D4
The Effect of Peripheral Nerve Lesion upon Postural Control Justin Bown 0501H1
Novel Access to the Human and Animal Locomotor Circuitry Yury Gerasimenko 0501H2
Transformation of Nonfunctional Spinal Circuits Into Functional and Adaptive States in Para- Gregoir Courtine 0501H3
lyzed Rats
Human Motor Control and Recovery of the Motor Functions after CNS Lesions Milan Dimitrijevic 0501H4
10.30–15.00
Spinal Cord Disorders
Acute Spinal Cord Injury: Advancements in Basic Science Research and Clinical Care Chi-Tsou Huang 0501B1
What We Learnt from Management of Spinal Cord Injury Post Sichuan Earthquake – 2 year Jianan Li 0501B2
Experience
Bowel Management in SCI patient: From Research to Real World. Apichana Kovindha 0501B3
Brindley’s Technique for the Treatment of Bladder Dysfunction Post Spinal Injury Injure Mou-Wang Zhou 0501B4
Neurogenic Bowel Dysfunction in Patients with Spinal Cord Injury Chin-Wei Liu 0501B5
The High-sensitivity C-reactive Protein in Patients with Chronic Spinal Cord Injury Chun-Chiang Huang 0501E1
International Perspectives of Spinal Cord Injury – Clinical Care Xianghu Xiong 0501E2
PET in Assessing Brain Plasticity among People with Spinal Cord Injury Yen-Ho Wang 0501E3
Effects of Electrical Stimulation of Pudendal Nerves on Bladder Voiding Function in the Yin-Tsong Lin 0501E4FP
Spinal Cord Injured Rat
Changes of Physical Abilities, Quality of Life, Incidences of Complications and Falls in Pa- Jiraporn Wannapakhe 0501E5FP
tients with Chronic Spinal Cord Injury 6 Months After Discharge: A Preliminary Study
An Overview of the Stem Cells in the Management of Spinal Cord Injury Farooq Rathore 0501E6FP
A Initial Study on Brain fMRI of Spinal Cord Injury Patients Lijuan Ao 0501E7FP
The International Spinal Cord Injury Core Data Set: Experience of a Non-model System Julia Patrick Engkasan 0501E8FP
Hospital
Quantitative Analysis of Bladder Compliance in Subjects with Neurogenic Bladder Voiding Su-Ju Tsai 0501E9FP
Dysfunction after Spinal Cord Injury
15.30–17.00
Assessment, Evaluation and Diagnosis
Innovation in Assessing Balance Function in Patients with Stroke: A Set of Functional-hierar- Wen-Hsuan Hou 0501I1FP
chy Short Forms and Computerized Adaptive Test
Does Marathon Running Cause Chronic Degenerative Lesions of the Knee?: An Ultrasono- Min-Hsin Lai 0501I2FP
graphic Study in Long-distance Runners

6
Influence of Chin-tuck Maneuver on Temporal and Kinematic Characteristics in Normal Swal- Ja-Ho Leigh 0501I3FP
lowing
New Portable System for Comprehensive Measurement of Spasticity Encompassing Electro- Jeong Hwan Seo 0501I4FP
physiologic, Kinematic and Biomechanical Aspects in Stroke Patients
Technical Validity and Reliability of Objective Measurement in Swallowing Kinematic Analysis Seongmin Chun 0501I5FP
Functional Assessment of Balance in Early Stages of Multiple Sclerosis Raabeae Aryan 0501I6FP
Developing Who ICF Core Sets for Subacute Stage of Spinal Cord Injury in Taiwan Chin-Wen Wu 0501I7FP
The Prognostic Role of the Modified Rankin Scale on Survival in Patients with Stroke Hsi-Ting Chiu 0501I8FP
Early Changes of Knee Joint Movement in People with Knee Osteoarthritis During Gait; A Masami Akai 0501I9FP
Motion Analytic Study with Point Cluster Technique
10z30–12.00
Pain Management: Part 1
Rehabilitation of Muscle Injuries in Sports Walter Frontera 0501C1
Current Concepts in Musculoskeltal Pain, Mobility and Gender Mark Young 0501C2
Phantom Pain in Amputees Parviz Mojgani 0501C3
Acupuncture and Myofascial Trigger Points-human Study Li-Wei Chou 0501C4
Effect of Neuromuscular Blocking Agent on the Spontaneous Electrical Activity in a Myofas- Shu-Min Chen 0501C5
cial Trigger Spot of Rabbit Skeletal Muscle
13.30–15.00
Musculoskeletal: Osteoarthritis & Osteoporosis
Physical Exercise and the Osteocyte Osteogenic Response Jorge Lains 0501F1
The Role of Exercise in Osteoarthritis (OA) of the Knee Angela B.M.Tulaar 0501F2
Exercise to Maximize Peak Bone Mass and Minimize Bone Loss Sukajan Pongprapai 0501F3
Headache Due to C2 Sensory Radiculopathy Juan Mauel Guzman 0501F4
Gonzalez
Cercvical Radiculophy Induced Neck Pain Kamyar Akrami 0501F5
Management of Cericalgia in the Middle Aged Chih-Wei Chou 0501F6
15.30–17.00
Current Advance in Myofascial Pain Chang-Zern Hong 0501J1
Diagnosis and Treatment for Myofascial Pain Syndrome of the Upper Back Muscles Baljinnyam Avirmed 0501J2
The Link Between Immobility and Microgravity Low Back Pain Reynaldo Rey Matias 0501J3
Approach to Mechanical Low Back Pain Ahmad Raeissadat 0501J4
Local Treatment of Myofasicl Pain: NSAID Patches Lin-Fen Hsieh 0501J5
Laser Treatment for Myofasicl Trigger Points Kai-Hua Chen 0501J6
13.30–15.00
Rehabilitation Technology and Engineering
Application of a Cycling Wheelchair to the Patients with Gait Disturbance Yasunobu Handa 0501G1
Functional Electrical Stimulation Cycling Exercise Shih-Ching Chen 0501G2
The Development of New Intelligent Comprehensive Interactive Care (ICIC) System for Alice M.K. Wong 0501G3
Elderly Care
Cortical Activation During Robot-aided Rehabilitation Futoshi Wada 0501G4
15.30–17.00
Prosthetic and Orthotics
Influence of the Level of Amputation on Survival Advantage and Functional Performance in Takaaki Chin 0501K1
Elderly Amputees
Lower-limb Prosthetics: Previous Research and Future Development Winson Lee 0501K2
The Effect of Rigid vs. Flexible Spinal Orthosis on the Clinical Efficacy and Acceptance of Man Sang Wong 0501K3
the Patients with Adolescent Idiopathic Scoliosis
Application of Ankle-foot Orthoses Following Stroke: Update and Future Chih-Kuang Chen 0501K4
Orthotic Management of Myelodysplasia Moon Suk Bang 0501K5
Rehabilitation and Assistive Technology Eric Tam 0501K6

7
sunday, may 2, 2010

08.30–10.00
Keynote Speech
Rehabilitation of Combat-Injured Polytrauma (TBI, Amputation and SCI): The U.S. Veterans David Cifu KS 03-01
Health Administration Experience
Recent Advancement and Management of Spasticity Anthony Ward KS 03-02
10.30–15.00
Brain Disorders: Spasticity
Severe Spasticity (ITB therapy) Zampolini Mauro 0502A1
Evaluating Functional Outcomes after the use of Botulinum Toxin for Spasticity Post Acquired John Olver 0502A2
Brain Injury: An Australian Experience
Botulinum Toxin and Intrathecal Baclofen: Concurrent or Sequential Therapies? Gerard Francisco 0502A3
The Application of Motor Control Assessment in Patients with Spasticity Simon Fuk-Tan Tang 0502A4
Treatment of Early Post-stroke Upper Limb Spasticity in Asian Patients: Results of a Prospective, Kong Keng He 0502E1
Multicentre, Randomized, Double-blind, Placebo-controlled Trial of Botulinum Toxin A Injection
Comprehensive Management of Spasticity in Cerebral Palsy Moon Suk Bang 0502E2
Neurophysiological Monitoring of Intrathecal Baclofen Delivery for Control of Spasticity Dobrivoje Stokic 0502E3
EMG Patterns Induced by Different Angular Velocity in Stroke Patients with Ankle Spasticity Ta-Sen Wei 0502E4
15.30–17.00
Rehabilitation Technology and Engineering,Geriatric Rebabilitation, Complementaray and Alternative Medicine
Application of Surface Eeg-Based Brain-Machine Interface (BMI) to Rehabilitation Practice Meigen Liu 0502I1FP
Can Transcranial Direct Current Stimulation (TDCS) Modify the Resting-state Functional Gad Alon 0502I2FP
Connectivity of the Motor Cortex?: A Proof of Concept FMRI Study
Efficacy of a Computerized Assessment and Training System for Chronically Dizzy Patients Chung-Lan Kao 0502I3FP
Functional Electrical Stimulation to Dorsiflexors and Plantar Flexors During Gait to Improve Gad Alon 0502I4FP
Walking in Adults with Chronic Hemiplegia
The Effect of Newly-Designed Dynamic Cushion System on Deep Tissue of Human Buttock: Shih-Cherng Lin 0502I5FP
A 3D Finite Element Analysis
Intensive Training of Chronic Stroke on a Motorized Cycle Combined with Functional Electri- Gad Alon 0502I6FP
cal Stimulation (FES): Effect on Locomotion
Malnutrition and Rehabilitation Outcome of Disuse Syndrome: A Retrospective Cohort Study Hidetaka Wakabayashi 0502I7FP
Performance on Hornsby Disc Test Predicts Rehabilitation Potential in Cognitively Impaired Jan Yueh-Chen Hong 0502I8FP
Elders
Walking and Balance Performance in Exercise, Lifestyle Active and Inactive Elderly Thiwaporn Thawee- 0502I9FP
wannakij
10.30–12.00
Brain Disorders: Speech & Swallowing
New development in Dysphagia Evaluation Tai Ryoon Han 0502B1
Effects of Pneumatic Dilation on Cricopharyngeal Function in Patients with Achalasia Zulin Dou 0502B2
Evaluation and Management in Irradiated NPC Patients with Dysphagia Tyng-Guey Wang 0502B3
Speech and Language Problems in Preschool Children in Taiwan Pao-Chuan Torng 0502B4
Recent Trends and Tools in the Assessment of Aphasia in Taiwan Lu Lu 0502B5
Lingual Kinematics When Speaking at a Fast Rate in Dysarthric and Nondysarthric Individu- Yea-Tzy Chen 0502B6
als Post Stroke
13.30–15.00
Molecules Biology
The Effects of Ultrasound on Tendon Cells Wen-Chung Tsai 0502F1
Proteomic Research in Ageing and Rehabilitation Medicine Carl P.C. Chen 0502F2
The Effects of Physical Agents on Musculoskeletal Cells Chia-Hsin Chen 0502F3
Caveolin-1 Deficiency Reduces Early Brain Injury After Experimental Intracerebral Hemor- Che-Feng Chang 0502F4FP
rhage

8
The Cross-talk Between Transforming Growth Factor-beta1 and Ultrasound-induced Matrix Yuan-Hung Chao 0502F5FP
Catabolism During Mechanotransduction of Rat Tenocytes
Living Muscle Tissues Imaging with Autofluorescence by Using Two Photon Laser Excitation Chien-Cheng Chen 0502F6FP
Microscopy (TPEM)
15.30–17.00
Education and Ethics in Rehabilitation
Evolving Medical Board Certification in the United States Joel A. DeLisa 0502J1
Strategies for Undergraduate Education in PRM John Melvin 0502J2
Submission and Publication of Scientific Articles in Rehabilitation Medicine Gunnar Grimby 0502J3
Title Missing Marta Imamura 0502J4
Education and Training of PM & R Professionals in Mainland China Dahong Zhuo 0502J5
Resident Training of PM & R in Taiwan Alice MK Wong 0502J6
Older People’s Acceptance of Falls Prevention Education Moreena Kwa 0502J7FP
Rehabilitation Doctors’ Attitudes Towards Ethics Issues Julia Patrick Engkasan 0502J8FP
10.30–12.00
Electrodiagnosis
Pitfalls and Pearls in Nerve Conduction Study and Needle EMG Shin J. Oh 0502C1
Peripheral Nervous System Electrophysiology: Reporting Procedures, and Pitfalls Gulseren Akyuz 0502C2
Post Polio: Etiology, Diagnosis and Treatment Gunnar Grimby 0502C3
Peripheral Nerve Electrodiagnosis in Rehabilitation Medicine Zongyao Wu 0502C4
On-nerve Needle Nerve Conduction Study: Histological Basis of NCS, Conversion Factor, and Shin J. Oh 0502C5
Its Clinical Relevance
13.30–15.00
Pain Management Marta Imamura 0502G1
The Application of Surface Electromyography on Treating Lumbar Disc Herniation Jingsong Mu 0502G2FP
Effect of Sitting Postures on Lumbar Multifidus and Internal Oblique Fatigue Pattanasin 0502G3FP
Areeudomwong
Increased Both Contractile Subunit Protein Phosphorylation Signaling and Endplate Noise Ta-Shen Kuan 0502G4FP
Prevalence in Myofascial Trigger Spots of Rabbit Skeletal Muscle
Comparison of Mire and Traditional Physical Therapy for the Inhibition of the Irritability of Wei-Chih Lien 0502G5FP
Myofascial Trigger Spot of Rabbit Skeletal Muscle
The Characteristics of Polysomnographic Findings Among the Patients with Chronic Neck– Hung-Shen Chen 0502G6FP
shoulder Pain
The Immediate Effects of A Single Thoracic Manipulation on Cervical Range of Motion and Thavatchai Suvarnnato 0502G7FP
Pain in Patients with Chronic Mechanical Neck Pain: A Randomized Controlled Trial
Intra-Articular Botulinum Neurotoxin Type a for Advanced Knee Osteoarthritis Chen-Liang Chou 0502G8FP
Occipital Nerve Stimulator Therapy for a Refractory Cervicogenic Headache Linqiu Zhou 0502G9FP
15.30–17.00
Pain Managemen: Part 4
Pictorial Guides to Myofascial Pain Yoon Kyoo Kang 0502K1
Various Interventions in Myofascial Pain Angela B.M.Tulaar 0502K2
Pathophysiology of Myofascial Trigger Point Ta-Shen Kuan 0502K3
Diagnostic Ultrasound to Myofascial Trigger Point and Taut Band Hsin-Shui Chen 0502K4
Three-dimensional Real Time Sonographic Morphologic Assessment of Human Myofascial Hung-Jih Hsu 0502K5
Pain During Needling: Demonstration of a Pilot Study
Myofascial Trigger Points in the Early Life Mu-Jung Kao 0502K6

9
10.30–17.00
Pediatric Rehabilitation
GABAA Receptor Expression in Patients with Spastic Cerebral Palsy Chang-Il Park 0502D1
Longitudinal Studies on the Developmental Functions and Clinical Variables in Children Born Suh-Fang Jeng 0502D2
with Prematurity
Advances in Measurement Methods for Children with Developmental Delay in Taiwan Hua-Fang Liao 0502D3
Advances in the Application of Botulinum Toxin in Pediatric Rehabilitation Jeng-Yi Shieh 0502D4
Advances in Current Intervention for Children with Cerebral Palsy Chia-Ling Chen 0502D5
Footprint Measurements Analysis of the Flatfoot in Preschool Children Kun-Chung Chen 0502H1FP
A Clinical Research on Frontal Lobe Development During Infants and Young Children Period Xiang Chen 0502H2FP
with Quantitative Assessment of Cranial Mri and Early Detection of Cognitive Function
Establishing Hypothetic Models Based on “International Classification of Functioning, Dis- Ai-Wen Hwang 0502H3FP
ability, and Health – Children and Youth Version“ (ICF-CY) In Infants and Toddlers with
Motor Delays – with Maintaining a Body Position (D415) as the Motor Outcome
Gene Expression Profiling in Congenital Muscular Torticollis Shin-Young Yim 0502H4FP
Characteristics of Children with Cerebral Palsy in South Korea In-Young Sung 0502H5FP
A Study of the Protection of Bdnf on Cortical Neurons Jiang-Bao Zhou 0502H6FP
The Effect of Therapeutic Exercise on Behavioral Performance in Children with Attention Chao-Chi Hong 0502H7FP
Deficit Hyperactivity Disorder: A Systematic Review
A Review on the Effect of Botulinum Toxin a Injection for Children with Cerebral Palsy Using Nar-Chi Chan 0502H8FP
ICF for Goal Setting and Outcome Measure
Functional Outcome of Acute Phase Rehabilitation by GMFCS And Disease Pattern Classifi- Kaoruko Takada 0502H9FP
cation for Pediatric Acute Encephalopathy Patients
Mirror Neurons, Empathy and Autism Ya-Wei Cheng 0502L1
Advances of Intraoperative Neurophysiologic Monitoring During Spinal Cord and Spinal Tsui-Fen Yang 0502L2
Surgery in Children
Speech and Language Intervention Program for Preschool Children in Taiwan Pao-Chuan Torng 0502L3
Development of Rehabilitation and Services of Child Cerebral Palsy in China Xiao-jie Li 0502L4FP
Prevalence and Associated Factors for Functional Articulation Disorders in Mandarin-speak- Isabel Tou 0502L5FP
ing Children of Taiwan
Practice Pattern Groups in the Pediatric Inpatient Physical Therapy Programs: Preliminary Hsu-Fan Chang-Chien 0502L6FP
Study
Systematic Review and Meta-analysis Of Horseback Riding Intervention on Gross Motor Hung-Chou Chen 0502L7FP
Change in Children with Cerebral Palsy
Group-based Physical Therapy Early Intervention for Infants with Developmental Delay: Two Szu-Chieh Lee 0502L8FP
Case Reports

10 AOCPRM – April 29–May 2, 2010, Taipei
Pre-conference workshop (April 29, 2010)
0429WS4 on ICF Core Set development” and “Measurement tools” is to

IMPLEMENTATION OF ICF IN REHABILITATION present different approaches to address that challenge.The current
state of the development of ICF Core Sets as well as their areas of
MEDICINE FROM THE ISPRM PERSPECTIVE use will be presented. The ICF Core Sets are international standards
Gerold Stucki1,2,3,4 based on a sound, evidence-based and consensus-driven process
1
Department of Health Sciences and Health Policy, University of involving experts from all over the world. ICF Core Sets have been
Lucerne and SPF, 2Swiss Paraplegic Research (SPF),3ICF Research developed for a number of specific health conditions. In addition,
a Generic ICF Core Set that allows the comparison of functioning
Branch, WHO FIC CC Germany (DIMDI) at SPF (Switzerland) and
and disability across health conditions and health-care contexts and
4
IHRS, Ludwig Maximilian University (Germany) that can be applied in the general population is under development.
The health sector employs four strategies: prevention, cure, support It is also possible to develop measurement standards based on the
and rehabilitation. The International Classification of Functioning, ICF Core Sets. The corresponding methodological approach will
Disability and Health (ICF) is the basis for the conceptualization of be introduced. It has been developed based on Rasch analyses to
the rehabilitation strategy and is of relevance for curative, preven- identify those ICF categories of a determined ICF Core Set which
tive and supportive health strategies. The ICF and the ICF-based differentiate among patients with different levels of functioning
conceptualization of the rehabilitation strategy are again the basis and disability and that, on the basis of which, a summary score can
for the organization of human functioning and rehabilitation re- be created. Based on this methodology clinicians will not only rely
search in distinct scientific fields and the development of research on profiles of functioning, which are the starting point for planning
capacity with respect to academic training programs, interdisci- treatment, but also on summary scores, which will allow them to
plinary university centres and national/international collaboration estimate the overall level of functioning of patients, to monitor
networks. Along with these conceptual developments, there is a disease and rehabilitation management, and to follow patients along
wide range of activities in the development of practice tools and the continuum of care and over a life span. A new methodology
applications of the ICF throughout the rehabilitation world. First developed to construct interval scales for specified ICF categories
of all, the ICF can serve as reference for the comparison, selection by integrating items from a variety of patient-oriented instruments
and further development of existing measures of human function- will also be shown. This methodology allows the estimation of
ing. The mapping of measures can now rely on established linkage the value on the ICF qualifier, which is the reference rating scale
rules. The development of minimal standards for the assessment proposed by WHO to rate the level of a problem in a determined
and reporting of functioning based on the ICF as a reference has ICF category. It represents a new development in how to measure
made progress over the last years in cooperation between ISPRM, single ICF categories in a sound way and provides the principles
the ICF Research Branch WHO CC FIC (DIMDI), and WHO. The to use the ICF qualifier as a reference metric for instruments that
Brief ICF Core Sets are the standards for reporting and planning of are already used in clinical practice.
studies as well as for clinical encounters. The Comprehensive ICF
Core Sets are the standards for multi-disciplinary assessments for 0429WS4
example in the context of rehabilitation medicine. Another important
development is the operationalization of ICF qualifiers as a means ICF-BASED STRATEGY FOR RETURN-TO-WORK
to directly applying the ICF in clinical practice and research. Under AFTER MEDICAL REHABILITATION
the leadership of the Functioning and Disability Reference Group
(FDRG) of the WHO Family of International Classification (WHO- Christoph Gutenbrunner
FIC) network, a task force is coordinating the further development Department for Rehabilitation Medicine, Hannover Medical School
of coding rules and specific measurements related to one ICF or (Germany)
more ICF categories. Purpose: Return-to-work rates after medical rehabilitation still are
unsatisfactory. Studies show, that they amount only around 55 and
75%. In order to increase return-to-work rates after rehabilitation
0429WS4 model for appropriate measures has been developed based on the
GETTING TO KNOW ICF, MEASUREMENT ICF-model and driven by results of the literature. Two of such
TOOLS, OVERVIEW AND UPDATES ON ICF CORE strategies are evaluated in pilot studies. Materials and Methods:
The literature has been reviewed in order to identify barriers for
SET DEVELOPMENT return-to-work after acute disease and in chronic conditions. Ad-
Alarcos Cieza ditionally studies aiming at an improvement of return-to-work after
Institute for Health and Rehabilitation Sciences, Research Unit for rehabilitation have been included. In a second step the identified
Biopsychosocial Health (Germany) factors were classified according to the dimensions of the ICF. Using
the ICF-models strategies for new elements for rehabilitation inter-
Functioning and disability are key concepts in the practice of reha- ventions were identified. Two of the strategies were implemented
bilitation medicine [8]. Thus, the implementation of approaches that and evaluated in pilot studies. Results: The most relevant barriers
describe, assess and evaluate functioning and disability of persons for return-to-work identified were psychosomatic comorbidities,
with health conditions in rehabilitation appears to be a priority and lack of motivation and empowerment, insufficient coping strategies,
presumably will remain so for years to come.The International Clas- payment of pensions during rehabilitation, lack of communication
sification of Functioning, Disability and Health (ICF) [21], approved between rehabilitation an vocational doctors, and insufficient fo-
by all member states of the World Health Assembly in 2001, is the cussing of rehabilitation measures on the requirements of the work
current agreed-on classification that contains the whole universe of place. They can be classified according to the ICF-model mainly
meaningful units necessary to describe the experiences of people as personal and environmental factors. Most important strategies
in relation to functioning, disability and health. These meaningful have to overcome the gap between these contextual factors and
units contained in the ICF are called ICF categories and are the units rehabilitation measures. Two strategies result: the first one aiming
of the classification.There are different challenges when applying at strengthening personal resources of the individual, the second on
the ICF in rehabilitation. One of them is the development of inter- aiming at focussing all rehabilitation measures to the requirements
national standards and methodological approaches to facilitate its at the work place including the linking of rehabilitation and occupa-
implementation.The objective of the talks “Overview and updates tional activities. After implementing the first strategy in a German

Pre-conference workshop 11
rehabilitation centre, the motivation has been improve significantly can be used to compare the level of functioning and disability of
compared to a control group. The second approach led to a signifi- the study populations across the studies. The present result should
cant reduction of sick-leaf days compared to a historical control. be compared to the results from other countries.
Conclusion: Using a systematic approach based on results of the
literature and the ICF-model relevant strategies to increase return-to-
work rates could be identified. The implementation of two of theses 0429WS4
strategies already improved the situation. Based on the conceptual EVALUATION OF PATIENTS WITH GAIT
work further strategies should be derived and evaluated. ABNORMALITIES IN PRM SETTINGS BASED ON
ICF
0429WS4 Alain Delarque1, Laurent Bensoussan1, Jean-Michel
VALIDITY STUDY OF THE ICF CORE SET IN Viton1
CHINA 1
University Hospital of Marseille (France)
Tao Xu1, Xiaolin Huang1, Tiecheng Guo1, Tiebin Yan2, Purpose: Assessment of patients with gait abnormalities in physical
Guangxu Xu3, Tong Wang3, Xiquan Hu4 and rehabilitation medicine settings. Materials and Methods: Clinical
1
Tongji Hospital, Tongji Medical College, Huazhong University of examination based on the International Classification of Functioning,
Science and Technology, 2Sun Yat-sen University, The Second Af- Disabilities and Health. Body structure, activities and participation,
filiated Hospital ,3The First Affiliated Hospital of Nanjin Medical and environmental factors (physical and human factors) must all be
University and 4The Third Affilated Hospital of Sun YatSen Uni- assessed. Qualitative and quantified assessments of gait are part of
versity (China) the activity and participation evaluation. Scales are also used to as-
sess gait activities. Results: Our programme leads to understand the
Purpose: To study the validity of the ICF Core Set for 10 of 12 underlying mechanisms and the aetiology of the disorders, to obtain
different health conditions in Chinese patients and to identify quantified gait parameters, to define suitable therapeutic methods, and
candidate categories for brief ICF Core Set to be used in China. to follow the course of the disease. Conclusion: Clinical evaluation
Materials and Methods: This study was a part of the ICF Core based on ICF leads to improving quality of life.
Sets multicenter international validation study. It was conducted in
39 different countries and coordinated by the ICF research branch
of the WHO collaborating centre for the Family of International 0429WS4
Classifications at the Ludwig-Maximilians-University in Munich. ICF AND AOCPRM–ESPRM COOPERATION
This cross-sectional multicenter study involving 10 study centers
in China with patients under 10 different health conditions includ- Alessandro Giustini
ing breast cancer, depression,diabetes mellitus, chronic ischaemic Scientific Director Rehabilitation Hospital San Pancrazio (Italy)
heart disease, low back pain, osteoarthritis, obesity, obstructive
To support and develop a truly international cooperation between
pulmonary diseases, stroke and osteoporosis. The comprehensive
Europe and Asia-Oceania in rehabilitation, agreeing on a common
ICF Core Set of 10 different health conditions were filled in by
language and education are essential. Of course the individual socio-
health professionals. The patients reported their health- related qual-
political cultural and financial circumstances in each region and
ity of life in the Medical Outcome Study Short Form 36 (SF-36),
country also play a role in developing such international cooperation,
the Self-administered Comorbidity Questionnaire (SCQ, Sangha,
especially when national and international health policymakers are
2003) and condition specific health-status measures such as heart
involved. The World Health Organisation’s ICF is an effective tool for
disease health-related quality of life questionnaire (MACNEW)
representing various health conditions and disability. The ICF takes
for CIHD patients. Descriptive statistics was used to describe the
into account not only the bio-medical aspects of a health condition,
study population as well as to examine the frequency of patients’
but also the functioning of the individual and other factors. The ICF
problems in each specific health condition and to examine the fre-
can also serve as the framework for policy and interventions. The
quency of patients problems in subsets including socio-economic
international exchange of scientific information and experience about
factors (age, gender and other variables), disease characteristics
ICF application as well as a common ICF educational platform (not
(disease severity and activity), disease duration, comorbidities etc.
only for PMR doctors, but also for all rehabilitation professionals)
Factor analysis and Spearman correlation were performed to test
are essential to facilitating the use ICF in rehabilitation. National and
the validity of comprehensive ICF Core Set. The brief ICF Core Set
international societies (AOSPRM and ESPRM) and scientific events
for Chinese patients with CIHD and stroke were developed by using
could be used as a vehicle for supporting international cooperation
patients interview combined expert’s questionnaire investigation.
by providing the opportunity to exchange knowledge and experience.
Cronbach, Kendall’s W and Spearman correlation were used to test
The ICF Workshop at the AOCPRM meeting in Taipei takes a big
the reliability and validity of the brief ICF Core Set. All analysis
step toward achieving this endeavour.
was performed with SPSS 11.0 for Windows. Results: 913 partici-
pating Chinese patients under 10 different health conditions were
recruited including 175 breast cancer, 48 depression , 215 diabetes 0429WS4
mellitus, 74 chronic ischaemic heart disease, 31 low back pain, 56
osteoarthritis, 83 obesity, 72 obstructive pulmonary diseases, 129 GETTING TO KNOW ICF
stroke, 30 osteoporosis patients. Those health conditions with sam- Melissa Selb
ple size over 50 patients were selected for further statistics analysis. Swiss Paraplegic Research (Switzerland)
Thus the validity of the ICF Core Set for 7 health condition such
as osteoarthritis were examined finally. The brief ICF Core Set for Purpose: 1. To get to know the ICF model hands-on (with exer-
Chinese patients with CIHD and stroke have good reliability and cises); 2. To acquire basic knowledge of ICF for applying in various
validity, the categories of them showed considerable similarity to settings. Materials and Methods: PowerPoint presentation and
the previously proposed brief ICF core set. Some discriminatory exercises (paper hand-outs) incl. paper copies of the ICF book. Con-
categories could be elucidated socio-economic factors ( age , gender clusion: The ICF provides an effective framework for evaluating
and other variables), disease characteristics (disease severity and patients in the rehab setting as well as for determining appropriate
activity), disease duration, and comorbidities, etc. Conclusion: The interventions. The ICF Training will address the following points:
present study served as a contribution to the ongoing development 1. Structure and framework of the ICF; 2. ICF categories and how
of the Brief ICF Core Set for several health condition developed by to use them in describing patients (with exercise); 3. ICF qualifiers
the ICF research branch of WHO. An ultimate aim is to provide tools and how to use them in describing the extent/severity of functioning
that can be applied to describe patients from all over world and that (with exercise); 4. Creating a categorical profile.

KEYNOTE SPEECH (April 30, 2010)
KS01-01 KS01-02
THE PHILOSOPHY OF REHABILITATION, FROM COMPLEX REGIONAL PAIN SYNDROME (CRPS):
CELL TO SOCIETY EVALUATION AND TREATMENT
Gerold Stucki1,2,3,4 Martin Grabois
1
Department of Health Sciences and Health Policy, University of Physical Medicine and Rehabilitation, University of Texas Health
Lucerne and SPF, 2Swiss Paraplegic Research (SPF), 3ICF Research Science Center, Houston (United States)
Branch, WHO FIC CC Germany (DIMDI) at SPF (Switzerland)
and 4Switzerland and at IHRS, Ludwig Maximilian University This topic is widely discussed and diagnosed. It is vital to un-
derstand the pathophysiology of CRPS if one is to understand its
(Germany)
evaluation and treatment. This will address in detail with multiple
With the International Classification of Functioning, Disability and possible theories addressed. The evaluation and its classification
Health (ICF) the World Health Organization (WHO) has prepared have recently been updated. A more comprehensive and specific
the ground for a comprehensive understanding of Human Func- classification will be presented based on recent research for utiliza-
tioning and Rehabilitation Research integrating the biomedical tion in the clinical and research diagnosis of CRPS. The treatment
perspective on impairment with the social model of disability. of CRPS is in evolution with new proposed treatments which
This poses a number of old and new challenges regarding the have questionable effectiveness and cost efficacy. This program
enhancement of adequate research capacity. The approaches will will address the evidence basis studies on treatment especially
be summarized to address these challenges with respect to three based on the proposed pathophysiology of CRPS. New treat-
areas: the organization of Human Functioning and Rehabilitation ments will be explored and critiqued. The educational objectives
Research into distinct scientific fields, the development of suitable of this symposium are that on the completion of this activity, the
academic training programs and the building of university centres participants will be able to: 1) understand the recent research in
and collaboration networks. the area of CRPS; 2) understand how recent research is changing
clinical practice of CRPS; 3) understand the current etiology of
CRPS; and 4) understand the current concepts of evaluation and
treatment of CRPS.

Musculoskeletal Disorders: Musculoskeletal Ultasonography 13
Oral presentations (April 30, 2010)
Musculoskeletal Disorders: Musculoskeletal Tendons are particularly suitable for ultrasonographic examination.
Ultrasonography The dynamic imaging of ultrasonography can be used to assess
the level of tendon subluxation, and determine the severity of a
tendon injury, either partial or complete. We compared ultrasound
0430A1 elastographic findings with gray-scale ultrasonographic findings
and evaluated the diagnostic value of ultrasound elastography for
ROLE OF ELASTOGRAPHY IN
detecting small full-thickness supraspinatus tendon tear. Ultra-
NEUROMUSCULOSKELETAL ULTRASOUND sound elastography was obtained using free hand manipulation.
Gi-Young Park For color-scale elastography, the diagnostic criterion indicative of
Department of Rehabilitation Medicine, Catholic University of the full-thickness tendon tear included a lesion with even elastic
pattern (diffuse purple or mixed purple, blue or green) involving
Daegu School of Medicine (Republic of Korea)
the full-thickness of supraspinatus tendon. Single-contrast shoul-
Tissue hardness, the elasticity of the tissue identified on palpation, der arthrography was performed by the physiatrist and used as the
that is, deformability of the tissue, is determined by the structure reference standard for the full-thickness tendon tear. Our results
and composition of the tissue. Tissue elasticity imaging consists of indicate that ultrasound elastography showed higher accuracy than
either an image of estimated elastic modulus or an image of strain gray-scale ultrasonography in the diagnosis of small full-thickness
in response to external force. The principles of tissue elasticity supraspinatus tendon tear. Therefore, ultrasound elastography
imaging are as follows. First, tissue compression produces strain should be considered as an additional ultrasonographic method
and displacement within the tissue. Secondly, Strain is smaller in for evaluating small full-thickness supraspinatus tendon tear.
harder tissue than in softer tissue. Thirdly, we can estimate tissue Myofascial pain syndrome is a common type of musculoskeletal
hardness by measuring the tissue strain induced by compression. pain and characterized by trigger points, which are defined as
Many methods for tissue elasticity imaging are based on static hyperirritable spots within taut bands of skeletal muscle fibers.
tissue compression, which measure the strain distribution inside Myofascial taut band is considered a shortened or contracted mus-
a body produced by relaxing or compressing a tissue. Therefore, cle fiber band with increased muscle tone. Therefore, myofascial
tissue elasticity imaging does not directly represent tissue elastic- taut band have its higher stiffness compared to the surrounding
ity but, rather, tissue displacement and strain. Diverse modalities muscle fiber. Magnetic resonance elastography is a non-invasive
may be used for tissue elasticity imaging, the most powerful MR-based phase contrast imaging technique to image difference
being magnetic resonance elastography. Ultrasound elastography in tissue stiffness. Its findings suggest that the stiffness of the
imaging is possible for the evaluation of nearly every tissue and is taut bands in patients with upper trapezius myofascial pain may
one of the useful methods to quantify the strain of soft tissue. As be 50–100% greater than that of the nearby surrounding involved
conventional ultrasonographic examination, freehand manipula- muscle or the controls. It may have a potential for objectively
tion of the transducer and real-time visualization are required for characterizing myofascial taut bands that have been detectable only
a practical system of ultrasound elastography. Commercial ultra- by the clinician’s palpation. Ultrasound elastography also showed
sound scanners already offered real-time elastography and more increase of stiffness in the taut band region of the affected upper
to follow. Ultrasound elastography provides information of tissue trapezius muscle relative to that of the unaffected side in patients
hardness, in addition to shape or vascularity, which is obtained with myofacial pain syndrome. In the evaluation of peripheral
with conventional ultrasonography. In clinical practice, ultrasound nerve injury, ultrasound elastography is important not only to ap-
elastography is not used independently but as a supplementary preciate the lesions but also to give more information about the
role for conventional ultrasonography. In the technical aspects of entire nerve structure involved in trauma. In a case with median
ultrasound elastographic examination, high quality of ultrasound sensory neuropathy after carpal tunnel steroid injection, focal
elastographic imaging is obtained with the transducer and lesion hyperechoic area in the damaged median nerve was revealed on
perpendicular to gravity and light contact using transducer that gray-scale ultrasonography. Ultrasound elastography showed that
does not distort the lesion. When excessive compression is ap- the stiffness of focal hyperechoic area in the median nerve (red on
plied, a false-negative finding may be observed because relations color-scale elastography) was greater than that of the surrounding
of nonlinear properties of tissue elasticity are changed. When us- nerve tissue (green on color-scale elastography). At 6 months after
ing ultrasound elastography, it is necessary to include a sufficient injection, pervious focal hyperechoic area in the median nerve
area of surrounding normal tissue in the region of interest (ROI) disappeared and showed normal nerve echogenicity on follow-up
correctly to determine the difference in hardness of the lesion ultrasonography. In addition, even stiffness of the median nerve
compared with the normal area. In color-scale elasticity images, (green on color-scale elastography) was noted on follow-up ultra-
the scale ranged from purple for tissue with greatest strain (soft- sound elastography. This means that it changed from hard abnormal
est tissue) to red for those with no strain (hardest tissue). Green tissue to soft normal nerve tissue. Therefore, ultrasound elastog-
indicated average strain in the ROI. These color-scale elasticity raphy can provide the precise information about serial structural
images are superimposed on the corresponding B-mode images changes of the injured peripheral nerve. Ultrasound elastography
so that the ultrasonographer can easily recognize the relationship may have potential for assessing the nature and consistency of
between strain distribution and the lesion on B-mode images. Ul- lesions including hemorrhage, infection, edema, cyst, lipoma, and
trasound elastography has potential for enhancing the specificity of tumor. Recent study suggests that ultrasound elastography may be
ultrasound and mammography for breast cancer detection. Lesions useful in monitoring the severity of lymphedema. I consider that
in the prostate, thyroid, pancreas, and lymph nodes have been ultrasound elastography can provide us with more information in
effectively imaged using ultrasound elastography. The technique order to get a precise diagnosis of neuromusculoskeletal disorders.
may also be possible in the evaluation of diffuse liver disease However, ultrasound elastography is recommended as a mean of
including cirrhosis and transplant rejection. Tissue elasticity not assessment to complement the conventional ultrasonographic
only varies among different tissues, such as muscle, tendon, and method. It is expected to be a new ultrasonographic technique
nerve, but seems to reflect disease-induced changes in tissue prop- for the diagnosis of neuromusculoskeletal disease such as tendon
erties. Therefore, ultrasound elastography is expected as means tear, nerve injury, myofascial pain syndrome, and lyphedema etc.
for providing novel diagnostic information for musculoskeletal It may be widely used in the field of neuromusculoskeletal disease
disease since the tissue hardness is closely related to its pathology. for the near future.

0430A2 lesion to the surrounding structures could be demonstrated so that the

ELASTOGRAPHY OF PLANTAR SOFT TISSUE function of the lesion could be understood. Ultrasound-guided aspi-
ration for the hematoma in the injured muscles can be immediately
PROPERTIES applied in the field to get better outcome. Conclusion: Ultrasound
Chih-Chin Hsu1, Wen-Chung Tsai2, Simon Fuk-Tan Tang2 is a very convenient and useful tool for sports injury.
1
Department of Physical Medicine and Rehabilitation, Chang Gung
Memorial Hospital and 2Department of Physical Medicine and 0430A4
Rehabilitation, Chang Gung Memorial Hospital (Taiwan)
non-invasive measurement of vascular
The plantar soft tissue, located beneath the calcaneus and metatar-
sals, is subject to repeated load bearing and functions as an efficient mechanical properties
shock absorber during walking and running. It contains organized Yio-Wha Shau, Sun-hua Pao
fibrous compartments that retain the adipose tissue. The fibrous Industrial Technology Research Institute (Taiwan)
septa extending from the skin to the perichondrium is organized into
superficial small chambers, the microchamber, and greater chambers, Dynamic imaging of ultrasonography provides a convenient real-time
the macrochamber, situated deep in the small chamber stratum. There diagnostic tool for clinical research. A novel interactive image analysis
is increasing interest in measuring the plantar soft tissue mechanical technique has been developed to quantify the biomechanical proper-
properties, which provide not only information regarding the mate- ties of blood vessels in-vivo. Automatic edge-detection techniques of
rial itself but also indicate the presence of a disease. Elastic modulus vascular walls and the depth compensation of ultrasound image were
(E), representing tissue stiffness, and energy dissipation ratio (EDR), implemented. The M-mode images were used to evaluate the vascular
representing tissue energy absorption, are parameters frequently used energy dissipation ratio (EDR) with a higher spatial resolution. Also,
in describing linear and non-linear tissue properties, respectively. In the sequential B-mode images offer the vascular stiffness in differ-
our previous observations, the plantar soft tissue thickness, E and ent radial direction. We also developed a non-invasive technique to
EDR increased in the aging process. The tissue properties are also detect the change of intima-media thickness (IMT) at common carotid
velocity dependent, which character is not seen in elderly individuals. artery (CCA). With the lumen pressure measured at brachial artery
The above tissue properties changes may be responsible for easy feet (BA), the CCA relative stiffness between the intima-media and the
pain in aging persons. The diabetic plantar soft tissue has absorbed adventitia could be calculated. Our present method discloses a non-
higher energy than healthy subjects. This phenomenon may contribute invasive method to evaluate the arterial stiffness index of normalized
to the development of foot ulcers in diabetic patients. Elastography thickness from its longitudinal scanning. Both the arterial strain and
is a non-invasive method to detect stiffness or strain images of soft intima-media thickness (IMT) can be detected quickly with high
tissues in response to external disturbance. It is, therefore, considered repeatability and reproducibility. The IMT on common carotid artery
to be an ideal examination to detect inhomogeneous plantar soft tis- of DM (diabetes mellitus) patients (n=28) was 0.52±0.18 mm and
sue properties. Microchambers tissue properties and physiological slightly larger than that of the normal control (n=36) (p<0.0001).
functions are thought to be different from those of macrochambers The stiffness of normalized thickness in DM patients was also higher
owing to the different structures. The stiffness of the two different than that of the normal group (p<0.001). The stiffness of normalized
layers in heels in healthy young subjects has been quantified. The thickness can distinguish the DM patients from CAD patients even
tissue stiffness of the microchamber is nearly 10 times of that in the if their artery had the similar stiffness β or incremental stiffness. The
macrochamber. The macrochamber plays a major role in the heel-pad present invention is suitable for screening the coronary artery disease
tissue resiliency, i.e., the ability of the tissue to recover its shape after (CAD) or the disorder of metabolism.
deformation caused by compression. This layer may be responsible
for the cushioning effect in the heel pad during walking. The micro-
chamber seems to function as an inherent heel cup that maintains 0430E1FP
most of the macrochamber layer beneath the calcaneus and prevents REHABILITATION POTENTIALS FOLLOWING
excessive macrochamber layer deformation. Heel pad tissue proper- FOOT DROP AMONG LEPROSY CURED PATIENTS
ties are altered heterogeneously in people with diabetes. Increased
macrochambers but decreased microchambers stiffness may cause Ajit Kumar Varma1, Akshay Kumar Sinha2, Arun
diminished cushioning capacities in diabetic heels. Kumar3, Naresh Prasad
1
Patna Medical College (India)
0430A3 Purpose: Foot problems in leprosy subjects are of major concern.

APPLICATION OF ULTRASOUND IN SPORTS Leprosy neuritis affects nerves where they are close to the skin and
pass through a narrow fibro-osseous canal. In the leg this involves
INJURIES the lateral popliteal nerve at the neck of the fibula which leads to
Yi-Pin Chiang foot drop, and the posterior tibial nerve in the tarsal tunnel which
Department of Rehabilitation Medicine, Mackay Memorial Hospital produces anaesthesia of the sole. Resultant effect is a high stepping
(Taiwan) gait. The purpose is to achieve heel to toe gait and thereby improving
the walking pattern among the leprosy cured patients. Materials and
High-frequency high-resolution ultrasound has been widely used Methods: 20 cases of Foot drop were selected for the recopnstruc-
in the past decade for the musculoskeletal injury. With higher tive surgery procedure who fulfilled the selection criteria. Muscle
frequency of the transducers and advanced processing speed of the charting and other routine envestigations were done besides the
machines, superficial structures could be clearly seen under the sensory evaluation. Routine pre-operative vigorous exercise therapy
real-time ultrasound scanning. The A4 size or pocket-sized portable was given for a minimum of two weeks to strengthen the Tibialis
ultrasound machine are available now. It is very convenient to bring Posterior tendon. The Post operative tendon training exercise therapy
the machine to the filed to scan for the sports injury. Application of was started after the third week of operation. A four week schedule
ultrasound to sports injury may include detection and localization rehabilitation module was vigorously applied to all patients. MCR
of the lesions, clarify the staging and severity of the injury, and help foot orthoses was supplied to them to protect their feet while their
in setting the program for treatment and rehabilitation. Superficial walking after the completion of tendon training exercises. Results:
muscles, tendons, ligaments, bursae and superficial bony structures All patients reported for their follow up at the end of 3rd and 6th
are easily depicted in the ultrasound. Panoramic view yields wider months. Foot pressure image pattern in preoperative and postopera-
vision of the lesions and facilitates the understanding of ultrasound tive were compared over different time duration. The heel to toe
images. A dynamic study of ultrasound to the lesions is very im- gait pattern was achieved in 80% of the cases. Recurrent inversion
portant in sports medicine. With dynamic scanning, interaction of was evident in one case only. Mean active dorsiflexion was more

than 20 degree. Conclusion: Tibialis posterior transfer with open cohort consisted of 139 men (64.7%) and 76 women (35.3%). The
elongation of tendo Achillis gives excellent results in foot drop due average age was 70 years (SD 15.5) with a range of 17 to 95 years.
to leprosy neuritis. Immobilisation for three weeks in a plaster cast In this series of patients, 182 of them (85%) were single amputees
in maximum dorsiflexion is sufficient, with full weight-bearing and and the remainder bilateral amputees (15%). Most amputations were
active plantar flexion starting six weeks after operation. Results are performed for indications related to ischaemia secondary to vascular
quite encouraging. As it brings improvement in their walking pat- insufficiency with or without diabetes (76.3%). Other indications
tern and thereby the quality of life, the rehabilitation plan should included trauma (4.7%), infection (9.3%) and tumor (9.8%). The
be encouraged among Leprosy cured patients. median length of stay in the acute ward is 32 days (mean 44 days,
range 4 to 212 days). Significant wound infection (those requiring
antibiotics) occurred in 64 (29.8%) of amputations. Significant
0430E2FP wound breakdown requiring re-operation occurred in 23%. Seven
THE PREVALENCE OF MUSCULOSKELETAL (3.3%) patients developed thromboembolism during hospitalization.
DISORDERS IN THE TEXTILE OCCUPATION, The mortality rate during admission was 11.6%. Of the 190 patients
who survived their acute admission, 135 patients (71%) were as-
THAILAND sessed by a rehabilitation physician to have rehabilitation potential.
Petcharat Keawduangdee1, Rungthip Puntumethak2, Fifty-five patients (29%) were transferred to nursing homes straight
Yodchai Boonphakop2, Sawitri Wanpen2 after medical stabilisation without having rehabilitation. The
subgroup selected for inpatient rehabilitation at POWH (n = 112)
1
Physical Therapy Program, Graduate School, Khon Kean Univer-
are further analysed for their rehabilitation outcomes. The median
sity and 2Back, Neck and Other Joint Pain Research Group, Khon length of stay in rehabilitation is 44 days (range 6–176 days). The
Kean University (Thailand) outcomes of inpatient rehabilitation of amputees are very pleasing:
Background: Work-related musculoskeletal disorders are the com- 79% are able to be discharged home and 9% to a hostel; only 12%
mon health problems which can make people discomfort during required nursing placement after a period of rehabilitation. In this
doing activity or during working and could affect the quality of their group, 44% achieved community ambulation with a prosthesis,
life, family and society. It can arise in every occupation especially 20% achieved household ambulation with a prosthesis, 12% used a
in the industries and also involved in textile occupation, too. The prosthesis to transfer or exercise only. 24% was wheelchair bound
knowledge of prevalence of musculoskeletal disorder is an impor- and not able to use a prosthesis. Eight-one percent of the patients
tant basic information and can be a potential practical guidance were prescribed a definitive prosthesis as part of their rehabilitation
to prevent musculoskeletal disorders which will be a good effect programme. Conclusion: Major lower limb amputations continue to
for people and economy in their country. Purpose: To examine give rise to extensive length of stay and perioperative morbidity and
prevalence of musculoskeletal disorders in the textile occupation in mortality in the patient population with peripheral vascular disease
Khon Kean, Thailand. Materials and Methods: Three hundred and as the major indication for such operation. Nearly one third have no
fifty-five workers of several divisions of the textile industry were rehabilitation potential post-amputation. Those that are accepted into
participated in this study. The participants were asked to fill out the rehabilitation do well in terms of their functional outcomes with the
Standard Nordic Questionnaire in Thai version. Results: This study vast majority achieving independent mobility and self-care.
found that the top three of the most prevalence of joint pain in seven
days were shoulder pain (40.58%, 95% CI 35.37–45.79), low back 0430E4FP
pain (36.95%, 95% CI 31.80–42.10) and hip pain (33.83%, 95% CI
28.75–38.90), respectively. The top three of the most prevalence of EFFECTS OF DISC DEGENERATION AND
joint pain in twelve months were low back pain (34.23%, 95% CI MUSCLE DYSFUNCTION ON THE CERVICAL
29.11–39.36), shoulder pain (33.43%, 95% CI 28.37–38.49), and SPINE STABILITY – FROM IN VITRO STUDY
hip pain (29.39%, 95% CI 24.45–34.33), respectively. And the top
USING PORCINE MODEL
three of the most disability which affected by pain were low back
pain (28.31%, 95% CI 23.44–33.18), hip pain (22.92%, 95% CI Chih-Hsiu Cheng1, Pei-Jing Chen2, Ya-Wen Kuo2, Jaw-
18.40–27.43), and shoulder pain (22.02%, 95% CI 17.57–26.48), Lin Wang2
respectively. Conclusion: The findings of the study demonstrated 1
Department of Physical Therapy, Chang Gung University and
that low back pain was the most frequent problem that was found 2
Institute of Biomedical Engineering, National Taiwan University
in the textile industrial workers and could make them absent from (Taiwan)
work. Therefore it would be worth to further investigate the risk
factors of this problem in the textile industrial workers in order to Purpose: This in vitro biomechanical study was to investigate the
prevent them suffering from the disorder. interactive effects of the degenerative spinal column (disc degenera-
tion) and degenerative spinal muscles (muscle dysfunction) on the
cervical spine stability. Materials and Methods: Nine cervical spines
0430E3FP (C2–T1, length: 14.9 ± 0.8 cm) from 6-month-old swine were used.
FUNCTIONAL OUTCOMES OF MAJOR LOWER The in vitro flexibility test was applied to examine the stability of all
LIMB AMPUTATION 1994–2006: A MODERN specimens under five simulated muscle recruitment conditions before
and after experiment-induced disc degeneration. The mechanically
SERIES simulated cervical muscles were paired sternocleidomastoid (SCM),
Jane Wu, Peter Chan splenius capitis (SPL), and semispinalis capitis (SSC). The five pat-
Department of Rehabilitation, Prince of Wales Hospital (Aus- terns of muscle recruitments included; no muscle recruitment, normal
tralia) muscle recruitment, and SCM/SPL/SSC muscle dysfunctions. The
untreated intervertebral disc was regarded to be intact spinal column,
Purpose: To describe the outcomes with major lower limb amputa- and the degenerated disc in this study was simulated by the surgical
tion in one institution in terms of morbidity, rehabilitation potential, nucleotomy at the C5–C6 and C6–C7 levels. Neutral zone (NZ) and
discharge destination and function. Materials and Methods: The range of motion (ROM) was measured from the load-displacement
medical records of all consecutive patients who underwent major curve in the sagittal plane to determine the spinal stability. Results:
lower limb amputations at Prince of Wales Hospital (POWH) be- The results showed that: 1) the NZ and ROM of both intact and de-
tween 1994 and 2006 were examined and demographic and clinical generative spinal columns were greatest under no muscle recruitment,
data were extracted. Those who were had toe and partial foot ampu- followed by SSC dysfunction, SCM dysfunction, SPL dysfunction,
tations or multiple limb loss were excluded for this analysis. Ethics and were smallest under normal muscle recruitment; and 2) the NZ
approval was obtained. Results: During a 12-year period, 215 major and ROM showed no significantly difference between intact and
lower extremity amputations were performed on 208 patients. This degenerative spinal columns under muscle recruitment conditions.

Conclusion: The main findings of this study were: 1) the normal re- year. In up to 85% of people with low back pain, despite a thorough
cruitment of cervical muscles strongly maintains the stability of both medical examination, no specific cause of the pain can be identi-
intact and degenerative spinal columns; 2) the muscle dysfunctions fied. For 90% of people, even those with nerve root irritation, their
did not further deteriorate the stability of degenerative spinal column; symptoms will improve within two months no matter what treat-
and 3) the three muscle dysfunctions showed different degrees of ment is used, even if no treatment is given. The trend of practice
inefficiency in stabilizing the spine compared with the normal muscle was prescribing bed rest for days together and this long period of
recruitments. Accordingly, the muscle dysfunction is a more crucial inactivity further aggravated the situation. Earlier topics on back
factor than the disc degeneration that causes the spinal instability. pain shows requesting of number of investigations; which may not
This study suggested that the clinicians should emphasize the muscle be appropriate at the stage and state of the disease. Now the ap-
training or education to improve the spinal stability in elderly with proach is changed and literatures are in favour of treating back pain
spinal degeneration. keeping the patient active. This saves working hours and potentiates
patient’s functional abilities. Back pain in special situations like
pregnancy, chronic kidney disease or in some other situations need
0430E5FP special attention. This article high lights overview of the problem
NITRIC OXIDE CONCENTRATIONS IN CSF ARE with graded approaches of evaluation and management.
POSSIBLE PREDICTORS OF POSTOPERATIVE
ADL IMPROVEMENT IN LUMBAR CANAL 0430E7FP
STENOSIS EFFECT OF TAPING FOR PATIENTS WITH
Shinji Kimura1, Kana Aoki1, Noboru Hosaka2, Hiroshi LATERAL EPICONDYLITIS AND MOTION
Denda3, Naoto Endo3, Mikio Muraoka4 TRACKING ON ELBOW TISSUE FROM
1
Rehabilitation center, Niigata Univ. Medical and Dental Hospital, ULTRASONIC IMAGE SEQUENCE
2
Dept. of Orthopedic Surg., Niigata Rousai Hospitaland, 3Dept. of
Orthopedic Surg., Niigata University and 4Dept. of Rehabilitation, Pei-Chun Hsieh, Shu-Min Chen, Jin-Wen Lei, Hsiu-
Kameda-Daiichi Hospital (Japan) Yun Hsu
Department of Physical Medicine and Rehabilitation, National
Purpose: Nitric oxide (NO) facilitates transmission of nociceptive Cheng Kung University, Tainan (Taiwan)
signals in the spinal cord of animals. We reported that the concentra-
tion in preoperative CSF NO metabolites (NO2– and NO3–: NOx) Purpose: Kinesio tape is an alternative treatment in many muscu-
are quantitative predictors of postoperative pain relief in degenera- loskeletal disorders, and its effect on lateral epidondylitis has been
tive lumbar diseases (DLD). Furthermore, the NOx in patients with inconclusive. This pilot study was aimed to investigate the effect
spinal cord injury correlates with neurologic severity and neurologic of Kinesio-tape as a treatment method for patients with lateral epi-
recovery rate postoperatively, or with conservative treatment. The dondylitis. Materials and Methods: In this study, Kinesio-Tape®
purpose of this study was to examine whether the preoperative con- (Kinesio Tex Tape, made in Japan ) was applied on patients with
centration of NOx predict the postoperative improvement of ADL lateral epicondylitis. Fourteen patients were recruited. The exclusion
(activities of daily living) in lumbar canal stenosis (LCS). Materials criteria were as following: subjects with cervical radiculopathy, with
and Methods: The LCS group comprised of 55 patients (27 males, skin lesion or wound in the forearm, and impaired cognitive func-
28 females, age: 50–84 years). The surgical procedures comprised of tion. The subjects were divided into two groups; one was treated
laminectomies (n = 51) and fenestrations (n = 4). The concentration with Kinesio-tape (experimental group), and the other one was
of NOx in CSF was measured based on the Griess method. The pre- treated with ordinary commercialized 3M tape (control group). The
and postoperative pain-related Japanese Orthopaedic Association kinesio-tape was applied as Kase method on extensor carpi radialis
score (JOA) (low back pain, leg pain, gait abnormality, and sensory muscle and was left on for 24 hours. The evaluation tools were both
disturbance, total 11 points), and ADL-related JOA (disabilities clinical and ultrasonic assessments. The clinical parameters, includ-
when rolling over, standing up, vending forward to wash the face, ing visual analogue scale (VAS), pressure pain threshold (PPT) &
continuous standing, long standing sitting, lifting the heavies, gait, maximal pain tolerance (MPT) and grip power (GP), were recorded
total 14 points) were examined. The statistical correlations were and analyzed. There were nine subjects in the Kinesio tape group
examined between the preoperative concentration of NOx and the originally. Only six out of nine subjects were evaluated based on
Hirabayashi’s recovery rate of pain-related JOA and ADL-related the clinical parameters, the other three subjects were excluded due
JOA at postoperative month 7. Hirabayashi’s recovery rate was to diverse baseline condition. The Dynamic ultrasonic series of the
calculated according to the formula (post JOA – pre JOA)/(11 or elbow was recorded, and the motion tracking, which was based
14 – pre JOA) X 100 (%). Results: Hirabayashi’s recovery rate of on optical flow method, was conducted meanwhile. The obvious
pain-related JOA and ADL-related JOA was 49 ± 4 (means ± SE) perimysium, which was hyperechoic on sonogram, was used as a
%, 55 ± 6%, respectively. There was a significant negative cor- landmark to estimate the motion of muscle. Three subjects were
relation between preoperative NOx (8.3 ± 0.8 μM in average) and excluded from the Kinesio tape group in statistic analysis due to
Hirabayashi’s recovery rate of Pain JOA (r = −0.42, p < 0.005) and poor image quality on sonogram. The proposed method of two stages
ADL-related JOA (r = −0.4, p < 0.01). Conclusion: The data in this MFBM (MultiFeature Block Matching) with Kalman prediction
study suggest a close relationship between the pain relief and ADL was used to perform motion tracking from 3D (2D+t) muscular
improvement in LCS. In conclusion, the preoperative NOx would be ultrasound images. The motions with and without Kinesio-Taping
possible predictors of postoperative ADL improvement in LCS. were compared. The above data were collected at the following time
points: pretreatment, immediately after application of tape, 24-hour-
application before removal of the tape, and 24-hour-application
0430E6FP after removal of the tape. Results: It was found that the mean VAS
PARADIGM SHIFT IN THE MANAGEMENT OF decreased, and the mean pain threshold increased in both Kinesio-
tape group and 3M tape group immediately after treatment and 24
BACK PAIN hours after treatment. The mean grip power had little change in
M Taslim Uddin Kinesio-tape group, but increased in the 3M tape group. The motion
Department of Physical Medicine and Rehabilitation, BSM Medical of muscle on the ultrasonic images decreased in both kinesio-tape
University (Bangladesh) & 3 M tap group, especially in the 3M tape group. Conclusion:
Both Kinesio-tape and 3M tape have therapeutic effects on the
Back pain is the fifth most common reason for physician visits. patients with lateral epicondylitis both subjectively and objectively.
About nine out of ten adults experience back pain at some point in There were no significant differences in these effects between the
their life, and five out of ten working adults have back pain every Kinesio-tape & 3M tape groups. A placebo effect of the tape could

Interventional Rehabilitation 17
be observed. Regardless, the findings in motion of muscle in both full-thickness supraspinatus tendon tear was 9.1 mm on gray-scale
groups showed some restricted movement. More limitation of 3M ultrasonography. Arthrography revealed 14 full-thickness tears,
tape than Kinesio-tape was proposed based on ultrasonic tracking 7 partial-thickness tears, and 27 shoulders without tear. In the 14
analysis in our study. Further studies were required to provide more small full-thickness tear identified by arthrography, gray-scale ultra-
comprehensive evaluation to concur the effect of Kinesio-tape as a sonographic diagnosis was correct in 7 (50.0%), and elastographic
treatment on patients with lateral epicondylitis. diagnosis in 12 (85.7%) shoulders. In the 7 partial-thickness tear and
27 no tear identified by arthrography, gray-scale ultrasonographic
diagnosis was correct in 28 (82.4%), and elastographic diagnosis
0430E8FP in 29 (85.3%) shoulders. Gray-scale ultrasonography showed sen-
ULTRASOUND-GUIDED INJECTION THERAPY sitivity, specificity, accuracy, positive predictive value, and negative
FOR FROZEN SHOULDER predictive value for small full-thickness supraspinatus tendon tear
of 50.0%, 82.4%, 72.9%, 53.8%, and 80%, respectively, and elas-
Sheng Bi, Yu-kun Luo, Jun Li tography 85.7%, 92.9%, 85.4%, 66.7%, and 93.3%, respectively.
The Chinese PLA General Hospital (China) Conclusion: Our results indicate that elastography was more ac-
curate than gray-scale ultrasonography in the diagnosis of small
Purpose: Frozen shoulder is a common disease in the elderly. The full-thickness supraspinatus tendon tear. Therefore, elastography
main lesions are long head biceps tendon, subacromial bursa, rota- should be considered as an additional ultrasonographic method in
tor cuff and coracohumerale ligament and the long head of biceps diagnosing small full-thickness supraspinatus tendon tear.
tendon lesions are the most common. Painful period of treatment
are treat by oral medication, physical therapy, manipulation and
injection. Adhesion period of treatment follows the way lysis, joint Interventional Rehabilitation
capsule expansion and arthroscopic release. Self-limited remission
last for 1.5–2 years. This study reported the use of ultrasound-guided
injection of frozen shoulder treatment. Materials and Methods: 0430J1
Twenty-two patients, 4 men and 17 women, aged 42–76 years, mean AN INTERVENTIONAL PM&R APPROACH TO
age 56.3 ± 10.0 jointed the study. The shortest duration was 10 days,
SPINAL PAIN: EVIDENCE-BASED APPROACH
and the longest was up to 3 years. Clinical manifestations were
shoulder pain and restricted the range of motion. Treatment was in AND BEYOND
the ultrasound-guided injection of triamcinolone acetonide 40 mg, David X. Cifu
2% lidocaine hydrochloride 5 ml. Prior to clinical evaluation for Center for Rehabilitation Sciences and Engineering, Virginia Com-
the treatment, VAS score and Constant & Murley shoulder function
monwealth University (United States)
scores were carried out. Re-assessment was completed in 7–14 days
after treatment. Two patients were dropped out and 19 patients were Purpose: To provide an overview of the interventional physiatric
completed the assessment. Paired t test was carried out before and approach to acute and chronic spinal pain utilized by an academic
after treatment. Results: VAS score was 7.0 ± 1.9 before treatment, tertiary care center in the United States, with particular emphasis on
3.4 ± 2.6 after treatment (p < 0.01). Constant & Murley shoulder the evidence-based underpinnings of the approach. Also reviewed
joint function score was 34.6 ± 12.7 before treatment, 44.4 ± 13.7 will be the current resident and fellowship training program activi-
after treatment (p < 0.01). Conclusion: Ultrasound-guided therapy ties in interventional pain management employed at our University.
has the following advantages of precision-guided visualization of Materials and Methods: Didactic lecture with Powerpoint presenta-
invasive treatment, diagnosis and treatment can be conducted con- tion and fluoroscopic video presentation. Results: This presentation
currently, green therapy, no radiation side effects and significantly will be appropriate for the novice and intermediate-level clinician
reduce drug use. Therefore, patients in this group were to obtain a in PM&R and pain management, introducing a clinical manage-
more desired effect. ment paradigm for the common spinal pain conditions that may
be amenable to therapeutic injections and procedures and ongoing
research protocols and findings. Conclusion: This presentation will
0430E9FP offer cutting edge information on interventional pain management
COMPARISON OF ELASTOGRAPHY AND GRAY- care that will be of practical use to attendees.
SCALE ULTRASONOGRAPHY IN DIAGNOSING
SMALL FULL-THICKNESS SUPRASPINATUS 0430J2
TENDON TEAR
ULTRASOUND DIAGNOSIS AND NEW
Gi-Young Park, Jeong-Gu Won TREATMENT IN ADHESIVE CAPSULITIS
Department of Rehabilitation Medicine (Republic of Korea) (FROZEN SHOULDER)
Purpose: To compare elastographic findings with gray-scale ultra- Gi-Young Park
sonographic findings and to evaluate the value of elastography as Department of Rehabilitation Medicine, Catholic University of
a diagnostic method for detecting small full-thickness supraspina- Daegu School of Medicine (Republic of Korea)
tus tendon tear. Materials and Methods: Ultrasonography of the
shoulder was performed in 48 patients (32 females and 16 males; Adhesive capsulitis of the shoulder is an insidious, painful condi-
mean age 58 years; age range, 40–82 years) who showed symptoms tion that results in a gradual restriction of movements. Adhesive
of unilateral shoulder pain. A physiatrist performed the gray-scale capsulitis is a poorly understood musculoskeletal disease that
ultrasonography and elastography together and made the real-time can be disabling. Despite extensive studies, the etiology is still
ultrasonographic diagnosis. Elastography was obtained using free unknown. It is characterized by a spontaneous onset of shoulder
hand manipulation. For color elastography, the criterion indicative pain accompanied by progressive limitation of both active and
of the full-thickness tear included a lesion with even elastic pat- passive glenohumeral joint movements, especially external rota-
tern (diffuse purple or mixed purple, blue or green) involving the tion. The natural history of the disease is characterized by three
full-thickness supraspinatus tendon. Single-contrast arthrography distinct phase: freezing or painful, frozen or stiff, and resolution or
was performed by the physiatrist and used as the reference stand- thawing. The diagnosis of adhesive capsulitis is based on a thor-
ard for the full-thickness supraspinatus tendon tear. The definitive ough history taking and careful physical examination and is one of
diagnosis of full-thickness supraspinatus tendon tear was made if exclusion from other painful conditions of shoulder. In the early
the contrast medium was leaked out from the glenohumeral joint to painful stage, it can be difficult clinically to differentiate adhesive
the subacromial subdeltoid bursa. Results: The mean length of the capsulitis from other causes of chronic shoulder pain including

rotator cuff tear, shoulder impingement, and subacromial subdeltoid recess of the capsule, where most of the adhesions lie, is elongated.
bursitis. Accurate diagnosis is important for effective treatment, as The axillary recess is usually ruptured on arthrography after the pro-
up to 50% patients will not have their full range of movement at cedure. All patients improve significantly in the outcome measures
long-term follow-up. Physical examination is characterized by the including passive range of shoulder motions, visual analog pain
painful loss of both passive and active range of shoulder motions. score, and Cyriax stage of adhesive capsulitis after the treatment.
Arthrography has been considered the imaging technique of choice The treatment is well tolerated in the patients, and no complications
for the diagnosis of adhesive capsulitis, demonstrating reduction are noted. Capsular stretching in combination with serial hydraulic
of joint volume less than 10 ml, obliteration of the axillary recess, distention is shown to be efficacious in the treatment of refractory
and irregularities of a capsular insertion at the humeral anatomical adhesive capsulitis and to present a low risk of iatrogenic injury.
neck. Magnetic resonance (MR) imaging and MR arthrography When selecting the treatment for adhesive capsulitis, it is extremely
may be useful in the diagnosis of adhesive capsulitis. MR imaging important to consider the patient’s symptoms and stage of the dis-
findings are reported, including thickening of the joint capsule in ease because each patient’s treatment should be individualized and
the axillary recess and the presence of inflammatory tissue at the tailored appropriately to patient’s needs.
rotator cuff interval that enhances after gadolinium enhancement.
The characteristic findings of MR arthrography include thickening of
the coracohumeral ligament and the joint capsule in the rotator cuff 0430J3
interval. However, they are not routinely needed for the diagnosis ULTRASOUND GUIDED INJECTION
of adhesive capsulitis. Ultrasonography of the shoulder is one of the TREATMENTS IN REHABILITATION MEDICINE
most common examinations performed in musculoskeletal disorders.
Ultrasonography for adhesive capsulitis can provide an early ac- Carl P.C. Chen, Simon Fuk-Tan Tang
curate diagnosis, allowing an effective treatment plan. The limited Department of Physical Medicine & Rehabilitation, Chang Gung
supraspinatus tendon movement during dynamic examination is Memorial Hospital (Taiwan)
described as a sensitive and specific sign of adhesive capsulitis.
Additional ultrasonographic signs include fluid collection within Ultrasound has been proven to be radiation-free, easy-to-use imaging
the sheath of the long biceps tendon and hypoechoic soft tissue tool in diagnosing soft tissue lesions and in performing ultrasound
around the long biceps tendon and the subacromial subdeltoid guided injections. Our previous studies have documented that ultra-
bursa. Increased vascularity and hypoechoic change within the rota- sound can be applied in performing ultrasound guided subacromial
tor cuff interval on gray-scale and color Doppler ultrasonography bursitis injections and aspirations in treating patients with shoulder
are useful findings for the ultrasonographic diagnosis of adhesive impingement syndrome. Ultrasound can also be applied in perform-
capsulitis. Coracohumeral ligament is thickened and shortened ing accurate sacral hiatus epidural spine injections. Under ultrasound
due to fibroblastic proliferation in adhesive capsulitis, restricting guidance, the advancing motion of the needle can be observed as
external rotation of shoulder. Ultrasonography is a useful imaging continuous and real-time images. The significant improvements in
modality for coracohumeral ligament depiction. The thickness of shoulder pain and range of motion after ultrasound-guided injection
the coracohumeral ligament is significantly greater in adhesive cap- may be clear clinical evidence that a higher volume of steroid–lido-
sulitis than in the asymptomatic and painful shoulders. A thickened caine suspension can be accurately infiltrated into the lesion site
coracohumeral ligament is highly suggestive of adhesive capsulitis. as compared with the conventional blind injection technique. In
Two anatomic reference points taken on ultrasonography are used sacral hiatus epidural injections, 100% accuracy in caudal needle
to measure shoulder external rotation: the coracoid process and the placement into the caudal epidural space under ultrasound guid-
lesser tuberosity of the humerus. The distance between two points is ance was confirmed by contrast dye fluoroscopy. Our latest study
measured using utlrasonography at the end range of active external has also shown that ultrasound may also be used in judging for the
rotation in the symptomatic and asymptomatic shoulders. The ultra- feasibility of caudal epidural injections. Anatomic variations of the
sonographic distance of the asymptomatic shoulder is significantly sacral hiatus can be clearly observed using ultrasound. Sonographic
greater than that of symptomatic shoulder. Ultrasonography is rec- images indicating a closed sacral canal and sacral diameter of less
ommended as a diagnostic tool to measure the degree of restriction than 1.5 mm may suggest higher incidence of failed caudal epidural
of shoulder movement in patients with adhesive capsulitis.The long injection. As a result, ultrasound may be used as an adjuvant tool in
period of shoulder pain and disability has been the reason for many caudal needle placement. It takes approximately 2 hours of training
different types of treatment. The importance of stage of disease in time for an inexperienced physician to learn the ultrasound guided
treatment selection may reflect the mixed results in the clinical tri- injection technique. It is highly recommended as one of the effec-
als. According to different distinct stages, non-operative treatments tive treatment options for physiatrists in treating patients with soft
such as anti-inflammatory medication, physical therapy including tissue lesions and low back pain syndromes.
therapeutic exercise, mobilization and stretching, translational
manipulation, intra-articular corticosteroid or sodium hyaluronate
injection, suprascapular nerve block, hydraulic distention arthrogra- 0430J4
phy, and combination treatment etc, have been performed with good NEW ADVANCES IN THERAPEUTIC
results. Treatments including manipulation under general anesthesia,
arthroscopic capsular release, and open surgical capsular release are ULTRASOUND
recommended for the patients who do not respond to or who demon- Wen-Shiang Chen
strate little improvement after adequate conservative treatment. For Department of Physical Medicine & Rehabilitation, National Tai-
patients who are unable to tolerate the pain and disability associated wan University Hospital (Taiwan)
with the disease, manipulation under anesthesia is the most reliable
treatment to improve the range of movement. It is recommended if Diagnostic ultrasound in medicine is now quite commonplace espe-
the functional disability persists in spite of adequate non-operative cially with the introduction of small, portable system and advanced
treatment for six months. Reported complications associated with imaging capability. Traditionally, therapeutic ultrasound is daily used
manipulation under general anesthesia include facture of the hu- in the rehabilitation department as a physical modality. However, in
merus and iatrogenic, intra-articular shoulder lesions. Patients with these years ultrasound has evolved beyond the realms of imaging and
refractory adhesive capsulitis typically suffer from significant pain physical therapy, with methods and applications extending to novel
and progressively diminishing shoulder function. Serial hydraulic therapeutic and surgical uses. This general review will introduce
distention with intra-articular steroid injection is performed using the basics of therapeutic ultrasound, new applications including tis-
arthrography before the point of capsular rupture. Thereafter, capsu- sue ablation (high-intensity focused ultrasound), site-specific gene
lar stretching is done using Cyriax’s technique. Capsular stretching transfection/drug delivery, extracorporeal lithotripsy, enhancement of
is not manipulation but rather mobilization. In this way, the axillary tissue repair, as well as future challenges of therapeutic ultrasound.

Brain Disorders: Traumatic Brain Injury 19
0430J5 Event Related Potentials (ERPs), 2) Auditory Brainstem Responses

EXTRACORPAL SHOCK WAVE THERAPY ON (ABR), 3) Pure Tone Audiometry, and 4) Behavioral Optometry,
we studied the prevalence of auditory and visual impairments in
REHABILITATION OF TENDINOPATHY patients with TBI. We also evaluated the influence of dual sensory
Mao-Hsiung Huang impairment (DSI) on rehabilitation outcome measures (FIM). Re-
Department of Physical Medicine and rehabilitation, Kaohsiung sults: DSI is quite common in patients with severe TBI. It is also
Medical University Hospital (Taiwan) negatively associated with functional improvements during the
inpatient rehabilitation process. Conclusion: Effective communica-
Purpose: To introduce the therapeutic effects of extracorpal shock tion is essential for successful rehabilitation. Clinicians need to be
wave therapy (ESWT) on tendinopathy. Materials and Methods: cognizant of, and proactively accommodating for sensory impair-
To summarize the update pathological findings and pathogen- ments in patients with TBI.
esis of tendinopathy, and their related managements. Besides,
the biomechanisms of ESWT and their clinical application on the
tendinopathy were also introduced. Results: The histopathologic 0430B2
changes of tendinopathies include degeneration, isorganization of TRAUMATIC BRAIN INJURY (TBI) RESEARCH IN
collagen fibers, increase cellarity, minimal inflammation, imbal- TAIWAN
ance between protective/regenerative changes and the pathologic
response tendon overuse. The most important factors implicated in Wen-Ta Chiu
chronic tendinopathy were age and blood supply. The nonsurgical Taipei Medical University (Taiwan)
treatment of tendinopathy included nonsteroid anti-inflammatory
drugs,exercise-based physical therapy, physical modalities, corticos- Traumatic brain injury (TBI) is a major cause of disability and
teroid injection, Glyceryl trinitrate patched growth factor treatment, death in Taiwan. For the past 22 years, we have conducted a series
and ESWT. From the recent studies showed that ESWT is an effec- of four-step researches. The first was an epidemiological study with
tive adjuvant therapy for chronic tendinopathy. Conclusion: ESWT TBI registry in 55 hospitals in Taiwan with data bank of more than
is dose dependent on the pathological changes of tendinopathy for 174,326 TBI cases from 1987 to 2009. The second was an interven-
rehabilitation of tendinopathy. tional study showing prevention effect of motorcyclists’ helmets.
The helmet use law of motorcyclists has been enforced in Taiwan
since June 1st, 1997. After the law enforcement, the number of TBI-
0430J6 related deaths has been decreased by 38%. After the law has been
implemented for a decade, 3000 people were saved every year that
THE SCIENCE OF INTRAVASCULAR LASER
changed the injury deaths from the third leading cause of deaths in
IRRADIATION OF BLOOD (ILIB) AND ITS 1996 to the sixth in 2008. The third was clinical researches which
APPLICATIONS included international collaborative studies, including Cooperation
with U. of Pittsburgh group, NIH (US), Isreal and Sweden to the
Tien-Yow Chuang
study of mild TBI in the Iraq War, an international cooperation with
Department of PM&R, Taipei Veterans General Hospital and 18 countries, QOLIBRI (Quality of Life after Brain Injury), achieved
National Yang-ming University (Taiwan) a new quality of life evaluation method after TBI, which is now
Purpose: ILIB is a relatively new and controversial therapeutic used in Taiwan, .The fourth was the establishment of guidelines
option used to relieve pain and inflammation and promote wound for managing patients with severe TBI in Taiwan. By the end of
healing. This study aimed to investigate the effect of intravascular February 2007, we had completed a systemic literature review and
low level laser therapy on mitochondrial function, ATP produc- published the eight-chapter guidelines for management of severe
ing, lipid peroxidation and antioxidative capacity. Materials and TBI. In 2008, we led the collaboration of Japan, Korea, China,
Methods: This was a prospective, intrinsically controlled study Hong Kong and other Southeast Asian countries to accomplish a
measuring base-line and post-intravascular low level laser thera- team work of Asian TBI Guidelines, which will serve to establish
peutic responses. We measured mitochondrial DNA copy number the standard treatment for TBI in Asia. In conclusion, a stepwise
from leucocytes, intracellular ATP in white blood cells (WBCs), approach of TBI has been done in Taiwan for the past 22 years, and
malondialdehyde (MDA) in blood serum, and total antioxidant ca- some good outcomes have been obtained. Further evaluation and a
pacity (TOA) of blood serum. Results: Across all night participants, collaborative study with other countries are recommended.
pre- and post-evaluation showed significant difference (p < 0.05)
including the items: mitochondrial DNA copy number from leu- 0430B3
cocytes, intracellular ATP in white blood cells, malondialdehyde
(MDA) in blood serum, and total antioxidant capacity (TOA) of NEUROPROTECTION STRATEGIES IN
blood serum. Conclusion: This study showed that mitochondria EXPERIMENTAL TRAUMATIC BRAIN INJURY
are sensitive to irradiation with monochromatic visible and near
infrared (IR) light. Szu-Fu Chen
Department of Physical Medicine & Rehabilitation, Cheng Hsin
General Hospital (Taiwan)
Brain Disorders: Traumatic Brain Injury Traumatic brain injury (TBI) triggers multiple secondary injury path-
ways that lead to delayed cell death and functional deficits. The de-
0430B1 layed nature of these events provides an opportunity for therapeutic
EVENT-RELATED POTENTIALS AND DUAL intervention aimed at either minimizing the process of progressive
damage or enhancing the processes that promote recovery. Various
SENSORY IMPAIRMENT (DSI) IN TBI elements have been implicated in the delayed injury biochemical
Henry L. Lew cascades including inflammatory responses, oxygen free radicals,
Harvard Medical School, and VA Boston Healthcare System excitotoxicity, and apoptosis. In the first part of the talk I shall
(United States) outline two specific components of the secondary pathogenesis of
TBI – Inflammation and oxidative injury – and potential therapeutic
Purpose: To determine the prevalence of dual sensory impairment strategies associated with each. The inflammatory response in the
(DSI), its clinical characteristics, methodology for evaluation, and traumatic brain is characterized by greater disruption of the blood-
its influence on rehabilitation outcome. Materials and Methods: brain barrier, intrathecal recruitment of neutrophils and macrophages
Using the following measurement tools: 1) Auditory and Visual (microglia), upregulation of adhesion molecules as well as release of

various cytokines/chemokines. The injured brain also has a muted 0430B5FP

response to oxidative stress including increased production of reac- EFFECT OF HYPERBARIC OXYGENATION (HBO)
tive oxygen species and impairment of the endogenous antioxidant
system. These processes thus provide potential therapeutic targets to ON UNILATERAL SPATIAL NEGLECT (USN)
TBI, including anti-inflammatory agents and antioxidants. We shall INDUCED BY TRAUMATIC BRAIN INJURY
also address questions about employing highly targeted strategies Jinglong Liu
to block just one of the death related processes. Another therapeutic
option may be identifying single agents that have actions on multiple Heilongjiang Province Rehabilitation Hospital, No. 4 Ward
secondary injury factors. In the second part of the talk I shall discuss (China)
genetic influences on outcomes following TBI. I shall present our Purpose: To evaluate the effect of Hyperbaric Oxygenation (HBO)
recent work regarding caveolin-1 (Cav-1) influence on outcome fol- on unilateral spatial neglect (USN) and basic activities of daily
lowing TBI using transgenic mice and discuss possible mechanisms. living (B-ADL) induced by traumatic brain injury. Materials and
Cav-1 is the major structural protein of caveolae known for its role Methods: Sequentially access 67 traumatic brain injured patients
in regulating cholesterol metabolism and signalling transduction. with hemiplegia admitted to the Heilongjiang Province Rehabilita-
The Cav-1 gene may affect trauma-induced neurological deficits via tion Hospital, according with the following: first traumatic brain
modulating Toll-like receptor 4/nuclear factor-kappa B signaling. injury, no aphasia, no dementia and serious system disease. The
I shall conclude the talk by comparing methodological differences age of all was between 27 and 55 ,and start to accept rehabilitation
between clinical and experimental studies. Further studies should within 4weeks after stroke .By ‘cross-out’ test, ‘digit cancellation’
aim to emphasis on the therapeutic window, drug pharmacokinetics/ test, ‘line-bisection’, clock drawing, ‘free hand drawing’ test, are
pharmacodynamics, and multi-potential strategies to better match used to identify the unilateral spatial neglect. When 3 of the 5 tests
preclinical and clinical design. are abnormal or more, we thought the patient had unilateral spatial
neglect. They were classified upon admission as having USN (group
0430B4FP A; n = 27; 40.3% of the entire sample) or not having such distur-
bance (group B(control group ); n = 40; 59.7% of the sample). Both
EFFECT OF NOISE ON RETENTION AND groups received standard rehabilitation treatment, including daily
TRANSFER OF A SPATIAL MEMORY TASK physiotherapy, occupational therapy, traditional Chinese medicine
IN UNEQUAL CONTEXT IN MALE RATS: A and other therapy according to individual needs. But the group A
do some special exercises for USN,such as electronic stimulation,
BEHAVIORAL REVIEW sensory stimulation and some occupational therapy to improve the
Mohammad Ali Gheraat1,2, Leila Eidi Abarghani1,2, attention to left side. The group A was randomly divided into two
Nasser Naghdi2, Farid Rezaie Moghaddam3, Bahram groups: group A1 (experimental group) (13) and A2 (observation
Jalaei4 group) (14). And group A1 was in Hyperbaric Oxygenation (HBO)
synchronously ,but group A2 not.The pressure of HBO was 0.12 MP
1
Sports Medicine Research Center, Medical Sciences University
and every treatment was 100 min including 20 min for increasing
of Tehran, 2Pasteur Institute of Iran, Dept. of Physiology & Phar- pressure and 20 min for decreasing pressure .the patients do treat-
maceulogy, 3Medical Sciences University of Artesh and 4Medical ment 2 h per day and 6 times per week. The Modified Barthel Index
Sciences University of Iran (Islamic Republic of Iran) (MBI) was used to assess patients’ capacity in B-ADL. Assessment
Purpose: Wide range of animal and human investigations has tested was done upon admission to rehabilitation and 6 weeks afterwards.
the neurobiological and immunological aspects of noise. But a few Results: Before treatment, the patients in the experimental and ob-
studies are related to behavioral characters of noise on neuromotor servation groups (A1 and A2) scored significantly lower with MBI
movements. New studies in this aspect have shown variable side ef- than those in the control group (B) (p < 0.05). After treatments, the
fects (positive or negative) of continuous noise like cognition fatigue, patients in all groups scored higher with MBI assessment after 6
over arousal, decrease in the capability of information processing (1 weeks (p < 0.05). However, after 6 weeks, the score with MBI as-
& 2) and in contrast positive functions like temporal coding, spatial sessment in the observation group (A2) was lower than the control
memory performance, decision making and error detection (1, 3, 5 & group, but no significant difference (p > 0.05), and there was no sig-
6). Also very few researches have studied the effects of continuous nificant difference between the experimental group and the control
noise on performance and learning a motor task. To examine this group (p > 0.05). But there was significant difference between the
aspect, we tested effects of continuous intensive noise on retention experimental group and the observation group (p < 0.05). Conclu-
and contextual transfer of spatial memory task in adult male rats. sion: Most USN had significant impact on the recovery of the inde-
Materials and Methods: The natural noise was recorded in a football pendent living of traumatic brain injured patients. The rehabilitative
stadium and set in high (HI),moderate (MI), and low (LI) intensities, intervention for USN may improve ADL performance of traumatic
86–90, 64–68, 52–54 decibels A (dbA), respectively. Rats were trained brain injured patients with USN. And with HBO, outcome maybe
in Morris water maze (MWM) for 3-consecutive-day program and better. The reason maybe that because of the abroad effect of HBO
at day 4, visible and probe tests were held under the same intensities on brain, metabolism of other areas in brain were also improved,
according to those own intensity in training. The retention evalu- and the outcome maybe a comprehensive effect. So it is better than
ated at day 7 on the basis of prior noise intensities of any exposure single or local stimulation treatment for USN.
situation. Also the contextual transfer test was held at day 8 after
exposing to 30 min high-intensity noise. Escape latency and traveled
distance were recorded and used for subsequent analysis. Results: 0430B6FP
Our results showed significant increases in latency and distance by ANALYSIS OF INFLUENCE FACTORS OF
increasing the noise intensity during acquisition period, Also the COGNITIVE IMPAIRMENT FOLLOWING FIRST
performance of HI group impaired significantly in retention test at ONSET OF STROKE
high intensity. At the contextual transfer test, the results showed no
significant increase except to LI group (unequal context). But the Xi-Quan Hu, Yue Lan, Hai-Qing Zheng, Jin-Lin Zheng,
higher latency and distance was found in HI group. Conclusion: It Ying-Bei Chen
can be concluded that high intensity noise has damaged the learning Department of Rehabilitation Medicine, The Third Affiliated Hos-
process. However, because the best results showed in the MI group, pital of Sun Yat-Sen University (China)
it can be suggested that the training at moderate intensity noise can
promote the performance at the continuous high intensity noise. It Purpose: To explore the influence factors of cognitive impairment
may be because of the best adaptation under this intensity without following first onset of stroke, in order to predict the existence of
interference of learning process. cognitive impairment in patients with stroke and help for future clini-

Brain Disorders: Neural Plasticity and Cognition 21
cal intervene. Materials and Methods: 364 survivors of first onset of visual attention between groups was found as indicated by fixation
stroke were evaluated by the mini-mental state examination (MMSE) duration and normalized fixation number on the presented stimuli
in this study. Data were collected on age, gender, education level, (p = 0.088; p = 0.594). Results: The mu suppression over the sen-
location of brain lesion, diagnostic stroke subtype and so on. Logistic sorimotor cortex was significantly affected by the experimental
regressions analyzing is used to determine those factors that could conditions (F 2,76 = 10.812, p < 0.001), but not by group member-
predict cognitive impairment of stroke patients by MMSE assessment ship (F 1,38 = 0.044, p = 0.835), nor the interaction between groups
scores. Results: The factors including location of brain lesion, area and conditions (F 2,76 = 2.437, p = 0.094). Individuals with ASD,
of the lesion, high homocysteine, side of the lesion, complications, similarly to the controls, exhibited stronger mu suppression when
education level and age can join in the logistic regression analysis watching hand actions relative to a moving dot. In addition, the mu
format.The R of the format is 0.849 and these seven factors can explain suppression during the observation of hand actions was positively
72.1% variation of the scores of MMSE. Conclusion: The logistic associated with the communication competence of individuals with
regression analysis revealed that location of brain lesion, area of the ASD (p = 0.015). Conclusion: It suggested that the functioning of
lesion, high homocysteine, side of the lesion, complications, education the mirror neuron system might be preserved in individuals with
level and age were predictors of the cognition function assessment ASD to a certain degree. Less mu suppression to action observa-
of stroke patients. The prevalence of cognitive impairment can be tion coupled with more communicational severity can reflect the
mainly influenced by these factors. symptom heterogeneity of ASD.
Brain Disorders: Neural Plasticity and Cognition 0430F3

COGNITIVE AND NEUROIMAGE ASSESSMENT
0430F1 AND HUMAN COGNITIVE REHABILITATION
COGNITIVE COMPONENT OF TAI CHI CHUAN – Yuejia Luo, Xiaoxu Yang
A FMRI STUDY National Key Laboratory of Cognitive Neuroscience and Learning,
Beijing Normal University (China)
Chetwyn C.H. Chan, Sam C.C. Chan, Gao Feng,
William P.W. Chen, Kin-hung Tin It is very important for cognitive assessment and cognitive reha-
Applied Cognitive Neuroscience Laboratory, Department of bilitation strategy from the perception, attention, memory, language
Rehabilitation Sciences, The Hong Kong Polytechnic University intelligence and etc. in rehabilitation practice. The development of
(Hong Kong) interactive multimedia computer-assisted cognitive rehabilitation
strategy could help patients to improve the cognitive function more
Purpose: The aim of the study is to gain better understand on the efficiently. Cognitive assessment is valuable and commonly used for
possible mechanisms underlying the beneficial effects of Tai Chi screening of cognitive impairment, rating of the severity of dysfunc-
Chuan (TCC) on cognitive functions. Materials and Methods: We tion, and monitoring disease progression. In clinical practice, detailed
involved subjects with or without experience on practising TCC. cognitive assessments influence the design of cognitive rehabilitation
The two experimental tasks were the Benton’s Judgment of Line strategy. A wide range of tools has been developed to aid the clinicians
Orientation test (JLO) which measures cerebellar-cortical related in this process, which varies from brief screening tests, neurobehav-
visuo-spatial judgment and custom-designed motor imagery task ioral cognitive status examination to more comprehensive tools, such
which measures motor planning and control of the subjects. The as remote neuropsychological assessments and virtual reality technol-
behavioural data and BOLD responses of the brain of the subjects ogy. Cognitive rehabilitation is defined as a systematic, functionally
generated from each of the tasks were captured. Results: The results oriented service to reduce cognitive disability and improve cognitive
indicated that the TCC group did not show significant differences function through 1) strengthening or reestablishing the previous
in the behavioural data for both tasks than the non-TCC group. The learned pattern of behavior; 2) establishing the new activity patterns
TCC group showed significant differences in BOLD responses than through compensatory mechanisms for impaired cognitive function;
the non-TCC group in the neural substrates subserving the cerebel- 3) establishing new activity patterns through external compensatory
lar-cortical network when performing on the JLO test. The TCC mechanisms (including individual orthosis and environmental sup-
group also showed significant differences in the neural substrates port); 4) enabling people to adapt their impairment to improve the
which mediates motor imagery, motor planning and in particularly overall function and the quality of life. Individualized and structured
motor control. Conclusion: Practice of Tai Chi Chuan appears to cognitive rehabilitation programs are effective in facilitating recovery
exert activity-specific effect on individuals which does not seem to with cognitive dysfunction. Goal management training could improve
enhance processing speed and precision. Its effects perhaps extend the self-control, self-management and problem-solving abilities in
from the motor system on enhancing visualization, planning and intelligence disorder patients.
monitoring, and conflict resolution.
0430F4
0430F2
REPRESENTATION OF TACTILE MOTION
HOW VALID IS THE BROKEN MIRROR THEORY IN THE PRIMARY SOMATOSENSORY
OF AUTISM? CORTEX: A PSYCHOPHYSICAL AND
Ya-Wei Cheng NEUROPHYSIOLOGICAL STUDY
Institute of Neuroscience, National Yang-Ming University (Taiwan) Yu-Cheng Pei1,2,3, S.S. Hsiao2,3, J.C. Craig4, S.J.
Purpose: The ‘broken mirror’ theory of autism, which proposes that Bensmaia2,3,5
a dysfunction of the human mirror neuron system is responsible for 1
the core social and cognitive deficits in individuals with ASD, has Memorial Hospital (Taiwan), 2Department of Neuroscience, Johns
received considerable attention. However, additional empirical evi- Hopkins University School of Medicine, 3Krieger Mind/Brain Insti-
dence is necessary to elucidate the validity of this theory. Materials tute, Johns Hopkins University, 4Department of Psychological and
and Methods: In this electroencephalographic study, we examined Brain Sciences, Indiana University and 5Department of Organismal
mu suppression, as an indicator of sensorimotor resonance, concur- Biology and Anatomy, University of Chicago (United States)
rent with oculomotor performance when individuals with autism
spectrum disorders (n = 20) and control participants (n = 20) either Purpose: The speed and direction of motion of one-dimensional
executed, observed hand actions or a moving dot. No difference in edges is ambiguous because information about the motion compo-

nent parallel to their orientation is not available. To acquire a veridi- but not in JXD. Characters in the RVF rather than in LVF induced
cal direction percept, it is necessary to integrate motion information the activations in the left lateral mid-fusiform gyrus in KY. Neu-
across multiple stimulus contours that differ in orientation or to rely ropsychological tests revealed that JXD was unable to read aloud
on terminators. Materials and Methods: We presented gratings and and even to recognize the characters. Worse, he was disturbed in
plaids using the 400-probe stimulator, a tactile analogue of a visual phonological, semantic and identity judgment tasks. However, JXD
monitor, and obtained the perceived direction of stimulus motion in could complete the tasks of lexical decision and perceptual judg-
human psychophysical experiment and recorded neuronal responses ment of characters normally. Conclusion: Similar to the reports of
to stimulus motion from neurons in the primary somatosensory cor- pure alexia for alphabetic language, the left lateral mid-fusiform
tex in macaque monkey. Results: We found that some neurons in the cortex is a key area and splenium is an essential neuropathway in
primary somatosensory cortex exhibited properties characteristic of inducing pure alexia (or left hemiparalexia) for Chinese characters.
motion integrators: Analogous to visual “pattern” neurons observed Nevertheless, unlike those studies, the property of Chinese pure
in the middle temporal area, these neurons integrate motion cues alexia is not a disturbance in visual word form processing itself,
from multiple contours to encode the direction of the plaid. The but in the connection between visual word form and its correspond-
neuronal responses to tactile plaids are determined by the vector ing semantic and phonological information, by which the identity
average of motion signals emanating from edges and terminators. (abstract representation) of a Chinese character is accessed.
Conclusion: Neurons in the primary somatosensory cortex encode
the direction of pattern motion. The mechanism of tactile motion
integration is similar but not identical to its visual counterpart. 0430F6FP
THE EFFECTS OF BASAL GANGLIA STROKE ON
0430F5FP IMPLICIT LEARNING
REVEAL THE NEURAL MECHANISM Zhongli Jiang, Jing Jin, Dianhuai Meng
AND THE PROPERTY OF PURE ALEXIA Nanjing Medical University (China)
FOR CHINESE CHARACTERS BY USING Purpose: The purpose of the present study was to gain a deeper
NEUROIMAGING TECHNIQUES AND COGNITIVE understanding of the role of the basal ganglia in implicit learning
NEUROPSYCHOLOGICAL TESTS by examining Weather Prediction Category Learning Task among
patients with basal ganglia stroke. Materials and Methods: Sev-
Chunlei Shan1,2, Tong Wang1, Xuchu Weng2, Benyan enteen patients with basal ganglia stroke contained 8 cases of left
Luo3, Zhisu Lü3, Xiaoyu Zhao3, Renjing Zhu3, Zhiqiang basal ganglia lesions and 9 cases of right basal ganglia lesions. Ten
Zhang4 cases without brain damage were used as the controls. All of the
1
Department of Rehabilitation Medicine, First Affiliated Hospital of subjects were tested by use of Weather Prediction Category Learn-
Nanjing Medical University, 2Laboratory for Higher Brain Function, ing Task (WPCLT) and Wisconsin Card Sorting Test (WCST) in 3
Institute of Psychology, Chinese Academy of Sciences, 3Department consecutive days. Results: Total numbers of correct of WPCLT in 3
of Neurology, First Affiliated Hospital, College of Medicine, Zhe- consecutive days were significantly lower in the patients with right
jiang University and 4Department of Radiology, General Hospital basal ganglia lesions than in the controls (first day: 52.72 ± 5.57 vs.
of Nanjing Millitary District (China) 61.85 ± 8.49, second day: 55.83 ± 4.52 vs. 71.85 ± 10.89, third day:
62.33 ± 7.70 vs. 80.15 ± 6.67). Total numbers of correct of WPCLT
Purpose: At present, it is still uncertain of the mechanism and the in the last day were significantly lower in the patients with left basal
property of pure alexia for Chinese characters. In this study we try ganglia lesions than in the controls (65.87 ± 1.18 vs. 80.15 ± 6.67). In
to investigate the critical cortical area and neuropathway where patients of left (0.761 ± 0.174) and right (0.799 ± 0.141) basal ganglia
lesions may induce pure alexia, and try to reveal the property of lesions, the learning potential of WPCLT decreased significantly in
pure alexia for Chinese characters. Materials and Methods: Three comparison with the controls (0.516 ± 0.084). In the controls, total
right-handed patients suffering from infarctions in the territory of numbers of correct of WPCLT were corrected positively with Num-
their left PCA were studied. JXD, who complained of deficits in bers of categories completed of WCST in the second day (p < 0.05).
recognizing and reading aloud any Chinese characters, without Total numbers of correct WPCLT were correlated positively with
other language deficits, was diagnosed as pure alexia. CYH, a percent errors (p < 0.05) and numbers of categories completed
patient with abnormal faces and objects naming while with normal (p < 0.05) of WCST in the third day, respectively. Conclusion:
reading was classified as anomia. KY was diagnosed as left hemi- The implicit learning is damaged which causes impairment of the
paralexia (a special form of pure alexia) considering the fact that bottom-up (implicit-to-explicit) learning pattern in patients with
he often made mistakes in the left radical of a character when he basal ganglia lesions.
read Chinese compound characters. For example, he read (deng 1,
lamp) as (da 3, beat), read (zhi 4, order) as (tie 3, iron). All three
patients accepted high spatial resolution 3D-SPGR scans. Analysis 0430F7FP
of lesion locations of JXD, CYH and KY was taken by adopting COGNITIVE FLEXIBILITY IN CHILDREN WITH
AFNI software. In the BOLD-fMRI experiments, JXD and CYH
were presented with an alternation of blocks of pictures including LEARNING DISABILITY
Chinese characters, faces, and line-drawing of objects. For KY, he H.S. Somashekara, Kumar B. Radish, Jayashree S. Bhat
was presented with Chinese characters flashed either in the right Kasturba Medical College (India)
visual field (RVF) or in the left visual field (LVF) while fixating
continuously a permanent central cross-hair. In order to reveal the Purpose: Cognitive linguistic flexibility is a measure which refers
property of Chinese pure alexia, JXD was arranged to perform a to the ability to shift cognitive linguistic set, aptitude, thought, or
series of cognitive neuropsychological tasks, including Chinese attention in order to perceive, process or respond to situations in
characters reading, phonological judgment, semantic judgment, different ways. It has been dichotomized into reactive flexibility and
identity judgment of abstract visual word representation, lexical spontaneous flexibility that may be differentially impaired in per-
decision, perceptual judgment of visual word appearance. Results: sons with communication disorders. Different tasks and situations
The lesion locations analysis indicated that the specific and addi- require different type of reactive shifts and presumably different
tional lesion of pure alexic (JXD), compared to CYH and KY, was underlying cognitive processes. If language and the learning difficul-
in the left lateral mid-fusiform gyrus. Splenium was an additional ties are the result of slow processing speed, then the differences in
lesion in KY rather than in CYH. FMRI results showed characters cognitive flexibility measures are expected in children with learning
could activate the left lateral mid-fusiform gyrus in CYH and KY, disability in comparison with age matched peers. Hence the study

Development of PRM in Asian and Oceanian Region 23
was attempted to compare the cognitive flexibility in children with intention of introducing medical students to such medical-specialty. He
learning disability and age matched typically developing children. established the resident training program for medical school graduates
Materials and Methods: Participants consisted of 12 children with who were interested in this field. The Department of Physical Medicine
learning disability and 12 age matched typically developing children and Rehabilitation at NTUH then experienced a booming growth, and
in the age range of 9–10 years. Children with learning disability became a modern rehabilitation center in the 1970’s. Undoubtedly,
were formally evaluated and diagnosed based on Early Reading Dr. Lien was regarded as the founder of the physical medicine and
Skills (Ray & Potter, 1980) by an experienced speech language rehabilitation in Taiwan. There are approximately 785 physiatrists,
pathologist. The experimental set comprised of a set of 20 pictures 3000 physical therapists, 1800 occupational therapists, and 400 speech
in 4 lexical categories (fruits, stationary items, animals and body therapists, 200 prosthetists and orthotists on the island today. The re-
parts). Later, these words were transferred and stored in DMDX habilitation medical care in Taiwan belongs to the tertiary care system.
software. The stimuli was then inserted into a single sequence and All medical center hospitals here offer high quality and international
presented to the participants such that four pictures of the same standard of rehabilitation medical care. Important Contributors to
lexical category appeared one after another on the computer screen The Field of PM & R in Taiwan: Dr. Chang-Zern Hong, who was a
following one from a different lexical category. The software was professor at UC Irvine, went to the laboratory of Dr. David Simons
programmed so that the picture stimuli were automatically displayed for the study of myofascial pain syndrome (MPS). He has advanced
on the screen one by one for 2000 msec. There was 3000 msec researches in the mechanism of MPS, and thus became a pioneer in
interstimulus interval between two stimuli. Each trial consisted of this field. He became the head of the Department of PM&R at National
the appearance of a fixation point (‘+++’) for 500 ms, followed by Cheng Kung University Hospital after he returned to Taiwan. His
the presentation of the target word, displayed for 2000 ms. DMDX department is a leading rehabilitation center in southern Taiwan, and
software measures the reaction time (the time interval between has certainly reached international level in terms of rehabilitation care
application of a stimulus and detection of a response) for naming and researches. The need of pediatric rehabilitation grew rapidly in
the stimulus. Only the vocal responses from the participants were Taiwan. Dr. Alice M.K. Wong, superintendent of Chang Gung Memo-
recorded. This was done through Check Vocal software where the rial Hospital at Tao Yuan, received four years of resident doctor training
stimulus spectrograph of the recorded response was shown. Results: in the Department of PM&R at NTUH . She has immense interest to
Results of the independent t-test revealed statistically significant improve the life quality of patients with cerebral palsy by using the
differences between the two groups for the cognitive flexibility concept of traditional medicine and acupuncture. Such concept was
index at p < 0.01. Conclusion: The present study investigated the also used to treat patients with neurological and musculo-skeletal
cognitive flexibility in children with learning disability and typically related diseases. Prominent therapeutic effects have been published
developing children and the results revealed significant differences in renowned journals. Exercise physiology and cardiac rehabilitation
between the two groups for the cognitive flexibility index. The was developed primarily in the sixties through the effort of Dr. Jin-
children with learning disability require more time to shift their Shin Lai and Dr. Chin Lan. They set up several renowned cardiopul-
cognitive set in response to changing stimuli when compared to monary rehabilitation laboratories around the island during the past
typically developing normal children. The obtained results were few decades. One of their most intriguing researches they discovered
attributed to the deficits in the attentional process and the knowledge was that the traditional Tai-Chi boxing could improve the cardiopul-
representation yielding a prolonged cognitive block in children with monary functions in humans and is the best exercise for Taiwanese.
learning disability. Electromyographic study is an important medical examination tool
for physiatrists. Dr. Chein-Wei Chang, chairman of the Department of
PM&R in NTUH, and Dr. Rai-Chi Chan, chairman of the Department
Development of Physical and Rehabilitation Medicine of PM & R in Veteran General Hospital, are the leaders in this field.
They have many advanced researches and certainly have brought the
in Asian and Oceanian Region field of electrodiagnosis in Taiwan to a higher level. Care of patients
with spinal cord injury (SCI) has also improved rapidly in Taiwan.
0430K1 Dr. Simon Tang, professor and program director of the Department
Development of physical and of PM & R in Chang Gung Memorial Hospital (CGMH), and Profes-
sor Yen-Ho Wang of NTUH, are the forerunners in this field today.
rehabilitation medicne in Taiwan Dr. Tang has applied the concept of motor control to such cases, and
Simon Fuk-Tan Tang Dr. Wang studied endocrine changes in SCI patients. Dr. Tang is also
interested in promoting foot care through the applications of orthotic
Department of Rehabilitation Medicine, Chang Gung Memorial insoles, and has thus turned CGMH into a famous foot orthotic center
Hospital and Chang Gung University (Taiwan) in Taiwan. He also set up a well-equipped laboratory for gait analysis
and motor control. Renowned journals were published from this labo-
The Rise of Rehabilitation Medicine in Taiwan: Since the end of ratory already, and more researches are taking place presently. On the
Second World War, Taiwan had numerous patients with cerebral palsies other hand, professor Liu-Ing Bib had done series of studies on the
and poliomyelitis. However, inadequate rehabilitation support could assessment and intervention for neurogeuic bladder in SCI at Chung
be offered at that time. Dr. I-Nan Lien and Dow-Chang Hsu recruited Shan Medical University Hospital. The pioneers in this field include
special medical personnel with experience in such fields to aid these Dr. Tyng-Guey Wang, Chih-Chin Hsu, Wen-Shiang Chen, Wen-Chung
patients. At the same time, the World Health Organization (WHO) Tsai. Newly Discovered Rehabilitation Fields in Taiwan: During the
planned to improve the quality of medical care in Asia, especially in the past decade, the application of soft tissue ultrasound was widely used in
field rehabilitation medicine, and has offered scholarships for doctors PM&R. Soft tissue ultrasound is frequently used for clinical diagnosis
in Asia to receive related trainings in the United States. Dr. I-Nan Lien and treatment plans. Soft tissue ultrasound is commonly used to help
had the opportunity to join the training course in New York University us in achieving the correct clinical diagnosis. More recently, we also
from 1967 to 1968. The Department of Physical Medicine and Reha- develop the technique of sonoquide injection for musculoskeletal
bilitation (PM&R) in the National Taiwan University Hospital (NTUH) lesions. Conclusion: In short, physical medicine and rehabilitation
was originally set up in 1962. However, the rehabilitation team was in Taiwan is a fast growing field in recent years. It has become an
not strong enough to deal with all the related problems in this field. important field of medicine here. With the combination of modern
After returning home in the summer of 1968, Dr. Lien reorganized the rehabilitation concepts of the western world, and traditional Chinese
department with the help of Dr. Huang Chi-Chow. He recruited physi- medicine, more medical assistance and new treatment stragtegies can
cal therapist, occupational therapist, speech pathologist, and prosthetist be offered to the patients. We are confident that the standard of reha-
to strengthen his team. During those days, he gave lectures in the field bilitation medicine will improve here in Taiwan, and more treatment
of rehabilitation in almost every medical school in Taiwan with the plans can be innovated in the future.

0430K2 Methods: The author presents information from his experiences as

THE DEVELOPMENT OF REHABILITATION chair of the International Task Force that organized the development
of the International Society of Physical and Rehabilitation Medicine
MEDICINE IN THE PHILIPPINES: OUR WORK, (ISPRM), as the Founding President of the ISPRM and as advisor to
MISSION AND VISION the succeeding presidents of the ISPRM. Results: The history of the
Reynaldo Rey Matias ISPRM can be divided into its 1) formative, 2) early operational, 3)
programmatic and 4) future evolutional periods. The challenges in
St. Luke’s Medical Center and College of Medicine (Philippines) each phase have similarities but require strategies consistent with the
Our Past embodies the ideals and aspirations of the academy from different phases of the ISPRM’s development. The formative period
its beginnings. Our rich heritage which stems from a group of Phy- of the ISPRM was one of dreams and diplomacy associated with
siatrist and Orthopaedic surgeons interested in the field organized substantial efforts from those committed to forming the ISPRM. The
the Philippine Society of Physical Medicine and Rehabilitation. The plan was to form the ISPRM through a merger of the International
Society then had an active membership of less than twenty. In 1974, Federation of Physical Medicine and Rehabilitation and the Inter-
the organization’s name was changed to the Philippine Academy national Rehabilitation Medicine Association. These organizations
of Rehabilitation medicine. Our Present is embodied in our Mis- differed in their membership, finances and programs. The formative
sion statement which are the following; to promote and advance period of the ISPRM was from 1992 to 1999 during which the Inter-
the field of Rehabilitation Medicine in the Philippines, to elevate national Task Force addressed a number of challenges. 1) The first
the standards of practice through training, education, research and challenge was to create a vision of the ISPRM that the members and
service thereby improving the quality of life of the Filipino people. leaders of both organizations could accept. 2) A second challenge
With the establishment of four accredited training institutions by was to identify categories of membership; 3) a third was to allocate
the Philippine Board of Rehabilitation Medicine, the academy now the disparate resources of the two organizations; 4) a fourth was to
boast of about 350 members – mostly home-grown specialist. The identify effective leaders; 5) and a fifth was to develop the documents
academy serves its members and their patients as well as other that defined the merger and those that would be the basis for the
health professionals and society by fostering excellence in Physistric ISPRM’s future operations. The final challenge was to convince the
practice, education, research and community service. Our Future is boards of the IFPM&R and IRMA to accept their dissolution and the
embodied in our Vision Statement which is to further promote and establishment of a new organization. The early operational period of
advance the field of Rehabilitation Medicine elevate its standards the ISPRM was one focused largely on developing the operational
of practice, education, research and service thereby improving the infrastructure of the ISPRM. I consider this phase of the ISPRM to
quality of life of the Filipino people. have been from 1999 to 2008. The leadership of the ISPRM during
this period devoted most of their time to its operations and proportion-
ately less to its programs. The challenges were similar to the earlier
0430K3 period, but in a different context. They included: 1) Continued focus
on the primary purpose of the ISPRM, in particular whether it mostly
DEVELOPMENT OF PHYSICAL AND
served societies or individual members; 2) the definition of members;
REHABILITATION MEDICINE IN MONGOLIA 3) struggles to obtain sufficient resources: 4) identification of leaders
Avirmed Baljinnyam, Sh. Batchimeg to replace those who founded the ISPRM; 5) continued refinement of
Department of Rehabilitation Medicine, School of Medicine, Health the By-Laws and Policies and Procedures to improve the ISPRM’s
operations; 6) and expansion of the infrastructure sufficient to pro-
Sciences University of Mongolia (Mongolia)
vide programmatic support capacity including a central office. The
Rehabilitation medicine is a medical branch which is very useful in programmatic period of the ISPRM is from 2008 to the present. It
the world but in Mongolia it is a new one and less popular. The main represents progression from a major preoccupation with operational
health issues for Mongolia are chronic diseases such as hypertension, issues to supporting programs for the support of the ISPRM’s mis-
diabetes, stroke and trauma but the rehabilitation diagnosis and treat- sion. These include ever improving Congresses, website support for
ment are not properly handled. Therefore Rehabilitation medicine took members, exchange programs and substantive contributions to World
up the role and tried to meet the need of this aspect of patient care. To Health Organization programs. Challenges remain in 1) defining the
lay the ground work it is very important to include rehabilitation in relationships of the ISPRM to other international PRM organiza-
the curriculum for medical students. We started to develop this field tions; 2) the definition of members; 3) obtaining resources to support
in early 1980s; the curriculum was reviewed and revised completely expanded potential programs; 4) identifying leaders to implement
in 2002. A physiatrist is required to undergo a 1-year training course more and larger programs; and 5) modifications in operations and its
in an approved program, which places the emphases of the clinical related documents to improve the effectiveness of the ISPRM. The
management of problems associated with disability and various future evolutional period of the ISPRM represents its maturation into
musculoskeletal problems for the purpose of restoring the disabled a contributing organization to its members and to society. There are
person to his optimum level. Unfortunately we cannot work by team significant challenges associated with this evolution. They include:
because lack of PT, OT and ST and all main state hospitals have very 1) sufficient voluntary leadership; 2) adequate economic resources;
old, out of dated equipment of physical modality and which abso- 3) an expanded and supported central office; 4) further refinement of
lutely does not meet to present requirement. The major challenges of membership categories; 5) relationships with regional PRM societies,
rehabilitation education in Mongolia: 1) Lack of qualified lecturers 6) interfaces with PRM journals: and (7) expanded involvement in
and teaching materials for the physiatrists, 2) do not have any modern UN and Who programs. Conclusion: The ISPRM has had significant
equipped centre for rehabilitation medicine, 3) do not have physical, success but has far to go to meet its full potential. All associated
occupational and speech therapists education at the moment. with it will need to devote effort towards overcoming its current and
future challenges.
0430K4
HISTORY OF THE DEVELOPMENT OF THE Brain Disorders: Stroke
ISPRM: REVIEW OF THE CHALLENGES 0430C1
John L Melvin Depression and anxiety in the
Jefferson Medical College (United States) hemiplegic
Purpose: The purpose of this presentation is to enable those leading Jorge Lains
or developing Physical and Rehabilitation Medicine organizations to
identify the challenges they may need to overcome. Materials and Abstract missing.

Brain Disorders: Stroke 25
0430C2 ity (p<0.01). All scores in the LOS test (EOSS, ECSS, SVSS, EPE
mirror neuron system in the pre-motor and DCL), the step length and velocity in the walking across test
and MAS score improved significantly than scores in pre-injection
cortical area: A rct in the post-acute (p<0.05). Dynamic balance training in the treatment group can more
stroke arm rehabilitation significantly improve the postural control than traditional balance
Marco Franceschini training in the control group. Conclusion: The results suggest
that ultrasound-guided Botox injection is safe and that the injec-
Neuro-Rehabilitation Department, IRCCS San Raffaele (Italy) tion technique combined with balance training strategies may get
Purpose: Recent studies demonstrated the presence in the human maximum effectiveness in relieving post-stroke lower extremities
pre-motor area of mirror neurons with the property to discharge spasticity with foot inversion, toes flexion and is especially more
during the observation of hand/arm actions. The aim of the research beneficial for deeper muscles.
was to evaluate if the observation of arm actions may constitute
an alternative rehabilitation strategy in post-acute stroke patients.
0430C4
Materials and Methods: A RCT included 102 patients (53 patients
in the experimental group (EG), 49 in the control group (CG)) at MASSAGE THERAPY IN DEPRESSED PEOPLE: A
the first acute stroke (30±3 days from stroke). All subjects had META-ANALYSIS OF CLINICAL TRIALS
received a conventional rehabilitation treatment and in addition
the patients included in EG were asked to watch filmed sequences Wen-Hsuan Hou
showing upper limb daily activities, while CG in addition watched E-Da Hospital (Taiwan)
a static imagine without animals movement. Assessments were
taken with the following: Fugl Meyer, Frenchay Arm Test, Box Objective: Many modalities have been used to treat depression
and Block (B&B), Barthel Index and FIM. All evaluations were including pharmacotherapy and psychotherapy, but some depressed
administered before (T0) and after the treatment (T1) and at follow- patients do not improve adequately. Massage therapy is a comple-
up (T2). Results: After adjusting for baseline scores and age, the mentary therapy employed in reducing psychological distress with
preliminary analysis demonstrated a significant improvement in all equivocal results. We systematically investigated the treatment
parameters in both groups from T0 to T1 (p<0.001) and from T0 effects of massage therapy in depressed people and incorporated
to T2 (p<0.001). Furthermore, a significant “time for treatment” data from recent studies with an aim to provide informations for
effect was shown in the B&B Test, favouring an higher impact of clinicians. Method: A meta-analysis of randomized controlled trials
Experimental treatment on upper limb recovery (p<0.001, T0 to (RCTs) of massage therapy for depressed people was conducted by
T1, and p=0.02, T0 to T2, respectively). Conclusion: This mew using published studies found on four main electronic databases.
rehabilitation approach suggests that the stimulation of the mirror A hand search of bibliographies of relevant papers was also con-
neurons may reveal useful in promoting motor dexterity recovery ducted. Outcome measures of massage therapy were the changes
in the post-acute phase of stroke. in mean scores of depression scales between treatment and control
groups. Trials with other interventions, combined therapy, and mas-
sage on infants or pregnant women were excluded. Two reviewers
0430C3 independently performed the initial screening and assessment of
quality indicators with the Jadad scale. Results: We included 18
EFFECTIVENESS OF ULTRASOUND GUIDED studies containing 831 persons out of 256 retrieved references.
BOTOX INJECTION ON BALANCE IN POST- All trials showed positive effect of massage therapy on depressed
STROKE PATIENTS WITH LOWER EXTREMITIES patients. Eighteen RCTs were of moderate quality, with a mean
quality score of 7.06 (SD 0.85). The pooled standardized mean
SPASTICITY differences in fixed- and random-effect models were 0.78 (95%
Zulin Dou, Xiaomei Wei, Hongmei Wen, Yi Fu, Xiafei CI 0.63 to 0.92) and 0.76 (95% CI 0.57 to 0.95), respectively. The
Lin variance between these studies revealed possible heterogeneity.
Department of Rehabilitation Medicine; The 3rd Affiliated Hospital; Conclusion: Massage therapy significantly alleviates depressive
Sun Yat-sen University (China) symptoms. However, the use of standardized protocols of massage
therapy, various depression-rating scales, and target populations in
Purpose: To determine the effect of ultrasound guided botulinum further studies is suggested.
toxin type A (Botox) injection on lower extremities spasticity and
to discuss the quantitative postural control outcome in post-stroke
patients in conjunction with an equilibrium training program after 0430G1
Botox injection. Materials and Methods: In this prospective study, POWER REHABILITATION, PRINCIPLE AND
Multipoint Botox injection at total dose less than 500 U was ap- METHOD
plied to tibialis posterior, flexor hallucis longus, flexor digitorum
longus for each patient with foot inversion and toes flexion. An Takahito Takeuchi
ultrasound-guided injection technique was used for these muscles. International University of Health and Welfare, Graduate School
The placement of the injection needle and injection into target (Japan)
muscles were observed during real time. 28 post-stroke patients
within 6 months were randomly divided into a treatment group and Purpose: Introduction of new method of rehabilitation, its principle
a control group, 14 subjects in each group after Botox injection. The and technology. Objective: Old stroke patient and geriatric care-
dynamic balance training with the smart equitest balance master needed people. Principle: Power rehabilitation has been developed
was used in the treatment group, traditional balance training for for the fragile elderly people to improve their physical activity. The
the control group. Both two groups received interventions 5 times decline of activity with aging is due to not loss of muscle strength
per week for 40 min. Patients were assessed before and at the 4th but loss of generating “Power” of activity. And the loss of power
week post-injection Botox using modified Ashworth Scale (MAS), is due to some inactive muscle in cooperative movement. Power
the sensory organization test (SOT), limited of stability (LOS) and rehabilitation is the training system making the inactive muscle
walking across test by the same balance equipment. Results: No to cooperative active condition using weight-stag muscle training
complications (e.g. bleeding, infection, nerve injury and neurovas- machines. The mechanical machine is useful to keep the axis of
cular compromise) were encountered during or immediately after movement constant, and to be able precise control of load. Method:
any procedure. All patients responded positively to the treatment. Major movement of whole body are exercised by six type machine.
At 4th week post-injection, a statistically significant decrease of two And on each machine, the patient practices 30 movements (10-10-
groups was determined in spasticity and improved in walking abil- 10). The load with weight-stag are between 10–12 level of Borg’s

RPE (rating perceived exertion).Standard program is 12 weeks with improve motor and functional outcomes based on the International
2 exercises each week. The case of simple aging care needed people, Classification of Functioning, Disability and Health (ICF). In addition,
old stroke, Parkinson disease will be shown by DVD. Results: It has clinimetric research showed the responsiveness and clinically impor-
many kind of effect on physical activity, apathy and depression and tant change of test instruments commonly used for measuring motor
life style. Conclusion: Power rehabilitation is effective on improve- function and quality of life after stroke. Use of regression analysis has
ment of physical-psychological activity of elderly people. revealed predictors of treatment outcomes important for prognostic
consideration in stroke rehabilitation. Implications of the findings for
practice and directions of further work will be discussed. Continued
0430G2 research will contribute to the translation of movement science and
Functional Electrical Stimulation clinical neurosciences to evidence-based stroke rehabilitation.
Improves Functional Recovery of the
Upper Extremity of Subjects with Acute 0430G4
Stroke: A 6 Months Follow-up Study FACILITATING MOTOR PERFORMANCE
Tiebin Yan , Zinlin Lin
1 2 THROUGH EXTERNAL CUEING FOR PEOPLE
1
Department of Rehabilitation Medicine, Sun Yat-sen Memory Hospi- WITH PARKINSON’S DISEASE
tal, Sun Yat-sen University and 2Department of Rehabilitation Medi- Hui-Ing Ma
cine, The 5th Affiliated Hospital, Sun Yat-sen University (China) Department of Occupational Therapy, National Cheng Kung Uni-
Purpose: To investigate whether functional electrical stimulation versity (Taiwan)
(FES) could improve the functional recovery of the affected upper
Purpose: The purpose of this presentation is to review research
extremities of patients with first acute stroke and whether its ef-
evidence on the effects of external cueing on motor performance
fectiveness could last for 6 m after finishing the treatment. Materi-
in people with Parkinson’s disease (PD), and to report research
als and Methods: Forty-six patients with first acute stroke were
conducted by the presenter related to the use of virtual reality to
recruited and randomly assigned after stratification by a computer
provide external cueing in PD. Materials and Methods: Experi-
program into 2 groups, FES group or control one. Thirty-seven
mental research has been conducted on the effects of visual and
completed the study. Among them, 19 were in the FES group with
auditory cueing in people with PD. In addition, virtual reality has
11 males and 8 females, aged 62.2±8.7 years, 43.5±25.2 days post
been used to provide virtual moving targets to facilitate motor
stroke, 13 with ischemia and 6 with hemorrhage. Eighteen in the
performance in this population. Results: Research shows positive
control group with 11 males and 7 females, aged 66.0±9.6 years,
results for the use of external cueing for people with PD, including
41.3±26.5 days post stroke, 12 with ischemia and 6 with hemorrhage.
the cueing provided in virtual reality. Conclusion: The findings
All patients received standard rehabilitation program. Patients in
support providing external cueing to people with PD and provide
the FES group received functional electrical stimulation with the
direction for future design of virtual reality program to improve
parameters at 30 Hz, 0.2 ms pulse width and for 5 s each on and
motor performance for this population.
off time. The treatment was 30 min at each session, once a day for
5 days each week, and lasted for 3 weeks or 15 sessions. Measure-
ments included modified Ashworth spasticity scale (MAS), the 0430G5
upper section of Fugl-Meyer motor assessment (FMA), manual
muscle testing (MMT), as well as Modified Barthel Index (MBI). Physical Findings, Sonography and
They were measured before treatment, at the end of the 2nd and 3rd Shoulder Pain of Hemiplegic Shoulders
week treatment and at the 1st, 3rd, 6th month post-treatment. All data in Acute Stroke Patients during
were analyzed with SPSS version 15.0, the statistical significance Rehabilitation
was set at the 5% level. Results: No significant difference was
found at the baseline between the two groups before treatment. Yu-Chi Huang, Pei-Jung Liang, Ya-Ping Pong, Chau-
After 2 week treatment, significant difference was found only in Peng Leong
the score of FMA between 2 groups. After 3 week treatment, how- Department of Physical Medicine and Rehabilitation, Chang Gung
ever, significant improvements were found in the scores of FMA, Memorial Hospital-Kaohsiung Medical Center (Taiwan)
MAS, MMT in patients in the FES group when compared with the
control one (p<0.05). During the follow-up, significant differences Objective: Physical and sonographic evaluation of hemiplegic
were also found in the scores of FMA, MBI, MAS, MMT at the 1st shoulders in acute-stroke patients and correlation between the
month post-treatment between 2 groups (p<0.05) and were further physical/sonographic findings and early-onset hemiplegic shoulder
demonstrated significant difference in the scores of MMT, MBI, pain (HSP), which play an important role in hemiplegic shoulder
FMA at the 3rd month post-treatment (p<0.05). At the 6th month pain and may impede rehabilitation. Subjects: Acute stroke patients
post-treatment, the scores of MBI, FMA in the FES group were with hemiplegic shoulders. Materials and Methods: The following
also significantly higher than those of the control group (p<0.05). characteristics of recruited acute stroke patients were recorded: age,
Conclusion: Three weeks of FES treatment on the affected upper gender, height, body weight, side of hemiplegia, type and duration
extremity of patients with acute stroke improved the motor function of stroke, Brunnstrom stage, subluxation, and degree of spasticity of
of the patients and the effectiveness lasted for at least 6 months after the upper extremity. On the basis of the Brunnstrom motor recovery
finishing the treatment. (BMR) stages of hemiplegic shoulders, subjects were assigned to
poor motor function (PMF) and good motor function (GMF) groups.
In a pilot study (n=34), shoulder sonography was performed at ad-
0430G3 mission and 2 weeks after rehabilitation for each patient. In the fol-
lowing study (n=57), more detail physical findings and sonography
EVIDENCE-BASED STROKE REHABILITATION?
of hemiplegic shoulders at admission, and before discharge were
Keh-Chung Lin compared, and the relationship between the physical/sonographic
School of Occupational Therapy, National Taiwan University Col- findings of hemiplegic shoulders and HSP was analyzed. Results: In
lege of Medicine (Taiwan) a pilot study (n=34), shoulder musculoskeletal sonography revealed
soft-tissue injury in 7 patients (33%) and 15 patients (71%) in the
This presentation highlights several areas of advances in evidence- PMF group at admission and 2 weeks after rehabilitation, respec-
based stroke rehabilitation in Taiwan. Growing evidence of ran- tively (p<0.05), and in 4 patients (31%) in the GMF group both at
domized controlled trials showed treatment-specific efficacy of admission and 2 weeks after rehabilitation. In the following study
constraint-induced therapy and bilateral arm training aimed to (n=57), the PMF and GMF groups differed significantly in prop-

rioception, spasticity, subluxation, and shoulder rotation (p<0.05). Background and Purpose: In this paper, a review of the use of
Frequency of abnormal sonographic findings and shoulder pain mental imagery and constraint-induced movement therapy (CIMT)
and VAS score of HSP before discharge were significantly higher for people with stroke will be presented. The role of imagery in
in the PMF group (p<0.05) than in the GMF group. BMR stages, CIMT is proposed. Associated with it, a series of studies conducted
shoulder motion, subluxation, and abnormal sonographic findings in both adults with stroke and children with cerebral palsy will be
of hemiplegic shoulders were moderately correlated to VAS scores presented.
of HSP (γ=0.34–0.65; p<0.01). Conclusion: Acute stroke patients Study One: Materials and Methods:In the first study on adults with
with poor upper limb motor function are more prone to soft-tissue stroke, a randomized clinical trial is being conducted. Up to now,
injury of the shoulder during hospitalization. The frequency of a total of 9 subjects were recruited in the imagery plus constraint-
shoulder soft tissue injuries (85%) and early-onset HSP (67%) was induced movement therapy (imagery+CIMT) group and 6 in the
significantly higher in the PMF patients with impaired sensation, control group receiving conventional occupational therapy+CIMT.
spasticity, subluxation, and restricted rotation of the hemiplegic All programs have duration of 2 weeks for 5 times a week. Data
shoulder before discharge. BMR stages, limited rotation, subluxa- on upper limb motor functions and daily task performance were re-
tion, and abnormal sonographic findings of hemiplegic shoulders corded before and after the programs, and at 2 month follow-up time.
were associated to HSP severity in acute stroke. Results: Subjects had a mean age of 61.67 (SD=11.69). Reviewing
the raw data showed that there was better improvement in all meas-
0430L1 ures in the imagery+CIMT group than the control group. Repeated
measure ANOVA showed that the group receiving imagery+CIMT
EFFECTS OF MOTION CONTROL SHOE ON THE had better significant improvement in the upper limb function of the
KINEMATIC, KINETIC AND MOTOR CONTROL Fugl Meyer Assessment FMA (F=3.45, p<0.05), but not for the Ac-
OF THE LEG DURING RUNNING tion Research Arm Test ARAT. No significant difference was found
in the subjective report using the Motor Activity Log MAL and the
T.H. Cheung1, Gabriel Y.F. Ng2 Lawton Instrumental Activities of Daily Living scale.
1
Clinical Associate, 2Chair Professor, Department of Rehabilitation Study Two: Materials and Methods: In this study, 10 children with
Sciences, Hong Kong Polytechnic University (Hong Kong) cerebral palsy (CP) with a mean age of 13.6 years (age 9 to 18 years)
were involved. A within-subjects design was used with children act-
Purpose: Motion control footwear is a shoe design that aims at ing as their own controls. The study was scheduled at three-week
reducing rearfoot pronation so as to minimize pronation related intervals. All children underwent conventional occupational therapy
running injuries. Although this technology is not new, there is (OT) and imagery+CIMT program. Both programs lasted for three
no consensus on its clinical efficacy. This study was therefore weeks. Each program was followed by a three-week no-treatment
conducted to examine the effects of motion control footwear on period to measure carry-over effect. Upper limb subtests of the
the foot kinematics and kinetics and lower limb muscle control Bruininks–Oseretsky Test of Motor Proficiency, the Jebsen-Taylor
in people with rearfoot over-pronation problem. Materials and Test of Hand Function, the Caregiver Functional Use Survey, a hand
Methods: Four experiments were done to compare the motion dynamometer, pinch gauge, and modified Ashworth scale were used
control footwear with normal cushion footwear in recreational for evaluation. All children were assessed for five times at 3-week
runners with excessive rearfoot pronation problem during running. interval: once before and twice after the conventional OT; and twice
The parameters being studied included rearfoot movements and after the imagery+CIMT at 1 week and at 3 weeks. Results: The
plantar loading pattern before and after a 1.5 km running bout results indicated that children showed significant improvements
and then the shank and quadriceps muscle activity during a 10 km in upper limb coordination, speed and dexterity, functional use of
fatigue running bout. Results: The data revealed that the subjects upper limb and hand strength after receiving the imagery+CIMT
had a reduction of maximum rearfoot pronation when wearing the program and these gains sustained for at least 3 weeks post treat-
motion control footwear and the effect persisted even after muscle ment. Children also demonstrated significant positive changes in
fatigue. There was a more balanced plantar loading force distribu- upper limb coordination, speed and dexterity and functional use of
tion under the foot in the motion control footwear as compared upper limb following the OT program, but carry over effect was
with the neutral cushioned footwear running condition. Surface relatively weak on the whole.
electromyographic testing of the lower limb muscles revealed Study Three: Materials and Methods: Event-related potential
that motion control footwear could provide a more favorable (ERP) technique was used for this study. Two children with hemi-
running condition in terms of higher resistance towards muscle plegic cerebral palsy (aged 9 male and female; normal intelligence)
fatigue, more stable activation of the shank stabilizing muscles received imagery+CIMT were recruited. Prior to the treatment
as well as enhancing the temporal activation of patella stabilizers. and after the 3-week treatment period, the children participated
Conclusion: These findings are suggestive of the importance of in event-related potential (ERP) sessions with finger-tapping
appropriate selection of running shoes in people with excessive tasks. Results: Both cases exhibited improved in reaction time
rearfoot pronation. In light of the lower limbs resembling a close in both right and left hand tasks post 3-week treatment period.
kinetic chain arrangement during running, the effects of footwear The improvement was larger in the affected left hand (733 ms to
may not be limited to the foot structures but it also affects the more 659 ms and 1104 ms to 1051 ms) than the right unaffected hand
proximal muscles thus having a potential influence on the control (583 ms to 573 ms and 894 ms to 882 ms). Improved accuracy
of the proximal joints. rates in affected hand were also demonstrated in both cases post-
treatment (79% to 89% and 89% to 94%). Visual inspection of
0430L2 the ERP waveform showed fewer abruptnesses in post-treatment
data. Topographical maps showed that in centro-parietal regions,
THE ROLE OF IMAGERY IN CONSTRAINT- patterns shifted from central and left-lateralized to more central
INDUCED MOVEMENT THERAPY and right-lateralized. Conclusion: CMIT has been shown to be a
Karen P.Y. Liu1, Y.M. Wong2, M.L. Yuen2, T. Leung3, C. useful method in improving function for people with hemiplegia.
Evidence also shows the advantage of using mental imagery as
Sum3, V. Mok4, C.M. Lum5, M.C.C. Kuo1, C.C.H. Chan1, a strategy to understand and plan for solutions to copy with own
K.H. Chan1 problems. The results of this series of studies suggest a trend of
1
Applied Cognitive Neuroscience Lab, Department of Rehabilitation better improvement in the imagery+CIMT group. Rather than a
Sciences, The Hong Kong Polytechnic University, 2SAHK, 3Oc- larger part of the brain regions recruited during the motor task, the
cupational Therapy Department, Shatin Hospital, 4Department of patterns are more discrete and lateralized after treatment. These
Medicine and Therapeutics, The Chinese University of Hong Kong results suggest that improvements gained could be explained by
and 5Medical and Geriatric Unit, Shatin Hospital (Hong Kong) cortical reorganization.

0430L3 0430L5
USE OF PROPRIOCEPTIVE STIMULATION IN INTEGRITY OF THE CORTICOSPINAL TRACT
STROKE REHABILITATION PREDICTS MOTOR RECOVERY IN STROKE:
Sang-I Lin1, Pei-Yi Lin2, Li-Ju Hsu1, Jia-Jin Chen2 DIFFUSION SPECTRUM IMAGING STUDIES
1
Department of Physical Therapy and 2Institute of Biomedical En- Pei-Fang Tang1,2, Yi-Hsin Ko1, Zheng-An Luo1, Jiann-
gineering, National Cheng Kung University, Tainan (Taiwan) Shing Jeng3, Miao-Chi Lo4, Shen-Hsing A. Chen5,6,
Purpose: The purposes were to determine the effect of propriocep- Ming-Jang Chiu3, Chein-Wei Chang7,8
tive stimulation induced by mechanical vibration and repetitive
1
School and Graduate Institute of Physical Therapy, College of
passive joint motion on movement control in patients with stroke. Medicine, National Taiwan University, 2Physical Therapy Center,
Materials and Methods: Part I. Stride characteristics and muscle National Taiwan University Hospital, 3Department of Neurology,
activation patterns during walking with and without vibration to the National Taiwan University Hospital, 4Center for Optoelectronic
unaffected Achilles tendon were compared. Part II. Sensorimotor Biomedicine, College of Medicine, National Taiwan University,
function and the cortical activation during leg cycling were com- 5
Department of Psychology, National Taiwan University (Taiwan),
pared before and after 1-month training of active-arm (control group) Division of Psychology, Nanyang Technological University (Sin-
and passive-leg (passive group) cycling. Results: Part I. Vibration gapore), 7Department of Physical Medicine and Rehabilitation,
resulted in significantly longer single stance time of the unaffected National Taiwan University Hospital and 8Department of Medical
limb and greater activation of the tibialis anterior of the affected limb Imaging, National Taiwan University Hospital (Taiwan)
during initial double and single support phases. Part II. While the
passive group had significant increase in the activation of bilateral Purpose: Previous studies using the region-of-interest approach of
sensorimotor cortex, and unaffected premotor and supplementary diffusion tensor imaging have shown relationships between structural
motor cortices, the contorl group only gained in the activation of integrity of certain white matter regions and general motor recovery
bilateral sensorimotor cortex. Furthermore, the passive group also after stroke. It remains unclear whether the motor recovery of af-
showed significant improvement in ankle dorsiflexion strength fected upper and lower extremities can be separately predicted by
and joint position sense, but not the control group. Conclusion: integrity indices of the corticospinal tract (CST). We investigated
Proprioceptive stimulations, even induced passively, could lead to the longitudinal changes of structural integrity of the CST fibers
changes in movement control in patients with stroke and thus have corresponding to the motor control of the affected upper and lower
the potential to be used in stroke rehabilitation. extremities, and the relationships between early integrity indices and
time-related changes of these indices with corresponding later motor
outcomes. Materials and Methods: Diffusion spectrum imaging (DSI)
0430L4 and motor assessments of the affected upper and lower extremities
were performed on the 30th (D30), 90th (D90), and 180th (D180) days
CORTICAL REORGANIZATION INDUCED BY in 6 patients with mild to moderate subcortical ischemic stroke. We
BODY WEIGHT-SUPPORTED TREADMILL used tract-specific analysis to derive generalized fraction anisotropy
TRAINING IN INDIVIDUALS WITH STROKE (GFA) and relative GFA (rGFA) values of the CSTs corresponding
to upper and lower extremity control at the posterior limb of the in-
Yea-Ru Yang, I-Hsuan Chen, Ray-Yau Wang ternal capsule (PLIC). Results: There was a significant improvement
Department of Physical Therapy and Assistive Technology, National in Fugl-Meyer upper extremity motor score (FMAUE) (p = 0.028),
Yang-Ming University (Taiwan) borderline improvement in Fugl-Meyer lower extremity motor score
(FMALE) (p = 0.068), but no significant changes in GFA and rGFA
The body weight support treadmill training (BWSTT) has been values (p≥0.45) across the three time points. The rGFA values of
suggested as an effective intervention to improve balance, motor the upper and lower extremity-related CSTs (rGFAPLIC-UE and
and gait performance for individuals with stroke. It consists of rGFAPLIC_LE) on D30 were significantly correlated with FMAUE
an overhead suspension system and harness to support partial and FMALE on D180 (rs = –0.845, p = 0.034 for both), respectively.
body weight of patients while walking on the treadmill. The Conclusion: Our results suggest that in mild to moderate stroke, the
theoretical background of BWSTT relies on the concept of central integrity indices of the affected CSTs undergo negligible changes
pattern generators and the task-specific repetitive treatment in after D30; and rGFAPLIC-UE and rGFAPLIC_LE on D30 can predict
gait rehabilitation after stroke. Although some studies suggested long-term recovery on FMAUE and FMALE, respectively.
that improvement in motor performance is related to cortical
reorganization, the cortical reorganization induced by BWSTT
remains unclear. We investigated the effects of BWSTT on motor 0430L6
performance and corticomotor activity elicited by the transcranial
magnetic stimulation in 14 subjects with chronic stroke. Seven TELEREHABILITATION IN SUBJECTS WITH
participants received general physical therapy, and others received SUBACUTE STROKE
additional BWSTT for 4 weeks. We found additional BWSTT im- Kwan-Hwa Lin1, Jin-Shin Lai2, Jer-Junn Luh1, Shih-
proved gait performance and corticomotor activity of the affected
hemisphere. In another study, we compared corticomotor changes Ching Chen3, Wen-Tzeng Huang4, Chin-Hsing Chen5,
induced by BWSTT in individuals with short (< 6 months) or long Yuan-Jen Chang5, Shang-Ming Yu6
(12 months) poststroke duration. Subjects in each short and long
1
School and Graduate Institute of Physical Therapy, National
duration groups were randomly assigned to either the experimental Taiwan University; Taipei; 2Department of Physical Medicine
or control groups. Subjects participated in BWSTT for 4 weeks and Rehabilitation, National Taiwan University Hospital, Taipei;
in the experimental groups and in the general exercise program 3
Department of Physical Medicine and Rehabilitation, Taipei
for 4 weeks in the control group. The 4-week BWSTT resulted Medical University, Taipei; 4Department of Computer Science
in a decrease of motor threshold and an increase of map size for and Information Engineering, Minghsin University of Science and
abductor hallucis in subjects with short duration, whereas only Technology, Hsinchu; 5Department of Information Management,
the expansion of the map size was noted in subjects with long Central Taiwan University of Science and Technology, Taichung,
duration. However, improvement of motor control occurred both 6
Institute of Electrical Control Engineering, National Chiao Tung
in subjects with short and long post stroke duration after BWSTT. UniversityTaichung (Taiwan)
In conclusion, the BWSTT can facilitate cortical reorganization
and such treatment-induced cortical reorganization is influenced Purpose: Telerehabilitation is the delivery of <http://en.wikipedia.
by the poststroke durations. org/wiki/Physical_medicine_and_rehabilitation>rehabilitation

service via <http://en.wikipedia.org/wiki/Telecommunica- ment of Physical Medicine and Rehabilitation, Changhua Christian
tion_network>telecommunication networks. Since 1998, telereha- Hospital (Taiwan)
bilitation has been applied to patients, such as stroke, brain injury
and orthopedic patients, living in their own home from a remote “Sit to stand” and “Stand to sit” (Sit-Stand-Sit) are daily and do-
provider.1 Previous studies demonstrated the feasibility of using the mestic functional activities. Postural stability during Sit-Stand-Sit
web-based telerehabilitation to improve upper extremity function in transitional movement draws great clinical attention in patients
chronic post-stroke patients.2,3 However, less attention paid to the with strokes who are considered as high risk group of falling with
remote training of standing balance in patients with subacute stroke. subsequent injuries. Sit-Stand-Sit is a common therapeutic exercise
The main purposes of the study were to set up the remote control implemented by therapists in rehabilitation training and requires
programs for telerehabilitation, and to examine the training effect delicate skills that involve coordinated head-trunk-limb movements,
on balance in subjects with subacute stroke. We hope the method of adequate muscle strength, and well-controlled balance. It is crucial
telerahabilitation would be modified and applied to subjects living to determine appropriate transition strategies in patient’s Sit-Stand-
in nursing home in the future. Materials and methods: This was a Sit for safe movement. Depending on severity of hemiplegia, level
randomized clinical trial for subjects from Outpatient Clinic of De- of spasticity and weakness, positioning of trunk-limb segment, and
partment of Physical Medicine and Rehabilitation, National Taiwan height of chair; stroke patients with functional limitation usually
University Hospital (NTUH) and Taipei Medical University Hospital develop different compensatory strategies in ADL to accomplish
(TMUH). Twenty one subjects with subacute stroke (less than 6 these tasks. Biomechanical studies provide useful information of
months post-stroke) participated this study. They were recruited joint moment, rate of rise in force, asymmetry of vertical force
into experimental group (i.e., telerehabilitation training group; and COP displacement at different foot positions, arm placements
Tele group) and control group (i.e., conventional balance training) and chair heights (the determinants) during Sit-Stand-Sit. Loading
in randomized order. Patients received 30 minutes training twice a asymmetry is often found before seat-off and after seat-on in Sit-
week for 4 weeks. The telerehabilitation training was conducted via Stand-Sit tasks. Positioning the affected foot behind reduces the
on-line internet FLASH system, and the physical therapist instructed asymmetry, while the unaffected foot behind increases the asym-
the 30 min exercise programs to the patients about 200 meters away metry. The sitting-down movement is carried out by a stereotyped
with microphone and webcam (Logi tech) setup which allowed motor strategy characterized by an activated gastrocnemius muscle
the tele-monitoring of the therapeutic sessions. The telerahabiita- coupled with deactivation of the erector spinae muscles. As well as
tion system comprised two computers, one for patients located at producing a transient center of pressure displacement in the forward
a laboratory room of NTUH and the second one for a therapist at direction, it also synchronously unlocks the trunk and prevents a
School of Physical Therapy, NTU. The server for the data collection fall backward. Our study shows that altering arm placement does
was at Central Taiwan University of Science and Technology, Taic- not significantly influence the leg load sharing strategy and sitting
hung. The system design included the input recording devices, user impact forces during stand-to-sit. The leg load sharing strategies are
interface, and software design. The on-line input recording devices ruled by the preferred use of the non-paretic side and the favored
included an oximeter for heart rate and SpO2 saturation monitor, as leg position for the biomechanical load. Placing the non-paretic
well as a multifunction data acquisition product (USB-6008, NI, leg posteriorly reduces the impact of stand-to-sit because of the
USA) for range of motion measurement. The user interface included advantage of the preferred use together with the favored leg position.
rehabilitation education on fall prevention, on-line physical therapy, Since the paretic leg is incapable of modulating the sitting-down
and on-line physical assessment/recording. The on-line physical process, placing the paretic leg posteriorly induces notably greater
assessment included user questionnaire, Simplified Berg balance sitting impact forces compared with the counter-leg placement.
scale (S-BBS) and the Borg scale. The software design included the From strength-training point of view, placing the paretic leg pos-
therapeutic exercise programs and the 3D games for subject to have terior would facilitate exertion of the paretic leg. Full knowledge
off-line practice. The off-line outcome measures for pre- and post- of Sit-Stand-Sit determinants could improve strategies for daily
training included Berg balance scale (BBS) and Activities-specific performance and rehabilitation of these tasks and decrease the
Balance Confidence (ABC) scale. Results: The mean age of Tele incidence of falls in stroke patients.
group (n=10) was 61.8 years old with 5-left and 5-right hemiparesis.
The mean age of Ctrl group (n=11) was 59.2 years old with 4-left and
7-right hemiparesis. There were no significant differences between 0430D2FP
two groups on basic data. The on-line recording indicated that the ROBOTIC-ASSISTED THERAPY OF PARETIC
training heart rate was within safety range (less than 60% maximal
UPPER LIMB FOR CHRONIC STROKE
heart rate) and the Borg scale was from mild to somewhat hard.
The SpO2 was all above 90% during training session. The elbow Pai-Yin Chen1, Shu-Min Chen1, Pin-Cheng Kung2,
flexion/extension recording helped the monitor of the joint angle Ming-Shaung Ju2, Chou-Ching K. Lin3
during training. From questionnaires, most the subjects satisfied 1
Dept. of Physical Medicine and Rehabilitation, National Cheng
with the telerehabilitation systems. The outcome measures includ- Kung University Hospital, 2Dept. of Mechanical Engineering, Na-
ing the S-BBS, BBS and ABC in each group showed significant tional Cheng Kung University and 3Dept. of Neurology, National
improvement post-training in both groups. However, there were
Cheng Kung University Hospita (Taiwan)
no significant differences between two groups.
References: Purpose: Robotic-assisted therapy has been used to assist rehabilita-
1. Burns RB, et al. Using telerehabilitation to support assistive technology. tion of paretic upper limb after stroke in the past decade. We intended
Assis Tech 1998; 10: 126–133. to evaluate the effects of robotic-assisted therapy for chronic stroke
2. Reinkensmeyer DJ, et al. Web-based telerehabilitation for the upper ex- patients with paretic upper limb. Materials and Methods: We in-
tremity after stroke. IEEE Trans Neu Sys Reh Eng 2002; 10: 102–108. cluded six outpatients with chronic hemiparesis after stroke. The
3. Lamberto P, et al. Motor tele-rehabilitation in post-stroke patients. Med inclusion criteria were 1) stable medical condition; 2) an interval
Inform 2004; 29: 119–125. of at least 1year from the stroke onset, 3) intact cognition to follow
instruction; 4) Brunnstrom stage III of the affected limb at least. For
each patient, the paretic upper limb was treated with robotic-assisted
0430D1
therapy, 50 min per session, two sessions per week, for four months.
Effects of Sit-Stand-Sit Strategies on All of the subjects were also engaged in conventional rehabilitation
Postural Stability in Stroke Patients program. The upper limb motor function of the subjects was assessed
objectively by Brunnstrom Stage, Modified Ashworth Scale (MAS),
Ta-Sen Wei1,2, Liang-Wey Chang1 Fugl-Meyer assessment (FMA), and integration of absolute devia-
1
Institute of Biomedical Engineering, College of Medicine and tion of torque (IADT). On the basis of the previous study, the IADT
College of Engineering, National Taiwan University and 2Depart- index could quantify the pronation/supination torque trajectory and

the paretic upper limb generated a larger pronation/supination torque 0430D4FP

and a larger IADT value, which could be a quantitative evaluation CORRELATION OF STROKE-ONSET SEVERITY
of abnormal synergy. The assessments were performed before the
therapy (T0), at the end of therapy (T1), and four months after the WITH HEALTH STATUS, QUALITY OF LIFE AND
end of therapy (T2). The rehabilitation robot was developed in our FAMILY IMPACT IN PATIENTS WITH ISCHEMIC
previous study for neuro-rehabilitation of upper limb and was de- STROKE
signed to perform a two-dimensional motion on the transverse plan.
Four directions of rectilinear tracking movements were designed for Ru-Lan Hsieh1,2, Ching-Shiang Tseng1, Shi-Chin Chen2,
treatments with the rehabilitation robot. The patient faced a screen Ling-Yi Wang3, Wen-Chung Lee3
that provided visual feedback of two icons. One icon represented the 1
Department of Physical Medicine and Rehabilitation, Shin Kong
target position, and the other represented the actual position of the Wu Ho-Su Memorial Hospital, 2School of Medicine, College of
patient’s wrist. Patient was asked to track the target and to keep the Medicine, Taipei Medical University and 3Graduate Institute of
error as small as possible. Each movement was repeated six times. Epidemiology, College of Public Health, National Taiwan Univer-
During the tracking movements, the robot applied resistant force, sity (Taiwan)
30% of maximum voluntary contraction, along a direction tangent
to the trajectory of moving direction. Results: Subjects showed Purpose: To study the correlation of stroke-onset severity with
significant improvement in FMA and IADT after robotic-assisted health status and quality of life (QoL) in patients with ischemic
therapy from T0 to T1 (mean increase in FMA of 8.5, p<0.05; mean stroke and their family impact at the acute stroke stage. Materials
decrease in IADT of 26.64, p<0.01) and to T2 (mean increase in and Methods: Stroke-onset severity was evaluated with the National
FMA of 6.0, p<0.05; mean decrease in IADT of 12.31, p<0.01). The Institute of Health Stroke Scale (NIHSS) within 6 hours of stroke
effects in FMA sustained longer from T1 to T2 (p=0.224) than in onset. Patients whose condition was stable and suitable for a reha-
IADT (p<0.05). We found no differences in Brunnstrom stage from bilitation program within 2 weeks after stroke were included. Health
T0 to T1 and to T2. MAS decreased after robotic-assisted therapy status was evaluated based on the International Classification of
from T0 to T1 (p=0.046), but there was no difference from T0 to Functioning, Disability and Health. It included 1) body structure and
T2. Conclusion: Robotic-assisted therapy improves motor function function: Mini-Mental State Examination for cognition, Fugl-Meyer
and decrease abnormal synergy pattern of the paretic upper limb in scores for upper extremity motor function, Wolf Motor Function
chronic stroke patients, and the effects can sustain 4 months after Test for upper extremity function, balance performance test for bal-
therapy. There is a trend that robotic-assisted therapy can decrease ance; 2) activities and participation: Frenchay Activities Index for
spasticity during the treatment course. This study is limited by the activity, Rivermead Mobility Index for mobility, Functional Inde-
small sample size and the lack of a control group. pendence Measure for functional independence; 3) personal factors:
Geriatric Depression Scale and Hospital Anxiety and Depression
Scale for emotion; and 4) environmental factors: family supporting
0430D3FP system. Family impact was evaluated by Caregiver Strain Index for
caregiver’s strain, visual analog scale for family burden. QoL was
CORRELATION FACTORS OF THE HEALTH- evaluated with the Stroke Impact Scale. The correlation of stroke-
RELATED QUALITY OF LIFE IN PATIENTS WITH onset severity with health status and QoL of stroke patients and
CHRONIC APHASIA DUE TO STROKE family impact at the acute stage of stroke was assessed. Results: We
enrolled 95 patients, 55 men and 40 women. Stroke-onset severity
Lochia Chang1, Lu Lu2 was significantly negatively correlated with attention (correlation
1
Graduate Program of Speech Therapy, Taipei Municipal University coefficient: –0.30), upper limb motor performance (correlation
of Education, 2Department of Physical Medicine and Rehabilitation, coefficient: –0.24 to –0.34) and functional performance (correla-
National Taiwan University Hospital (Taiwan) tion coefficient:–0.21 to –0.60), mobility (correlation coefficient:
–0.28), and QOL (correlation coefficient: –0.23 to –0.51) at the acute
Purpose: To investigate the correlation between chronic aphasic
stage of stroke. A significant positive correlation was noted between
patients’ health related quality of life and several possible variables.
stroke-onset severity and anxiety (correlation coefficient: 0.22) and
Materials and Methods: 26 stroke patients with aphasia were re-
depression (correlation coefficient: 0.27) in stroke patients, and
cruited in this study. The inclusion criteria were more than 6 months
family burden (correlation coefficient: 0.27). Conclusion: Stroke-
post onset, fair auditory comprehension (scored 5/10 or above in the
onset severity correlated with health status and QoL in patients with
comprehension subtest of Western Aphasia Battery) and minimal
stroke at the acute stage. The lesser the stroke-onset severity, the
motor disability. The Chinese version of The Stroke and Aphasia
better the attention, upper limb motor performance and functional
Quality of Life Scale-39 (SAQOL-C) and the Burden of Stroke
performance, mobility, functional independence, and QoL. The
Scale (BOSS) were used for assessment of their HRQOL. The
greater the stroke-onset severity, the more depression and anxiety
Western Aphasia Battery (WAB), the Communicative Effectiveness
in patients, and the more family impact.
Index (CETI), and the Beck Depression Inventory-Second Edition
(BDI-II) were used to assess their severity of language impair-
ment, functional communication ability, and degree of depression 0430D5FP
respectively. Stroke-related variables such as time post-onset, type
of stroke and number of co-morbid diseases were also collected. COMPARISON OF INTRAMUSCULAR
Results: Patients with more severe language impairment or higher BOTULINUM TOXIN TYPE A INJECTION AND
communication disability reported significantly poorer total HRQOL PERCUTANEOUS MUSCULAR BRANCH BLOCK
on the SAQOL-C, and perceived greater difficulties in communi- OF THE TIBIAL NERVE FOR REDUCING ANKLE
cation and social relationships on the BOSS. However, it was not
correlated with the subjects’ psychological distress. People with PLANTARFLEXOR SPASTicity: A RANDOMIZED
higher depression perceived more trouble in the energy subscale CLINICAL TRIAL
of SAQOL-C. People with more co-morbid diseases also perceived Jau-Jia Lin1, Hsiao-Yun Chang2, Wei-Wen Chen3, Su-Ju
more trouble in the energy subscale of SAQOL-C and had poorer
Tsai4, Tzer-Bin Lin5
total HRQOL and more cognition associated psychological distress.
Conclusion: Our results were consistent with the fact that the health
1
Department of Physical Medicine and Rehabilitation, Chung Shan
related quality of life is a multi-facet concept and could be affected Medical University Hospital, 2School of Physical Therapy, Chung
by many variables including the severity of the patient’s impairment, Shan Medical University, 3Department of Physical Medicine and
functional level, and other personal factors. Rehabilitation, Chung Shan Medical University Hospital, 4Depart-

Cardiopulmonary Rehabilitation and Obesity 31
ment of Physical Medicine and Rehabilitation, Chung Shan Medical ing during the nonparetic wrist movement, including contralateral
University Hospital and 5Department of Physiology, Chung Shan primary sensorimotor cortex (SMC) and limbic system. During
Medical University (Taiwan) the paretic wrist movement, activated regions were mainly in the
contralateral and ipsilateral SMC, SMA, contralateral primary
Purpose: To compare the efficacy of intramuscular botulinum toxin sensorimotor cortex and contralteral parietal lobule are increaser
type A (BTX-A) and muscular branch block of the tibial nerve with than before. After training, the upper limb functional assessments
phenol (Phenol) for the treatment of ankle plantarflexor spasticity. have significant improved (p<0.01). Conclusion: Using computer
Materials and Methods: Thirty hemiplegic patients with ankle exercise can improve the upper limb function of stroke, and its
plantarflexor spasticity at least 2 in modified Ashworth Scale and mechanism promotes brain functional reorganization.
15 degree difference in Tardieu scale were randomly assigned to
receive a single treatment of 100 mouse units (MU) of BTX-A in-
jected into the calf muscles or to receive a muscular branch block of 0430D7FP
the tibial nerve with 5% phenol. Sixteen were in the BTX-A group THE EFFECT OF REHABILITATIVE TRAINING
and fourteen in the Phenol group. One patient in BTX-A group was
excluded because she underwent intrathecal baclofen pump trial dur- ON BRAIN FUNCTIONAL REORGANIZATION IN
ing the study period. Objective evaluations included Tardieu scale, PATIENTS WITH CEREBRAL INFARCTION BY
modified Ashworth scale and 6 minute walk test were assessed at FMRI: A LONGITUDINAL STUDY
baseline, at weeks 2, 4, 8, and 12. Results: At follow-up, significant
improvement (p<0.05) in the modified Ashworth score and Tardieu Xi-Quan Hu1, Ya-Dan Zheng1, Rui-Shu Jiang1, Zhuang
scale for dorsiflexion was observed in both groups. When those Kang2
variables were compared between the two groups, the changes in 1
Department of Rehabilitation Medicine, the Third Affiliated Hos-
the modified Ashworth score and Tardieu scale at weeks 2, 4, 8, and pital of Sun Yat-sen University and 2Department of Radiology, the
12 were not significantly different (p>0.05). There was significant Third Affiliated Hospital of Sun Yat-sen University (China)
improvement (p<0.05) in the walking speed and step length at all
measured points in the Phenol group and weeks 2, 12 in the BTA Purpose: To explore the effect of rehabilitative training on brain func-
group. However, walking speed was returned to baseline at Weeks tional reorganization in patients with cerebral infarction. Materials
4, 8 and step length was also returned at weeks 4 in the BTA group. and Methods: 16 patients within 3 months after subcortical infarct
Conclusion: We conclude that intramuscular botulinum toxin type A were assigned to rehabilitation group (n=10) or control group (n=6).
injection and muscular branch block of the tibial nerve with phenol The rehabilitation group received 4 weeks rehabilitative training
are both effective in reducing ankle plantarflexor spasticity. section and the control group did not in this research. All patients
were assessed by fMRI scanning and Fugl-Meyer motor assessment
(FMA), Modified Barthel Index (MBI) and the Moter assessment scale
0430D6FP (MAS) prior to and following the section. All patients received fMRI
THAT USING COMPUTER EXERCISE UPPER scanning during passive movement at both affected and unaffected
wrested separately clenching. Brain functional mapping was acquired
LIMB OF THE ISCHEMIC STROKE PATIENTS with SPM2, and different activation patterns of brain were compared
OBSERVE THE CHANGES OF BRAIN between both groups. The volume and intension of M1 activation
FUNCTIONAL MAGNETIC RESONANCE were calculated, and the relationship between laterality index (LI) and
IMAGING motor function was examined. Results: 1).The scores of motor func-
tion assessment in the rehabilitative training group were significantly
Jin Chen1, Feifei Yang2, Yongmei Li3, Gang Lu4, Qi Li5, better than the control group. 2).The first fMRI before rehabilitative
David Yao6, Lijuan Ao7 training showed an early general hyperactivation when the affected
1
Department of Rehabilitation, the Second Affiliated Hospital of hand was moved in bilateral brain. 3).M1 activation moved from an
Kunming College, 2Department of Radiation, the Second Affiliated early contralesional hyperactivation to a later ipilesional hyperactiva-
Hospital of Kunming College, 3Department of Rehabilitation, the tion. 4).There were positive correlation between LI (M1) and FMA,
Second Affiliated Hospital of Kunming College (China), 4The Chi- MAS changes(r=0.917, r=0.949). Conclusion: The rehabilitative
nese University of Hong Kong, Prince of Wales Hospital, 5Hong training can promote the motor function recovery and induce brain
Kong University, 6The Chinese University of Hong Kong (Hong functional reorganization. Activation of M1 regions are associated
Kong) and 7Department of Rehabilitation, the second Affiliated with motor function recovery.
Hospital of Kunming College (China)
Purpose: To observe the changes of brain functional Magnetic Cardiopulmonary Rehabilitation and Obesity
Resonance Imaging (fMRI) between computer exercising before
and after of the cerebral arterial thrombosis in patients. Materials 0430H1
and Methods: From Nov 2007 to May 2008, We chose 10 patients
SCHEDULE OF CARDIAC REHABILITATION
with ischemic stroke, giving them computer training (E-link E4000
equipment), training 6 weeks, choosing six different games ,about Farzaneh Torkan1, Laleh Hakemi2
45 minutes every time, every week used the same game ,according 1
Chair of Physical Medicine & Rehabilitation Medicine, NIOC
the subject’s result to adjust the game’s difficulty, speed and load. Subspecialty Hospital and 2Internal Medicine Specialist, NIOC
training contents included flexion and extension of shoulder–elbow Subspecialty Hospital (Islamic Republic of Iran)
and wrist, pronation and supination of forearm, side pinch of fin-
gers. Evaluating upper limb function (Functional seven levels with Cardiovascular disease especially coronary heart disease is a major
stroke, Fugl-Meyer, Modify Barthel index (MBI)) and fMRI with a problem in many countries. The incidence of cardiovascular disease
1.5T scanner was performed at the time of the subjects attempting has changed dramatically in Iran. Now, coronary heart disease is the
sequential flexion and extend wrist at pre-treatment, post-treatment. most common and serious problem (Iranian Heart Journal 2004).
Results: Before training, on fMRI, the activated regions were in Post myocardial infarction survivors suffer a re- infarction 5 times
the contralateral primary sensorimotor cortex (SMC) and ipsilateral the healthy population. Secondary prevention protocols can help
homonymy cerebellum during the nonparetic wrist movement, the patients to live healthier with fewer morbidity and mortality.
the subjects showed scattered activity in the contralateral primary Cardiac rehabilitation decreases coronary heart disease mortality
sensorimotor cortex (SMC) which is weaken, the homonymy SMC for nearly 26%. Cardiac Rehabilitation program consist of: 1) in-
and SMA which are increased during the paretic wrist movement. patient programs with an early assessment for risk factor manage-
After training, the activated regions were more than before train- ment and mobilization, 2) transition cares and discharge planning

design for daily activities like driving, lifting, sexual activity and activity and augmenting hyper-fibrinolytic activity during strenuous
so on, 3) out-patient rehabilitation and secondary prevention, the exercise. However, these favorable effects of exercise training on
patients are assessed for risk factors and they will be divided into thrombotic modification return to a pre-training state after a period
different categories. Necessary interventions for minimizing the of deconditioning. These findings can aid in determining appropri-
effects of risk factors explained to patients such as non pharmaco- ate exercise training to prevent early thrombotic events and further
logic interventions or a healthier life style (quitting tobacco use, hinder the cardiovascular disease progression.
healthier diet, regular physical activity, weight management, stress
reduction). In this stage, the patients undergo medical evaluation
and exercise testing and based on the results, exercise plan is pre- 0430H3
scribed and ECG monitoring and medical supervision applied when Benefits of phase 2 cardiac rehabilita
indicated. Appropriate equipment, staffing and safety measures tion in patients with myocardial
help minimizing the rehabilitation programs and in Iran, qualified
physiatrists, nurses, physiotherapists, nutritionists, psychologists infarction
work as a group. In Tehran, in a study on 2137 subjects (35–65 Ssu-Yuan Chen1, Bai-Chin Lee2, Mao-Yuan Marine Su3,
years), the prevalence of cardiovascular risk factors is as follows: Ching Lan1, Hsiu-Ching Hsu2, Wen-Yih Issac Tseng3,
Hypertension 31.3%, Isolated systolic hypertension 8.2%, Smoking Ming-Fong Chen2, Jin-Shin Lai1
13.3%, borderline high total cholesterol 34.3%, high total cholesterol
27.4%, borderline-high LDL 28.4%, high LDL cholesterol 21.2%,
1
low HDL 5.8%, borderline high triglyceride 4.7%, diabetes mellitus Taiwan University Hospital and National Taiwan University College
9.2%, overweight 39.8%, obesity 23.4%, and lack of leisure time of Medicine, 2Department of Internal Medicine, National Taiwan
physical activity 88.9% (Oraii et al). Our future direction is mak- University Hospital and National Taiwan University College of
ing our efforts for changing life style habits in the population for Medicine and 3Department of Medical Imaging , National Taiwan
primary prevention, on the other hand we have to expand cardiac University Hospital and National Taiwan University College of
rehabilitation centers, and education of the staff; also we ought to try Medicine (Taiwan)
our best to account the insurance companies for supporting primary
prevention protocols in high risk individuals. Researches in Iran, Purpose: The purpose of this study was to determine the benefits of
is under optimal however, have important results in organization phase 2 cardiac rehabilitation in patients with myocardial infarction
of secondary prevention strategies. The effectiveness of secondary including myocardial perfusion reserve (MPR) in the remote and
prevention measures, the costs of disease and its consequences infarcted myocardium and plasma levels of angiogenic cytokines.
compared to the costs of prevention, the KAP analysis on the tar- Materials and Methods: Thirty-nine postinfarction patients were
get population can help a fruitful organization. In a study on 118 recruited for this study and randomly assigned to a training group
coronary artery disease patients in Shahid Rajaee Hospital, after the (n=20) or a non-training group (n=19). Those in the training group
monitoring period, BMI, weight, waist circumference, and waist to participated in a 3-month cardiac rehabilitation training program at an
hip ratio decreased (p < 0.001) however, these indices returned to exercise intensity of 55% to 70% of peak oxygen uptake (VO2); those
the pre rehabilitation period after 12 months (Masoumi 2005). In in the non-training group continued their usual lifestyle. Nineteen age-
another study on 8 weeks exercise rehabilitation on 100 patients , weight-, and height-matched subjects without cardiovascular risk
(Farahani 2003), 10% increase in METs was noticed compared to factors were selected as healthy controls. Main outcome measurement
pre exercise situation (p = 0.001), also a 6% decrease in resting heart included peak VO2, MBF by cardiac magnetic resonance imaging,
rate and 18% increase in maximal attainable heart rate were noticed. and plasma levels of stem cell factor (SCF), stromal-derived factor-1
Also a slight decrease in systolic blood pressure and improvement (SDF-1), and vascular endothelial growth factor (VEGF). Results:
in lipid profile were occurred. After myocardial infarction, a reduction in perfusion reserve was
seen not only in the infarcted myocardium, but also in the remote
myocardium. The postinfarction patients had higher plasma levels of
0430H2 VEGF and SDF-1 comparing with the healthy controls at baseline. In
the training group, the post-training MPR increased in both remote
EXERCISE PRESCRIPTION AND and infarcted myocardium while VEGF and SDF-1 decreased. The
THROMBOGENESIS exercise capacity increased to the same level as in healthy controls.
The change in exercise capacity significantly correlated with the
Jong-Shyan Wang change in MPR in the remote myocardium. In the non-training group,
Graduate Institute of Rehabilitation Science, Chang Gung Uni- exercise capacity, MBF, and cytokines were unchanged. Conclusion:
versity (Taiwan) Phase 2 cardiac rehabilitation improves perfusion reserve in both
infarcted and remote myocardium, increases exercise capacity, and
Lifestyle habits, such as exercise, may significantly influence risk of
decreases circulating angiogenic cytokines.
major vascular thrombotic events. The risk of primary cardiac arrest
has been shown to transiently increase during vigorous exercise,
whereas regular moderate-intensity exercise is associated with an 0430H4
overall reduced risk of cardiovascular diseases. What are the mecha-
nisms underlying these paradoxical effects of vigorous exercise CARES THAI ACTIONS: PREVENTIVE AND
versus exercise training on thrombotic modification? This investiga- REHABILITATIVE PROGRAM FOR CARDIAC
tion analyzes research regarding effects and their underlying mecha- AND HIGH RISK FACTORS PATIENTS
nisms of acute exercise, endurance training, and deconditioning on
platelets, coagulation, and fibrinolysis. Evidence suggests that (i) Pravit Tanprasert, Rapeephon Kunjara, Sukajan
light, acute exercise (≤49%VO2max) does not affect platelet reactivity Pongprapai, Piyanuj Ruckpanich, Khunying Mallika
and coagulation and increases fibrinolytic activity; (ii) moderate, Wannakrairot, Visal Kantaratanakul, Pattrawut
acute exercise (50~74%VO2max) suppresses platelet reactivity and Intarakamhaeng, Rukfun Sawadpanich
enhances fibrinolysis, which remains unchanged in the coagulation Cardiac Rehabilitation Center, Perfect Heart Institute, Piyavate
system; and, (iii) strenuous, acute exercise (≥75%VO2max) enhances Hospital (Thailand)
both platelet reactivity and coagulation, simultaneously promoting
fibrinolytic activity. Therefore, moderate exercise is likely a safe Purpose: 1) To do the registry collection of multi-center cardiac
and effective exercise dosage for minimizing risk of cardiovascular rehabilitation program in Bangkok, Thailand. 2) To evaluate the
diseases by inducing beneficial anti-thrombotic changes. Moreover, effects of CARES THAI Action program for the cardiac and risk
moderate-intensity exercise training reduces platelet reactivity and factors patients. 3) To expand the usefulness of CARES THAI Ac-
enhances fibrinolysis at rest, also attenuating enhanced platelet re- tion program in other cardiac rehabilitation program. Materials and

Methods: This is a observational prospective study being conducted Rehabilitation, National Taiwan University College of Medicine,
in 9 Cardiac rehabilitation programs in Bangkok. Two hundred 3
Department of Surgery, National Taiwan University Hospital,
participants who are eligible to enroll in the study are either cardiac 4
Department of Surgery, National Taiwan University College of
patients with the diagnosis of Acute coronary syndrome (ACS), post Medicine and 5Department of Physical Medicine and Rehabilitation,
Percutaneous Coronary Intervention (PCI), post Coronary Artery Miao-Li Hospital Department of Health (Taiwan)
Bypass Graft (CABG),Congestive Heart Failure (CHF) or High
Risk Factors Group. All of the participants will use data collection Purpose: Few studies have evaluated benefits of cardiac rehabilita-
of CARES THAI Actions program to evaluate their risk profile, tion (CR) among Asian heart transplantation recipients (HTR). The
food questionnaire and exercise questionnaire. Vital sign, body aim of this study was to examine the effects of post-operative phase
composition and blood chemistry are also collected pre and post 2 CR on aerobic capacity among Asian HTR at one year after trans-
intervention. The total follow up period are 4 times during one year plantation. Materials and Methods: The study assessed 42 clinically
period and can be done by telephone follow up during 2nd and 3rd stable HTR at one year (12 ± 2 months (mean ± SD)) after heart
visit. Results: This is a preliminary report of the study. During the transplantation. The training group included 28 HTR (age: 49 ± 15
time frame from January 2009 to January 2011. Up to November years; male/female: 22/6) who had participated in the postopera-
2009, 81 participants are enrolled. Majority of participants are post tive phase 2 CR (31 ± 13 weeks, 3 days/week). The control group
revascularization (37% and 33% from post CABG and post PCI, included 14 HTR (age: 46 ± 16 years; male/female: 11/3) who had
respectively). Others are risk factors (18%), ACS (9%) and CHF not participated in outpatient CR. A graded bicycle exercise test with
(3%). Male are predominate (62%) and more likely to smoke and breath-by-breath respiratory gas analysis was conducted to assess
have higher body weight compare to women. The analysis of the the aerobic capacity and cardiorespiratory response to exercise of
of the complete follow up participants will be analyzed and present the study subjects. The Wilcoxon rank-sum test was used to analyze
in the conference. Conclusion: This preliminary report represents the differences between groups. Results: At peak exercise, the train-
the pictures of Thai cardiac and high risk factors patients who are ing group exhibited significantly higher oxygen uptake (20.1 ± 4.7
enrolled in Cardiac Rehabilitation Program in 9 participating hos- vs 16.8 ± 4.2 mL·kg-1·min-1, p = 0.047), work rate (110 ± 37 vs
pitals in Bangkok. When the data collection is completed, we will 82 ± 29 watts, p = 0.010), heart rate (141 ± 21 vs 125 ± 18 beat·min-1,
able to evaluate the usefulness and benefit of CARES THAI Actions p = 0.044), and minute ventilation (62.5 ± 15.8 vs 51.2 ± 12.9 L·min-1,
program, then able to convince implication of the cardiac rehabilita- p = 0.021) than respective values of the control group. At the ventila-
tion program in all cardiac center hospital nation wide. tory threshold, the training group also showed significantly higher
oxygen uptake (14.4 ± 3.6 vs 11.6 ± 3.2 mL·kg-1·min-1, p = 0.003),
work rate (62 ± 24 vs 44 ± 22 watts, p = 0.006), and minute ventila-
0430H5 tion (33.4 ± 8.8 vs 27.1 ± 8.5 L·min-1, p = 0.009) than the control
TO FACILITATE RETURN TO WORK THROUGH group. Conclusions: At one year after heart transplantation, HTR
who had participated in phase 2 CR displayed significantly higher
CARDIAC REHABILITATION aerobic capacity than those who did not receive phase 2 CR. The
Leonard S.W. Li postoperative phase 2 CR is effective for Asian HTR in improving
Division of Rehabilitation Medicine, University Department of aerobic capacity at one year after transplantation.
Medicine, Tung Wah Hospital and University of Hong Kong (Hong
Kong)
0430M2FP
Purpose: Cardiac rehabilitation has 2 important aspects. One is to
achieve secondary prevention to reduce the morbidity and mortal- STUDY OF PHYSIOLOGICAL ISCHEMIC
ity related to the cardiac impairment. Another aspect is to enhance EXERCISE TRAINING ON CIRCULATING EPCS
functional status of cardiac patients. Return to work after a cardiac AND NEOVASCULATION IN PATHOLOGICAL
rehabilitation program is one of the important indicators for the suc- MYOCARDIAL ISCHEMIA ANIMALS IN VIVO
cessfulness of the program. Materials and Methods: Work assessment
and training is part of the components at the cardiac rehabilitation Chunxiao Wan1,2, Chengjian Yang1, Jianan Li2, Jing Xu3
centre of Tung Wah Hospital. Work hardening or retraining is indi- 1
Wuxi No. 2 people’s hospital,affiliated with Nanjing Medical
vidualised according to the cardiac function, patient’s previous work University, 2Nanjing Medical University and 3Nanjing Tradional
history and education level. The status of work after cardiac rehabilita- Medicine University (China)
tion was collected together with the exercise capacity, risk factors and
psychosocial status at the centre. The rate of and factors influencing Purpose: This study is to investigate the benefits of the physiological
return to work were analysed statistically. Results: The rate of return ischemic exercise training on endothelial progenitor cells (EPCs)
to work after cardiac rehabilitation could be around 90% after one and also the identification of EPCs mobilisation in rabbits with
year time if appropriate assessment, training or retraining program pathological myocardial ischemia (MI). Materials and Methods:
was offered. The single important factor affecting the return to work Thirty-six adult male Zealand rabbits were used for the investiga-
after a cardiac event is the exercise capacity. The return rate was poor tion and were randomly grouped into four groups: Group A had
if the exercise capacity was 4METS or less in both young and elderly. neither physiological ischemic exercise (IE) training nor myocardial
Conclusion: Vocation aspect for patients with cardiac disease should ischemia (MI) and served as a control group; Group B underwent IE
be addressed in a cardiac rehabilitation program, which can achieve only; Group C underwent MI only; and Group D underwent both IE
good results to facilitate patients safely return to work. and MI. Physiological ischemic exercise was induced by electrical
stimulation (40% maximum current strength, 1 ms, 40 Hz) for 4
min twice a day, 5 days a week, for 4 weeks. Pathological MI was
0430M1FP induced by left ventricular branch intermittent occlusion for 2 min
PHASE 2 CARDIAC REHABILITATION twice a day, also for 4 weeks. EPCs in circulation were quantified
by fluorescence-activated cell sorter (FACS) analysis (FACS) for
IMPROVES AEROBIC CAPACITY OF HEART rabbits at the end of the four-week-experiments. Capillary densities
TRANSPLANTATION RECIPIENTS AT ONE YEAR in ischemic heart tissues were also counted for all groups. Results:
AFTER SURGERY The numbers of CD34+/FLK-1+ cell in peripheral blood of trained
rabbits in group B, C and D were 3.8 ± 0.6 fold increase, 6.1 ± 2.8
Ssu-Yuan Chen1,2, Ching Lan1,2, Jin-Shin Lai1,2, Chen- fold increase and 6.9 ± 1.7 fold increase, respectively with respect
Jung Hsu1,5, Nai-Kuan Chou3,4, Shoei-Shen Wang3,4 to the control group. Neoangiogenesis as assessed by a capillary
1
Department of Physical Medicine and Rehabilitation, National density in ischemic myocardium which elevated accompanied with
Taiwan University Hospital, 2Department of Physical Medicine and EPCs were found to be 326 ± 76 in Group A, 327 ± 59 in Group

B, 516 ± 77 in Group C, and 824 ± 106 (/mm2) in Group D at the treadmill walking, and 10 min of cool down. The exercise intensity
end of the experiments for all groups respectively. Conclusion: was set at 50–80% of peak oxygen uptake (VO2peak) according to
Endogenous EPCs were increased significantly with physiological patient’s condition. The HRQoL of the study subjects was evalu-
isometric exercise training in rabbits with MI, and homed to the ated by the SF-36 questionnaire at baseline and after CRP. Results:
injure heart fraction for protection by angiogenesis. After CRP (training duration: 80 ± 24 days), the HTR had signifi-
cantly higher SF-36 scores in physical functioning (59.7 ± 18.9 to
77.0 ± 14.0, p < 0.0001), physical role (21.1 ± 34.1 to 38.3 ± 37.9,
0430M3FP p = 0.0496), bodily pain (57.4 ± 24.3 to 73.6 ± 21.5, p = 0.0011), social
ELECTRICAL STIMULATION IN PATIENTS WITH functioning (63.6 ± 23.4 to 72.8 ± 22.1, p = 0.0147), emotional role
(59.2 ± 43.7 to 76.3 ± 37.4, p = 0.0464) and mental health (67.1 ± 17.9
SEVERE CHRONIC HEART FAILURE to 73.4 ± 14.6, p = 0.0137). Conclusion: The HRQoL of our HTR
Masahiro Kohzuki, Makoto Nagasaka, Osamu Ito, significantly improved after the early post-operative phase 2 CRP.
Nobuyoshi Mori, Sakata Keiko, Fumika Suzuki, Satoru The phase 2 CRP might have the possible benefit to improve HRQoL
Ebihara in Asian HTR during the early post-operative phase.
The Department of Int Med and Rehabilitation Science, Tohoku
University Graduate School of Medicine (Japan) 0430M5FP
Purpose: The exercise training has been shown to improve the THE EFFECT OF ISOMETRIC EXERCISE ON
functional capacity, quality of life and also the patterns of strength HUMAN CORONARY COLLATERAL FUNCTION
muscles in patients with chronic heart failure (CHF). Most of ac- DURING ACUTE CORONARY OCCLUSIONS
tual training types, however, are based on the systemic exercises
resulting in increased cardiac workload. This could lead to onset of Xiao Lu1, Jianan Li1, Song Lin2
life-threatening side effects such as fatal dysrhythmias. Moreover, 1
The First Affiliated Hospital of Nanjing Medical University and
most of patients with CHF have low exercise tolerance and poor 2
Nanjing First Hospital (China)
motivation to exercise. Materials and Methods: Low-frequency
electrical stimulation (ES) has been shown to increase oxidative Purpose: The purpose of this study using the acute coronary occlusion
capacity in the skeletal muscle fibers, to enhance muscular regen- model in patients with stable coronary artery disease (CAD) was to
eration and to prevent atrophy. We aimed to evaluate the possible directly measure the effect of isometric exercise on collateral blood
benefit of ES in patients with mild to severe CHF, and to compare flow. Materials and Methods: Patients with one-vessel CAD (18)
the results with the conventional bicycle training. Results: In our underwent routine percutaneous transluminal coronary angioplasty
data, 6 weeks ES (60 min/day) of quadriceps and calf muscles of were assigned to isometric exercise group (10 patients) and control
both legs significantly improved muscle strength and blood flow in group (8 patients). Patients in isometric exercise group did isometric
patients with advanced CHF. Moreover, a similar improvement of handgrip exercise (50% maximal voluntary contraction) during 1 min
exercise capacity in patients with CHF can be achieved either by coronary balloon occlusion while patients in control group remain
aerobic bicycle training or by local ES of the strength muscles of at rest during coronary occlusion. Collateral flow index (CFI) was
the lower limbs in patients with mild to moderate CHF. Conclusion: determined before and at the end of 1min coronary occlusion in both
Although the effectiveness of conventional exercise protocols in groups. CFI expressing collateral flow relative to normal antegrade
cardiovascular rehabilitation is beyond doubt, the safety and easy flow was determined by simultaneous coronary occlusive pressure
application of ES could be of great benefit in the rehabilitation of (Poccl), mean aortic pressure (Pao) and central venous pressure
patients with CHF, especially those with a severe grade of the dis- measurements (CVP): CFI = (Poccl – CVP)/(Pao – CVP). Heart rate
ease. Future studies should also address the possibility of combining (HR), systolic blood pressure (SBP) and diastolic blood pressure were
ES with some type of classical exercise training. also recorded before and at the end of coronary occlusion. Results: In
isometric handgrip exercise group, the difference values of CFI (CFI
at the end of coronary occlusion – CFI before coronary occlusion)
0430M4FP were significantly higher than those in the control group (0.09 ± 0.07
vs 0.03 ± 0.02, p < 0.05). The difference values of DBP (DBP at the
THE EFFECTS OF PHASE 2 CARDIAC end of coronary occlusion – DBP before coronary occlusion) were
REHABILITATION PROGRAM ON HEALTH- also significantly higher than those in the control group (4.25 ± 7.74 vs
RELATED QUALITY OF LIFE AMONG HEART –2.5 ± 4.07, p < 0.05). The difference value of HR and SBP tended to be
TRANSPLANTATION RECIPIENTS higher in isometric handgrip exercise group than those in control group
(HR 4.25 ± 5.87 vs –1 ± 4.1, p > 0.05; SBP: 4.37 ± 5.45 vs –0.25 ± 3.54,
Chen-Jung Hsu1,2, Ssu-Yuan Chen1,3, Ching Lan1,3, Shu- p > 0.05). Conclusion: Isometric exercise among patients with CAD
Fang Hsiao1,3, Jin-Shin Lai1,3, Nai-Kuan Chou3,4, Shoei- induces an overall increase in coronary collateral flow during acute
Shen Wang3,4, Syi Su5 vessel occlusion. The effect of which is statistically more relevant than
1
Department of Physical Medicine and Rehabilitation, National that of collateral flow enhancement due to the occlusion itself.
Taiwan University Hospital, 2Department of Health, Miao-Li Hospi-
tal, 3National Taiwan University College of Medicine, 4Department 0430M6FP
of Surgery, National Taiwan University Hospital and 5Institute of
Health Care Organization Administration, College of Public Health, IS HORSEBACK RIDING MORE EFFECITVE
National Taiwan University (Taiwan) THAN HORSE RIDING ROBOT FOR PHYSICAL
EXERCISE?: HEART RATE MONITORING,
Purpose: There are few studies about the exercise benefits to health-
related quality of life (HRQoL) among Asian heart transplantation CALORIC CONSUMPTION, 2D MOTION
recipients (HTR) in the early postoperative period. The aim of this ANALYSIS AND SURFACE EMG MONITORING
study was to examine the effects of an early post-operative phase Naohisa Kikuchi1,3, Kazuya Mizuochi1, Hidetaka
2 cardiac rehabilitation program (CRP) on HRQoL among Asian
HTR. Materials and Methods: The study included 45 clinically Wakabayashi2, Kaoruko Takada2, Hironobu Sashika2,
stable HTR (age: 47 ± 14 years (mean ± SD); Male/Female: 36/9) Takuya Ikeda3
who started phase 2 CRP within 6 months after surgery (time post-
1
Department of Rehabilitation, Yokohama City University Hospital,
transplant: 70 ± 33 days) and completed the supervised exercise 2
Dept. of Rehabilitation, Yokohama City University Medical Center
training program (3 days/week, 42 days at least). Each training and 3Crane Sports Medical Research Center for Horseback Riding
session comprised 5–10 min of warm up, 25–30 min of cycling or (Japan)

Purpose: To determine effectiveness of horseback riding for physi- male patients (aged 16–75 yrs) who could breathe spontaneously for
cal exercise and compare effectiveness with horseback riding robot, at least one minute and were receiving standard chest physiotherapy
we studied by heart rate monitoring, caloric consumption measure- were randomly assigned to a cross-over study consisting of 2 treat-
ment, 2D video motion analysis and surface EMG monitoring. ment conditions: test and sham. They received either test or sham
Materials and Methods: Participants were 7 volunteers without any treatment in the first round and vise versa in the second round. In
cardiopulmonary, neurological and musculoskeletal diseases. They the test treatment the patients performed spontaneous deep breathing
were expert horseback riders in the private riding club (3 males and against a resistance equal to 20% of their peak inspiratory pressure
4 females, 27–44 years old). For studying cardio-respiratory fitness, with a steady inspiratory flow for 6–10 breaths/set, 10 sets/day with
we measured horseback riding each 2 times in the training class for 1 min rest between sets. In the sham treatment the protocol was the
45 min. We measured heart rate monitoring and caloric consump- same but there was no inspiratory load, oscillation or humidification
tion by the monitor RS 400 (Polar Company). For 2D video motion of the air. The mucus secretions were collected for 3 hours before
analysis and surface EMG monitoring, we measured horseback rid- and after treatment and are reported as clearance rate of wet weight
ing each 2 times at the horse walking speed for straight 5 m distance. (g/h), volume (ml/h) and percentage change (%) before and after
We recorded from the side by the high-speed monochrome video the treatment.Oxygen pulse saturation (SpO2), heart rate (HR) and
camera, and we put the 1 cm square markers on human shoulder, respiratory rate (RR) were monitored while using the BreatheMAX.
lower lumber, major trochanter, knee, ankle and horse top tale. Then Results: The results showed that the test but not sham treatment
we calculated the data by Dipp-Motion 2D (Ditect Company), then significantly increased the mucus clearance rate both by wet weight
we looked rhythm in riding and measured total quantity of motion and volume after using the BreatheMAX compared to before treat-
in each body part. As for surface EMG monitoring (Nihon Koden ment. The changes in mucus secretion clearance rates after treatment
Company), we put the electrodes on lower para-vertebral, medial were by wet weight, 2.9 ± 2.5 g/h for test and –0.3 ± 1.2 g/h for sham
gluteus, quadriceps femoris and gastrocnemius muscles, and then (p < 0.05), and by volume, 2.7 ± 2.2 and -0.4 ± 1.1 ml/h (p < 0.05)
we synchronized with 2D video motion analysis. All of these stud- for test and sham, respectively. The average percentage changes
ies, we compared real horseback riding with the horseback riding of mucus clearance rate were also significantly different (p < 0.05)
robot ‘JOBA’ (Panasonic Company). Results: Average heart rate was between the test and sham treatment by wet weight (658 % vs –5.8
123.3 ± 9.3 in the horseback riding vs. 91.8 ± 9.3 in the robot riding. %) and by volume (628 % vs –4.6 %). SpO2, HR, and RR did not
Heart rate monitoring in the horseback riding showed 100–130 per change while breathing with the BreatheMAX. Conclusion: The
min, this data suggests that horseback riding is suitable for aerobic BreatheMAX breathing device is safe to use with intubated patients,
exercise. Average caloric consumption was 430.0 ± 81.1 kcal in real and is an effective technique for increasing mucus secretion clear-
horseback riding vs. 224.4 ± 63.6 kcal in horseback robot riding for ance. BreatheMAX can be used alone or as an adjunct to standard
45 min exercise, this data shows that horseback riding in the training chest physiotherapy to enhance the clearance of secretions.
class is enough for proper energy consumption. 2D video motion
analysis showed horseback robot riding is more rhythmic than real
horseback riding. But unnecessary motion of lower extremities 0430M8FP
was observed in horseback robot riding more than real horseback EFFECT OF PHASE II CARDIAC
riding. And total quantity of lower extremities movement in real REHABILITATION AFTER CORONARY ARTERY
horseback riding is smaller than in horseback robot riding. This
data suggests that element of isometric muscle exercise is more BYPASS GRAFT: A COMPARISON OF QUALITY
than that of eccentric exercise. And surface EMG showed that OF LIFE, PEAK VO2, AND FUNCTIONAL AEROBIC
real horseback riding made higher voltage than horseback robot IMPAIRMENT
riding especially in paravertebral and quadriceps femoris muscles.
Conclusion: Horseback riding is suitable for aerobic exercise. And Po-Chin Strong1, Ko-Lun Tsai1, Yi-Chieh Chou1, Si-
2D video motion analysis and surface EMG showed that horseback Huei Lee1, Su-Ying Hung1, Chen-Liang Chou1,2, Shun-
riding is also effective for muscle strengthening in trunk and lower Ping Cheng3, Cheng-Ming Chiu4
extremities. Also horseback riding is more effective for physical 1
Department of Physical Medicine and Rehabilitation, Taipei Vet-
exercise than horseback riding robot. From this study, we concluded erans General Hospital, 2Department of Physical Medicine and
that horseback riding is effective for physical exercise as cardio Rehabilitation, School of Medicine, National Yang-Ming University,
pulmonary fitness and muscle strengthening exercise. 3
Department of Health at Lo-Sheng Sanatorium and 4Department
of Physical Medicine and Rehabilitation, Far Eastern Memorial
Hospital (Taiwan)
0430M7FP
Purpose: To evaluate the relationship of the quality of life (QOL)
EFFECTIVENESS OF BREATHEMAX BREATHING and physical fitness of patients before and after the phase II cardiac
DEVICE ON AIRWAY SECRETION CLEARANCE rehabilitation following coronary artery bypass graft (CABG). Ma-
IN PATIENTS DEPENDENT ON MECHANICAL terials and Methods: From May 2005 to October 2009, 15 patients
VENTILATION underwent CABG and post-operative phase II cardiac rehabilitation
were enrolled in this study. We used WHOQOL-BREF (Taiwan) to
Sujittra Kluayhomtho1, Chulee U Jones1, Wilaiwan evaluate the quality of life, VO2 peak and functional aerobic impair-
Khrisanapan2, Seksan Chaisuksan3 ment (FAI) to evaluate physical fitness. We applied Wilcoxon signed
1
Department of Physical Therapy, Faculty of Associated Medical rank sum test to analyze the relationship among them. Results:
Sciences, Khon Kaen University, 2Department of Physiology, Fac- Patients underwent phase II cardiac rehabilitation have significant
ulty of Medicine, Khon Kaen University and 3Division of Medicine, increases in physical fitness(VO2 peak: 17.90 ± 3.57 vs. 21.91 ± 4.97
Khon Kaen Hospital (Thailand) ml/kg/min, p = 0.027; FAI: 21.60 ± 13.69 vs. 12.33 ± 14.08%,
p = 0.043). But their QOL showed no significant improvement (Do-
Background: Bronchial mucociliary clearance is impaired in main 1-physical domain: 46.87 ± 12.14 vs. 50.47 ± 13.83, p = 0.370;
patients receiving mechanical ventilation and this leads to stasis Domain 2-psychological domain: 60.60 ± 18.81 vs. 59.40 ± 14.54,
of the mucus in the airway. Impaired clearance of mucus can re- p = 0.634; Domain 3-social relationship domain: 62.13 ± 14.28
sult in a vicious cycle of colonization with pathogenic organisms vs. 63.60 ± 13.51, p = 0.523; Domain 4-environment domain:
that further increases sputum production. A new breathing device 72.93 ± 21.21 vs. 76.3 ± 18.60, p = 0.135). Conclusion: Based on
(BreatheMAX) provides an oscillating flow of humidified air that the results of our study, the patients after CABG should receive
may increase clearance of mucus. Purpose: To determine the ef- phase II cardiac rehabilitation to improve their physical fitness.
fects of BreatheMAX on secretion clearance in intubated patients However, the improvement in physical fitness doesn’t correlate
dependent on mechanical ventilation. Materials and Methods: Six with patients’ subjective awareness of QOL. Thus, in addition to

phase II cardiac rehabilitation, more emphasis should be put upon of techniques and methods applied as Modern Rehabilitation Medi-
psychosocial therapy, family/peer group support, and environmental cine (MRM) and the Traditional Chinese Rehabilitation Medicine
modification. (TCRM). It is clearly shows the team is lacking of the professionals
with the background of rehabilitation medicine and the highly edu-
cated persons. Rehabilitation therapy education for undergraduate
0430M9FP student has been started for nearly 10 years, and it was developed
NOS-3 EFFECTED ON THE PULMONARY quickly in recent years. TCM education has been long history and
there is a large number of the TCMT education exited. There are
ARTERIAL PRESSURE AND ALLEVIATED THE
three main organizations for children rehabilitation in China and the
PULMONARY SMALL ARTERIAL REMODELING national conference was held every two years. Conclusion: Although
IN CHRONIC HYPOXIC HYPERCAPNIC RATS BY the rehabilitation and the services have made great achievements, it
KALLIKREIN is still a distance between China and developed Counties and a lot
of questions and challenges we have to face.
Xiaotong Wang1, Hanwen Yang1, Lu Jin1, Yinhua Liu1,
Hai Yuan1, Yi Zhuge2
1
Wenzhou Medical College and 2Quzhou College (China) 0430I2
Purpose: To Observe the change of pulmonary arterial pressure Neural Function informatics and
and the pulmonary small arterial remodeling in chronic hypoxic rehabilitation engineering
hypercapnic rats by the Kallikrein. Materials and Methods: Thirty Jue Wang, Mingming Zhang
male Sprague-Dawley rats were randomly divided into three groups:
The Key Laboratory of Biomedical Information Engineering of
control group (NC group, n = 10), hypoxic hypercapnic group (HH
group, n = 10), hypoxic hypercapnia + Kallikrein group (HC group, Ministry of Education,Institute of Biomedical Engineering, School of
n = 10).The mPAP was measured by external jugular vein cannula, Life Science and Technology, Xi'an Jiaotong University (China)
the expression of endothelial NOS-3 (NOS-3) in pulmonary arteri-
oles and bronchus was detected by immunohistochemistry and RT- Purpose: This paper discusses the inner link between the Neuro-
PCR. Results: 1) Compared with the HH group, the value of mPAP Functional Informatics (NFI) and the Rehabilitation Engineering
and RV/(LV+S) in the NC group and HC group was significantly (RE). It probes the role of NFI research in promoting the RE and
lower (p < 0.01), and those in HC group were higher than those in NC the requirements of RE on NFI research. Materials and Methods:
group (p < 0.01).The value of mCAP was not significantly different The paper analyzed the inner link of NFI and RE by comparing
among the three groups (p > 0.05). 2) The value of WA/TA(vessel their definition, study object and study scope. It introduces the
wall area/total area) and PAMT in HH group was significantly model of Neural Function Information Transfer and Processing,
higher than those in the NC group and HC group (p < 0.01). And Human Activity Assistive Technology Model, Medical Model of
compared with NC group ,the value of WA/TA and PAMT in HC Assistive Technology, and “Five Satisfaction” principle in Assistive
group was not significantly different (p > 0.05). 3) With the method Technology Industry. Results: It forms a system that combines the
of immunohistochemistry, the expression of NOS-3 in pulmonary research on Neuroscience, rehabilitation engineering with clinic
arterioles and bronchus in HH group was significantly lower than rehabilitation treatment closely. As a sample, the paper discusses
those in the HC and NC groups. 4) The expression of NOS-3 mRNA that a neuro-information feedback (NFB) system is applied to treat
in HC group and NC group was significantly higher than that in the the children with attention deficit hyperactivity disorder (ADHD).
HH group (p < 0.01), and in the HC group it was lower than the NC Finally, it discussed the ten frontiers which would be broken in the
group (p < 0.01). Conclusion: Activation of NOS-3 by kallikrein Rehabilitation Engineering Research in China. Conclusions: RE
has decreased mPAP and alleviated vascular remodeling in anoxia needs to be supported by NFI achievement and makes NFI research
and hypercapnia rats. to be much significant and valuable on clinic rehabilitation. It is
believed that the understand to the mechanism of Neuro-functional
information generation, transfer and processing will open new
Cross-Strait Session ways and raise new methods for clinic rehabilitation intervention
and evaluation. It promotes also that new generation products on
rehabilitation engineering and assistive technology come into being.
0430I1 Acknowledgement: This work is supported by National Science
Development of rehabilitation Foundation of China, (Grant No. 30670660) and by “863” project
services for child cerebral palsy plan, China (Grant No.2006AA04Z370).
in China
Xiaojie Li 0430I3
Prevention, Treatment and Rehabilitation Center for Child Cerebral The Theory and Approach of
Palsy of Heilongjiang Province (China) Disability Classification and
Evaluation Based on ICF model
Objective: To summary and discuss Chinese rehabilitation services
Zhuoying Qiu
for children with cerebral palsy, identify the characteristics and short-
comings and explore the direction of development, the correct ways Research Institute of Rehabilitation Information, China Rehabilita-
and methods in the future. Methods: The following were summarized tion Research Center (China)
and discussed as the basic situation of the child cerebral palsy, the his-
tory of setting up the first rehabilitation center, the basic situation of Purpose: To explore the classification and evaluation of disability
the rehabilitation and services, the situation of the professional team, based on ICF approach. Materials and Methods: Frameworks
the situation of the education and training, the academic organiza- of theory of disability classification based on ICF approach and
tions and conferences and the questions and challenges through the psychological measurement, and disability evaluation and tools.
questionnaires, investigations and a large number of the references. Results: A model and classification of disability based on ICF had
Results: The incidence of CP was 1.8~4 ‰ and the prevalence of been developed. The characteristics of disability evaluation and
CP in 1~6 years was 1.92‰. The types of CP is divided into spastic, tools had been discussed. The implementation modular of clas-
dyskinetic, rigid, ataxia, hypotonic and mixed types currently. The sification and evaluation of disability had been developed using
first rehabilitation center for CP children was set up in 1987. There ICF approach. Conclusion: This research discussed the theory and
are three ways of the rehabilitation and services and the two types approach of functioning and disability of ICF in which a framework

Cross-Strait Session 37
of disability consisted of body function and structure, activity group (CRN), high-exercise group (CRH) and low-exercise group
and participation, and environment. ICF had been recognised as (CRL). The rats with exercise training were forced to run on tread-
international standard of disability statistics and fundamental of mill for 8 weeks. The expressions of HSP72 mRNA in cardiac
the sciences of functioning. It has significances for the countries to muscle were determined by RT-PCR and myocardial apoptosis
develop a adaptive framework and evaluation system of disability were observed with Tunel staining. Results: 1) Blood glucose in
for the implementation of UN Convention on the Rights of Persons diabetic rats were higher than that in rats with euglycemia (p<0.05).
with Disabilities, World Health Assembly resolution WHA58.23 on Blood glucose in DE decreased significantly after 8 weeks exercise
disability, including prevention, management and rehabilitation, in comparison with baseline (p<0.05). After an 8-week study, the
and the development and implementation of the laws and policies. levels of INS in serum and pancreas were significantly higher in
This research proposed a framework and classification of disability DE than in DS (p<0.05). Pancreatic islet morphology showed that
based on ICF, analysed the evaluation and standardized procedures the size of islets and the number of islets significantly increased
of disability, and discussed the development of disability standard (p<0.05) and Shape Factor (SF) decreased (p<0.05) in DE compared
and evaluation system applied in different sectors in which a com- with DS. The CNCV slowed remarkably in all diabetic rats and
mon framework based on ICF had been adopted and a data interface significantly increased after 8 weeks of exercise training. Muscle
had been recommended for different purposes. NT-3 levels were significantly lower in DS than in other 3 groups.
Muscle NT-3 levels were correlated positively with CNCV values
(r=0.407, n=31, p<0.026). 2) The expressions of HSP72 mRNA in
0430I4 cardiac muscle of diabetic rats were significant lower than that in
ANALYSIS OF CLINICAL ASSESSMENT OF control rats. The expressions of HSP72 mRNA in CRL and DRL
were significantly higher than that in CRN and DRN. The expres-
UNILATERAL NEGLECT AFTER STROKE sions of HSP72 mRNA in CRH and DRH were significantly lower
Weiqun Song than that in CRN and DRN. Apoptosis index (AI) of cardiac muscles
Department of Rehabilitation Medicine, Xuanwu Hospital, Capital in DRN and DRH were significantly higher than that in CRN and
Medical University (China) CRL. Myocardial AI in DRL was significantly higher than that in
CRL. There was significantly negative correlation between expres-
sions of HSP72 mRNA and AI of cardiac muscles in DRL and
Purpose: The purpose of this study is to investigate unilateral neglect DRN, which was not observed in DRH and DRN. Conclusion: 1)
patients, performance in line bisection and line cancellation tasks. Exercise training not only increases insulin secretion capacity and
Materials and Methods: We retrospectively analyzed the unilateral ameliorates pancreatic islet morphology, but also improves CNCV
neglect patients, performance in line bisection and line cancella- which is associated with increase of muscle NT-3 in STZ-induced
tion tasks before and after rehabilitation treatment. Results: Before diabetic rats. 2) Low-intensity exercises increase expressions of
treatment, statistical analyses revealed the patients, performance in HSP72 mRNA and inhibit apoptosis rates of cardiac muscles in
line cancellation and line bisection did not differ from each other type 2 diabetic rats, which play an important role of protection from
(p=0.902). After treatment, statistical analyses revealed a significant diabetic cardiomyopathy.
difference between the two tasks (p=0.007). With line bisection only,
we detected 29/30 (97%) patients with neglect; with line cancellation
only, we detected 22/30 (73%) patients with neglect. Conclusion: 0430I6
As the performance of unilateral neglect patients improved, patients THE EFFECTS OF ANGELICA SINENSIS
have revealed difference between the performance in line bisection
and in line cancellation. One test alone would miss more subjects INJECTION ON THE NEURONAL METABOLITES
with neglect. That is to say, combination of the two tests was more AND BLOOD FLOW SPEED WITHIN
sensitive than any single test alone. REPERFUSION FOLLOWING THE ISCHEMIC
CEREBRAL INJURY IN RATS
0430I5 Wei-jing Liao1, Yun-huang Yang2, Wan-tong Yang1, Li-
Applied research of exercise therapy in yun Li2, Mai-li Liu2
complications of diabetes
1
Zhongnan Hospital of Wuhan University and 2Wuhan Institute of
Physics and Mathematics, Chinese Academy of Sciences (China)
Zhongli Jiang
Department of Rehabilitation Medicine, First Affiliated Hospital of Purpose: To investigate the effects of Angelica sinensis injection on
Nanjing Medical University (China) the neuronal metabolites and blood flow speed within reperfusion
in the ischemic cerebral injury in rats. Materials and Methods:
Purpose: 1) To explore the effects of exercise on pancreatic β-cell Sixty-nine male Sprague Dawley rats with an average body weight
function and islet morphology and cadual nerve conduction velocity of 160±10 g (mean±SD) were used, and were randomly divided into
in streptozotocin-induced diabetic rats. 2) To investigate effects of three groups: group A rats (n=4) underwent sham operation, group
different intensity exercises on the expressions of HSP72 mRNA B (n=30) underwent an operation of ischemic brain injury, group C
and myocardial apoptosis in type 2 diabetic rats. Materials and rats (n=35) underwent the same operation and received the treatment
Methods: 1) Twelve diabetic rats induced by streptozotocin (STZ, of Angelica sinensis injection (5 g/kg weight, i.p). The right middle
55mg/kg) were divided into diabetic exercise group (DE, n=6) and cerebral artery occlusion (MCAO) of both group B and group C
diabetic sedentory group (DS, n=6). Twelve SD rats with euglycemia rats was induced by 5/0 nylon suture for 2 hours. The reperfusion
were randomly divided to control exercise group (CE, n=6) and was conducted for four hours and six hours respectively following
control sedentary group (CS, n=6). The exercise rats were forced MCAO. T2 weighted-imaging (T2WI) and 1H magnetic resonance
to swim 60 min/day with 5days/week for 8 weeks. At the end of spectroscopy (1H MRS) were performed, to study the changes of
the experiment, blood glucose, serum insulin (INS), pancreatic the imaging and the neuronal metabolites N-acetyl aspartate (NAA),
insulin contents and muscle NT-3 levels were determined by RIA creatine/phosphocreatine (Cr/PCr) and choline (Cho) following
and pancreatic islet morphology was evaluated by Image-Pro Plus cerebral ischemia. The changes of blood flow speed were measured
6.0. The cadual nerve conduction velocity (CNCV) in all rats was by laser Doppler flowmetry. The surface vascular density in right
evaluated before and after 8 weeks. 2) Thirty six of male SD rats hemisphere were calculated. Results: The hyperintense signals and
were divided into diabetic rats (DFM, n=18) and control rats (CFM, volume in the right cerebrum in group C were decreased compared
n=18). The diabetic rats were randomly divided into non-exercise to that of the group B, the T2 values were decreased, and the level
group (DRN), high-exercise group (DRH) and low-exercise group of NAA increased, the ratio of Cr/NAA and Cho/NAA decreased.
(DRL). The control rats were randomly divided into non-exercise The blood flow speed in group C were improved. The length of brain

surface vessels in group C increased. Conclusion: The Angelica 0430N3FP

sinensis injection enhanced the blood circulation in the ischemic PROTECTIVE EFFECT OF BDNF TO NEWBORN
brain, improved the neuronal metabolisms.
RATS WITH HYPOXIE-ISCHEMIC BRAIN
DAMAGE
0430N1FP
Jiangbao Zhou, Xiaoxiao Xu
MENTAL HEALTH STATUS OF THE PARENTS Children’s Hospital of Chongqing Medical University (China)
OF CEREBRAL PALSY CHILDREN AND ITS
RELATIONSHIP WITH PERSONALITY TRAITS Purpose: Studies of brain-derived neurotrophic factor (BDNF) on
neonatal rat hypoxic-ischemic brain damage (hypoxie-ischemic
Zhimei Jiang1,2, Fengming Xiao1,2, Zhihai Lu1,2, Wei brain damage, HIBD) and its possible mechanism, provide the
Pang1,2, Lan-Min Guo1,2 basis For the treatment of hypoxic-ischemic brain injury and its
1
Department of Development and Behavior Pediatrics, The 3rd Af- related diseases. Materials and Methods: two hundred and fifty-
filiated Hospital of Jiamusi University and 2The Laboratory of Child six 7-day-old Wistar rats were randomly divided into four groups:
Neurological Rehabilitation of Jiamusi University (China) normal control group (n = 64) A);HIBD model group (n = 64) B);
Early injection group (n = 64, C); after surgery group (n = 64, D),
Purpose: To explore mental health status of the parents of cerebral every group respectively divided into 1 day, 3 days, 5 days, 7 days
palsy children and its relationship with personality traits. Materials four time points (n = 8).The expression of Trk-B and P75 in Hip-
and Methods: 128 parents of cerebral palsy children and 128 nor- pocampus was examined with immunohistochemical staining and
mal parents were tested with the domestic popular questionnaires, real-time PCR. Results: compared with A, B, the two groups after
including Symptom Check-List 90 (SCL-90), Eysenck Personality injection of BDNF, C, D groups at four time points showed Trk-B
Questionnaire. Data were analyzed by t-test and multiple regression levels were significantly elevated, p75 expression levels decreased,
analysis with SPSS13.0. Results: Comparing the score of mental the most significant change in C group – the difference was statisti-
health status with that of the parents of healthy children, the parents cally significant (p < 0.05). D group and A, B there was a marked
of cerebral palsy children had much higher SCL-90 subscales on so- change in the two groups, the difference was statistically significant
matization, obsession, depression, anxiety, paranoid (p < 0.01). The p < 0.05), but of which the most significant change in C group. The
personality traits mainly include internalizing behaviors (p < 0.05) performance of real-time fluorescence quantitative PCR for the C, D
and neuroticism (p < 0.01). Conclusion: There are mental health compared with groups A, B, Trk-B gene expression levels increased,
problems in the parents of cerebral palsy children. The personality p75 gene expression level decreased, the most obvious changes in
traits of the parents of cerebral palsy children, especially neuroti- group C, and the same trend of changes in immunohistochemistry.
cism, have effects on their mental health. Conclusion: Injection of BDNF in advance plays an important role
to improve the prognosis of HIBD; after injection may improve the
prognosis HIBD; but BDNF in advance to give the prognosis of
0430N2FP HIBD more effective than after injection; The possible mechanism is
CCK-8 PREVENTS GLUTAMATE-INDUCED that BDNF-induced Trk-B can be produced in advance and suppress
APOPTOSIS IN CULTURED CORTICAL NEURONS the expression of p75, thus play a role by increasing the expression
of Trk-b levels and reduce the expression level of p75.
VIA UP-REGULATION OF BCL-2/BAX RATIO AND
DOWN-REGULATION OF CASPASE-3
0430N4FP
Jiangbao Zhou, Huichun Zhang
MORPHINE PRECONDITIONING INDUCES
Children’s Hospital of Chongqing Medical University (China)
DELAYED NEUROPROTECTION AGAINST
Purpose: To investigate the effects of cholecystokinin octapeptide GLUTAMATE-INDUCED EXCITOTOXICITY
(CCK-8) on glutamate-induced cell apoptosis in cultured cortical
neurons and explore the mechanisms. Materials and Methods: Huichun Zhang1, Jiangbao Zhou2, Qing Shang3
Cultured rat cortical neurons at culture days 8 to 9 were incubated 1
The Rehabilitation Medicine Center, Children’s hospital of
with 50 µmol/l glutamate for 30 min, with or without pre-incubation Zhengzhou, 2Department of Rehabilitation Medicine, Children’s
with CCK-8 (1 µmol/l for 24 h). Neuronal viability were determined hospital of Chongqing Medical University and 3The Rehabilitation
by the colorimetric MTT (3-[4,5-dimethylthiazol-2-yl]2,5-diphenyl Medicine Center, Children’s hospital of Zhengzhou (China)
tetrazolium bromide) assay. Apoptosis was first analyzed with
acridine orange and ethidium bromide stain under fluorescence mi- Purpose: To investigate the effects of morphine preconditioning
croscope, then confirmed by terminal deoxynucleotidyl transferase- on glutamate-induced cell injury in cultured cortical neurons and
mediated nick end labeling (TUNEL) method. The expressions of explore the mechanisms. Materials and Methods: Cultured rat
Bcl-2 family protein and Caspase-3 in cortical neurons were detected cortical neurons at culture days 8 were incubated with morphine at
by immunohistochemistry and immunofluorescence, respectively. 0.1–100 μmol/l for 30 min. They were then kept in morphine-free
Results: There was obvious apoptosis phenomenon induced by 50 culture for 24 h before they were subjected to 200 μmol/l gluta-
µmol/l glutamate, the morphological changes of neuronal apoptosis, mate for 6 h. Naloxone (a non–type-selective opioid antagonist,
such as membrane shrinkage, neurite fragmentation, and karyopyk- 50 μmol/l) were present during the period from 30 min before the
nosis ,can be observed under fluorescence microscope. The apoptosis addition of morphine to the end of morphine pretreatment (total of
rate was lower in neurons preconditioned with CCK-8 before the 1 h). After being damaged in glutamate for 6 h, they were fixed for
glutamate injury (3.87 ± 1.04%) than that of the glutamate injury morphologic examination and neuronal viability were determined
alone (17.53 ± 2.93%, p < 0.05). Pretreatment with CCK-8 for 24 by the colorimetric MTT (3-[4,5-dimethylthiazol-2-yl]2,5-diphenyl
h was significantly improved glutamate-induced suppression of tetrazolium bromide) assay. The expressions of Bcl-2 family protein
cell viability. Pretreatment with CCK also completely reversed the and cytochrome c in cortical neurons were detected by immunohis-
suppression of Bcl-2 expression, and significantly inhibited Bax tochemistry. Results: The cell viability was significantly higher in
overexpression and Caspase-3 activition induced by glutamate cortical neurons preconditioned with morphine (≥0.5 μM) before
(p < 0.05). Conclusion: CCK-8 pretreatment could inhibit neuronal glutamate-induced excitotoxic injury (0.377 ± 0.009 at 0.5 μM mor-
apoptosis induced by glutamate in cultured cortical neurons, and phine) than that of the glutamate-induced excitotoxic injury alone
the mechanisms may be associated with up-regulation of Bcl-2/Bax (0.362 ± 0.008, p < 0.05). This morphine preconditioning–induced
ratio and down-regulation of Caspase-3. neuroprotection was abolished by naloxone. Pretreatment with

Cross-Strait Session 39
morphine completely reversed the suppression of Bcl-2 expression, Ma Hui) and Chinese Acupuncture and Moxibustion Prescription
and significantly inhibited Bax overexpression and cytochrome c (Zhong Chongyang and Cheng Lihong). The network was visual-
release induced by glutamate (p < 0.05). Conclusion: morphine ized by Pajek1.25. The density, connectivity, average shortest path
preconditioning induced delayed neuropreconditioning (from hours length and degree distribution were measured by Pajek1.25 and
to days after morphine exposure) inhibit neuronal apoptosis induced Matlab7.0. Results: The visualization showed a complex network
by glutamate in cultured cortical neurons, and the mechanisms may of meridian system. The Density was 0.0037 and there were no
be associated with up-regulation of Bcl-2/Bax ratio and inhibiting unreachable acupoints. The average shortest path length was 26. The
cytochrome c release. input degree distribution followed a power-law with an exponent of
2.57 (R2 was 0.9964), suggesting a scale-free structure in meridian
network. Conclusion: Meridian can be represented by a complex
0430N5FP network composed of acupoints and channels, which was character-
CLINICAL COMPARATIVE STUDY ON ized by connectivity and scale-free property. The perspective of this
ACUPUNCTURE AND SWALLOWING TRAINING study is to select acupoints for different diseases by using complex
network analysis. Network thinking and its methods are forming
FOR TREATING DYSPHAGIC PATIENTS WITH a paradigm for meridian researches. Such paradigm is expected to
STROKE exert profound influences on the understanding of the essence of
Pande Zhang1, Huichang Zhou1, Hong Yao2 the meridian system and on the clinical practices of acupuncture
and moxibustion.
1
Department of Rehabilitation, The First people’s Hospital of
Foshan and 2Guangzhou Medical College (China)
Purpose: To compare the effect of acupuncture and swallowing 0430N7FP
training on dysphagic patients with subacute stroke. Materials and POSTISCHEMIC WHEEL RUNNING INCREASED
Methods: One hundred and thirty-two subacute stroke patients who NEUROGENESIS IN THE SUBVENTRICULAR
were hospitalized, included 73 males, 59 females, with mean age of ZONE OF ADULT RATS WITH LOCAL CEREBRAL
67.9 ± 9.0 years, 26 cerebral hemorrhage patients, 106 cerebral inf-
arct patients, were participated the study. Patients were divided into INFARCTION
3 groups: Swallowing training group (ST, n = 53), were treated with Xi-Quan Hu1, Jie Fang1, Hai-Qing Zheng1, San-Qiang
swallowing training, included thermal-tactile stimulation, degluti- Pan2
tion organ exercise and food swallowing training. Acupuncture 1
Department of Rehabilitation Medicine, the Third Affiliated Hospi-
group (AP, n = 48), were treated with acupuncture that was given
at Fengchi (GB20), Lianquan (RN23), Bailao (EX-HN15), Jinjing tal of Sun Yat-Sen University and 2Department of Anatomy Medical
(EX-HN12) and Yuye (EX-HN13). Control group (CG, n = 31). The College of Jinan University (China)
therapies were once a day, 6/week. Before and after the treatment Purpose: To explore that the postischemic wheel running excise
regimen, the patients were evaluated with Water-Swallow Test, “Any might play activating role in promoting the subventricular zone
Two” test and monitoring the arterial oxygen saturation (SpO2) by neurogenesis and improving the neural function in adult rats with
pulse oximetry. Results: ST and AP groups showed improvement local cerebral infarction. Materials and Methods: A cortical infarct
in Water-Swallow Test, Any Two teat after the treatment regimen was induced by ligating the left middle cerebral artery to the striatal
(p < 0.001), and were better than control group (p < 0.05). No sig- branches in total sixty-four adult Sprague-Dawley rats, which were
nificant difference existed between ST and AP group. The average further randomly divided into two groups. The control group rats
decrease in SpO2 during water-swallow was under 2%. After the (n = 32) were housed in standard case without any excise. The train-
treatment regimen – base SpO2 and post-water swallow SpO2 of ST ing group (n = 32) were taking wheel running excise everyday for
group were higher than control group (p < 0.001). The post-water total three weeks, The rats were scarified on 3rd,7th,14th, 21th day and
swallow SpO2 of AP group were higher than control group (p < 0.05), the neurological severity scores (NSS) was examined for evaluating
no differences at base SpO2. Conclusion: Acupuncture and swal- the neural function, as well as the generation of neurogenesis in the
lowing training is effective for dysphagic stroke patients,there subventricular zone were studied with the cell specific marker Ki-67.
effectiveness is not significantly different. Aspiration cannot be Results: Though proliferating cells in the subventricular zone were
predicted based on decrease in SpO2. observed in both control group and training group, which showed
the highest signal on the 7th day after ischemic, the number of Ki67
positive cells in subventricular significantly increased in training
0430N6FP
group in comparison with those in control group, on the 14th and
APPLICATION OF NETWORK THINKING 21th day after ischemic (p < 0.05). Furthermore, the neurological
AND NETWORK ANALYSIS ON MERIDIAN severity scores in the training group showed more quick declination
RESEARCHES as compared to those in control group from 7th day after ischemic.
Conclusion: Our results suggested that postischemic wheel running
Feng Lin, Zhongli Jiang might promote the proliferation of neurogenesis in subventricular,
Department of Rehabilitation Medicine, Nanjing Medical Univer- implicating that exercise could play important role in the revcovery
sity (China) of neural function in adult rats with local cerebral infarction.
Purpose: By network thinking, structure of an object is represented
by a network composed of nodes (building elements of the object) 0430N8FP
and lines (relations between the building elements). Network analy- STUDY ON AUDITORY SEMANTIC PRIMING
sis is a set of theories, approaches and tools based on the network
thinking. By analyzing relations between elements, the network EFFECTS IN APHASIA PATIENTS
analysis is available for interpreting the object’s structure, function Zhongli Jiang, Shujing Li, Ying Li
and evolution. The present study is to explore a complex network Nanjing Medical University (China)
analysis of the meridian system. Materials and Methods: A meridian
network was constructed by 362 acupoints (nodes) and 488 connec- Purpose: The purpose of this study was to explore the character-
tions (lines) amongst them, selecting the acupoints according to the istics of semantic priming effects in Chinese words with different
channel and the crossing points. The acupoints and channels were association strength in patients with aphasia by auditory stimula-
selected from records in the following documents: Science of Acu- tion. Materials and Methods: Stimulus-response word pairs with
puncture Points (Yang Jiashan), Modern Researches and Practices different association strength including strong, moderate, weak,
of Acupuncture and Moxibustion (Guo Changchun, Zhang Li and and no association categories were chosen from word association

thesaurus as experiment materials. Both patients with aphasia 0430N10FP

(n = 11) and normal subjects (n = 16) were requested to finish an STUDY ON THE THERAPEUTIC EFFECTS OF
auditory lexical decision task for target words. Semantic priming
effects were investigated by means of measuring reaction time (RT) CHINESE TRADITIONAL MANIPULATION
and error rate of each word-pair. Results: In patients with aphasia COMBINED WITH LUMBODORSAL AND
and normal subjects, the mean RTs were significantly shorter in ABDOMINAL MUSCLE EXERCISE IN TREATING
strong, moderate and weak association strength words than in no WAIST SPORTS INJURIES
association strength words (p < 0.05). In strong, moderate and no
association strength words the mean RTs were no significantly Zhang Hong, Zhang Guohui, Zhang Guangyuan, Zhao
differences between two groups. In the weak association strength Qian
words mean RTs were longer in patients with aphasia than in Yueyang Hospital Affiliated to Shanghai University of Traditional
normal subjects (p < 0.05). In two groups, mean error rates were Chinese Medicine (China)
significantly less in strong, moderate and weak association strength
words than in no association strength words (p < 0.05). In strong Objective: To observe the therapeutic effects of Chinese Traditional
association strength words, mean error rates were significantly manipulation combined with lumbodorsal and abdominal muscle
higher in patients with aphasia than in normal subjects (p < 0.05). exercise in treating waist sports injuries in athletes. Methods: Firstly,
In moderate, weak and no association strength words, there were normal values of the ratio between lumbodorsal muscle strength and
no significantly differences between two groups. Conclusion: The abdominal muscle strength (F/E) and the peak torque (PT) of lum-
patients with aphasia follow gradient of the association strength bodorsal and abdominal muscle were tested in 30 athletes without
words like normal subjects and have semantic priming effects in lowback pain by a Biodex dynamometer (Biodex-System 3, Biodex
the strong, moderate association strength words. These results Medical Systems, Inc., USA). Secondly, 60 athletes with low back
suggest that speech therapist may choose vocabularies with strong pain were randomly divided into two groups. Chinese traditional
and moderate associated strength words as training materials and manipulation combined with lumbodorsal muscle exercise were
help patients with aphasia to achieve the desired goal of speech performed in the control group. Chinese Traditional manipulation
rehabilitation. combined with lumbodorsal and abdominal muscle exercise were
performed in the experimental group, which the ratio (F/E) less
than the normal value was considered as weakness of lumbodorsal
0430N9FP muscle strength and the main prescription was to exercise lum-
DYSFUNCTION OF THE MITOCHONDRIA IN THE bodorsal muscle, while the ratio more than the normal value was
CEREBRUM OF MICE INDUCED BY CHRONIC considered as weakness of abdominal muscle strength and the main
prescription was to exercise abdominal muscle. On the other hands,
HYPOXIC HYPERCAPNIA the peak torque (PT) less than the normal value was considered as
Xiaotong Wang, Bin Wu, Hanwen Yang, Lu Jin weakness of lumbodorsal or abdominal muscle and the exercise of
Wenzhou Medical College (China) relevant muscle group should be reinforced. The treatment course
was 4 weeks with 3 times treatments in one week. The treatment
Purpose: To explore the influence of mitochondria in the cerebrum included Chinese traditional manipulation therapy about 20 min
of the mice induced by chronic hypoxic hypercapnia. Materials and exercises about 20 min. The VAS pain score, JOA score, and
and Methods: Thirty male C57BL/6 mice were randomly divided isokinetic muscle strength were performed before and after the treat-
into two groups: hypoxic hypercapnia 4-week experiment group ment. Results: The athletes with low back pain in the two groups
and normal control group. Experiment group was exposed to underwent 4 week’s Chinese traditional manipulation therapy and
9%–11% O2 and 5%–6% CO2 eight hours a day for four weeks. relevant functional exercise. After treatment, the VAS pain score
The concentration of ATP, ADP and AMP was measured by HPLC. apparently decreased, but there was no significant difference be-
The changes of the ultramicrostructures in the mitochondria of the tween the two groups; JOA score was apparently higher, which in
cerebrum were observed by the transmission electron microscope. the experimental group was higher than that in normal groups.The
The membrane potential of the mitochondria was observed by the normal value in athletes of the ratio between lumbodorsal muscle
confocal and the intensity was measured by spectrophotofluorometry strength and abdominal muscle strength (F/E) was 56.99 ± 8.07 in
respectively. The activity of the COX I and III in the mitochondria 60°/s. The ratio of athletes with low back pain was higher than that
and the density of the SOD and GSH in the tissue of the cerebrum of health athletes. After 4 week’s treatment, it significantly decreased
were measured by spectrophotofluorometry. Results: Compared in the two groups, but more in the experimental group; PT (peak
with the normal group, the concentration of the ATP and AMP of torque), PT/BW (peak torque/body weight), AP (average peak) and
mice was lower respectively (p < 0.001), the ultramicrostructures TW (total work) of athletes with low back pain was lower than that
were abnormal and the density of the membrane potential was of health athletes, which increased after treatment; PT, PT/BW, TW
decreased by the confocal, the activity of the COX I and III in the value of lumbodorsal muscle and TW value of abdominal muscle in
mitochondria of the cerebrum and the density of the SOD and GSH the experimental group were close to normal level after the treat-
was decreased significantly (p < 0.01) in the cerebrum tiusse in the ment, which was a significant difference compared to the control
experiment group respectively. Conclusion: Under the condition group. Conclusion: Chinese traditional manipulation combined
of exposure to chronic hypoxic hypercapnia,the changes of the with lumbodorsal and abdominal muscle exercise could apparently
function of the mitochondria in the cerebrum may have taken. Free relieved the pain degree, ameliorate the clinical signs and life quality
radicals (ROS) reaction may contribute to the biological dyfunction of the patients, improve flexors/extensors ratio, increase the muscle
of mitochondria. strength of athletes with low back pain.

Keynote Speech 41
KEYNOTE SPEECH (May 1, 2010)
KS02-01 KS02-02
POSTURAL MOTOR CONTROL: WHAT WE APPLICATION OF RTMS AND TDCS IN
LEARNED FROM ANIMAL MODEL AND ITS REHABILITATION AFTER BRAIN DAMAGE
RELEVANCE FOR HUMAN Ying-Zu Huang1, John Rothwell2
Tatiana G. Deliagina 1
Department of Neurology, Chang Gung Memorial Hospital and
Department of Neuroscience, Karolinska Institute, SE-17177 Chang Gung University College of Medicine (Taiwan) and 2Sobell
(Sweden) Department of Motor Neuroscience and Movement Disorders, Insti-
tute of Neurology, University College London (United Kingdom)
Maintenance of the basic body posture – upright in humans and
dorsal-side-up in quadrupeds – is a vital motor function. It is non- Purpose: Recovery of patients after stroke depends to a large extent
volitional activity, based on the in-born neural mechanisms. Inability on modifications in behaviour that allow patients to achieve goals
to maintain the upright body posture and equilibrium is one of the in ways that are different to those they used prior to the stroke.
major motor disorders following traumatic spinal cord injury (SCI). However, it is increasingly recognised that there is considerable
Selection of appropriate rehabilitation strategies for SCI-caused potential for plastic reorganisation of neural connections in the
postural deficits depends largely on an elucidation of the relative brain to restore function to the extent that patients’ movements
contribution of spinal and supraspinal mechanisms to the control of are restored to relatively normal levels. Brain stimulation, e.g.
posture. This question is difficult to address in human subject due rTMS and tDCS, may be able to play a useful role in this process
to methodological restrictions. By contrast, animal models give a of restorative neurology. Materials and Methods: A number of
unique opportunity for deep analytical studies of postural system. studies have been performed to test whether a single or multiple
We believe that the basic principles of organization and operation sessions of rTMS/tDCS to the motor cortex can improve recovery
of the postural system were kept in evolution, and that the results of arm and hand function in the acute and chronic phases after
obtained in animal models are also relevant for humans. The postural stroke. Two approaches have been used: in the first an excitatory
system stabilizing body orientation in the frontal plane, as well as protocol is applied to the affected hemisphere in order to increase
the corresponding spinal and supraspinal networks were studied in its contribution to recovered movements; in the second, inhibitory
two mammals (rabbit and cat). Experiments on intact animals, on protocol is applied to the non-stroke hemisphere in an attempt to
decerebrated preparations, and on SCI-subjects led to the following prevent it inhibiting activation of the stroke hemisphere and again
conclusions: (i) The lateral stability of the anterior and posterior improve involvement of the stroke hemisphere in movement (inter-
parts of the body is maintained by two independent sub-systems hemispheric competition). Results: Single session studies in which
driven by somatosensory inputs from the corresponding limbs. The motor performance of patients has been examined before and after
reflex mechanism of an individual limb generates a part of the cor- rTMS have generally shown a 10% or so improvement compared
rective response to postural perturbation; another part is produced to a placebo rTMS in chronic patients; there have been no single
on the basis of crossed influences. (ii) A number of motor centers session studies in acute cases given the day to day variation in their
(including motor cortex, brainstem and spinal cord) participate in symptoms. Daily treatments for one or two weeks have also been
stabilization of trunk orientation in the frontal plane. Each of them applied in order to give an effect that might last days or months.
operates on the feedback principle and generates corrective motor Both chronic and acute studies have been successful with 10–20%
commands if the trunk orientation is perturbed. The integrity of improvement in hand and arm function lasting several weeks after
pathways located in the ventral funiculi of the spinal cord is criti- the stroke. However, far more work needs to be done to define
cally important for the operation of this system. (iii) The spinal exactly what parameters of stimulation are optimal for individual
cord contains neuronal networks underlying spinal postural limb patients, as well as to define the best time post-stroke in which this
reflexes, which contribute to trunk stabilization in intact animals. type of therapy might be most effective. There have also been similar
In acute spinal animals, these networks can be activated by electri- investigations in a small number of studies on aphasia. These have
cal and pharmacological stimulation, suggesting that normally (in followed a similar logic of interhemispheric competition. Thus,
intact animals) these networks are activated by the tonic supraspinal fMRI work suggests that patients who recover speech best activate
drive. (iv) Over time, the spinal networks, deprived of supraspinal the left hemisphere during speech tasks whereas those with worse
influences, undergo considerable changes. As a result, the factors, recovery tend to activate the right hemisphere. Thus, rTMS and
which restore postural limb reflexes in the acute state, become less tDCS interventions have tended to apply inhibitory conditioning to
effective. The goal of future studies is to find the factors which, the overactive right hemisphere in an attempt to increase function
when regularly applied in the spinal animal, will increase the ef- in the left and promote recovery. Conclusion: So far, it seems as
ficacy of spinal postural reflexes to such a level that they will be if there may be some benefit in some patients, but since only small
able to cause significant postural corrections and to maintain the numbers of subjects have been studied so far more work needs to
lateral stability of the body. Relevance of the obtained data for bet- be done before any definitive conclusions can be drawn.
ter understanding of postural function and dysfunction in humans
will be discussed.

Oral Presentations (May 1, 2010)
Brain Disorders: Sensory-Motor Control 0501A2

MOTOR CONTROL MODIFICATIONS CAUSED BY
0501A1 SCI
BIOPHYSICS OF ASSESSMENT OF Barry McKay
HUMAN MOTOR CONTROL BY SURFACE Norton Neuroscience Institute, Louisville (United States)
POLYELECTROMYOGRAPHY The control of movement, or motor control, occurs when the central
Arthur M. Sherwood nervous system (CNS) integrates voluntary, reflex, and automatic
National Institute on Disability and Rehabilitation Research activity with internal and external feedback signals to accomplish a
(NIDRR), U.S. Department of Education (United States) motor task. This motor act is generated in the form of spatiotempo-
rally organized output to muscles that contract and, within constraints
Although not feasible for routine clinical use, the most direct meas- imposed by the skeletal system, cause movement to occur (1). The
ure of motor control would be to monitor the activity of the spinal performance of this motor act requires the coordination of neck, trunk,
motor neurons. However, surface electromyography or recording and proximal and distal limb muscles innervated from multiple motor
of the electrical activity arising from the muscles and driven by nuclei of the spinal cord (2, 3). Some often-repeated tasks may call
those motor neurons, is a practical way of gaining insights into upon organizational synergies that arose because of the need to coordi-
the activity of the motor control of nervous system as the basis for nate and exploit enormous numbers of degrees of freedom in complex
functional assessment of neurocontrol of movement, in other words motor systems. For example, synergistic organization functions in the
functional EMG (fEMG) In the case of fEMG, emphasis is placed performance of whole-limb extension for standing and leaning forward
on broad representation of motor activity, with less concern about and backward or reaching for an object or whole-limb flexion for step-
the selectivity of the recording motor units; thus, surface electrodes ping or bringing an object toward the body (4). Traumatic injury to the
are used to detect the activity to be monitored. The characteristics spinal cord disrupts CNS organization, altering synaptic connectivity
of the surface EMG signal are determined by the biophysics of and synergistic coordination within neuronal networks needed for
the recording situation, determined predominantly by the amount the performance of such motor acts. The resulting spatiotemporal
[degree?] of tissue depolarized (a function of both the size of the disorganization manifests as spastic paresis with wide-spread, “muscle
muscle and the imposed firing rate), and 2) the distance from the overactivity” (5). For example, after SCI, the attempt to perform a
muscle to the recording electrode. The analysis also reveals that unilateral single-joint task such as ankle dorsiflexion may activate the
the frequency characteristics of the recorded signal are determined whole-limb flexion synergy. Or, CNS control may be so disrupted as to
by the conduction velocity in the tissue and the distance from the bring only diffuse, bilateral activation of spinal motor neurons, or no
muscle to the electrode. Thus, the depth of the muscle beneath the motor output at all. To assess the degree of motor control disruption
skin, and placement of the electrode on the skin are major determi- caused by SCI in an individual, it is valid and beneficial to measure the
nants in establishing the amplitude and frequency characteristics ability of the CNS to produce this spatiotemporally organized output
of the signal. The surface electromyographic (sEMG) signal can by recording multi-muscle surface EMG (sEMG) during attempts to
therefore be considered to represent the summation of activity of perform selected motor tasks under carefully controlled conditions.
the muscle recorded, or pooled firing rate (PFR), an indication of This can be done using the Brain Motor Control Assessment (BMCA)
the strength of activation of that one muscle. Given that muscles do protocol of standard volitional and reflex motor tasks (1). The degree
not act in isolation, and considering that the elementary functional of disruption that results from SCI ranges from minimal to severe and
units of living things are synergies, which is a functional grouping can be quantified by comparing the spatiotemporal output patterns
of structural elements together temporarily constrained to act a as produced in response to the simple volitional tasks of the BMCA by
single coherent unit, the information from just one muscle group persons with SCI to those recorded from non-injured subjects. The
is insufficient to characterize motor control. Rather, it is neces- degree of the damage-induced disruption can then be calculated from
sary to document the activity of multiple muscles. fEMG offers the sEMG using a vector-based analysis tool (6). Within a group of
the most direct, feasible measure of motor control to the extent 97 persons with SCI, recorded in Vienna, Austria, this tool showed
that it quantitatively represents the activity of the central nervous that, across distinct qualitatively-determined categories of disordered
system, called the pooled firing rate (PFR). The key problem in patterns, there was a continuous distribution of control disruption (7),
taking this approach is therefore to derive the best estimate of the in contrast to the categorical distribution suggested through the use of
PFR from the fEMG signals. However, while the biophysics of current clinical scales such as the American Spinal Injury Association
the situation dictate that, if the PFR (underlying neural activity) is Impairment Scale (8). When severe SCI brings clinically complete pa-
known, the fEMG signals created can be computed to the degree ralysis, other neurophysiological parameters derived from the BMCA
of accuracy that the muscle geometry is known, but the converse can be used to describe conduction across the lesion. For example, the
is not true, if the fEMG is measured, one cannot automatically ability to induce muscle activation caudal to the injury by performing
know the PFR that generated that data. The ill-posed nature of the strong voluntary contractions of muscles rostral to the lesion. Such
inverse problem of inferring the source has not kept electrophysi- tasks as neck flexion and Jendrassik reinforcement maneuvers can
ological techniques from finding utility in non invasive studies of increase the central state of motor excitability and induce motor unit
motor control in humans and its application in medical practice. By discharging in paralyzed muscles caudal to the lesion (9–11). Similarly,
adding a priori information, it is possible to utilize these surface the ability to decrease the central state of motor excitability can be
potentials for monitoring and assessment of motor functions of the measured as a volitionally-induced decrease in cutaneomuscular reflex
CNS, in practical medical terms in diagnostic evaluation of motor withdrawal from plantar surface stimulation (10–12). With even less
disorders. Functional electromyography relies on the motor act translesional conduction, the presence of sustained responsiveness
as its organizing framework, and seeks to document activity in as to vibration (13–15) or the multi-muscle distribution of responses to
many muscle groups as practical. In fEMG, emphasis is placed on tendon taps (16) offer evidence of translesional conduction. Taken to-
broad representation of motor activity, with less concern about the gether, recording the amount and spatiotemporal distribution of spinal
selectivity of the recordings; thus, surface electrodes are used to motor output produced in response to the BMCA’s motor tasks can
detect the activity to be monitored. provide a functional EMG measure of motor control after SCI.

Brain Disorders: Sensory-Motor Control 43
References: hamstrings, anterior tibialis and triceps surae muscles. SEMG pat-
1. Sherwood AM, McKay WB, Dimitrijevic MR. Motor control after terns of activities recorded in the supine position during volitional,
spinal cord injury: assessment using surface EMG. Muscle Nerve 1996; unilateral, multi-joint (hip/knee flexion and extension) movement
19: 966-79. attempts were characterized, divided into seven groups and compared
2. Routal RV and Pal GP. A study of motoneuron groups and motor columns with the subjects’ self-selected ambulation device. The neurological
of the human spinal cord. J Anat 1999 195:211-224. patterns recorded in the supine position correlated well with the SCI
3. Sharrard WJW. The distribution of the permanent paralysis in the lower subjects ambulatory assistive device. Marked decreases in motor unit
limb in poliomyelitis: A clinical and pathological study. J Bone Joint output and/or loss of motor organization were found in the nonam-
Surg 1955; 37B: 540-558. bulatory group. Coactivation of proximal muscles, poor timing of
4. Kelso JAS. Synergies: Atoms of Brain and Behavior. In: D. Sternad (ed). muscle activity, and radiation of activity into contralateral muscles
Progress in Motor Control: A Multidisciplinary Perspective, Advances were noted in subjects who required a walker or crutches.
in Experimental Medicine and Biology Vol 629. pp. 83-92, Springer
2009, New York.
5. Gracies J-M. Pathophysiology of spastic paresis. II: Emergence of muscle 0501A4
overactivity. Muscle & Nerve 2005; 31: 552-571. NEUROPHYSIOLOGY OF THE HUMAN SPINAL
6. Lee DC, Lim HK, McKay WB, Priebe MM, Holmes SA, Sherwood AM.
CORD TESTED BY LUMBOSACRAL EVOKED
Toward an objective interpretation of surface EMG patterns: a voluntary
response index (VRI). J Electromyogr Kinesiol 2004; 14: 379-388. POTENTIALS, THE H REFLEX, AND POSTERIOR
7. Ladenbauer J, Rattay F, Freundl B, Binder H, Dimitrijevic MR. Motor ROOT-MUSCLE REFLEXES
control in spinal cord injured people below the level of the lesion. Proc
Karen Minassian1,2, Ursula S. Hofstoetter1,2, Winfried
Soc Neurosci 2009; 542: 13.
8. Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH,
Mayr2, Frank Rattay1, Milan R. Dimitrijevic1,3,4
Ducker TB, Garber SL, Marino RJ, Stover SL, Tator CH, Waters RL,
1
Institute of Analysis and Scientific Computing, Vienna University
Wilberger JE, Young W. International Standards for Neurological and of Technology, 2Center for Medical Physics and Biomedical Engi-
Functional Classification of Spinal Cord Injury. American Spinal Injury neering, Medical University of Vienna (Austria), 3Department of
Association. Spinal Cord. 1997; 35: 266-74. Physical Medicine and Rehabilitation, Baylor College of Medicine,
9. Dimitrijevic MR, Dimitrijevic MM, Faganel J, Sherwood AM. Supraseg- Houston (United States) and 4Foundation for Movement Recovery
mentally induced motor unit activity in paralyzed muscles of patients with (Norway)
established spinal cord injury. Ann Neurol. 1984; 16: 216-21.
10. Sherwood AM, Dimitrijevic MR, McKay WB. Evidence of subclinical Purpose: The present work describes electrophysiological methods
brain influence in clinically complete spinal cord injury: discomplete for assessing conduction and processing functions of spinal neuronal
SCI. J Neurol Sci. 1992; 110: 90-8. circuits in spinal cord injured humans. Lumbosacral evoked poten-
11. McKay WB, Lim HK, Priebe MM, Stokic DS, Sherwood AM. Clinical tials (LSEP): Electrical stimulation of primary afferents within the
neurophysiological assessment of residual motor control in post-spinal tibial nerve in humans elicits the H reflex that is electromyographi-
cord injury paralysis. Neurorehabil Neural Repair. 2004; 18: 144-53. cally recorded from the calf muscle. The neuronal activity along the
12. Cioni B, Dimitrijevic MR, McKay WB, Sherwood AM. Voluntary su- reflex pathway can be recorded by surface electrodes placed over
praspinal suppression of spinal reflex activity in paralyzed muscles of the low thoracic and lumbosacral spine as LSEPs. The waveforms
spinal cord injury patients. Exp Neurol. 1986; 93: 574-83. of the LSEPs reflect peripheral and central generators. Responses
13. Matthews PB. The reflex excitation of the soleus muscle of the decer- recorded over the vertebral levels L2, L4 and S1 are double peaked.
ebrate cat caused by vibbration applied to its tendon. J Physiol. 1966; The first negative peak (R-wave) is generated by afferent impulses
184: 450-72. in the posterior roots, while the second negative peak (A-wave) is
14. Dimitrijevic MR, Spencer WA, Trontelj JV, Dimitrijevic M. Reflex ef- the reflex outflow through the motor axons in the anterior roots.
fects of vibration in patients with spinal cord lesions. Neurology. 1977; A stationary wave (S-wave) is recorded from the T12-electrode,
27: 1078-86. generated by activity of dorsal horn interneurons trans-synaptically
15. Sherwood AM, Dimitrijevic MR, Bacia T, McKay WB. Characteristics depolarized by the afferent input. LSEPs can be interpreted as electro-
of the vibratory reflex in humans with reduced suprasegmental influence neurograms and are testing whether the input to and output from the
due to spinal cord injury. Restorative Neurology and Neuroscience, S1 spinal cord segment is preserved and whether the afferent input
1993; 5: 119-129. depolarizes neurons in the dorsal horn gray matter of the spinal cord.
16. Calancie B, Molano MR, Broton JG. Tendon reflexes for predicting The Hoffmann reflex (H reflex): The H reflex is due to activation
movement recovery after acute spinal cord injury in humans. Clin Neu- of low-threshold, large-diameter group-Ia muscle spindle afferents
rophysiol. 2004; 115: 2350-63. within the tibial nerve and the subsequent recruitment of motoneurons
through mono-/oligosynaptic connections in the ventral horn of the
spinal cord. The H reflex of triceps surae tests the preservation of
0501A3 the corresponding stretch reflex arc. Assessment of the functional
condition of the spinal cord can be extended to numerous other
CORRELATION OF MOTOR CONTROL IN THE neuronal pathways that are acting upon the H reflex by employing
SUPINE POSITION AND ASSISTIVE DEVICE USED conditioning-test paradigms. Changes in H reflex amplitude follow-
FOR AMBULATION IN CHRONIC INCOMPLETE ing a conditioning stimulus assess post-synaptic events or changes in
SPINAL CORD-INJURED PERSONS presynaptic inhibition acting on Ia afferent terminals. One example is
the demonstration of disynaptic Ia inhibitory pathways by a decrease
Simon Fuk-Tan Tang of the H reflex size when the common peroneal nerve is electrically
Department of Physical and Rehabilitation Medicine, Chang Gung stimulated. Likewise, assessment can be extended to spinal pathways
memorial hospital and School of Medicine Chang Gung University influencing the monosynaptic reflex gain by volitional motor tasks.
(Taiwan) Posterior root-muscle reflexes (PRM reflexes): PRM reflexes are
spinal reflexes elicited in large-diameter afferents within the pos-
Ambulation is an important part of neurorehabilitation. How to assess terior roots and are electromyographically recorded as compound
and predict ambulatory outcome is utmost important. To evaluate muscle action potentials from the homonymous muscles (2). We have
the relationship between neurocontrol patterns evoked by lower limb recently described a non-invasive method for the transcutaneous
movement in the supine position and the assistive device used for elicitation of PRM reflexes via surface electrodes attached over the
ambulation in chronic incomplete SCI persons, 15 neurologically back and the abdomen (3). A single pulse applied at the T11–T12
healthy and 36 incomplete SCI persons were recruited. Surface interspinous space elicits monosynaptic PRM reflexes in multiple
EMG (SEMG) was recorded from bilateral quadriceps, adductors, lower limb muscles in subjects with intact nervous system in supine

(3) or standing position (1). Electrophysiological similarities between We have demonstrated that PRM reflexes were modulated in the
the PRM reflex and the H reflex allow to extend H reflex studies of flexor and extensor muscle groups of the lower limbs to meet the
a single muscle to the assessment of synaptic transmission of two- functional requirements of the motor tasks and at the same time to
neuron reflex arcs at multiple segmental levels simultaneously under counteract perturbation of equilibrium. In particular, the excitability
different conditioning influences (1). The transcutaneous technique of motoneurons associated with muscles that were quiescent during
and epidural spinal cord stimulation (SCS) stimulate similar neuronal a specific task was inhibited. Moreover, modifications of motornu-
structures, i.e., large-diameter afferents of multiple cord segments. clei excitability took place even before the execution of the motor
Hence sustained transcutaneous SCS can open new avenues as a tasks. Conclusion: The presented approach opens a new avenue
neuromodulation technique. In a pilot study we combined transcuta- for non-invasively investigating how motor control is triggered
neous SCS with assisted treadmill stepping in subjects with complete and maintained by spinal cord networks in subjects with intact or
and incomplete SCI. We found effects of transcutaneous SCS on the altered nervous system functions. Expanding the knowledge about
activity of multiple motoneuron pools throughout the lower limbs. the interaction between segmental reflex organization and automatic
These widespread effects strongly suggested that the tonic transcu- postural capacities will be crucial in designing new and adjusting
taneous SCS delivered from a single site enhanced the activity of already available rehabilitation strategies for restoration of locomo-
locomotor-related circuits inherent to the human lumbar spinal cord. tor functions in people with neurological disorders. Moreover, it will
Conclusions: The above presented, non-invasive neurophysiological help advancing our understanding of how to maintain intact motor
methods provide information on both main function of the spinal control functions and prevent postural disturbances.
cord, i.e. its conducting and processing capacities. References:
References: 1. Hofstoetter US, Minassian K, Hofer C, Mayr W, Rattay F, Dimitrijevic
1. Hofstoetter US, et al. Modification of reflex responses to lumbar posterior MR. Modification of reflex responses to lumbar posterior root stimulation
root stimulation by motor tasks in healthy subjects. Artif Organs 2008; by motor tasks in healthy subjects. Artif Organs 2008; 32: 644-648.
32: 644–648. 2. Minassian K, Persy I, Rattay F, Dimitrijevic MR, Hofer C, Kern H. Pos-
2. Minassian K, et al. Human lumbar cord circuitries can be activated by terior root-muscle reflexes elicited by transcutaneous stimulation of the
extrinsic tonic input to generate locomotor-like activity. Hum Mov Sci human lumbosacral cord. Muscle Nerve 2007; 35: 327-336.
2007; 26: 275–295.
3. Minassian K, et al. Posterior root-muscle reflexes elicited by transcuta-
neous stimulation of the human lumbosacral cord. Muscle Nerve 2007;
0501D2
35: 327–336. NEUROIMAGING ASSESSMENT OF HUMAN
SPINAL CORD WHITE AND GREY MATTER
0501D1 Spyros S. Kollias
HUMAN NEURAL CONTROL OF POSTURE: Institute of Neuroradiology, University Hospital of Zurich (Swit-
zerland)
MODIFICATIONS OF LUMBAR POSTERIOR
ROOT-MUSCLE REFLEXES The past ten years have witnessed a revolution in the diagnosis and
management of spinal disorders. MR imaging has quickly emerged
Ursula S. Hofstoetter , Karen Minassian , Winfried
1,2 1,2
as the study of choice for virtually all disorders of the spine. With
Mayr2, Frank Rattay1, Milan R. Dimitrijevi3,4,5 the inherent contrast sensitivity, the high spatial and temporal resolu-
1
Institute of Analysis and Scientific Computing, Vienna University tion, the multiplanar sampling of anatomy, the reliable differentia-
of Technology and 2Center for Medical Physics and Biomedical En- tion between normal and pathologic tissue and the lack of irradiation
gineering, Medical University of Vienna (Austria), 3Department of hazards of MR, the morphology of the spinal cord, and nerve roots
Physical Medicine and Rehabilitation, Baylor College of Medicine, but also of the vertebrae, intervertebral disk, epidural space, can be
Houston (United States), 4 Institute of Clinical Neurophysiology, visualized with striking clarity. The use of paramagnetic contrast
University Medical Center Ljubljana (Slovenia) and 5Foundation agents became well established in a variety of disorders allowing
for Movement Recovery (Norway) definition of abnormal vessels, leptomeninges, and disrupted blood-
cord barrier. State-of-the-art MR has increased the specificity of
Purpose: The maintenance of body posture in humans during the diagnosis of spinal disease, aided earlier diagnosis of spinal lesions
execution of postural and volitional tasks relies on dynamically and increased the anatomical precision of disease localization. It
adjusted, continuous motor coordination. The goal of the present is now possible to diagnose processes that were previously only
study was to test the underlying sensory-motor control mecha- inferred from imaging studies. Diagnostic innovations have been
nisms by assessing task-dependent modifications of short-latency followed by considerable therapeutic advances. But also therapeutic
spinal reflexes associated with tonic and phasic motor activities. advancements particularly in the field of regeneration of the neural
The originality of the study lies in analyzing monosynaptic spinal tissue in spinal cord injury are driving technological developments
reflexes of several lumbar spinal cord segments in healthy adult in imaging. Despite this progress, the modality remains in an evo-
subjects simultaneously elicited by electrical posterior root-stimula- lution stage, with almost unlimited room for improvement. New
tion and in testing their modifications during the execution of well imaging methodologies have been developed over the last years
controlled and coordinated postural and volitional multi- and single that are used to clarify not only morphological changes but also the
joint (i.e., multi- and oligosegmental) movements. Materials and physiology and pathophysiology of neural tissue. High-resolution
Methods: A novel, non-invasive method of transcutaneous spinal Magnetic Resonance (MR), diffusion-weighted (DWI) and diffu-
cord stimulation was used to simultaneously elicit monosynaptic sion-tensor (DTI) imaging, functional MR imaging (f-MRI) and
posterior root-muscle (PRM) reflexes – named according to the MR spectroscopy (MRS) have evolved into important research tools
sites of their initiation and their detection by surface electromy- for examining the structural and functional nature of neurological
ography – in multiple thigh and leg muscle groups bilaterally in pathology, in both animal and human tissue. Applications in the
subjects with intact nervous system functions (1, 2). PRM reflexes brain have already gained widespread clinical acceptance however,
were used to assess the modification of synaptic transmission at imaging the spinal cord places additional demands on imaging, due
several segmental levels simultaneously with the subjects (i) in to its fine structure and its elasticity, the requirement for high in-
upright standing position, performing unilateral dorsal and plantar plane resolution and avoidance of artefacts arising from cord and
flexion while standing on the contralateral lower limb as well as CSF motion, respiratory motion, and swallowing. Optimization
while leaning forward and backward at the ankle; and (ii) in supine and application of these non-invasive MR techniques on studying
position, isometrically lifting one of the extended lower limbs at the human spinal cord can potentially provide new morphological,
the hip; and just before the execution of a fast withdrawal move- physiological and functional information in vivo and eventually,
ment, i.e., during the preparatory phase of the movement. Results: important insight into a variety of disease processes affecting the

Brain Disorders: Sensory-Motor Control 45
spinal cord and its functional recovery after injury improving the within the spinal cord. In the case of surgically induced transient
specificity of conventional imaging approaches. Presently, ap- paraplegia, this system is temporarily compromised by selective
plication of advanced imaging methodologies for in vivo imaging surgery while the CT is left intact. After the patient wakes up, other
of the human spinal cord gain widespread acceptance for potential descending systems compensate for the lack of propriospinal tonic
use in clinical studies. These include high resolution differentiation influence on ά-motoneurons. This results in the fast recovery of
between spinal cord grey and white matter using high field (3-T) these patients. This suggested mechanism is speculative but from
MR systems, evaluation of microstructural changes in the integrity a prognostic and pragmatic point of view is critical because it cor-
of white matter using DTI, mapping functional activity of the spinal relates extremely well with clinical outcome. Comparatively, if the
sensorimotor neurons using fMRI, as well as metabolical imaging of CT tract is damaged during surgery (complete loss of D wave or
the spinal cord tissue using MR spectroscopy. First clinical applica- decrement of the amplitude compared with the baseline of more
tions in patients with demyelinating disease, (i.e., multiple sclerosis), than 50%), a permanent motor deficit is expected (3). Combining
spinal cord injury (SCI), neoplastic processes etc, indicate that these the information about the D wave and about the muscle MEPs
techniques provide better demonstration of the structural damage during surgery for intramedullary spinal cord tumors makes this
and understanding of its functional consequences and its evolution in surgery safer, changes the intraoperative strategy, and significantly
the human spinal cord. Quantitative imaging parameters can be used diminishes the occurrence of postoperative deficits.
as surrogate markers of disability for determining prognosis and for References:
following up rehabilitation and pharmacologically induced recovery. 1. Kothbauer K, Deletis V, Epstein F. Motor evoked potential monitoring
With the progression of regeneration enhancing treatment for spinal for intramedullary spinal cord tumor surgery: Correlation of clinical
cord injury form basic research to patient trials, these new diagnostic and neurophysiological data in a series of 100 consecutive procedures.
tools for the clinical assessment, including prognosis and post-treat- Neurosurg. Focus (electronic journal), (4), Article 1 (http://www.aans.org/
ment follow-up, become of utmost importance for assessing with journals/online_j/may98/4-5-1), 1998.
increased specificity and sensitivity the structural, physiological and 2. Deletis V, Kothbauer K. Intraoperative neurophysiology of the corticos-
functional status of the human spinal cord in vivo and in the clinical pinal tract. In “Spinal cord monitoring” (E. Stalberg, H.S. Sharma, and Y.
setting. It must be always remembered, however, that the body has a Olsson, eds.), 1998, pp. 421–444. Springer, Wien, New York.
limited range of responses to an apparently infinite variety of insults 3. Morota N, Deletis V, Shlomi C, Kofler M, Cohen H, Epstein F. The role of
from infectious, inflammatory, traumatic, and neoplastic entities. motor evoked potentials (MEPs) during surgery of intramedullary spinal
Images are often sensitive but not specific, and a logical pathologic cord tumors. Neurosurgery 1997; 41: 1327–1366.
differential diagnosis must be given. Further, many morphologic
derangements can be demonstrated in asymptomatic individuals,
which further complicates the concept of abnormality. In certain 0501D4
situation there may only be a moderate correlation between the THE NEUROPHYSIOLOGY OF HUMAN
imaging evidence of morphologic alteration and the presence of LOCOMOTOR TRAINING
symptoms. These facts emphasize that we need to concentrate more
effort on determining the significance of the morphological changes Keith E. Tansey
we can now so exquisitely demonstrate, and the central importance Spinal Cord Injury/Neurology & Physiology, Shepherd Center/
of both the clinical and electrophysiological evaluation in the work- Emory University (United States)
up of patients with spine disorders. Imaging is an intermediate test
that must be integrated into, rather than isolated from, the clinical Purpose: The goal of the research to be presented is to localize and
and neurophysiological evaluation. The management of patients characterize the neural plasticity associated with locomotor training
with spinal disorders must begin and end with a thorough clinical and functional recovery of gait following motor incomplete spinal
assessment and imaging findings must be correlated and validated cord injury in humans. The premise is that if we can understand
with clinical and electrophysiological parameters. the relationship between neurophysiology and functional capacity
following injury and training we may be able to identify ways to
improve upon that therapy and the recovery in our patients. Ma-
0501D3 terials and Methods: Electrophysiological and fMRI studies on
Transitory human paraplegia patients with a spectrum of spinal cord injuries will be presented
and how those measures are affected by locomotor training in some
Vedran Deletis of those patients will be examined. Results: We have demonstrated
Institute for Neurology and Neurosurgery, Roosevelt Hospital that locomotor training leads to supraspinal neural plasticity and
(United States) that plasticity in the cerebellum may be best linked with functional
recovery of gait. In examining spinal neural circuits after injury
Surgically induced transient paraplegia: During surgery for and training, we have found a less clear picture. Patients who re-
intramedullary spinal cord tumors in the thoracic region,MEPs in cover faster over-ground walking speeds after locomotor training
the TA muscles will frequently disappear while the D wave remains experience normalization of their soleus H reflexes but the opposite
unaffected. All patients demonstrating this finding during surgery is seen in patients who recover only very slow over-ground gait.
wake up paraplegic (or monoplegic if the TA MEPs disappear in Conclusion: We have growing evidence of the neural plasticity, both
one leg). In patients in whom we have observed this phenomenon, supraspinal and spinal, that is associated with locomotor training
motor strength is typically recovered in a few hours to a few days following motor incomplete spinal cord injury and we can relate
following surgery. No permanent motor deficits have been observed certain features of that neural plasticity with certain features of
(1, 2). With almost all cases of transient paraplegia, the first changes functional recovery in our patients. We have also identified several
are seen in the MEPs and not in the parameters of the D wave. This lines of additional investigation that need to be carried out to address
gives the surgeon a warning sign and a window of time to plan to the new questions raised by the research done to date.
end the tumor removal. This is a critical point for intraoperative
planning of the extent of tumor removal. If changes in the MEPs
do not appear, tumor removal can proceed until a gross total resec- 0501H1
tion is accomplished without the patients having permanent motor THE EFFECT OF PERIPHERAL NERVE LESION
deficits postoperatively. Neurophysiological Basis for Surgically
Induced Transient Paraplegia: Taking into account the previous UPON POSTURAL CONTROL
evidence that the generation of muscle MEPs involves more than just Justin Brown
the CT, activation of the CT and other descending systems within Washington University School of Medicine (United States)
the spinal cord is necessary. We speculate that the propriospinal
(diffuse) system of the spinal cord is activated by CT axons that While the effects upon shoulder girdle posture and dynamics are
are linked via synaptic connections to the propriospinal system often clear when they are the result of complete proximal nerve

injuries, the effects of milder neuropathy syndromes more distal for inducing of locomotion. The present results suggest that SEMS
in the extremity is less well understood. Numerous animal studies could be an effective, noninvasive clinical tool for facilitating the
have demonstrated the neurological system involved in posture recovery of locomotion after a spinal cord injury.
to be a closed-loop system, which requires brainstem and spinal
networks to process critical peripheral sensory feedback input to
the CNS for its normal function. As such, diabetic neuropathy 0501H3
has been a useful model of an impairment of somatosensory input TRANSFORMATION OF NONFUNCTIONAL
to this system which affects upright balance and gait. Similar SPINAL CIRCUITS INTO FUNCTIONAL AND
research has demonstrated that the postural system is composed
of at least two subsystems, one for the pelvic girdle and another ADAPTIVE STATES IN PARALYZED RATS
for the shoulder girdle. Particular shoulder postures and dynamics Grégoire Courtine1,2
have been suggested as contributing factors in the development 1
Neurology Department, University of Zurich and 2Rehabilitation
of neuropathy syndromes of the upper extremity as they are com- Institute for Neuroscience and Technology Zurich (RITZ) (Swit-
monly observed in those suffering from such upper extremity
zerland)
neuropathy syndromes. Using an infrared motion capture system
we demonstrate shoulder postures and dynamics in normal and Severe spinal cord injury (SCI) permanently abolishes motor
neuropathy-affected subjects, highlighting their differences. We functions caudal to the lesion. In this talk, I will show that com-
will then demonstrate the aspects of these postures which can binations of monoaminergic agonists and electrical spinal cord
be induced via afferent reduction, indicating a possible reverse stimulations can acutely transform spinal networks from non-
phenomenon – distal neuropathy resulting in proximal postural functional to highly functional and adaptive states as early as one
changes. week after a severe SCI. Specifically, using detailed kinematic,
force, physiological and statistical analyses, I will demonstrate
the capacity of various monoaminergic receptors and multiple
0501H2 sites of epidural electrical stimulations to promote unique pat-
NOVEL ACCESS TO THE HUMAN AND ANIMAL terns of locomotion in paralyzed rats. Next, I will demonstrate
LOCOMOTOR CIRCUITRY the power of these interventions to mediate the recovery of full
weight bearing locomotion when combined with step training
Yury Gerasimenko1,3, Ruslan Gorodnichev2, Pavel rehabilitation. Finally, I will show that limited, indirect connec-
Musienko1, Roman Seifner1,6, Roland R. Roy3,5, V. tions between the brain and spinal locomotor circuits are sufficient
Reggie Edgerton3,4,5 to allow paralyzed rats with severe SCI to regain the capacity to
1
Pavlov Institute of Physiologyand 2Velikie Luky State Academy of walk overground when pharmacological and electrical stimula-
Physical Education and Sport (Russian Federation), 3Departments tions are provided. The potential of these novel multi-pronged
of Physiological Science, University of California, 4Departments strategies to improve functional recovery in people with spinal
of Neurobiology, University of California and 5Brain Research cord injuries will be discussed.
Institute, University of California (United States) and 6Technical
University Graz Institut für Medizinitechnik (Austria) 0501H4
Purpose: To determine whether the spinal locomotor circuitry in Human Motor Control and recovery of
non-injured humans as well as in decerebrated cats and in adult spi- the motor functions after CNS lesions
nal cord transected rats can be activated by spinal electromagnetic
stimulation (SEMS). Materials and Methods: In individuals with the Milan Dimitrijevic
legs placed in a gravity-neutral position a circular electromagnetic
coil (70 mm) was positioned over the T11–T12, T12–L1, L1–L2, and Abstract missing.
L2–L3 vertebrae. One 10-sec train of impulses at 1, 3, 5, 10, and 20
Hz was applied to the spine at a strength ranging from 1 to 1.5 Tesla
(Magstim-Rapid2 stimulator). In decerebrated cats and in spinal rats
the magnetic stimulation at 3–5 Hz and strength ranging from 0.2 to 1 Spinal Cord Disorders
Tesla was used. Kinematic and EMG analysis of stepping movements
during SEMS was performed. We also used computer modeling of
the cat spinal cord to calculate the distribution of the electrical fields 0501B1
in the spinal cord in response to SEMS at different locations of the ACUTE SPINAL CORD INJURY: ADVANCEMENTS
magnetic coil over the spinal cord. Results: SEMS at 3Hz applied IN BASIC SCIENCE RESEARCH AND CLINICAL
to T11–T12 vertebrae at strength of 1.5 Tesla induced involuntary CARE
bilateral locomotor-like movements in the legs of some individuals.
The formation of locomotor-like activity during SEMS started im- Chi-Tsou Huang
mediately after delivering of the first stimulus. SEMS at 1 Hz did not University of Alabama in Birmingham - School of Medicine (United
induce any clear, sustained locomotor-like activity in the leg muscles. States)
Locomotor-like movements, however, were observed at 3, 5, 10, and
20 Hz. Displacement of the coil in a more caudal direction resulted in Purpose: An overview of current basic science research in acute
a progressive impairment of stepping performance. In decerebrated SCI and clinical presentation of SCI from the acute to chronic
cats SEMS, both of lumbar and cervical spinal cord, could induce stage of disease. Materials and Methods: Clinical experience in
quadrupedal locomotion on the moving treadmill. In spinal rats SEMS managing SCI patients for the last 34 years through in and out-
induced episodes of locomotion only. However after administration of patient setup, and study of cardiopulmonary function, nutritional
5-HT agonist (quipazine) the facilitation of locomotion during SEMS requirements, and hematological abnormalities. Results: SCI
of spinal rats was significant. Conclusion: We speculate that SEMS patients have severe cardiopulmonary intolerance, low calorie
directly activates the circuitry intrinsic to the spinal cord, as suggested requirement particularly during the first two weeks post injury,
by the immediate response and the electrophysiological observations and decrease in total body red cell mass. Conclusion: During
demonstrating an absence of strictly time-linked responses within the acute stage of SCI, aggressive cardiopulmonary care and
the EMG burst associated with individual stimuli during SEMS. moderate daily calorie nutritional support should be performed.
Based on modeling of the electrical fields in the cat spinal cord in Moreover, deviations from the decline in the red call mass should
response to SEMS, positioning of the coil over spinal cord is critical be monitored.

Spinal Cord Disorders 47
0501B2 and daily transrectal (electrical) bowel stimulation for 2 to 3 weeks

WHAT WE LEARNT FROM MANAGEMENT helped improve FI and bowel function without untoward effects in
children with myelodysplasia. When conservative bowel program
OF SPINAL CORD INJURY POST SICHUAN fails, the Malone antegrade colonic enema (MACE) procedure has
EARTHQUAKE – 2 YEAR EXPERIENCE significant improvement in children and their parent who after years
Jianan Li, Yongqiang Li, Shouguo Liu, Mingyue Xiao, battled with constipation and fecal incontinence. In addition, neu-
romodulation with intravesical electrical stimulations did reduce FI
Xia Zhang, Sijin Chen, Wenchao Yi but not affect bowel movement. One should notice that ideal bowel
First Affiliated Hospital of Nanjing Medical University (China) care is very different for physicians and for patients: ‘ideal bowel
Purpose: To review outcome of rehabilitation service for victims with care of physician’ is defined as spontaneous or reflex defecation
spinal cord injury (SCI) from Sichuan earthquake. Materials and without enema or suppository, at least once every 2 days and within
Methods: On site investigation was conducted, including interview, 30 min, while ‘ideal bowel care of patient’ is defined as lack of
home visit and physical assessment. Total of 51 SCI victims aged 11 defecation difficulty; and, the concept of ‘satisfactory’ varied con-
to 77 years were investigated, including 30 females and 21 males. siderably among individuals. Conclusion: Bowel program should
Injury level was C7 or above in 5 cases, C8–T5 in 3 case, T6–L2 in be established for each SCI patient during rehabilitation phase. In
35 cases and L3 and below in 8 cases. Completed injuries were 22 real life, a bowel care regimen and an appropriate equipment need
cases and the incompleted were 29 cases. Most cases (86.3%) had to fit the person’s long-term routine and aims at effective bowel
internal fixation. Outcome of locomotion, ADL and complications evacuation without fecal incontinence.
were evaluated. Results: Most complications from SCI were reha-
bilitated, including healed pressure sore in 62.5%, relief of pains in 0501B4
64.7% and healed DVT in 85.7%. But neurogenic bladder and bowel
were still seen in 90% and 83% of the victims. All victims between BRINDLEY’S TECHNIQUE FOR THE
C8 and L2 were able to walk with KAFO, but only 25% of them TREATMENT OF BLADDER DYSFUNCTION POST
remained to use KAFO regularly (1 to 2 hrs per day). No people with SPINAL INJURY INJURE
KAFO might walk independently without supervision. Major causes
of poor application with KAFO were complications/comorbidity, Mou-Wang Zhou
inconvenience, difficulty to use and poor home environment. Most Department of Rehabilitation Medicine, Peking University Third
victims (84%) finally used wheelchairs as their transportation tool Hospital (China)
at home and community. Only 11.8% of them resumed independent
walking, who had imcompleted injury or neuro-level below L3. The Purpose: To report the effects of Brindley’s technique for the treat-
capacity of activity of daily living (ADL) was independent in 13.7%, ment of bladder dysfunction in spinal cord injury patient and the
partially independent in 80.4% and dependent in 5.9%. The major relative experimental study. Materials and Methods: To review
factors to affect independence were severe pain, unhealed fractures, worldwide experience about Brindley’s technique in the treatment
pressure sore, severe depression, and/or poor motivation. In addition, of bladder dysfunction in spinal cord injury patient. A patient with
most wheelchairs were not individualized and not suitable for local C7 spine cord completely injured was treated with Brindley’s tech-
environment. Community service of rehabilitation is limited due to nique in our department and was followed up 6 months late. For
medical insurance policy and limited trained people in rehabilitation experimental study: Male SD rats were selected to do microsurgical
medicine. Conclusion: Rehabilitation for SCI from Sichuan earth- anatomy and electrostimulation to study innervation effectiveness
quake was successful in institution settings. But long term strategy of the dorsal rootlets of L6–S1. Results: Patient could control their
of community based rehabilitation and nursing home for completed evacuation of urine with the system by themselves. The capacity of
quadriplegia patients are important. their bladder were increased to normal with residual volumes de-
creased under 50 ml and reflex incontinence abolished. Urinary tract
infection and autonomic dysreflexia were not occurred postsurgery.
0501B3 The dilatation of the upper urinary tract improved to normal. The
time of defecation reduced by used the system but reflex erection
BOWEL MANAGEMENT IN SCI PATIENTS: FROM
were not possible. In experimental study we found that there are
RESEARCH TO REAL WORLD different rootlets in the L6–S1 dorsal root which conduct bladder
Apichana Kovindha detrusor, external urethral sphincter and penis cavernous which
Department of Rehabilitation Medicine, Faculty of Medicine, Chi- could be distinguished by microanatomy and electrostimulation.
Conclusion: Brindley’s technique could help patient for control-
ang Mai University (Thailand)
ling evacuation of urine, increasing the capacity of his bladder,
Purpose: To present bowel management in spinal cord injured decreasing residual volumes, urinary tract infection and autonomic
patients. Materials and Methods: Literature review. Results: Most dysreflexia. From the experimental study we infer that For Brind-
of spinal cord injured (SCI) persons experience defecation as well ley’s technique, selective dorsal rootlets deafferentation could be
as urination dysfunction. Anticholinergic drugs and fluid intake chose to combine with preservation of rootlets which conduct penis,
restriction are prescribed to control neurogenic bladder overactivity so the reflex erection function could be restored and the patients’
and urinary incontinence; however, these inhibit bowel motility and quality of life could be improved.
cause more constipation, fecal impaction and fecal incontinence
(FI). The latter is a main barrier of SCI persons’ social participa-
tion. To overcome such barrier, proper bowel program and bowel 0501B5
care are necessary. Bowel program consists of cleansing the colon, NEUROGENIC BOWEL DYSFUNCTION IN
normalizing of stool consistency with adequate fluid and fiber in- PATIENTS WITH SPINAL CORD INJURY
takes, and stimulating evacuation of stool on a regularly scheduled
basis. Chemical stimulants, taken orally or suppository or enema, Chin-Wei Liu1, Chun-Chiang Huang1, Chia-Hsin Chen1,
are usually prescribed. Recent researches prove that digital rectal Tien-Wen Chen1, Ming-Chang Weng1, Chia-Ling Lee1,
stimulation facilitating bowel evacuation in SCI patients; abdomi- Mao-Hsiung Huang1
nal massage in a clockwise motion enhances bowel movement. In 1
Department of Physical Medicine and Rehabilitation, Kaohsi-
addition, anal stimulation with water stream was proved to shorten ung Medical University Hospital, Kaohsiung Medical University
time needed for bowel care in SCI persons. Transanal/transrectal (Taiwan)
irrigation with up to 1.5 L of tepid water improved constipation, FI,
and symptom-related quality of life much better than conservative Purpose: 1) To investigate the risk factors of severe neurogenic
bowel management in children and neurogenic bowel dysfunction; bowel dysfunction (NBD) in persons with spinal cord injury (SCI).

2) To assess the relationship between the severity of NBD and 0501E2

health-related quality of life in persons with SCI. 3) To evaluate INTERNATIONAL PERSPECTIVES OF SPINAL
that whether functional electrical stimulation cycling exercise
(FESCE) can provide benefits on SCI patients to improve their CORD INJURY – CLINICAL CARE
bowel condition. Materials and Methods: Totally, three question- Xianghu Xiong
naires were used, including the Neurogenic Bowel Dysfunction Burwood Spinal Unit, Burwood Hospital (New Zealand)
Score (NBDS), the Beck Depression Inventory second edition
(BDI-II), and the Short-Form 36-Item health survey (SF-36). Purpose: To summarise the contents and recommendations of
The demographic factors, injury-related factors, and psychologi- clinical care for patients with spinal cord injuries. Materials and
cal factors were recorded in order to evaluate any relationships Methods: International Perspectives of Spinal Cord Injury (IPSCI)
with severe NBD. In addition, the quality of life in patients with is a joint international report of WHO and International Spinal Cord
SCI would be measured and analyzed. Furthermore, FESCE was Society (ISCoS). This report will reflect all aspects of spinal cord
performed for patients with incomplete SCI. Patients received injury including global pictures of epidemiology, basic clinical
the FESCE thrice a week for 8 weeks. Each session lasted 30 min research, clinical care, as well as overall rehabilitation, commu-
with warm-up and cool-down periods of 3 min. Evaluations were nity reintegration and psychological and social implications. This
performed before and after 4 and 8 weeks of training. Results: presentation will focus on the clinical care section, outlining the
Nearly half of the persons with SCI suffered from moderate to state of the art as well as global practices of clinical management
severe degrees of neurogenic bowel dysfunction. Patients with for patients with spinal cord injuries. This chapter will cover acute
cervical injury, complete injury (ASIA A), or longer duration of management, triage, early emergency, ICU management, as well
injury (≥10 years) had higher risk of severe NBD. The severity as surgical interventions and comprehensive medical management
of NBD was associated with the physical component summary and cares. This section will also address the early stage of compre-
(PCS). However, there was no significant association between hensive rehabilitation including mobility, activities of daily living,
the severity of NBD and mental component summary (MCS). In psychosocial rehabilitation and medical management of complica-
addition, our results revealed that some participants became much tions. Results: There are diverse clinical approaches to the care of
better in their bowel function after FESCE training. The frequency patients with spinal cord injuries globally. Resources and systems of
of their constipation and fecal incontinence were both reduced. care are considerably different between the well resourced countries
Therefore, it will be good for us to do further exploration in this and the less resourced countries. Comprehensive and systematic
field. Conclusion: Level of lesion, completeness of cord injury, and approaches to clinical care of patients with spinal cord injury have
longer duration of injury (≥10 years) were independent factors of been recognised as life saving, minimising the complications and
severe NBD in persons with SCI. Moreover, the severity of NBD morbidities, as well as improving the quality of life for patients
is associated with health-related quality of life. FESCE might be with spinal cord injuries. Maintenance and further development
an adjuvant treatment for NBD resulting from SCI. of comprehensive spinal cares remain a challenge and the consist-
ency can be an issue globally. We are also facing new challenges
in health care for patients with spinal cord injuries, especially in
0501E1 relation to late onset health-related complications as well as age-
ing-related problems. Conclusion: There is a need to promote
THE HIGH-SENSITIVITY C-REACTIVE PROTEIN evidence-based medical treatments and rehabilitation guidelines.
IN PATIENTS WITH CHRONIC SPINAL CORD There is also a need for the less well resourced countries to catch up
INJURY with provision of a systematic health care system for patients with
spinal cord injuries. For the well resourced countries, maintenance
Chun-Chiang Huang1,2, Chin-Wei Liu2, Ming-Cheng and future development of best cares and rehabilitation are going
Weng1, Tien-Wen Chen1, Mao-Hsiung Huang2,3 to be ongoing challenges, together with managing new issues such
1
Department of Physical Medicine and Rehabilitation, Kaohsiung as ageing-related clinical problems.
Municipal Hsiao-Kang Hospital, 2Department of Physical Medicine
and Rehabilitation, Kaohsiung Medical University Hospital and
0501E3
3
School of Medicine, Kaohsiung Medical University (Taiwan)
PET IN ASSESSING BRAIN PLASTICITY AMONG
Purpose: To analyze high-sensitivity C-reactive protein (HsCRP)
PEOPLE WITH SPINAL CORD INJURY
level and study the correlation with insulin resistance and rest-
ing metabolic rate in patients with spinal cord injury. Materials Yen-Ho Wang
and Methods: Thirty-two subjects who had sustained spinal cord Department of Physical Medicine and Rehabilitation, National
injuries at least 6 months before enrollment. Circulating glucose, Taiwan University Hospital and National Taiwan University Col-
insulin, C-reactive protein levels were measured and resting lege of Medicine (Taiwan)
metabolic rate was evaluated by indirect calorimeter after 12-hour
fasting. The homeostasis model insulin resistance index was used Spinal cord injury (SCI) results in interruption of motor, sensory or
to evaluate insulin resistance. Insulin resistance, resting meta- autonomic function. It may damage descending or ascending corto-
bolic rate and C-reactive protein levels were compared between cospinal tracts. It leads to variable degrees of sensorimotor disability
complete/incomplete patients and between paraplegic/tetraplegic depending on the level and completeness/incompleteness of injury.
patients. The subjects were then divided into three groups (C- Somatosensory cortical plasticity or reorganization has been observed
reactive protein levels < 1, 1 to 3, > 3 mg/l) to compare insulin for these patients by functional magnetic resonance imaging and
resistance and resting metabolic rate. Results: fifteen (46.86%) transcranial magnetic stimulation. Nevertheless, the neuronal activity
subjects had C-reactive protein levels > 3 mg/l The C-reactive outcome of the plastic process is not well understood. 2-[18F]fluoro-
protein levels and insulin resistance did not significantly differ 2-deoxyglucose (18F-FDG) positron emission tomography (PET) has
between complete/incomplete or between paraplegic/tetraplegic been shown to be able to study regional cerebral glucose metabolism,
subjects. However, insulin resistance and resting metabolic rate which is reported to be a measurement of regional synaptic activity.
in the high C-reactive protein group ( > 3mg/l) significantly dif- The purpose of this study is to delineate the metabolic changes in the
fered from that of the other two groups. Conclusion: Most young regions of brain plasticity for patients with chronic SCI using18F-FDG
and middle-aged chronic spinal cord injury patients with high PET. In our study, brain 18F-FDG PET examination was performed
C-reactive protein levels, high insulin resistance and low resting for male patients with chronic SCI and age-matched male healthy
metabolic rate, and C-reactive protein levels may predict cardio- volunteers without history of previous neurologic or psychiatric
vascular disease in this group. illnesses. Our result demonstrates that the most common areas of

Spinal Cord Disorders 49
increased cerebral metabolic rate for glucose (CMRGlu) are cerebellar To evaluate the changes of physical abilities and quality of life of
vermis and internal capsule while the most common area of decreased patients with chronic complete SCI 6 months after discharge. During
CMRGlu was frontal cortex for chronic SCI patients. These CMRGlu this time, the study also explored incidence of complications and
changes may be the effects of brain plasticity after SCI. falls of these patients. Materials and Methods: The study recruited
10 chronic complete SCI with the mean age of 42.90 ± 14.02 year
and post-injury time 5.56 ± 4.80 years. Their physical abilities were
0501E4FP measured by using the Spinal cord independence measure (SCIM)
EFFECTS OF ELECTRICAL STIMULATION OF and quality of life of the patients was investigated by using the
WHOQOL-BREF-THAI. Incidences of complications and falls
PUDENDAL NERVES ON BLADDER VOIDING were assessed by using a questionnaire. Results: Physical abilities
FUNCTION IN THE SPINAL CORD INJURED RAT and quality of life of the patients were slightly increased (from
Yin-Tsong Lin1, Te-Son Kuo1,3,4, Chih-Wei Peng2, Shih- 51.80 ± 16.04 to 52.22 ± 17.42 and from 86.90 ± 13.65 to 87.70 ± 14.38
Ching Chen2 scores for the SCIM and WHOQOL respectively). Importantly, all
of them experienced complications (pressure sore, urinary tract
1
Graduate Institute of Biomedical Electronics and Bioinformatics, infection, and pain) which 4 of them had to rehospitalization. In ad-
National Taiwan University, 2Department of Physical Medicine dition, 5 of them fall at least once (1–8 times). Conclusion: Physical
and Rehabilitation, Taipei Medical University and Hospital, 3De- abilities and quality of life of patients with chronic complete SCI 6
partment of Electrical Engineering, National Taiwan University, months after discharge were nearly unchanged. However, they had
4
Institute of Biomedical Engineering, National Taiwan University high incidences of complications and falls that required treatments.
(Taiwan) The results suggested that the follow-up time should be longer and
should include the details of socioeconomic and psychological factors
Purpose: Spinal cord injured (SCI) patients often accompanied in order to thoroughly report effects of chronic SCI.
detrusor-EUS dyssynergia (DSD) have low efficiency of micturition
function, incomplete voiding, and high risk of urinary tract infec-
tion. Long-term period under this situation, it might cause ureteral 0501E6FP
edema, renal damage, and even renal failure. In our study, micro-
cuff electrodes were placed on the sensory and motor branches AN OVERVIEW OF THE STEM CELLS IN THE
of pudendal nerves (PUN) for the electrical stimulations study in MANAGEMENT OF SPINAL CORD INJURY
chronic SCI rats. Functional electrical stimulation (FES) and high Farooq A. Rathore1, Ali Raza1, Tayyab Rathore2
frequency blocking (HFB) currents were applied on PUN, sensory
and motor branch respectively, to determine if PUN stimulation
1
Spinal Rehabilitation Unit, Armed Forces Institute of Rehabilita-
can improve the voiding efficiency in the SCI rat. Materials and tion Medicine and 2Medical and Regulatory Affairs, Novartis (Pvt)
Methods: Female Sprague-Dawley rats (n = 8) were used in this Ltd (Pakistan)
experiment. After complete transection at T9–T10 of the spinal Purpose: To present an overview of the latest trends in the use of stem
cord, the rats were treated with antibiotic for 7 days (ampicillin, im., cells for the repair of the injured spinal cord. Materials and Methods:
150mg/kg). After 6 weeks of recovery, the SCI rats were equally A literature search was carried out on Pubmed, Science direct, Spring-
divided into two groups. One group was used for FES study, and erlink, Ovid and Google scholar using Spinal cord injury, stem cells,
the other for HFB studies. Voiding function was calculated via advances, management, paraplegia, quadriplegia as the Key words.
cystometrpgrams (CMG) measurement (0.12 and 0.6 ml/min, infu- Only English language articles were retrieved and analyzed. Because
sion rates) to determine the stimulation effect. Results: In our study, the purpose of this work was essentially descriptive, no attempt was
low amplitude (~0.03 mA) of electrical stimulation delivered on the made to weight the quality of the articles that were identified. The
sensory branch of the pudendal nerve can significantly increase the literature comprised case reports, case series, clinical experience,
voiding efficiency from 10% to 30% in SCI animals. However, high original research articles, expert opinion, and literature reviews. Re-
amplitude current (~0.2 mA) stimulation inhibited the contraction of sults: Spinal cord injury is a devastating neurological injury with little
the bladder. On the other hand, high frequency blocking (HFB, 10 chances of full recovery, especially in complete lesions. Attempts to
kHz or 20 kHz) applied on the motor branch of the pudendal nerve enhance recovery after spinal cord injury by stem cell transplant are
can relax the EUS. After applying HFB on the motor branch, the a promising technique widely used in the animal models. Stem cells
CMG would keep normal pattern. Therefore, it seems like HFB did have been widely used in the animal models of spinal cord injury.
not cause any significant damage on nerve tissue. Conclusion: In There is evidence for some degree of recovery from spinal-cord
this study, we proved FES combined with high frequency blocking injury in animals after experimental cell transplantation alone, or in
technique can improve the bladder voiding function in chronic SCI combination with other agents. However there are there are important
rats. It is expected that our results may provide a new approach to differences between the animal and human spinal cord which should
restore efficient bladder emptying in persons with SCI. be considered before reaching a conclusion. Conclusion: Although
the exact mechanisms are not fully known a large number of spinal
0501E5FP cord injury patients have already received transplants of stem cells and
other cell types. A rigorous scientific analysis failed to demonstrate
CHANGES OF PHYSICAL ABILITIES, QUALITY any benefit of stem cell transplant in human spinal cords in terms
OF LIFE, INCIDENCES OF COMPLICATIONS AND of improved functional outcome. A stem cell-based transplantation
FALLS IN PATIENTS WITH CHRONIC SPINAL strategy that proves successful in human models, where mechanisms
are understood and functional outcome is improved still faces practical
CORD INJURY 6 MONTHS AFTER DISCHARGE: A
challenges. However this is an exciting area of research in regenera-
PRELIMINARY STUDY tive medicine which holds promise in the future.
Jiraporn Wannapakhe1, Sugalya Amatachaya1, Wantana
Siritaratiwa1, Preeda Arayawichanon2 0501E7FP
1
School of Physical Therapy, Faculty of Associated Medical Sciences
and 2Rehabilitation Medicine, Faculty of Medicine (Thailand) AN INITIAL STUDY ON BRAIN FMRI OF SPINAL
CORD INJURY PATIENTS
Introduction: Spinal cord injury (SCI) restricts patient’s performance
that results in the patients facing with a high risk of complications Lijian Ao, Liqing Yao, Feifei Yang, Yongmei Li, Qiu
and falls. With inappropriate environmental conditions, patients may Luo, Jun Li, Ying Wu
have to spend most time after discharge in beds or houses which Department of Rehabilitation, the Second Affiliated Hospital of
may affect their levels of independence and quality of life. Purpose: Kunming College (China)

Purpose: To obtain the brain function imaging changes in patients rehabilitation unit. In non-traumatic spinal cord dysfunction, it is dif-
with spinal cord injury ,to explore the brain mechanism of nerve ficult to be certain on the dates when the injury occurred because most
function recovery. Materials and Methods: Collected 6 patients in symptoms are slowly progressive and patients’ recall may not be ac-
line with international diagnostic criteria for spinal cord injury and curate. Also, in non-traumatic cases that involves tumors or infection;
6 cases of healthy volunteers as controls group at Rehabilitation it is difficult to agree on what constitutes vertebral injury. Even when
department of the Second Affiliated Hospital of Kunming Medical there is no fracture or dislocation, the destruction of vertebral bones
College hospital in December 2006–June 2008. Groups are accepted by tumor or infection can be extensive leading to spinal instability.
to the same task (passive lift his left leg, passive alternating lift his In our setting, we would like to collect additional information such
legs, imagine lift his left leg, imagine walking), Samples were MRI as routine administration of oxygen, CPAP and tracheostomy.All the
scanned brain disease exclusion. using GE1.5T MRI scanner for All initial neurological examinations according to the American Spinal
Subjects axial T1WI and fMRI scans. Using statistical parametric Injury Association (ASIA) guidelines were done after 72 hours. At
mapping (SPM2) software for all subjects of the fMRI data process- present, only rehabilitation doctors are trained to do neurological
ing analysis. To obtain brain activation maps superimposed on the examination according to the ASIA guidelines. Conclusion: Despite
Talairach standard three-dimensional template “Record activated these difficulties, the International SCI Core Data set has made our
areas in the scope and intensity of activation,” Using SPSS13.0 data collection for SCI patients more systematic. We will continue
for Windows software between two groups activation of scope and to use it to develop the SCI database of this hospital. Training the
intensity of brain functional area t-test to compare Different levels Rehabilitation Medicine Trainees to use this data set will facilitate
and positions between the similarities and differences the brain development of the country’s SCI database in the future.
activated regions. Results: Test group had 3 cases A grade and 3
cases B grade; Patients compared with healthy control group differ-
ences in brain activation; The patient’s passive pairs of lower limb 0501E9FP
movement and imagination pairs of lower extremity motor brain
regions no differences in expression. In the imagined movement QUANTITATIVE ANALYSIS OF BLADDER
compared with the patients and healthy people are different brain COMPLIANCE IN SUBJECTS WITH NEUROGENIC
areas activated; different levels of spinal cord injury difference BLADDER VOIDING DYSFUNCTION AFTER
between the activation of brain regions and different planes of the SPINAL CORD INJURY
spinal cord injury no differences in brain activation. Conclusion:
spinal cord injury patients and the normal acompared with activation Amy I-Hui Lin1, Yu-Hui Huang1,2, Liu-Ing Bih1,2, Su-Ju
of different brain regions. In the same movement and the imagined Tsai1,2, Tsung-Ho Ying3
movement activated more; showed spinal cord injury patients had 1
Department of Physical Medicine & Rehabilitation, Chung Shan
brain compensatory mechanisms, varying degrees of spinal cord Medical University Hospital, 2Department of Physical Medicine &
injury compensation area may be different. Rehabilitation, School of Medicine, Chung Shan Medical University
and 3Department of Obstetrics and Gynecology, Chung Shan Medi-
0501E8FP cal University Hospital (Taiwan)
THE INTERNATIONAL SPINAL CORD INJURY Purpose: To provide reference ranges for variability in bladder com-
CORE DATA SET: EXPERIENCE OF A NON- pliance among patients with neurogenic bladder voiding dysfunction
after spinal cord injury (SCI). Materials and Methods: First, a total of
MODEL SYSTEM HOSPITAL
twenty-four healthy volunteers, twelve men and twelve women with
Julia Patrick Engkasan, Tze Yang Chung mean age of 25.2 were enrolled in this study. During the standardized
University of Malaya (Malaysia) procedures of urodynamic study, pairs of data on bladder volume
and detrusor pressure were simultaneously recorded at five infusion
Purpose: To describe our experience of using the International Spinal stages, including at the beginning of examination, infusing at 100 ml,
Cord Injury (SCI) Core Data Set in a non-model system hospital. infusing up to half of maximum bladder capacity, infusing at initial
Materials and Methods: Information from all SCI patients seen in detrusor contraction, and infusing at maximum bladder capacity. The
an acute tertiary hospital was collected using the International SCI calculation of bladder compliance was based on a theoretical equation
Core Data Set for a period of 3 months. The International SCI Core (DV/DP). Because there is no standard, variability ranges for mean,
Data Set consists of 24 variables including basic demographic char- median, interquartile range, and quartile coefficient of dispersion
acteristics, dates of admission and discharge from initial acute and were calculated. Therefore, sixty-one SCI patients (mean age, 44.3
rehabilitation care, cause of injury, place of discharge, presence of years; mean postinjury duration, 5.5 months) also received the same
vertebral fractures and associated injuries, occurrence of spinal sur- urodynamic procedures for calculation of bladder compliance as
gery, and measures of neurological and ventilator status. SCI patients described above. According to the patterns of detrusor and sphincter
who were managed by the Spinal Rehabilitation team in the wards function, they were classified into two groups: upper motor neuron
and those attending the Spinal Rehabilitation clinic were included. neurogenic bladder (UMN-NB) in 39 patients and lower motor neuron
In-patient data was collected by Master of Rehabilitation Medicine neurogenic bladder (LMN-NB) in the remaining 22 patients. Results:
Trainees during their Spinal Rehabilitation rotation while the out- The results with the least varied range were obtained with the fol-
patient data was collected by Rehabilitation Physicians by reviewing lowing method: DV is the capacity change between the beginning of
patients’ folders from the clinic. All of them read the manual and went examination and the initial detrusor contraction and DP is the detru-
through the training cases. Results: 170 patients (19.4% in-patients, sor pressure change between the beginning of examination and the
80.6% out-patients) were included in this study. The main limitation initial detrusor contraction. These values and ranges of variability are
noted when reviewing the medical folders is insufficient data. The as follows in healthy volunteers and UMN-NB groups: mean value,
missing information was mostly the dates of injury, acute admission 61 vs. 48; median value, 61 vs. 39; interquartile range, 53–68 vs.
and final inpatient discharge, total days hospitalization, presence of 34–63; quartile coefficient of dispersion, 0.11 vs. 0.3. Whereas there
vertebral injury or associated injury, occurrence of spinal surgery and is no obvious detrusor activity on urodynamics in LMN-NB group,
neurological examination findings. The date of final discharge after the least varied range was obtained with another method: DV is the
completion of rehabilitation does not necessarily reflect the length capacity change between the beginning of examination and the half
of hospital stay and duration of rehabilitation process. Some patients of maximum bladder capacity and DP is the detrusor pressure change
were referred to the Spinal Rehabilitation team months to years after between the beginning of examination and the half of maximum blad-
the initial injury and were readmitted in our unit for active rehabilita- der capacity. Conclusion: The measurements of bladder compliance
tion process. These patients are typically from out of town and did not have variability in different urodynamic studies. Knowing the least
receive in-patient rehabilitation. In this situation, another column is varied range can be helpful for assessment of bladder compliance in
added to record the admission and discharged dates from our spinal SCI patients with neurogenic bladder voiding dysfunction.

Assessment, Evaluation and Diagnosis 51
Assessment, Evaluation and Diagnosis lateral and medial femoral condyles, the grade included ranged from
grade 1 to 6 in US. Cartiage thickness in long-distance ruuner on the
femroal condyles as a median of 2.8 ± 0.2 mm were much thicker
0501I1FP than control group. No knee showed US Baker’s cyst. No adverse
INNOVATION IN ASSESSING BALANCE long-term consequences were observed in active runners. Conclusion:
Non-physiological maximal loads secondary to the marathon race
FUNCTION IN PATIENTS WITH STROKE: A SET
do not cause any permanent damage in the internal structures of the
OF FUNCTIONAL-HIERARCHY SHORT FORMS knee joint in individuals without significant pre-existing damage. A
AND COMPUTERIZED ADAPTIVE TEST disposition for premature arthrosis was not registered in the popula-
tion investigated. A protective value of long distance running on the
Wen-Hsuan Hou1, Jyun-Hong Chen2, Ching-Lin Hsieh3
internal structures of the knee joint is discussed.
1
Department of Physical Medicine and Rehabilitation, E-Da hospital
& I-Shou university, 2Department of Psychology, National Chung
Cheng University and 3School of Occupational Therapy, College 0501I3FP
of Medicine, National Taiwan University (Taiwan) INFLUENCE OF CHIN-TUCK MANEUVER
Purpose: We developed a computerized adaptive testing (CAT) ON TEMPORAL AND KINEMATIC
system and hierarchical short forms (i.e., sitting, standing, and step- CHARACTERISTICS IN NORMAL SWALLOWING
ping) for assessing balance function in an efficient, reliable, and valid
fashion for assessing balance function of stroke patients in different Ja-Ho Leigh, Byung-Mo Oh, Keewon Kim, Tai Ryoon
clinical settings. Materials and Methods: The study consisted of three Han
parts. Firstly, 764 patients were administered for a newly developed Seoul National University College of Medicine (Republic of Ko-
balance item pool (41 items) on the basis of pre-defined balance rea)
concepts, expert opinions, and field testing. We fit an item response
theory model and a simulation study to determine the remaining 34 Purpose: The purpose of this study is to investigate kinematically
items with sufficient reliability and efficiency for the item bank of influences of the thraputic maneuver, such as chin tuck, upon the
the Balance CAT. Secondly, we constructed 6 sets of 6-item balance movements of the hyoid bone and the epiglottis, known as an important
short forms for each hierarchical balance stage on the basis of previous airway protective mechanism, in healthy subjects and to suggest the
developed 34-item bank of Balance CAT. A simulation study was also standards of effective maneuver. Materials and Methods: A total of 25
used to determine the reliability and the optimal set of short forms healthy subjects were enrolled in this study. Subjects swallowed 10 ml
named the Hierarchical Balance Short Forms (HBSF). Finally, we of diluted barium solution in a neutral, chin down and chin tuck posture,
tested the CAT, HBSF, and Berg balance scale (BBS) on 85 patients which distinguished by the effort to attach the chin to chest. Changes
to determine the concurrent validity and time needed for administra- of initial position and movements of the fluid bolus, hyoid bone, vocal
tion of both measures. Results: Seven items did not meet the model’s cords and epiglottis analyzed two-demensionally using videofluoro-
expectations and 34 items formed the item bank of the CAT. We set scopic images. Both temporal and spatial variables were computed
2 stopping rules (i.e., reliability coefficient > 0.9 or ≤ 6 items) for by MATLAB version 7.5.0. These variables were compared among
the CAT. The simulation studies showed CAT and 3 short forms of postures. Results: The distance from chin to neck was distinctively
HBSF had an average reliability of 0.94~0.95. The scores obtained shorter in chin tuck than others (p < 0.01). There were significant differ-
from the CAT and 3 short forms of HBSF were all closely associated ences in the maximal horizontal displacement and maximal horizontal
with those of the full-item set (Pearson r = 0.91~0.98). The scores of velocity of the hyoid bone between chin tuck posture (10.1 ± 4.1 mm,
the CAT and 3 short forms of HBSF were not only highly correlated 43.9 ± 27.6 mm/s) and the neutral (12.9 ± 2.5 mm, 76.5 ± 51.3 mm/s)
(Pearson r = 0.80~0.91) but also greatly reduction the average admin- or chin down posture (12.1 ± 2.8 mm, 59.5 ± 47.0 mm/s; p < 0.01).
istration time (18 and 40%, respectively) with BBS. Conclusion: We When chin tuck was applied, the distance from epiglottic base to
concluded that both Balance CAT and HBSF tailed to hierarchical posterior wall also significantly reduced (18.6 ± 2.9 mm vs. 20.5 ± 2.4
balance ability of stroke patients are innovated, efficient, reliable and mm, p < 0.01). The epiglottic base displaced further vertically in chin
valid in the application of different clinical settings. tuck (14.5 ± 4.4 mm vs. 11.7 ± 3.5 mm, p < 0.05) than neutral posture.
Velocity of fluid bolus, displacement of vocal cords and the maximal
angle of the epiglottic downward rotation were equivocal. Conclu-
0501I2FP sion: These results substantiate alleged effects of chin tuck maneuver
kinematically, which suggest effects of chin tuck posture to restrict the
DOES MARATHON RUNNING CAUSE CHRONIC
horizontal movement of hyoid bone and to facilitate the posterior and
DEGENERATIVE LESIONS OF THE KNEE? vertical movement of epiglottic base. Between chin down and chin
ANULTRASONOGRAPHIC STUDY IN LONG- tuck posture, only exact chin tuck posture can derive the significant
DISTANCE RUNNERS change on spatial and temporal characteristics.
Min-Hsin Lai, Tsung-Ying Li, Heng-Yi Chu, Shang-Lin
Chiang, Shin-Tsu Chang 0501I4FP
Department of Physical Medicine and Rehabilitation, Tri-Service NEW PORTABLE SYSTEM FOR COMPREHENSIVE
General Hospital, School of Medicine (Taiwan) MEASUREMENT OF SPASTICITY
Purpose: To investigate the findings in ultrasonographic studies of ENCOMPASSING ELECTROPHYSIOLOGIC,
the knee in recreational marathon runners and determine whether KINEMATIC AND BIOMECHANICAL ASPECTS IN
long-distance running results in long-term damage of knee joints. STROKE PATIENTS
Materials and Methods: Thirty non-professional marathon runners
and 30 asymptomatic sedentary subjects not performing long-distance Jeong Hwan Seo1, Myoung Hwan Ko1, Keo Sik Kim2,
running as controls were invited to participate in an ultrasonography Chul Gyu Song2
investigation concerning their knee joints. We evaluated lesions of 1
Chonbuk National University Medical College and 2Chonbuk
menisci and femoral condylar cartilage (six-point scale), tendons National University Division of Electronics and Information Engi-
(three-point scale), ligaments (three-point scale), joint effusion, and neering (Republic of Korea)
additional findings. Results: Five of the 35 subjects were excluded
by our exclusion criteria. We analyzed the remaining 30 marathon Purpose: To introduce a new hand-driven portable system for
runners and 30 healthy subjects. US findings in long distance run- measuring the spasticity comprehensively encompassing electro-
ners’ knees were effusion in 8 knees. While mixing the data from physiologic, kinematic and biomechanical aspects and to test the

availability of the new portable system for the spasticity measure- 0501I6FP
ment. Materials and Methods: A new device was designed in order FUNCTIONAL ASSESSMENT OF BALANCE IN
to measure the spasticity comprehensively including many aspects
such as the joint angle, the angular velocity, the electromyographic EARLY STAGES OF MULTIPLE SCLEROSIS
signals, and force (torque). Human hand was used as a driving force Raabeae Aryan1, Mohammad Jafar Shaterzadeh
to make this device small and simple. Spasticity was evaluated in Yazdi1, Shahin Goharpey1, Ali Asghar Arastoo1, Naser
the elbow of 15 stroke patients using a new portable system and Sharafoddinzadeh2
the Modified Ashworth scale (MAS). Using this new device one
set of 10 passive movements was conducted at 5 different angular
1
Jondishapour University of Medical Sciences, Faculty of Rehabili-
velocities such as 60, 90, 120, 150, and 180 degree/sec. During tation Sciences and 2Jondishapour University of Medical Sciences,
the passive movements, the surface electromyographic data were Department of Neurology (Islamic Republic of Iran)
collected from the biceps and triceps muscles. The data of joint Purpose: The aim of this study was to assess balance performance
angle and angular velocities were recorded via electric goniometer. in minimally impaired multiple sclerosis (MS) patients (Expanded
The force (torque) on the wrist was recorded by the 2 force sen- Disability Status Scale 0–2) and to clarify differences in ability of
sors at wrist. Velocity-dependent dynamic stretch reflex thresholds balance between this group of patients and healthy subjects. Materials
(DSRTs) were recorded. These values were used to compute tonic and Methods: Using four common functional balance tests (Berg Bal-
stretch reflex threshold (TSRT). The correlations among TSRT, ance Scale, Timed Up & Go test, Modified Romberg test and Lateral
area of force and the MAS were investigated. Results: MAS grade Functional Reach test), 20 minimally impaired multiple sclerosis
was distributed from 1 to 2 grade (grade 1: 40.0%, grade 1+: patients compared to 20 healthy subjects matching for age, gender,
33.3%, grade 2: 26.7%). TSRT values were ranged from 116.6 to weight and height. Results: Statistically significant differences were
134.6. There were strong correlations between the MAS grades observed in all functional balance tests (p < 0.001). Multiple sclerosis
and the parameters of this new system: MAS and TSRT (r = 0.708, group had poor balance performance compared to control group.
p = 0.003), MAS and area of torque (r = 0.669, p = 0.006), area of Conclusion: Our results showed that multiple sclerosis patients who
torque and TSRT(r = 0.686, p = 0.005). The multiple regression were in early stages of the disease suffered from improper balance
equation, combining TSRT and area of torque, was significant control even they had no falls in their daily mobility.
(F = 13.08, p = 0.003) with adjusted R2 explaining 70.7% of the
variability of MAS grade. Conclusion: The new system is a port-
able, comprehensive hand-driven spasticity-measurement system. 0501I7FP
We showed that this new system can produce objective and com-
prehensive data in the ususal clinical settings for the measuremet DEVELOPING WHO ICF CORE SETS FOR
of the spasticity. We suggest that this new system can be used for SUBACUTE STAGE OF SPINAL CORD INJURY IN
the spasticity measuremet, objectively and easily. TAIWAN
Chin-Wen Wu1, Tsan-Hon Liou1, Yen-Ho Wang2, Wen-
Ta Chiu3
0501I5FP 1
Department of Rehabilitation, Taipei Medical University – Shuang
TECHNICAL VALIDITY AND RELIABILITY OF Ho Hospital, 2Department of Physical Medicine & Rehabilitation,
OBJECTIVE MEASUREMENT IN SWALLOWING National Taiwan University Hospital and 3Institute of Injury Preven-
KINEMATIC ANALYSIS tion & Control, Taipei Medical University (Taiwan)
Seong Min Chun, You Sun Min, Byung-Mo Oh, Tai Purpose: The purpose of this study is to report the core sets of suba-
Ryoon Han cute spinal cord injury (SCI) patients with International Classification
of Functioning, Disability, and Health (ICF) in Taiwan. Materials and
Department of Rehabilitation Medicine Seoul National University Methods: The study took Comprehensive ICF Core Sets as reference
College of Medicine (Republic of Korea) and there were 118 second-level ICF categories related to subacute
Purpose: To assess the technical validity, inter-rater and intra-rater SCI. Delphi technique was applied to rank and the study tried to
reliability of objective measurement in kinematic analysis of swal- narrow the range of these categories. Results: 24 health experts in
lowing. Materials and Methods: Two well-trained investigators Taiwan including neurosurgeons, rehabilitation physicians, therapist
participated in a reliability study, and one of them in a validity and psychologists answered questionnaires in three rounds. Finally the
study. To assess technical validity, we developed an instrumental most important ICF categories emerged and the core sets of subacute
model of linear and rotational movement representing physiologic SCI in Taiwan were made. Conclusion: This is the first study using
movement of the hyoid and epiglottis, respectively. Still images ICF concept to identify subacte SCI core sets in Taiwan. Further
of 6 objects and sixteen movie files of the model with different evaluation is necessary for island-wide application.
velocities were analyzed. The correlation and Bland-Altman
analysis were used. Ten videofluoroscopic swallowing studies 0501I8FP
and their copies with different file names were also analysed to
evaluate reliability. The intraclass correlation coefficient analysis THE PROGNOSTIC ROLE OF THE MODIFIED
was performed. Results: The correlation between measured and RANKIN SCALE ON SURVIVAL IN PATIENTS
true values was significant (p < 0.001). Using Bland-Altman plot, WITH STROKE
the 95% confidence interval of agreement between measured and
true values ranged 0.1050~0.9632, -0.7324~1.6776 mm/sec, and Hsi-Ting Chiu1,2, Yen-Ho Wang1, Shin-Liang Pan1,
-3.3441~6.1359 degree/sec for still image, linear and angular Jiann-Shing Jeng3
velocity, respectively. Intraclass coefficient analysis revealed 1
high intra-rater reliability with all measured values in both raters Taiwan University Hospital, 2Department of Physical Medicine and
(0.861–0.996 and 0.918–0.996 for rater 1 and 2). As for the inter- Rehabilitation, Keelung Hospital, Department of Health, Executive
rater reliability, all variables except two (0.550 for the maximal Yuan and 3Department of Neurology, National Taiwan University
angle of epiglottic rotation, and 0.752 for the maximal velocity Hospital (Taiwan)
of the hyoid) showed high intraclass correlation coefficient. Con-
clusion: Kinematic variables measured by swallowing motion Purpose: To evaluate the prognostic value of the modified Rankin
analysis shows not only high intra- and inter-rater reliabilities, Scale (mRS) score on the survival in patients with stroke. Materials
but also high technical validity. and Methods: A total of 664 stroke patients who had survived for

Pain Management: Part 1 53
more than 3 months after stroke were recruited from a university The most commonly injured muscles in the human body are the
hospital during January 2006 to December 2007. The subjects were extensor and flexors of the knee, the ankle plantar flexors, and
divided into two groups according to the mRS scores measured at the biceps. The mechanisms of injury may include direct trauma
three months after stroke: Low mRS (LRS) group for mRS score with contusion, repetitive eccentric muscle actions, stretching
0–3, and high mRS (HRS) group for mRS score 4–5. The effects of the muscle at rest, and stretching of an active muscle. These
of the mRS and other clinical correlates on the survival were ana- injuries are accompanied by clinical symptoms, such as pain of
lyzed by using the Cox regression model. Results: The HRS group sudden onset and functional loss. Physical signs include swell-
had significant higher mortality rates in comparison with the LRS ing, ecchymoses, tumor formation, and palpation defects. Muscle
group (hazard ratio = 7.36, 95% CI: 3.59,15.10). Subjects with past injuries are classified based on the amount of tissue damage into
history of hypercholesterolemia had lower mortality rates (hazard first, second, and third degree injuries. The latter is the most ex-
ratio = 0.40, 95% CI: 0.18, 0.91). As for age, elder subjects tended to tensive. Treatment and rehabilitation interventions vary according
have higher mortality rates (hazard ratio = 1.02, 95% CI: 0.99, 1.05). to the degree of injury. Rehabilitation should begin immediately
Conclusion: The 3-month mRS score was an independent favorable after the injury, with the use of R (rest), I (ice), C (compression),
prognostic factor for the survival in patients with stroke. This finding and E (elevation) therapy. Healing of muscle injuries includes
highlights the potential benefit of rehabilitation to the survival of inflammation and degeneration of damaged tissues, regenera-
stroke patients through improving their functional performance. tion, and fibrosis. More research is needed to identify agents that
may limit the fibrotic response to injury. The second phase of the
rehabilitation process should include properly prescribed exer-
0501I9FP cises to develop flexibility, muscle strength, and endurance. In
EARLY CHANGES OF KNEE JOINT MOVEMENT the case of strengthening, exercises should activate specifically
IN PEOPLE WITH KNEE OSTEOARTHRITIS those muscles that must be strengthened. Exercise prescription
should be specific and include the type, intensity, duration, and
DURING GAIT; A MOTION ANALYTIC STUDY frequency of the exercise. Prevention of future injuries includes
WITH POINT CLUSTER TECHNIQUE maintenance of a conditioning program, modification of training,
Masami Akai1, Kenji Naito1,2, Yasuharu Nagano2, and correction of technical errors. Rehabilitation should take
into account not only the physical healing of the injury but also
Hirofumi Ida3, Kimitaka Nakazawa1, Toru Fukubayashi2 psychological recovery.
1
Department of Rehabilitation for Movement Functions, 2Faculty of
Sports Sciences and 3Kanagawa Institute of Technology (Japan)
0501C2
Purpose: 1) To assess the early kinematical changes of the knee
joint during gait in patients with knee osteoarthritis, comparing CURRENT CONCEPTS IN MUSCULOSKELTAL
with young normal subjects. 2) To examine the responsiveness of PAIN, MOBILITY AND GENDER
such changes to interventional therapeutic exercise. Materials and
Methods: 1) Comparative study with 19 healthy people and 50 Mark A. Young1,2
patients with knee osteoarthritis. Three-dimensional gait analysis
1
Workforce & Technology Center, State of Maryland, Division
was conducted applying the “point cluster technique” which was of Rehabilitation, Department of Education and 2Department of
an accurate and extensible approach for estimation of bone motion. Physical Medicine and Rehabilitation (PM&R), The Maryland
OA patients were assessed by X-rays grading and divided into Rehabilitation Center (United States)
subgroups. 2) Comparative study between the exercise and control
groups among the above 50 knee OA patients. They performed 12 Gender is a critical factor in musculoskeltal pain prevention, diag-
weeks muscle strengthening program mainly around hip and knee nosis and treatment. Pathologic gait patterns may exert a negative
joint, and gait pattern was assessed before and after the interven- influence on pain syndromes involving the joints, muscles, bones,
tion. Results: In the mild OA subgroup, there were; 1) inhibition of ligaments, spinal structures and soft tissue. Early identification of
physiological external rotation of the knee joint and 2) occurrence dysmorphic gait in women and men can help to avert pain synrome
of sudden abduction or adduction (i.e., lateral instability), early in onset and progression. The application of technologic (assistive
the stance phase. In advanced OA subgroup, there was a specific technology) diagnostic solutions can improve theraputic outcomes.
adduction displacement covering the whole stance phase. Those This presentation will address the following fundamental objec-
changes appeared to respond to the interventional exercise. Exercise tives: 1) Provide a definition of pain; 2) Discuss gender differences
therapy had an effect on altering abnormal knee kinematics during & pain effects; 3) Review the most common musculoskeltal pain
gait. Conclusion: We found the following two characteristic changes conditions in women; 4) Explore the link between the Foot and
in knee joint movement; 1) inhibition of physiological rotation of the Low Back Pain Syndromes; 5) Understand the relationship between
tibia in horizontal plane at the early half stage of stance phase, and altered foot biomechanics and musculoskeltal pain pathogenesis
2) occurrence of sudden instability in the frontal plane early in the in men and women; 6) Elaborate on technologic Solutions for
stance phase. Those early changes could respond to the therapeutic evaluating pathologoc gait’s impact on the musculoskeltal system;
exercise which targeted the muscles around the hip joint. 7) Review common gender specific complementary treatments of
musculoskeltal pain and gait alterations. This oral presentation will
provide a Comprehensive overview of the literature pertaining to
Gender and Pain and the impact on gait abnormalities. Theraputic
Pain Management: Part 1 strategies including complementary and traditional modalities will
be reviewed.
0501C1
REHABILITATION OF MUSCLE INJURIES IN 0501C3
SPORTS PHANTOM PAIN IN AMPUTEES
Walter R. Frontera Parviz Mozhgani
University of Puerto Rico, School of Medicine (Puerto Rico) Iran-Helal institute of applied sciences affiliated to Red Crescent
Society Of Iran (Islamic Republic of Iran)
Muscle injuries represent one of the top five types of injuries
in sports. Several risk factors have been identified including Patients with limb loss are at risk of developing pain from different
inadequate training and warm-up, previous injuries followed by sources, but obviously one of the most “unpleasant sensory and
inadequate rehabilitation, fatigue, and lack of joint flexibility. emotional experiences” is that felt in the limb that no longer exists.

This phenomenon known as Phantom Limb Pain (PLP) has been a 0501C5
matter of controversy in almost all its aspects since first described EFFECT OF NEUROMUSCULAR BLOCKING
5 centuries ago. Although some studies have estimated it as an
uncommon condition in terms of chronic pain, current data reports AGENT ON THE SPONTANEOUS ELECTRICAL
its incidence as high as 85% though a wide range of discrepancy is ACTIVITY IN A MYOFASCIAL TRIGGER SPOT
seen in the literature. Despite the proposed explanations, the exact OF RABBIT SKELETAL MUSCLE
cause is unknown. Pathophysiological theories focus on brain,
spinal cord or periphery. Since there is no consensus on the sole Shu-Min Chen1, Ta-Shen Kuan1, Wei-Chang Yen1, Jeng-
causality, for managing purposes it would be better to consider Feng Yang2, Chang-Zern Hong3, Jo-Tong Chen1
PLP as a multifactorial disorder. There are also some factors and 1
Department of Physical Medicine and Rehabilitation,National
conditions known to modulate or increase the risk of phantom Cheng-Kung University Hospital, 2 Department of Physical
pain perception. Although in a significant proportion of patients Therapy,National Cheng-Kung University Hospital and 3Depart-
the intensity of pain is graded as severe, many sufferers seem ment of Physical Therapy, Hung-Kuang University (Taiwan)
to be reluctant to discuss it with their healthcare professionals,
so PLP may clinically remain unrecognized. Diagnosis requires Purpose: This study is designed to investigate the effect of mivacu-
awareness and specific inquiries. A great variety of treatments try rium, a new nondepolarizing diester neuromuscular blocking agent,
to prevent the occurrence of PLP with different rates of success. on the prevalence of spontaneous electric activity (SEA) recorded
Pain management initiates with a thorough assessment to charac- from the myofascial trigger spot (MTrS) in rabbit skeletal muscle
terize it according to type, frequency, intensity, duration and its which is equivalent to human myofascial trigger point (MTrP).
effect in terms of phantom pain disability. There is no definitive Materials and Methods: Eighteen adult New Zealand rabbits
treatment ensuring pain alleviation in all cases. Many researches equally and randomly divided into two groups. Mivacurium was
have offered different therapeutic approaches and ongoing stud- injected intravenously at a concentration of 0.15 mg/kg followed
ies continue to introduce new options. Nevertheless acquiring by flushing with normal saline for the animals in the experimental
the best results necessitates an individualized multidisciplinary group. Same amount of saline was injected intravenously for the
approach. This paper briefly reviews the epidemiology, etiology animals in the control group. Prevalence of spontaneous electrical
and management of phantom limb pain in amputees. activity (SEA) recorded from the MTrS region in the biceps femoris
muscle was assessed before, immediately after, and 30 min after the
intravenous injection for all animals in both groups. Results: The
0501C4 SEA prevalence decreased from 40.3% to 4.6% after Mivacurium
ACUPUNCTURE AND MYOFASCIAL TRIGGER injection (p < 0.001). However, it recovered up to 33.9% about
30–40 min after injection. For group comparison, there were no
POINTS – HUMAN STUDY significant differences in SEA prevalence before and 30 min after
Li-Wei Chou1,2,3, Yueh-Ling Hsieh3,4, Chang-Zern Hong4 injection between the experimental and control groups. However,
1
Department of Physical Medicine and Rehabilitation, China Medi- SEA prevalence immediately after injection was significantly lower
cal University Hospital, 2School of Chinese Medicine, College of in the experimental group than the control group. Conclusion: The
short-acting, non-depolarizing, neuromuscular blocking agent can
Chinese Medicine, China Medical University, 3Department of
reversibly suppress the prevalence of SEA recorded from a rabbit
Physical Therapy, China Medical University and 4Department of MTrS (equivalent to human MTrP) region. This finding further
Physical Therapy, Hungkuang University (Taiwan) confirms that the SEA is predominantly endplate potentials. The
Purpose: To investigate the effectiveness of a new modified acu- dysfunction endplate potentials may be involved in the pathogen-
puncture (MAcP) technique for suppression of remote myofascial esis of MTrP. The irritability of an MTrP can be suppressed by a
trigger point (MTrP), as compared to the simple acupuncture neuromuscular blocking agent.
(SAcP) and placebo therapy (PT). Materials and Methods: Pa-
tients with active MTrPs in upper trapezius muscles and with no
previous experience in acupuncture therapy were randomly divided Musculoskeletal Disorders: Osteoarthritis and
into three groups (PT, SAcP, and MAcP). The acupuncture needles Osteoporosis
were place in contact with the skin surface for the PT group, and
inserted into the regular depth without needle manipulation for
the SAcP group. For the MAcP group, the needles were inserted 0501F1
into multiple loci in the acupuncture (AcP) point region with rapid Physical exercise and the osteocyte
“in-and-out” movement and simultaneous rotation (“screwed in-
and-out”) to elicit local twitch responses. The AcP points of Wai- osteogenic response
guan and Qu-chi were treated. For every patient, the subjective Jorge Lains
pain intensity (PI), pressure pain threshold (PPT), and objective
changes in the ROM of cervical spine were assessed, both before Abstract missing.
and after the whole treatment course. EPN in the MTrP region of
the upper trapezius muscle was monitored and assessed before,
during, and after the whole course of treatment. Results: Imme- 0501F2
diately after acupuncture in the SAcP and MAcP groups, mean PI The Role of Exercise in Osteoarthritis
and mean EPN amplitude were significantly reduced. Mean PPT
and mean ROM of the cervical spine were significantly increased. of the Knee
There were significantly larger changes in all four parameters of Angela B.M. Tulaar
measurement in the MAcP group than that in the SAcP group. Department of Rehabilitation Medicine, Faculty of Medicine, Uni-
Simultaneous needling manipulation on two AcP points could versity of Indonesia (Indonesia)
provide better effects than needling manipulation of a single AcP
point. Conclusion: It appears that the MTrP irritability can be Purpose: To see the effect of Quadriceps exercises in osteoar-
suppressed after a remote acupuncture treatment, with a better thritis (OA) of the knee. Materials: Patients with OA of the Knee
effectiveness after the modified acupuncture therapy than the grade 2 according to Kelgrenn & Lawrence. Methods: Weight-
simple one. The effectiveness after needle manipulation on two bearing Plain radiograph of the knee joint. Measurement of the
AcP points simultaneously was much more remarkable than that FemoroTibialAngle using the Toda’s method. Pain measurement
after needle manipulation on a single AcP point. using VAS (Visual Analog Scale). Walking speed was measured

for 15 m. Quadriceps strength was measured using Cable Tensi- 0501F4
ometer. Quadriceps strengthening exercise performed until local HEADACHE DUE TO C2 SENSORY
muscle fatique, three times a week for 6 weeks, using 80% of 3RM
weight determined weekly. Blood Serum was taken and stored RADICULOPATHY
in -60ºC, before- and after 6 weeks of- exercise. Serum MMP3 Juan Manuel Guzmán González
(Metalloproteinase-3), TIMP-1 (Tissue Inhibitor of Metallopro- Physical Medicine and Rehabilitation Indiana (Mexico)
teinase-1) and COMP (Cartilage Oligomeric Matrix Protein) were
analyzed with ELISA method. Results: Plain Radiographs of 93 Purpose: To spread this technique in order to demonstrate its great
patients with mean age of 54 years old (42–65 years) with OA of value for the diagnosis in patients with headache from C2 sensory
the knee joint were taken in weightbearing (standing) positions. root injury origin, with difficult clinical diagnostic. Materials and
The Femoro-Tibial Angle was measured using the Toda’s method. Methods: We developed the technique to measure the latency of C-2
The VAS ranges from 4.5–8.4 with a mean of 6.31 (SD 1.07). The sensory root in our laboratory and studied the range of values of the
FTA ranges from 165º to 194º with a mean of 175.22º. There was a latency of C2 sensory root in both sides of able body people, with
significant correlation (p=0,02) between the FTA and VAS of 0.20. EMG equipment. Later on, we applied this technique to a group of
Serum from 29 female patients who completed the 6 weeks Quad- patients with headaches from upper neck origin. 80% had latency
riceps exercise showed a decrease in the mean MMP-3 level from more than 2.5 milliseconds. Results: 100 able body people studied:
mean 17.65±12.79 ng/ml pre-exercise to 14.53±7.67 ng/ml at 6 58 male, 42 female. Age: 18–40 years old. 200 Sensory C2 root
weeks post exercise (p=0.048; t-test ); the TIMP-1 level increased latencies, 100 right and 100 left. Range: 1.5–2.5 ms. Normal value:
significantly (p=0.024; t-test) from mean 180.43±48.25 ng/ml 2.0 ± 0.5 MS. Conclusion: In this research study we have found
to 201.32±55.84 ng/ml and the MMP-3/ TIMP-1 ratio decrease that one of the main causes of headache from upper neck origin is
from 0.105±0.08 pre-exercise to 0.078±0.05 post-exercise. The the entrapment of the C2 sensory root. In order to know if the C2
serum COMP showed a decrease significantly (p=0.012; paired sensory root is affected, we developed a new technique to measure
t-test) from 11.97±2.90 U/l to 11.14±2.61 U/l post-exercise. The the latency of C2 sensory root. The range of values of the latency of
Quadriceps muscle strength increased significantly (p<0.0001) C2 sensory root was standardized in both sides of able body people.
from 7.84±1.92 kg pre-exercise to 10.72±2.35 kg post exercise. This technique has become of great value in order to diagnose sensory
The mean VAS decreased significantly (p<0.0001) from 6.03±1.23 radiculopathy C2, with difficult clinical diagnostic. It is very useful
to 1.73±1.71 and the 15 m walking speed increased significantly to do the differential diagnosis in the cases of secondary headaches,
(p<0.0001; paired t-test) from 18.97±5.80 s pre-exercise to cranial neuralgias, facial pain, and other headaches.
14.18±3.51 s post-exercise. The percentage increase in the mus-
cle strength has correlation, although weak, with the decrease in
serum MMP-3 (linier regression with r=0.16), with the increase 0501F5
in serum TIMP-1 (quadratic regression with r=0.51, and with Cervical Radiculopathy-induced Neck
the decrease in serum COMP (quadratic regression with r=0.34.
Pain
Conclusion: Quadriceps strengthening exercise increased quad-
riceps muscle strength, increased serum TIMP-1 level, decreased Kamyar Akrami
serum MMP-3 and serum COMP level. The percentage increase
in the muscle strength has correlation, although weak, with the Abstract missing.
decrease in serum MMP-3, with the increase in serum TIMP-1,
and with the decrease in serum COMP. Quadriceps strengthening
exercise also decreased pain and increased walking speed. Key 0501F6
words: osteoarthritis, matrix metalloproteinase (MMP), tissue Management of cericalgia in the
inhibitor of metalloproteinase (TIMP), cartilage oligomeric matrix middle aged
protein (COMP).
Yi-Jia Lin1, Cheng-Hsiu Lai1, Chih-Wei Chou2, Shih-Wei
Chou2, Alice MK Wong2
0501F3 1
Department of PE and Health, Taipei Physical Education Col-
EXERCISE TO MAXIMIZE PEAK BONE MASS lege and 2Department of PM&R, Chang Gung Memorial Hospital
(Taiwan)
AND MINIMIZE BONE LOSS
Purpose: To evaluate the effects of neck muscle training on cer-
Sukajan Pongprapai vicalgia and balance in the middle aged. Materials and methods:
Department of Rehabilitation Medicine, Vichaiyut Hospital (Thai- 30 patients with chronic neck pain were recruited. X-ray of their
land) cervical spines revealed nonspecific spondylosis. 17 out of them
had completed 18 times training sessions, including warm-up,
Exercise plays a key role in bone health. The best way to prevent stretching, strengthening, and neuromuscular control exercises.
osteoporosis is to maximize peak bone mass in the first three A SMART Balance Master® System was employed to acquire
decades of life. Physical activity during adolescence and early equilibrium scores of SOT under 6 conditions. Visual analog scale
adulthood is a far more important predictor of peak bone mass than (VAS) of neck pain, range of motion (ROM) and isometric strength
calcium intake, possibly because growing bone has a much greater were measured. 17 healthy age-matched adults were also recruited.
capacity of new bone formation than mature bone. But different Statistical analyses were firstly performed for baseline comparison
types of exercise have different effects. Weight bearing exercises between groups using independent-t test. Learning effects of tested
increase in bone density than non-weight bearing exercises. Also, conditions were screened by comparisons between two test trials
the skeletal response to exercise is site-specific, being greatest at of the control group with 6-weeks interval using paired-t test.
the site of maximum stress. Hormonal determinants of peak bone Then, the effects of 18-sessions muscle training were tested by
mass and mechanotransduction related to osteocyte , osteoblast , and pre- and post- intervention comparison in the training group using
osteoclast will be discussed. During natural bone loss period (late paired t-test. Results: Baseline comparison between groups using
30 years), exercise intervention program is prescribed to minimize independent-t test revealed difference in neck fitness and balance
bone loss and reduce risk of falling. Well-designed exercise program performance existed between the patients with chronic neck pain
should address the issues of weight bearing , balance, posture, co- and the normal controls. Comparisons between two test trials of the
ordination, and functional strength. Systematic review of exercise control group with 6-weeks interval eliminated the learning effect
and bone mineral density and bone marker in postmenopausal in all the tested conditions. Pain scale, ROM, and strength of neck
osteoporosis women will be presented. were all improved after neck muscle training. Equilibrium scores

were significantly higher in all the SOT conditions except the EC. analog scale and pain index significantly decreased in the all three
Sensory ratios were all improved except the SOM. Strategy score groups. Compared with healthy people, myofascial pain syndrome
were improved in the three more challenged conditions of EOSS, patients reported significantly more often fatigue and poor sleep.
ECSS, and SVSS. Conclusion: In the patients with cervicalgia, The mean scores on Beck Depression Inventory were higher in
neck muscle training may help reduce neck pain, improve ROM myofascial pain patients than healthy people (p < 0.001). Compared
and strengthen neck muscle. As a result, balance performance with control group quality of life of people with MPS was extremely
was improved in terms of SOT and strategy score. The visual and low on six subscales of SF-36. In our study quality of life of patients
vestibular sensory ratios, which may reflect the ability to use the with MPS was statistical significance in physical functioning, role
respective balance-related sensory systems, were both improved physical, vitality, role emotional, mental health, mental composite
after neck fitness improved. Neck fitness training may be suggested scale. Of the four correlations exceeding 0.30, three related to the
in the middle aged with cervicalgia, not only for pain relief, but also mental composite scale t-score. Spearman’s correlation showed
balance re-education. that level of depression negatively correlated with the scores on
quality of life (r = –0, 57; p < 0.001). Conclusions: When combined
with neck stretching exercises, acupuncture, massage treatment and
trigger point injections were found to be effective. But lidocaine
Pain Management: Part 2 injection is more practical and rapid than other treatment and is
more cost effective and seems the one of the choice of treatment in
MPS. The quality of life profile and depression level of myofascial
0501J1 pain patients is quite different from healthy people. Myofascial pain
CURRENT ADVANCE IN MYOFASCIAL PAIN syndrome impacted mostly on mental health than physical health.
The multidisciplinary and integrated team approach is important in
Chang-Zern Hong managing the symptoms of MPS.
Hung-Kuang University (Taiwan)
Myofascial trigger point (MTrP) is the major cause of myofascial pain
syndrome. Based on recent studies, MTrP is the accumulation of mul- 0501J3
tiple sensitized nociceptors associated with dysfunctional endplates. THE LINK BETWEEN IMMOBILITY AND
The degree of irritability is determined by the amount of sensitized no- MICROGRAVITY LOW BACK PAIN
ciceptors. Stimulation of sensitive nociceptors can cause pain, referred
pain, and local twitch response. Morphologically MTrP is a contraction Reynaldo Rey-Matias
knot in the endplate zone of the involved muscle. Biochemically high St. Luke’s Medical Center and College of Medicine (Philippines)
concentration of inflammation and pain related substances can be found
in an active MTrP region. Due to excessive leakage of acetylcholine The lecture is designed to provide you with a basic understanding of
in the dysfunctional endplate, sarcomeres in this endplate region be- the physiological effects associated with exposure to microgravity as
come shortened that can cause taut band formation and elicit energy it compares to Immobilization. Emphasis is placed on understand-
crisis to perpetuate the vicious cycle train of “excessive acetylcholine ing low back pain as well as the time course of these adaptations.
leakage”-“increase of tension in taut band”-“release of sensitizing Astronauts exposed to microgravity frequently report low back pain.
painful substance”. Interruption of this cycle can inactivate the MTrP. This pain is described as moderate to severe in intensity. This will
However, the most important strategy to treat myofascial pain is to discuss microgravity to study assumed changes in the functions of
identify and treat the underlying etiological lesion that activates the the deep back muscles as an effect of disuse. They will also inves-
MTrP. The effective methods to inactivate an MTrP include stretching, tigate the pressure/spinal-length relationship: Hypotheses related to
deep pressure massage, laser therapy, needling, etc. atrophy of specific muscles, to the effect of functional strength of
others, as well as to the reasons for changes in spine length during
weightlessness, will be examined. It is also possible that the patho-
0501J2 genesis of back pain in microgravity is discogenic (or mechanical)
and somatic, referred from the sinuvertebral nerves due to exces-
DIAGNOSIS AND TREATMENT FOR sive expansion of the lumbar intervertebral discs associated with
MYOFASCIAL PAIN SYNDROME OF THE UPPER reduction of gravitational compressive loads in space. Changes in
BACK MUSCLES bone structure appear to be caused by increased osteoclastic activity
and are particularly pronounced in the spine and legs will be also
Avirmed Baljinnyam1, Sh. Batchimeg1, N. Tumurbaatar2 discussed. Further studies of countermeasures are recommended to
1
Department of Rehabilitation Medicine, School of Medicine, Health prevent excessive spinal elongation and disc expansion, reduce low
Sciences University of Mongolia, 2School of Traditional Medicine, back pain in microgravity, and simulate 1-G disc homeostasis, which
Health Sciences University of Mongolia (Mongolia) may also help prevent HNPs postflight. This brings the potential
to help our general understanding of spinal physiology, and could
Purpose: To investigate the short term effects of diagnosis and provide important information resulting in improved treatments of
treatment methods on myofascial pain in the upper back muscle and back problems in terrestrial patients.
to develop standard diagnostic and treatment methods that are ap-
propriate in Mongolia. Method: A comparative study was conducted
by randomized clinical control trial. The patients participated in our 0501J4
study were randomly divided onto 3 treatment groups using a single
APPROACH TO MECHANICAL LOW BACK PAIN
blind method with portions of 1:1:1. The treatment result has been
comparatively assessed using a clinical parallel research design. Ahmad Raiessadat1, Leya Sedighipour2
Outcome measures: The treatment result was evaluated and meas- 1
Shahid Beheshti University of Medical Sciences,Modarres Hospital
ured by following methods: Pain pressure threshold (PPT) by and 2Physical Medicine & Rehabilitation, Shahid Beheshti Univer-
algometry (kg/cm2); cervical range of motion by tape meter (cm); sity of Medical Sciences (Islamic Republic of Iran)
pain pattern and intensity by the McGill pain questionnaire; level of
depression by the Beck’ depression inventory; level of anxiety by the Introduction: Mechanical Low back pain and sciatica are common
Tailor Manifest Anxiety Scale; quality of life by the health survey complaints that affect a major proportion of general population
SF-36 questionnaire. Results: Pain pressure thresholds improved with lifetime prevalence exceeds 70% in most countries. Its social
in lidocaine and massage group and did not significantly change in and economic impact is substantial all around the world. Clinical
acupuncture group. In the lidocaine group, PPT values were signifi- approach and management of this condition may vary widely. Ap-
cantly higher than in the acupuncture and massage group. Visual proximately 80% of low back pain has no specific or recognizable

Rehabilitation Technology and Engineering 57
etiology and is therefore termed “mechanical” or “musculoskeletal.” tation, Tohoku University Graduate School of Medicine (Japan)
low back pain. In approach to an acute or chronic low back pain,
same as other medical disorders, a careful informed history and Purpose: To clarify to which patients with severe gait disturbane
physical examination are invaluable and cornerstone of further the newly developed cycling wheel chair (C–C/W) can be ap-
evaluation .Diagnostic imaging, however; could never be a sub- plied and to evaluate its effects on physical function. Materials
stitute. Even though low back pain has a benign course in 90% and Methods: C–W/C which we developed can be propelled
of patients, at the initial assessment of a patient presenting with by pedaling with both legs. We have applied to the patient with
low back pain, it is important to identify any ‘red flag’ indicators gait disturbance caused by stroke, spinal cord injury, Parkinson
of serious spinal pathology, or ‘yellow flag’ indicators of psycho- disease, osteoarthritis, femur fracture of the etc. In particular, C–
logical risk factors. By excluding rare systemic and serious causes W/C was applied to the hemiplegics with the Brunnstrom stages
of low back pain, the physician can avoid catastrophic outcomes from I to III. In these patients, functional changes before and after
due to patient mismanagement. Conclusion: Eventhough multiple C–W/C application was evaluated by surface EMG, maximum
evidence-based guidelines worldwide have indicated how low back driving speed (MDS), score of Barthel index etc. Results: All of
pain should be managed, a patient-focused strategy combining best the patients could drive C-W/C with almost the same speed as
evidence and clinical expertise is suggested as the mainstay for the quick step of walking. EMG recordings showed apparent recipro-
management of this disorder. The physiatric approach to low back cal firing during pedaling movement even in the hemiplegics with
pain is functional and interdisciplinary. Physiatry approaches the Brunnstrom stage I. In other patients, maximum walking speed,
patient from the physical, psychological, and social perspectives score of Barthel index and maximum driving speed and distance of
to obtain a thorough understanding of his or her goals and needs. C–W/C significantly increased after C–W/C training for 4 weeks.
Once the assessment is complete, treatment focuses on reducing Conclusion: Physical training with C–W/C has a possibility to
pain; restoring ability to participate in activities of daily living, improve physical function through reinforcement of reciprocation
work, and recreation; achieving patient independence with care; in the lower extremities and efficient use of physical fitness.
and reducing dependence on the health care system. We evaluated
evidence based clinical approach to mechanical low back pain in
the present paper. 0501G2
FUNCTIONAL ELECTRICAL STIMULATION
0501J5 CYCLING EXERCISE
LOCAL TREATMENT OF MYOFASICL PAIN – Shih-Ching Chen1, Chih-Wei Peng1, Chien-Hung Lai1,
NSAID PATCHES Jia-Jin Jason Chen2
1
Department of Physical Medicine and Rehabilitation, Taipei Medi-
Lin-Fen Hsieh cal University and Hospital and 2Institute of Biomedical Engineer-
Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) ing, National Cheng Kung University (Taiwan)
Locally administered nonsteroidal anti-inflammatory drugs Purpose: FES-cycling system is a kind of the FES devices, which
have been widely used in acute soft-tissue damage and articular is by means of a stimulator’s cycling software to control sequential
musculoskeletal pain. This double-blind, placebo-controlled, stimulation of the large leg-actuating muscles of paralyzed leg
randomized study was designed to evaluate the efficacy and muscles in subjects with spinal cord injury (SCI) and produce
safety of a topical diclofenac sodium patch in the relief of pain cyclical leg motion. Currently, the FES cycling has often been
and inflammation as a result of myofascial pain syndrome (MPS) used in rehabilitation therapy. There were a number of subsequent
in the upper trapezius. investigations reported the physiological adaptations after regular
cycling exercise training. This article provides an overview of the
potential therapeutic benefits of FES-cycling exercise training in
0501J6 rehabilitation applications in subjects with SCI. Materials and
LASER TREATMENT FOR MYOFASICAL Methods: In general, FES-cycling ergometers can be divided
TRIGGER POINTS into two major types, mobile and stationary types. The mobile
type, a locomotion device, focused on muscle training as well
Kai-Hua Chen as giving some mobility to patients. For the stationary type of
Department of Physical Medical and Rehabilitation, Chang Gung cycling ergometer, it is usually used for aerobic exercise training
Memorial Hospital (Taiwan) in subjects with SCI for conditioning their muscles strength and
enhancing cardiopulmonary function. Currently, the stationary
Low-level laser therapy (LLLT) has been widely used in treating cycling ergometers has more often been used in rehabilitation
myofascial pain syndrome due to myofascial trigger points (MTrPs). therapy than mobile ones. A typical pattern of stationary FES-
Various double-blind placebo control studies have demonstrated cycling system will be shown with a closed-loop control software
positive effects of LLLT on pain relief, range of motion or disability (developed in National Cheng-Kung University, Taiwan), which
scale. However, other studies have reported no therapeutic effect. has been used in multiple clinical centers (1). Sometimes FES-
These inconsistent results may be related to different modes, types cycling devices may combine with certain accessories for specific
or dosages of LLLT, and different frequency of treatments were ap- purposes, e.g. arm-crank for the purposes of upper-extremities
plied. In this session, we will review the literatures about the effect training or warm-up exercise, as shown in Fig 1b (2). This paper
and the possible mechanisms of LLLT on MTrPs. provides a brief review of the research findings regarding the
effects of FES cycling on candidate patients’ cardiopulmonary,
muscular, and skeletal systems. Results: Individual with spinal
Rehabilitation Technology and Engineering cord injury (SCI), typically lost motor control and muscle mass
of lower limbs and consequently have limited opportunities for
conditioning their lower extremities and destined to a relatively
0501G1 sedentary lifestyle. This can lead to marked adaptations of the
APPLICATION OF A CYCLING WHEELCHAIR TO cardiovascular, muscular, and skeletal conditions (3). Studies have
THE PATIENTS WITH GAIT DISTURBANCE reported that FES-cycling exercise training can increase the cross
area of arteries and the density of capillary and improve blood
Yasunobu Handa1, Takaaki Sekiya2, Kazunori Seki2 inflow volume to the lower limbs (4–5). Studies also indicated
1
Division of Developmental Neurosience, Tohoku University Gradu- that subjects with SCI after 12 to 20 weeks of training increased
ate School of Medicine and 2Division of Restorative Neurorehabili- a 4.1% of left ventricular mass, a 2.5% of left ventricular end-

diastolic volume, and a 6% of high-density lipoprotein (6). All Department of Physical Medicine & Rehabilitation, Chang Gung
these results suggested that FES-cycling exercise could improve Memorial Hospital (Taiwan)
cardiopulmonary capacity as well as reduce the risk of cardio-
vascular disease. Moreover, several studies reported that subjects Purpose: In Taiwan, the elderly population is increasing rapidly.
with SCI after several months of FES-cycling training can improve In addition to the decreased fertility rate during recent years, the
muscle endurance and peak power output. Besides, the training Taiwan society is ageing at a really rapid pace. Presently, more and
can also increase their muscle mass and muscle strength. (7). more elderly individuals are living alone or are living alone during
Another aspect, several studies have evaluated the effects of the daytime hours when their family members are out working.
subjects with SCI after FES-cycling exercise training on bone Therefore, proper care system should be established to in order to
mineral density. Many studies found the FES-cycling training deliver services to their homes. In elderly care, telemedicare is only a
could significantly reduce the rate of SCI-induced bone loss or part of the caring system. Diet, living, transportation, education, and
even increase the bone density of paralyzed limbs (8–10). Thus, safety issues are also important parts of elderly care and must not be
the potential therapeutic benefits of FES-cycling exercise include neglected. Therefore, we have developed a new intelligent compre-
conditioning cardiopulmonary, muscular, and skeletal systems, hensive interactive care (ICIC) system to provide complete elderly
as well as improving other physiological and psychological per- care services through the integration of personal to community
formances. Conclusion: The general objective of rehabilitation information technology (IT) platforms. Materials and Methods: The
management of subjects with SCI is to improve quality of life. “ICIC” system composes of seven different services items. Medica-
This article indicated that lower limb FES-cycling exercise train- tion care model consists of physiology measuring system, medica-
ing can provide multiple health benefits for subjects with SCI. In tion reminder system, and doctor – patient interactive system. In the
addition, studies evidenced that FES-cycling exercises are safe, doctor – patient interactive system, the health education information
functional, and accessible to subjects with SCI or stroke. Although system is integrated into the medical care system. The diet, living,
the potential therapeutic benefits of FES-cycling exercise training and transportation services are delivered by living information,
are immense, currently the cycling exercise is still not widely household electronic control, and service reservation systems. The
prevalent among all subjects with SCI. This may be owing to entertainment system combines personal media sharing, and touch-
most of the subjects find the daily back-and forth transportation able community entertainment systems (share-touch). For safety,
to a clinical center is difficult, which may reduce the feasibility accidental fall detection, positioning and navigating systems, and
to participate the cycling exercise training. Therefore, to develop emergency rescue and dispatch systems are intergraded to prevent
an in-home use and low cost of FES-cycling ergometer might elderly individuals from injuries in home and community settings.
be a feasible way to promote the wide use of the cycling device However, all the new electronic devices or IT system should be
among subject with SCI. examined first by technology acceptance model (TAM). For this new
References: “ICIC” system, it has been tested by the following demands includ-
1. H.Y. Chen, N.Y. Yu, K.S. Chen, K.H. Tsai, L.L. Fu, S.C. Chen, M.H. Huang,
ing behavior intention, perceived usefulness, perceived ease of use,
J.J. Chen, “Development of FES cycling system with network capabil- enjoyment, subjective norm, image, job relevance output quality,
ity for multi-center clinical studies,” J. Med. Bio. Eng., 21:85–92, 2001. result demonstrability, and voluntariness. Results: For the medical
2. K. Chen, S.C. Chen, K.H. Tsai, J.J.J. Chen, N.Y. Yu, M. H. Huang, “An education model, 30 elderly subjects (75.0±5.7 years) were invited
improved design of home cycling system via functional electrical stimula- for the test. Result showed that no one complained of difficulties in
tion for paraplegics,” Int. J. Ind. Ergon., 34:223–235, 2004. the use of this model. There was no statically difference between
3. P.C. de Groot, M. W. Bleeker, M. T. Hopman, “Magnitude and time course pre-test and post-test scores for different sex and educational level
of arterial vascular adaptations to inactivity in humans,” Exerc. Sport Sci. groups. For the medication reminding system, 18 elderly subjects
Rev. 34:65–71, 2006. (82.3±5.5 years) participated in the evaluation of this system. The
4. H.L. Gerrits, A. de Haan, A.J. Sargeant, H. van Langen, M.T. Hopman. “Pe- questionnaire of behavior intention, perceived usefulness and ease
ripheral vascular changes after electrically stimulated cycle training in people of use were very acceptable in these elderly individuals. However,
with spinal cord injury”, Arch. Phys. Med. Rehabil., 82:832-839, 2001. the acceptance scores of female group were lower than the male
5. N.T. van Duijnhoven, T.W. Janssen, D.J. Green, C.T. Minson, M.T. Hop- group in all items. As for the community entertainment system
man, D.H. Thijssen, “Effect of functional electrostimulation on impaired (share tough IT table), which could provide communication, data
skin vasodilator responses to local heating in spinal cord injury,” J. Appl. sharing (pictures), and interactive games for the elderly, the ac-
Physiol., 106:1065-10671, 2009. ceptance scores in 52 elderly individuals were good to excellent.
6. D. Danopulos, P. Kezdi and E.L. Stanley, “Changes in cardiovascular
However, the number of elderly individuals participation in these
circulatory dynamics after a twelve week active bicycle rehabilitation in
young tetraplegics,” J. Neurol. Orthop. Med. Surg., 7:179-184, 1986.
study groups is still relatively small. The empowerment of self care
7. C. Skold, L. Lonn, K. Harms-Ringdahl, C. Hulting, R. Levi, M. Nash, et and improvement in quality of life for elderly people by this ICIC
al., “Effects of functional electrical stimulation for six months on body system still need further study. Conclusion: This newly developed
composition and spasticity in motor complete tetraplegic spinal cord- Intelligent Comprehensive Interactive Care system (ICIC system)
injured individuals,” J. Rehabil. Med. 34: 25–32, 2002. for the elderly is a interdisciplinary model of care that integrates
8. S.A. Bloomfield, W.J. Mysiw, R.D. Jackson, “Bone mass and endocrine medical care, diet, living, transportation, education, entertainment,
adaptations to training in spinal cord injured individuals,” Bone 19:61- and safety demands into a common IT platform. Therefore, the pro-
68, 1996. motion of health and quality of life can be delivered to the elderly
9. S.C. Chen, C.H. Lai, W.P. Chan, M.H. Huang, H.W. Tsai, J.J. Chen, population at home. Positive acceptance scores were observed for
“Increases in bone mineral density after functional electrical stimula- the elderly individuals who have used the ICIC system.
tion cycling exercises in spinal cord injured patients,” Disabil. Rehabil.,
27:1337-1341, 2005.
10. T. Mohr, J. Podenphant, F. Biering-Soerensen, H. Galbo, G. Thamsborg, 0501G4
M. Kjaer, “Increased bone mineral density after prolonged electrically
induced cycle training of paralyzed limbs in spinal cord injured man,”
Cortical activation during robot-
Calcif. Tissue Int., 61:22–25, 1997. aided rehabilitation
Futoshi Wada, Kenji Hachisuka
0501G3 Department of Rehabilitation Medicine, School of Medicine,University
of Occupational and Environmental Health (Japan)
The Development Of New Intelligent
Comprehensive Interactive Care System Robotic-assisted rehabilitation training is expected to offer the
For Elderly Care opportunity to help restoring the upper and lower limb functions
in paretic patients. However, it is not clear how robotic-assisted
Alice M.K. Wong rehabilitation training change cortical activation pattern during

Prosthetic and Orthotics 59
gait. Yasukawa Electric Corporation and our university have for directly connecting a trans-femoral prosthesis into the femur
co-developed the robotic rehabilitation system (BRMS; Bio- using a titanium implant. Improved comfort and sensory feedback,
Responsive Motion System) for the stroke patients with severe and greater hip range of motion are the advantages. But there are
gait disturbance. We measured the cortical activation of the motor occasional mechanical failures of fixation and fears of infection
area during robot assisted gait by a near-infrared spectroscopic and bone fracture. This presentation introduces the two types of
imaging system in normal healthy subject and stroke patients. prostheses (external and implanted). It also reviews the use of vari-
2-demension topography indicated significant cortical activation ous advanced technologies, including computer-aided design and
of the motor area was induced when subject actively walked ac- manufacturing, computational modeling, gait analysis, and mate-
cording to the robotic arm trajectories. Otherwise, small cortical rial testing in evaluating and optimizing the mechanical designs of
activation were observed when subject passively walked with lower-limb prostheses.
both legs moved by the robot arm. Motor imagery also has a small
contribution to induce cortical activation in normal subject during
robot assisted gait. Passive leg movement during robot assisted 0501K3
gait enhances this cortical activation. The same phenomenon was THE EFFECT OF RIGID VS FLEXIBLE SPINAL
observed when using upper-limb rehabilitation robot (Bi-Manu-
Track arm trainer) in stroke patients. Cortical activation was ORTHOSIS ON THE CLINICAL EFFICACY
enhanced when subject practices bilateral forearm pro-supination AND ACCEPTANCE OF THE PATIENTS WITH
in an active training mode than in a passive training mode. These ADOLESCENT IDIOPATHIC SCOLIOSIS
experiment results indicate that active arm or leg movement is
important factor to induce significant cortical activation during Man Sang Wong1, Jack C. Y. Cheng2, Tsz Ping Lam2,
robot assisted training. Bobby K. W. Ng2, Sai Wing Sin3, Sandra L. F. Lee-Shu4,
Daniel H. K. Chow1, Sandra Y. P. Tam1
1
Department of Health Technology and Informatics, The Hong
Kong Polytechnic University, 2Department of Orthopaedics and
Prosthetic and Orthotics Traumatology, Chinese University of Hong Kong, 3Department of
Prosthetics and Orthotics, Prince of Wales Hospital and 4Depart-
ment of Physiotherapy, Prince of Wales Hospital (Hong Kong)
0501K1
Purpose: The objective of this prospective study is to compare
INFLUENCE OF THE LEVEL OF AMPUTATION the treatment effectiveness and patients’ acceptance of the flexible
ON SURVIVAL ADVANTAGE AND FUNCTIONAL spinal orthosis, SpineCor with that of the rigid spinal orthosis for
PERFORMANCE IN ELDERLY AMPUTEES the patients with moderate adolescent idiopathic scoliosis. The pa-
tients’ acceptance to the rigid spinal orthoses is always a concern as
Takaaki Chin, Sayaka Hamamura, Tetsuhiro Iguchi it could greatly affect the clinical outcome. SpineCor is a relatively
Department of Rehabilitation Science, Kobe University Graduate new design for tackling those inevitable drawbacks found in rigid
School of Medicine (Japan) orthosis. However, there was no study to compare this design with
the conventional method regarding their treatment efficacy and the
There has been an increase in cases of peripheral arterial disease patient’s acceptance. Materials and Methods: Forty-three subjects
(PAD). PAD is the cause of 80–90% of the amputations in the with moderate adolescent idiopathic scoliosis were randomly as-
elderly population. In recent years, increased recognition of the signed to the SpineCor group (S group, n = 22) and rigid orthosis
functional advantage of the preservation of the knee joint, advance group (R group, n = 21). Their survival rate in the first 45 months
in revascularization procedures have brought about a change of of intervention was studied. The subjects’ acceptance to the or-
surgical policy. As a result, the ratio of transtibial to transfemoral thoses was evaluated by a purpose-designed questionnaire, which
amputation has increased over the years. The level of amputation was administered in the 3rd, 9th, and 18th months of intervention.
has a clinical impact on survival advantage and functional per- Results: In the study period, there were 68% of the subjects in the
formance. The first purpose of this presentation is to review the S group and 95% of the subjects in the R group did not show curve
influence of amputation level from the perspective of functional progression. Significant difference (p = 0.046, by Fisher exact test)
performance and survival advantage in vascular amputees. It is in failure rate between the 2 subject groups was found although the
well known that higher amputation level results in decreased 2 groups had similar responses to the questionnaire. Conclusion:
functional performance. Decision making on selecting candidate The current study showed that the failure rate of the SpineCor was
of prosthetic rehabilitation should be directed toward maximiz- significantly higher than that of the rigid spinal orthosis, and the
ing functional performance and independent living. The second patients’ acceptance to the SpineCor was comparable to the con-
purpose is to address the factors affecting successful prosthetic ventional rigid spinal orthosis.
ambulation based on our research results investigating 64 unilateral
trans-femoral or hip-disarticulation amputees (40 males and 24
females) aged between 60 to 81 years. 0501K4
APPLICATION OF ANKLE-FOOT ORTHOSES
0501K2 FOLLOWING STROKE – UPDATE AND FUTURE
Lower-limb prosthetics - previous Chih-Kuang Chen1,2
research and future development
1
Department of Physical Medicine and Rehabilitation, Chang
Gung Memorial Hospital and 2School of Medicine, Chang Gung
Winson Lee University (Taiwan)
The Hong Kong Polytechnic University (Hong Kong)
Stroke has been one of the leading causes of mortality in both
A lower-limb prosthesis is conventionally attached to the residual the developed and the developing countries. The World Health
limb by a socket and often some suspension devices. Although this Organization estimates 5.7 million people died from stroke
approach has been used for many years, local residual limb pain, gait worldwide in 2005, which was approximately 1/10 of all deaths
deviation and structural failure are common. Some new prosthetic (1). Although the incidence of stroke is decreasing in high-income
designs have been brought to the market, aiming to bring amputees countries through the efforts of preventive medicine, the overall
better comfort and gait efficiency, but with higher cost. Meanwhile, rate of stroke remains high due to the aging of the population. On
researchers are developing a surgical approach (osseointegration) the other hand, the stroke incidence rates in low to middle income

countries have grown rapidly and exceeded those in high-income improve the symmetry in quiet standing and the dynamic standing
countries since 2000 (2). This makes stroke an unavoidable chal- balance in stroke patients with hemiparesis of less than six months
lenge for the healthcare and socioeconomic system globally. While duration (18). Chen et al. reported that an anterior AFO might
stroke threatens human life for its potential mortality, disability assist stroke patients with hemiplegia in improving their postural
resulting from stroke is the main burden to the individuals and stability in the early stage of recovery (14). For long-term hemi-
societies. About half of the stroke survivors are left some degree plegic individuals, Chen et al. suggested that use of an anterior
of physical and functional impairment (3–4). Among the clinical AFO could provide improvements in lateral weight shifting and
spectrum of stroke, mobility problem is a major concern of the weight bearing through the affected leg (19). However, Park et al.
patients and carers (5). In a prospective study of 804 acute stroke stated that the Berg Balance Scale scores of hemiplegic patients
patients, Jørgensen et al. reported 18% of the patients lost their did not differ significantly among the barefoot condition, wearing
walking ability and 11% were in need of assistance for walking an anterior AFO, and wearing a posterior AFO (15). The debat-
at the end of rehabilitation (6). A variety of lower limb orthoses able results can be attributed to the different assessment methods.
are designed for patients with mobility problems following stroke. As the novel AFO devices, such as the MIT active AFO (20), are
Of these, the ankle-foot orthoses (AFOs) are most frequently pre- being introduced, the relevant evidence needs to be strengthened
scribed. AFOs are externally applied devices encompassing the in terms of high-level research design, applicable methodology,
ankle joint and the whole or part of the foot (7), with the goals to and logical interpretation of the outcome. In addition, patient
control motion, correct deformity, and/or compensate for weak- perception is the most important value to be studied. Only when
ness (8). The clinical applications of AFOs are common, yet the the best evidence from reseach meets clinical information, as well
rationale and efficacy of using AFOs in stroke patients should be as patient feedback, will the optimal decision on the application
verified in the times of evidence-based medicine and practice. Old of AFOs following stroke be possible.
style AFOs are made of metal and leather. Gök et al. reported metal References:
AFOs provide better stabilization of the ankle, allowing better heel 1. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around
strike and push-off during gait (9). Due to the heavy weight and the world. Lancet Neurol 2007; 6: 182–187.
unappealing appearance, however, the metal AFOs are much less 2. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide
commonly used nowadays. The rare indications for the metal AFOs stroke incidence and early case fatality reported in 56 population-based
include wearers satisfied or accustomed to previous metal AFOs, studies: a systematic review. Lancet Neurol 2009; 8: 355–369.
large or heavy individuals, patients with fluctuating edema, and 3. Atlas of Heart Disease and Stroke, WHO, 2004.
people sensitive to heat (8). The plastic AFO has been replacing 4. Young J, Forster A. Review of stroke rehabilitation. BMJ 2007;334:86-90.
the metal AFO as the mainstream of lower limb orthotic manage- 5. Bohannon RW, Horton MG, Wikholm JB. Importance of four variables of
ment of stroke. It can be a prefabricated product or a custom-made walking to patients with stroke. Int J Rehabil Res 1991; 14: 246–50.
one. Prefabricated plastic AFOs are convenient, but seldom fit the 6. Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Recovery of
stroke patients well because the shapes and sizes available for walking function in stroke patients: the Copenhagen Stroke Study. Arch
selection are limited. In addition, they can not effectively control Phys Med Rehabil 1995; 76: 27-32.
the complex deformity of the foot and ankle, which is common in 7. International Organization for Standardization. ISO 8549-3;1989 Prosthet-
stroke patients with spasticity. For individuals with hypertonicity ics and Orthotics – Vocabulary. Terms relating to external orthoses. Geneva,
Switzerland: International Organization for Standardization 1989.
or spasticity, a custom-made plastic AFO is more appropriate for its
8. Michael JW. Lower limb orthoses. In: Hsu JD, Michael JW, Fisk JR,
adequate correction by intimate fitting (10). Custom-made plastic eds. AAOS of Orthoses and Assistive Devices. 4th ed. Philadelphia, PA:
AFOs can be divided into articulated and non-articulated design. Mosby Elsevier 2008: 343–355.
Articulated AFOs have mechanical joints at the ankle to control, 9. Gök H, Küçükdeveci A, Altinkaynak H, Yavuzer G, Ergin S. Effects of an-
assist, or limit the motion of the ankle joint. They can improve kle-foot orthoses on hemiparetic gait. Clin Rehabil 2003; 17: 137–139.
gait performance (11–12), but the mediolateral control of the 10. Condie ME, Campbell JH, Matina JD. Report of a consensus confer-
foot and ankle complex may be inadequate due to the space left ence on the orthotic management of stroke patients. Copenhagen: ISPO;
for the mechanical ankle joints. A Solid AFO is a non-articulated 2004.
design. It is the AFO of choice to provide maximal stability of 11. Tyson SF, Thornton HA. The effect of a hinged ankle foot orthosis on
the foot and ankle complex (10). The stiffness of a solid AFO is hemiplegic gait: objective measures and users’ opinion. Clin Rehabil
determined by the material, thickness, and geometry of the plas- 2001; 15: 53–58.
tic. For example, a posterior leaf spring (PLS) AFO is a variant 12. Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment
of solid AFO. The trim line around the ankle of the PLS AFO is and foot-plate length on the gait of adults with poststroke hemiplegia.
narrowed to below and behind the malleoli. This modification Arch Phys Med Rehabil 2009;90:810–818.
allows some sagittal motion at the ankle level of the PLS AFO 13. Wong AMK, Tang FK, Wu SH, Chen CM, Clinical trial of a low-
despite its non-articulated design. Consequently, the PLS AFO temperature plastic anterior ankle foot orthosis. Am J Phys Med Rehabil
compromises the stability of the foot and ankle complex and is 1992;71:41–43.
only indicated in isolated dorsiflexor weakness (10). In general, 14. Chen CK, Hong WH, Chu NK, Lau YC, Lew HL, Tang SF. Effects of an
the plastic AFOs are designed in posterior leaf type. Anterior leaf anterior ankle-foot orthosis on postural stability in stroke patients with
type AFO is a modification by moving the calf shell anteriorly to hemiplegia. Am J Phys Med Rehabil 2008;87:815–820.
the pretibial area (13). The advantages of an anterior AFO include 15. Park JH, Chun MH, Ahn JS, Yu JY, Kang SH. Comparison of gait analysis
between anterior and posterior ankle foot orthosis in hemiplegic patients.
the interchangeability with different types of shoes as well as the
Am J Phys Med Rehabil 2009;88:630–634.
convenient use for indoor barefoot walking, as is the custom in
16. Leung J, Moseley A. Impact of ankle-foot orthoses on gait and leg muscle
some Asian countries (14). Wong et al. first reported the positive activity in adults with hemiplegia. Physiotherapy 2003;89:39-55.
effects of an anterior AFO on gait performance in stroke patients 17. Corcoran PJ, Jebsen RH, Brengelmann GL, Simons BC. Effects of plastic
with hemiplegia (13). The effectiveness of an anterior AFO has and metal leg braces on speed and energy cost of hemiparetic ambulation.
been proven comparable to that of a posterior AFO in terms of Arch Phys Med Rehabil 1970;51:69–77.
gait improvement (13, 15). Based on a systemic literature review, 18. Wang RY, Yen L, Lee CC, Lin PY, Wang MF, Yang YR. Effects of an
Leung and Moseley concluded that AFOs might improve velocity, ankle-foot orthosis on balance performance in patients with hemiparesis
stride length, gait pattern and walking efficiency in people with of different durations. Clin Rehabil 2005;19:37–44.
hemiplegia (16). Some researchers described the effect of AFOs 19. Chen CL, Yeung KT, Wang CH, Chu HT, Yeh CY. Anterior ankle-foot
on the energy consumption of walking (17). The AFO effect on the orthosis effects on postural stability in hemiplegic patients. Arch Phys
muscle activities of paretic lower limbs, however, is inconclusive Med Rehabil 1999;80:1587–1592.
according to Leung and Moseley (16). The effect of AFOs on bal- 20. Dollar AM, Herr H. Active orthoses for the lower-limbs: Challenges
ance and postural control in stroke patients is an emerging topic to and state of the art. Proceedings of IEEE International Conference on
be investigated. Wang et al. reported that a posterior AFO might Rehabilitation Robotics, Noordwijk, Netherlands, 2007.

Prosthetic and Orthotics 61
0501K5 increasing and improving their functional capabilities, augment-

ORTHOTIC MANAGEMENT OF ing communication deficiency, facilitating learning activities
and providing assistance in rehabilitation. In this presentation,
MYELODYSPLASIA specific applications of rehabilitation and assistive technology
Moon Suk Bang will be highlighted. Current limitations and future challenges in
Department of Rehabilitation Medicine, Seoul National University this field will also be discussed. Materials and Methods: Based
College of Medicine (Republic of Korea) on author’s pass experience in providing AT services, specific
cases were selected to highlight the different applications of AT
Myelodysplasia affects spinal cord, nerve root or even brain. As a for individual use and rehabilitation training. These included the
result, limb paralysis and developmental deformity may follow. use of a small motion sensor for switch activation and computer
Orthotic management for myelodyspalsia is one of the main com- input, a gangplank to bridge platform gaps in public transit and
ponent s of the rehabilitation management. Still, most of orthotic various interactive computer therapeutic training devices for
managements have been done by empirical basis, not by objec- rehabilitation training. Results: Individuals with severe limita-
tive evidence. Pattern of practice depends on geographic area or tions of hand/finger movements and weak activation power have
insurance system of each country. Main purposes of orthosis are great difficulties in control an input device. To overcome these
preventing deformity, support for normal joint alignment and me- functional deficits, an accelerometer was used to detect subtle
chanics, providing variable range of motion when appropriate, and motions of the finger and the toe. Although this sensor was found
facilitation of function. For tetrapegia or high paraplegia, standing to be effective for many users, it fails to perform well when the
frame, praapodium, or swivel walker can be used. Crawling, scoot- user cannot initiate a fast motion. As an alternative, optical/hall-
ing training, or wheelchair training may be needed for mobility. effect sensors were used instead. Platform gap between trains and
Various Hip Knee Ankle Orthosis (HKAFO) including Reciprocat- stations is a major obstacle to barrier free access for individuals
ing Gait Orthosis can be prescribed for the patients with deficit with disabilities and the elderly. In Hong Kong, a gangplank
from T11 to L3 level. KAFO is for mid lumbar level and various was developed to bridge the platform gap of the railway system.
AFO can be prescribed for lower lumbar level. FO or shoe can be The operation of this device only requires minimal support from
applied for sacral lesion. Patients may prefer wheel chair to orthosis the station operator. Wheelchair users can get in and out of the
for ambulation. Special concern should be made not to cause skin train compartment safety within the normal boarding time. This
problem after orthotic management because it may easily progress gangplank can handle a platform gap of up to 500 mm and a
to skin ulcer or even osteomyelitis due to sensory deficit. Orthotic height discrepancy of 190 mm between the platform and the
managenment is a component of comprehensive rehabilitation for train compartment. Traditional therapeutic training could be an
myelodysplasia. For the optimization of orthotic management, uninteresting process for many patients as it involves many repeti-
combined education, physical therapy, occupational therapy, and tive movements without any feedback of the user’s performance.
home exercise should be encouraged. Lack of motive in participation is often a cause of failure to many
rehabilitation training programs. The use of computerized thera-
peutic training devices can allow therapeutic training to become
0501K6 interactive. Therapists can prescribe training program for each
individual patient prior to the training session. During training,
REHABILITATION AND ASSISTIVE user’s performance was also tracked and recorded in the database,
TECHNOLOGY to allow outcome evaluations. Conclusion: The successfulness of
Eric Tam using AT to improve independency of individual with disabilities
Jockey Club Rehabilitation Engineering Centre, Department of is highly dependent on the design of a good human-equipment in-
Health Technology and Informatics, The Hong Kong Polytechnic terface. This is apparent for those suffered from lock-in syndrome
University (Hong Kong) and other severe physical limitations. The future challenges in
rehabilitation and assistive technology will be directed towards
Purpose: Rehabilitation and Assistive technology (AT) helps the elderly where functional and cognitive impairments increase
individuals with disabilities to improve their quality of life by during the aging process.

KEYNOTE SPEECH (May 2, 2010)
KS03-01 and chemodenervation. Together, these have allowed clinicians to

REHABILITATION OF COMBAT-INJURED define treatment expectations and outcomes with greater precision.
Updated guidance has now been published for pharmacological
POLYTRAUMA (TBI, AMPUTATION AND SCI): therapy in patient management and this also sets out the essentials
THE U.S. VETERANS HEALTH ADMINISTRATION of a competent service1. This presentation will use these to assist
EXPERIENCE those clinicians, who have developed the expertise in managing
their own patients with spasticity and who plan to take on referrals
David X. Cifu from other sources. The following are of strategic importance in
Center for Rehabilitation Sciences and Engineerin,Virginia Com- creating a successful spasticity service:1) The establishment of
monwealth University (United States) dedicated teams of expert professionals in this field; 2) Trained
clinicians in treatments for disabling neurological conditions; with
Purpose: To provide an overview of the U.S. Veterans Health the knowledge & experience of all available spasticity treatments;
Administration’s Polytrauma System of Care for service members 3) Organisational commitment to accept referrals from outside;
with Combat-Injured Polytrauma, including TBI, Amputation and 4) Business plan and financial security to identify the range of
SCI. Materials and Methods: Didactic lecture with Powerpoint the service Physical treatments, including casting and splinting;
presentation. Results: This presentation will be appropriate for Functional electrical stimulation; Botulinum toxin treatment;
the novice and intermediate-level clinician in PM&R and reha- Intrathecal baclofen treatment. The following are then important
bilitation, introducing an overview of the system of care and the for success; 5) Multi-disciplinary team working using evidence-
latest statistical data available. Conclusion: This presentation based protocols, where possible; 6) Team networking with other
will offer both a overview of this important topic and a descrip- health professionals in hospitals and in the community for inward
tion of the specifics of the polytrauma care that is of practical use referral of patients and onward treatment after the patient has
to attendees. been seen in the service; 7) Facilities to assess & treat patients;
8) The necessary documentation and systems to evaluate audit
KS03-02 the service; 9) Education, training and research activity: This
presentation will go through the steps of how organisations can be
RECENT ADVANCES IN THE MANAGEMENT OF encouraged to support clinicians in delivering optimal specialist
SPASTICITY spasticity services.
Anthony B Ward Reference:
North Staffordshire Rehabilitation Centre (United Kingdom) 1. Turner-Stokes L, Ashford S, Bhakta B, Heward K, Moore AP, Robertson
A, Ward AB. The Management of Adults with Spasticity Using Botulinum
The management of spasticity has developed greatly since the Toxin: A Guide to Clinical Practice. Royal College of Physicians. London,
introduction of newer technologies and the resurrection of splinting 2009.

Brain Disorders: Spasticity 63
oral presentations (MAY 2, 2010)
Brain Disorders: Spasticity walking speeds of 58 patients who had been enrolled in a double
blind placebo controlled trial looking at dosing and effectiveness
of Botox on lower limb spasticity after stroke were retrospectively
0502A1 analysed before and after calf injection. With respect to the up-
SEVERE SPASTICITY (ITB THERAPY) per limb, in a third study, Dysport 500U–1000U or placebo was
injected into the affected distal upper limb muscles twice (12
Mauro Zampolini weeks apart), in a multi-centre, randomised, double-blind, placebo
Department of Rehabilitation, ASL3 (Italy) controlled study in 96 (ITT) patients. The primary endpoint was
Purpose: The intrathecal baclofen therapy has become widespread the assessment of Quality of life scale (AQol) with other end-
in the treatment of conditions of severe spasticity general. A group points being Goal attainment scaling (GAS), pain, mood, global
of diseases that benefit from this treatment are the acquired severe benefit, Modified Ashworth Scale and measures of disability and
Brain Injuries traumatic or non traumatic. In order to evaluate carer burden. Results: In the first study the AQol returned utility
the effect of intrathecal baclofen therapy was carried out a mul- values ranging from –0.04 (a state worse than death) to 1.0 (perfect
ticenter study. Materials and Methods: This retrospective study health). Analysis of the utility scores for the functional walking
included 184 patients who underwent implant of SynchroMed® categories found statistically significant differences between the
pump (Medtronic. Inc., Minneapolis, MN) for the intrathecal groups, with community walkers having a better QoL relative to
administration of baclofen between September 1994 and January household walkers. In the second study BoNTA significantly in-
2007 at 21 Italian centers. Results: The difference between the creased walking speed by 23.6%, 23.8%, and 34.5% at 4, 8, and 12
follow-up and pre implant scores showed a significant improve- weeks post-treatment (p = 0.014, p = 0.018, and p = 0.003, respec-
ment in both Ashworth upper and (3.8 vs 3.1, p < 0.05), lower tively). Placebo increased walking speed by 18.6% (p = 0.027) at 4
limbs scale (4.2 vs 2.9, p < 0.05), and in spasm scale (1.5 vs 0.4, weeks; however, no significant change was seen at 8 or 12 weeks.
p < 0.05). The ITB prevention of deformities/contracture was par- After the injection, walking speed improved in 70.3% (26/37) of
tially/totally obtained in 71% of patients. An improvement of care BoNTA-treated patients significantly enough to change mobility
management in 82%, participation to rehabilitation programs in by at least one functional walking category, compared with 33.3%
66%, improvement in activities of daily living (ADLs) in 70%, a (7/21) of placebo-treated patients (p = 0.012, BoNTA vs placebo).
decrease of pain in 67%, an improvement in mobility in 67%, and In the upper limb study, compared with placebo, the injected group
a decrease of neurovegetative crisis in 50%. 77% of caregivers has showed signiﬁcant reduction in spasticity (MAS) (p < 0.001),
been obtained. Conclusion: The study showed the effects of the which translated into higher GAS scores (p < 0.01*) and greater
treatment in terms of reduction of the spasticity, help to achieve global beneﬁt (p < 0.01) There was however, no significant differ-
the Rehabilitation goals and satisfaction for the patient and the ence in AQoL (primary endpoint) , pain and mood disability or
caregiver. As a retrospective observational study some data can- carer burden. Conclusion: In looking at outcome measurement
not be completely reliable. In order to overcome the problem a after injection of botulinum toxin for spasticity management, there
prospective study has been started that will aim to better outline is a need to focus on the improvement of function in individual
the terms and the effects of treatment. patients with respect to their daily activities as well as looking at
issues of changes in quality of life.
0502A2
EVALUATING FUNCTIONAL OUTCOMES 0502A3
AFTER THE USE OF BOTULINUM TOXIN FOR BOTULINUM TOXIN AND INTRATHECAL
SPASTICITY POST ACQUIRED BRAIN INJURY – BACLOFEN: CONCURRENT OR SEQUENTIAL
AN AUSTRALIAN EXPERIENCE THERAPIES?
John Olver Gerard E. Francisco
Chairman of the Clinical Institute of Rehabilitation, Psychiatry Physical Medicine and Rehabilitation, University of Texas Medical
and Pain Management Epworth Healthcare, Monash University School, TIRR Memorial Hermann (United States)
(Australia)
Botulinum toxin and intrathecal baclofen therapies are the most im-
Purpose: The current literature is convincing when considering portant recent developments in the pharmacological management
that injection of botulinum toxin reduces spasticity related to of spasticity. The choice of one over the other depends on various
acquired brain injury but is sparse when reviewed to look for evi- factors related to spasticity (e.g., severity, clinical presentation,
dence of improvement of an individual’s function after injection. limb distribution), pharmacologic properties (e.g., drug delivery,
The purpose of this paper is to review three Australian studies duration of action, adverse effects) and cost-effectiveness. In
aimed at demonstrating improvements in function and quality general, botulinum toxin is preferred for focal spasticity while
of life following injection of botulinum toxin for spasticity post intrathecal baclofen, for generalized spasticity. Frequently the
stroke and TBI. Materials and Methods: The first study, was a complex clinical presentation and functional impact of spasticity
prospective, non-interventional study conducted at 17 investi- challenge clinicians to reconsider if these therapies are mutually
gational sites in Australia to examine the relationship between exclusive or should be considered part of the armamentarium of
functional walking capacity (ie gait speed) and health related spasmolytic therapies that can be used concurrently. This pres-
quality of life in patients with focal lower limb spasticity due to entation will discuss various situations where it is appropriate
upper motor neuron syndrome (all etiologies). 127 patients were to use botulinum toxin and intrathecal baclofen as sequential or
recruited. Based on gait speed, each patient was assigned to one concurrent therapies dictated by, among others, desired clinical
of 4 functional walking categories. (e.g. a gait speed of > 25 m/ outcome, tolerance of adverse effects, and current treatment goals.
min was used as a demarcation between the household and limited Since each management strategy has its own beneficial effect,
community groups) The Assessment of a Quality of Life (AQoL) they should be considered complementary, rather than compet-
questionnaire was completed by each patient. In a second study the ing, therapies.

0502A4 Keng-He Kong, R Rosales, W Kumthornthip, KJ Goh, J

THE APPLICATION OF MOTOR CONTROL Sain, KS Wong, V Mok
ASSESSMENT IN PATIENTS WITH SPASTICITY Tan Tock Seng Hospital (Singapore)
Simon Fuk-Tan Tang Purpose: To investigate the efficacy of a single injection of

Department of Rehahilitation Medicine, Chang Gung Memorial Botulinum toxin A in the treatment of early post-stroke upper
limb spasticity in Asian patients. Materials and Methods: This
Hosipital and Chang Gung University (Taiwan)
is a prospective, multicentre, randomized, double-blind placebo-
The ability to ambulate indepedently is the ultimate goal in reha- controlled study. Patients with upper limb spasticity within 2–12
bilitation treatments. However, depending on the severity of the weeks of a stroke were randomized to receive a single dose of
central nervous system injury and the degree of spasticity, the goal Botulinum toxin A or placebo into muscles of the elbow and wrist.
of independent ambulation is often difficult to achieve. Therefore, it The primary outcome measure was the Modified Ashworth Scale
is crucial to have reliable clinical tools that can precisely assess and of the elbow or wrist. Secondary outcome measures included
predict ambulatory outcome. During the past 16 years, we have suc- passive and active range of motion of the elbow/wrist, Barthel
cessfully applied polyelectromyography (PEMG) and gait analysis to Index, Pain, Modified Rankin Scale and Motor Assessment Scale.
assess the motor control feature of spasticity in patients with stroke, These measures were evaluated at baseline, 4, 8, 12 and 24 weeks
cerebral palsy, and spinal cord injuries (SCI). In hemiplegic stroke after injection. Results: 163 patients (80 on Botulinum toxin A,
patients, we have discovered that PEMG patterns are a more sensi- 83 on placebo) were studied. Patients in the Botulinum toxin A
tive assessment tool as compared with Brunnstrom’s stages. Patients group had significantly greater reduction in Modified Ashworth
with patterns of 3 and 4 had better motor recovery and ambulatory Scale scores than those in the placebo group and this effect was
capabilities 6 months after stroke than those with patters of 1 and 2. sustained up to 24 weeks. Patients receiving Botulinum toxin A
This was an essential finding as PEMG patterns may allow physicians also reported significant reductions in pain at 4 and 24 weeks.
to predict the fine motor outcome soon after stroke, even in patients There were significant improvements in passive elbow and
who can not move their legs initially. In terms of motor control assess- wrist ROM at several time points, and improvements in active
ment for cerebral palsy patients who are to receive selective posterior hand movements at weeks 4, 8 and 12.There were no significant
rhizotomy, PEMG patterns of 2–3 was discovered to be able to predict changes in the Barthel Index, modified Rankin scores, or Motor
independent ambulatory ability. On the other hand, PEMG patterns Assessment Scale. Adverse events were no different between arms
of 6–7 will interfere with ambulatory ability. Based on these findings, of the study. Conclusion: In patients with early post-stroke upper
it is possible that PEMG patterns may allow physicians to select the limb spasticity, a single dose of Botulinum toxin A is effective
appropriate children with spastic cerebral palsy to receive rhizotomy in reducing spasticity and this effect is sustained up to 24 weeks
with good treament results. In patients with hemiplegic stroke, cane is post-injection.
often needed for walking. We have conducted a study using temporal
stride and force analysis to examine in detail the significance behind
cane-assisted gait pattern in patients with hemiplegic stroke. Interest- 0502E2
ingly, we discovered that cane provided support and a braking function
for people with hemiplegic stroke. The sound limb was in fact used COMPREHENSIVE MANAGEMENT OF
for propulsion. Data obtained in this study could be used for assessing SPASTICITY IN CEREBRAL PALSY
the nature of cane assistance and in planning therapeutic strategies for Moon Suk Bang
patients with hemiplegic stroke. In our other stroke related studies,
we have also discovered that motor recovery and functional outcome Department of Rehabilitation Medicine, Seoul National University
after stroke correlated more with brain lesion profiles (BLPs). Surpris- College of Medicine (Republic of Korea)
ingly, motor recovery and functional outcome had no or only a weak Spasticity is one of the frequently encountering problems in cer-
relationship with either the absolute or relative lesion size. These ebral palsy (CP). Spasticity causes torsional deformity of joint and
findings suggested that motor recovery and functional outcomes after muscle, developmental problems such as gait disturbance, or dif-
stroke correlated more with BLPs (a combination of delimiting sizes ficulty for caring patients. An integrated team is required to manage
and primary locations) rather than with the absolute and relative lesion spasticity successfully including physiatrist, orthopedic surgeon,
size only. In our pilot study using poly-surface EMG (poly-SEMG) neurosurgeon, physical therapist, occupational therapist, orthotist,
to assess the motor control in chronic incomplete SCI patients, our nurse, and family members. After careful evaluation of spasticity,
results suggested that SCI individuals exhibit identifiable patterns of physician should consider whether spasticity is affecting function,
motor control in the lower extremities and these patterns can help us in pain or will lead to musculoskeletal deformity. Appropriate treat-
predicting clinical characteristics of ambulation such as choosing the ment decision can be made with considering the goal of the therapy
assistive device used. Coactivation of proximal muscle, poor timing in consultation with the patient and caregiver, with an emphasis on
of muscle activity and radiation of activity into contralateral muscles patient function. Therapeutic approaches can be classified as fol-
were noted in subjects who required a walker or crutches and may be a lows. 1) Functional approach is aimed to maintain proper length of
marker of inadequate motor control for more independent ambulation. muscle and optimization of muscle spindle activity. Side effects are
Our team has integrated PEMG and gait analysis to serve as reliable minimal but duration is short; reduction of noxious stimulation, posi-
tools to predict the motor recovery and functional outcome in spastic tioning, stretch, physical modalities such as heat and cold, electrical
patients who suffer from stroke, cerebral palsy and SCI. Our findings stimulation, splint, orthosis, seating device. 2) Oral medications
may provide crucial information for the physicians to apply early and are for control of generalized spasticity and may cause systemic
aggressive treatment strategies for patients who are predicted to have side effects such as sedation or metabolic loads. Mechanism of
good motor recoveries. Early rehabilitation treatments to these patients action of most medications are related to neurotransmsion except
may ensure good subsequent ambulation capabilities. dantrolene, which interferes with calcium release from sarcoplasmic
reticulum.;bezodiapine, balcofen, tizanidine, clonidine, diazepam,
gabapentine, dantrolene. 3) Chemodenervation is targeted for focal
0502E1
spasticity. For motor point or nerve block, phenol and alcohol are
TREATMENT OF EARLY POST-STROKE UPPER preferred agents, which need EMG guided or electrical stimulator.
LIMB SPASTICITY IN ASIAN PATIENTS – Botulinum toxin type A (Botox, Dysport, Neuronox, Prosigne, Xe-
RESULTS OF A PROSPECTIVE, MULTICENTRE, omin) and type B(Myoblck)act on neuromuscular junction, which
are easy to administer comparing with phenol block. 4) Orthopedic
RANDOMIZED, DOUBLE-BLIND, PLACEBO- procedure and neurosurgical procedure such as intrathecal baclofen
CONTROLLED TRIAL OF BOTULINUM TOXIN A pump (ITP) and selective dorsal rhizotomy. Goal of orthopedic
INJECTION procedure is to elongate contracted muscle, simplify a complex

Rehabilitation Technology and Engineering, Geriatric Rehabilitation, Complementaray and Alternative Medicine 65
muscle action and corrects lever-arm dysfunction of patients with peak torque, work, and catch angle, but iEMG does not. Based
CP. Combination of above treatment options should be considered on isokinetic dynamometer with sEMG recording, clinician can
for the successful outcome with functional gain, satisfaction, or objectively follow the effect of rehabilitation treatment and tone
elimination of pain. reduction treatment for strokes. In addition, it is essential to match
the biomechanical and clinical findings. The rheological change of
muscles in strokes with different onset durations may play an im-
0502E3 portant role of passive stiffness, affected limb and the relationship
NEUROPHYSIOLOGICAL MONITORING OF of spasticity to contracture, but remains to be determined.
INTRATHECAL BACLOFEN DELIVERY FOR
CONTROL OF SPASTICITY
Dobrivoje S. Stokic Rehabilitation Technology and Engineering, Geriatric
Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation, Complementary and Alternative
Rehabilitation Center, Jackson (United States) Medicine
Intrathecal baclofen (ITB) is commonly used for management of
muscle hypertonia. Despite generally favorable results, the spinal 0502I1FP
cord response to ITB is not well understood and the implanted APPLICATION OF SURFACE EEG-BASED
system occasionally fails. Thus, neurophysiologic monitoring of BRAIN-MACHINE INTERFACE (BMI) TO
ITB delivery seems warranted. The purpose of this presentation is
to demonstrate the utility of Hoffman (H)-reflex recording in the REHABILITATION PRACTICE
soleus muscle as a valid, reliable, and user-friendly technique for Meigen Liu1, Toshiyuki Fujiwara1, Junichi Ushiba1,2,
monitoring neurophysiologic response to ITB administration in Yasunari Hashimoto2, Kimiko Kawashima2, Keiichiro
different clinical scenarios. Rationale for utilizing the H-reflex as Shindo3
an adjunct to clinical assessment will first be presented followed 1
Department of Rehabilitation Medicine, Keio University School of
by results of several “proof of principle” investigations describing
clinical applications, data interpretation, and limitations of this Medicine, 2Graduate School of Fundamental Science and Technol-
technique. The greatest yield of the H-reflex is achieved with serial ogy, Keio University and 3Department of Rehabilitation Medicine,
evaluations, starting with baseline assessment, hourly after the ITB Tokyo Metropolitan Rehabilitation Hospital (Japan)
bolus injection, immediately after the pump implantation at the low- Purpose: Brain-machine interface (BMI), which operates external
est possible dose, during initial dose titration, and then “as needed” device based on brain activities, is a potentially useful technology in
when system malfunction is suspected. This approach proved useful rehabilitation not only to substitute for lost functions but to induce
for troubleshooting ITB bolus injection, “low reservoir syndrome”, brain plasticity. Among various types of BMI, EEG-BMI is widely
“early” system malfunction, and “late” system malfunction, in- used because of its fine temporal resolution, ease of use, portability
cluding more challenging situations, such as partial or progressive and low cost. However, it is susceptible to noise, and extensive train-
interruption of continuous ITB delivery. Although more sensitive, ing is required to use it. Recently, we developed a new EEG-BMI
H-reflex should be viewed as complimentary to clinical and other system to counter these problems. The purpose is to test its applicabil-
methods for monitoring and troubleshooting ITB delivery. ity to rehabilitation practice. Materials and Methods: EEG signals
were recorded from C3, Cz and C4, and mu rhythms appearing or
disappearing on motor attempts (mu-ERD) were quantified with a
0502E4 bispectral function. To extract motor associated signals with high
EMG Patterns Induced by Different SN ratio, we performed coherence analyses between the two EEG
Angular Velocity in Stroke Patients signals obtained with two different recording methods from the same
with Ankle Spasticity site. Real-time classification was performed with both linear and
nonlinear detectors depending on patterns of signal changes. With
Ta-Sen Wei1,2 this system, we performed the following experiments. 1) We tested
1
Department of Physical Medicine and Rehabilitation, Changhua the accuracy of classification in 6 healthy individuals, and applied
Christian Hospital and 2Institute of Biomedical Engineering, Col- the system to a patient with muscular dystrophy and 2 patients with
lege of Medicine and College of Engineering, National Taiwan cervical cord injury to control an avatar in the virtual 3-D world
University (Taiwan) Second Life®. 2) We tested the feasibility of a BMI neurofeedback
training in 4 patients with chronic hemiparetic stroke who were un-
Spasticity of ankle plantarflexors is a common positive symptom of able to extend their fingers fully. We recorded EEG from the primary
upper motor lesion observed in stroke patients. Abnormal muscle motor cortex during motor imagery of extending the affected fingers,
tone results in an equinovarus foot which not only affects patient’s and simultaneously recorded EMG activities from extensor digitorum
functional performance but increases the risk of fall. Precise assess- communis (EDC). We analyzed mu-ERD and provided a real time
ment of muscle tone is a prerequisite task for predicting the outcome visual feedback in the direction of moving a cursor on the monitor.
and as an indicator for tone reduction treatment, such as a tone After successful motor imagery, the affected fingers were extended by
blocker injection. Ashworth and Tardieu scales are usually used for activating a motor-driven hand orthosis. The patients tried to extend
assessing the severity of spasticity in clinical practice. While select- their paretic fingers by thought for 2–5 seconds in every 10 s, and
ing the scales, inter-intra, test-retest reliability and validity are most performed 50–100 trials a day, 12 time(s) a week. The training period
concerned. Since these scales are based on clinical rating, it is easily ranged from 4 to 7 months. We analyzed changes of mu-ERD, motor
prone to subjectiveness. A constructed test standard is necessary and recruitment of EDC with motor intention, and cortical excitability as
can promote understanding of the relationship between scales and assessed with transcranial magnetic stimulation (TMS) before and
instrumented measurements. Isokinetic Dynamometer and sEMG after the intervention. Results: 1) In healthy individuals, the accuracy
have been used for studies in this field. Isokinetic dynanometer can of detection was 80%, much higher when compared with previously
perform consecutive sinusoidal passive movement at preset angular reported methods. The 3 patients successfully learned to control the
velocity and quantify the velocity-dependent phenomenon of spas- avatar after 5 training sessions. 2) With long-term BMI training, the
ticity. Stretch response can be verified by electromyographic activity accuracy of the affected hand imagery improved and the degrees of
of anterior tibialis and gastrocnemius. Resistive peak torque and mu-ERD became larger and more stable at the final session. The af-
integrated EMG (iEMG) amplitude are analyzed for quantitatively fected EDC EMG activities increased during motor imagery, although
assessing spasticity. The EMG activity increased significantly when no apparent functional improvement was observed. With TMS, the
angular velocity increased. The Modified Ashworth Scale correlates resting motor threshold of the motor evoked potential recorded from

first dorsal interosseus decreased in 3 of the 4 patients. Conclusion: 1

Department of Physical Medicine and Rehabilitation, Taipei Vet-
Our EEG-BMI system can be a useful tool not only to assist persons erans General Hospital (Taiwan)
with disability to broaden their world, but to restore more effective
motor control in paralyzed limbs.
2
School of Medicine, National Yang-Ming University, 3Institute of
Physical Therapy and Assistive Technology, National Yang-Ming
University, 4Department of Neurology, Neurological Institute, Tai-
0502I2FP pei Veterans General Hospital and 5Department of Ophthalmology,
CAN TRANSCRANIAL DIRECT CURRENT Taipei Veterans General Hospital (Taiwan)
STIMULATION (TDCS) MODIFY THE RESTING- Purpose: It is known that disruption of vestibulo-ocular reflex
STATE FUNCTIONAL CONNECTIVITY OF THE can contribute to oscillopsia, which in turn, will cause dizziness
MOTOR CORTEX? A PROOF OF CONCEPT FMRI and unsteadiness in persons suffering from vestibular disorders.
STUDY The assessment of vestibular dysfunction is generally based on
vestibulo-ocular reflex (VOR) and vestibule-spinal reflex (VSR).
Gad Alon1, Steven Roys2, Rao P Gullapalli2 To date, the clinical evaluations have certain limitations. The
1
University of Maryland, School of Medicine, Department of objectives of this study were to 1) develop a device providing
Physical Therapy & Rehabilitation Sciences and 2Department of evaluation and training modules for chronically dizzy patients,
Diagnostic Radiology (United States) 2) compare the differences of DVA and center of pressure (COP)
among normal, unilateral vestibular hypofunction (UVH) and bi-
Purpose: To develop and test an innovative method to obtain fMRI lateral vestibular hypofunction (BVH) subjects, and 3) to evaluate
data during the application of non-invasive tDCS. Materials and the effectiveness of this computerized training device. Materials
Methods: One subject participated in 5 MRI sessions. Functional and Methods: The signals of rate sensor and force plate were
images (Siemens 3T Tim Trio scanner, 8-channel head coil) were transferred and composed. The evaluating module and training
acquired using single-shot EPI T2*-sensitive sequence (TE = 30 ms, module were created by LabVIEW software. Dynamic visual
TR = 3 s, 1.8×1.8 mm2 in-plane resolution and a FOV of 23 cm) using acuity and COP were evaluated with our device on subjects’ first
36 axial slices (4 mm thick) with no gaps between slices. A high reso- visits and one month after training. Questionnaires and objective
lution T1-weighted-MPRAGE (TE = 3.44 ms, TR = 2 s, TI = 900 scales were evaluated on their first and follow-up visits. Statisti-
ms, flip angle = 9º, 72 slices, slice thickness 2 mm, 0.898×0.898 mm2 cal analysis: 1) The changes in DVA and COP among the three
in-plane resolution and a FOV of 23 cm) was acquired for anatomic groups were compared by ANOVA (p < 0.05), 2) post hoc was
reference. In each session, two resting state scans were separated used to compare the difference between groups, 3) the results in
by two tDCS scans and one functional activation scan involving the DVA, COP displacement and questionnaire between pre-training
motor cortex. The functional scan was a self paced finger-thumb and post-training in three groups were compared by paird-t test.
apposition task. Block design was used with 20 s-On and 20 s-Off Results: Thirty-four patients were included in this study (17 Male
for a total of 8 cycles. In tDCS sessions 1–3, 2 mA of direct current and 17 female, average 58.85 ± 21.19 years). Based on physical
was applied for 6.45 min placing the positive electrode over the right examinations and caloric test results, subjects were categorized
primary motor area of the cortex and the negative electrode over into 3 groups including normal, UVH and BVH subjects. Sig-
the supra-orbital area on the left side of the head. In session 4–5 we nificant differences in horizontal DVA (HDVA) (p = 0.000) and
applied a pulsed tDCS stimulator (tPDCS) with identical electrodes vertical DVA (VDVA) (p = 0.001) were found among the 3 groups
size and positions.Data were analyzed using AFNI (Robert Cox, before training. No significant difference was found in COP dis-
NIH) and MATLAB (MathWorks Inc., Natick, MA). Images were placement (SVA: p = 0.684, HDVA: p = 0.447, VDVA: p = 0.076).
corrected for slice timing, registered, blurred with a 6 mm FWHM After 4.78 ± 1.26 weeks training, subjects improved significantly
Gaussian blur, and intensity normalized. For motor fMRI analysis, in HDVA (p = 0.000) and VDVA (p = 0.000) and COP displacement
the general linear model (GLM) was used to determine the voxels reduced from 11246.74 ± 4280.46 mm to 8005.60 ± 2765.43 mm
that were significantly correlated with the motor task paradigm. For (p = 0.006). Subjects’ subjective and objective clinical assessments
fcMRI, 7 mm spherical regions of interest (ROIs) were drawn centered improved significantly after training (p < 0.005). Conclusion: The
on the right M1 and left M1 regions, guided by the fMRI results. device developed in this study can evaluate and train subjects’
The resting-state time series from the voxels in the RM1 ROI were visual acuity and center of pressure simultaneously. This low
averaged and the resulting time series used as a regressor in the GLM priced equipment with minimal environmental constraints could
analysis of resting state data. The functional connectivity maps thus be applied to vestibular patients to improve their life quality.
obtained were thresholded at 0.6 of the maximum R2 value, and then
combined to give overlap maps for each of the 3 resting-state condi-
tions (non-simulated, tDCS, and tPDCS). Voxels that were above the 0502I4FP
0.6 threshold in all of the scans for each condition were considered
“highly active” seed voxels (HASV). Results: The ROI were the left FUNCTIONAL ELECTRICAL STIMULATION
and right M1 regions. During rest, the number of HASV in the left M1 TO DORSIFLEXORS AND PLANTAR FLEXORS
were 401 compared to 65 HASV in the right M1, indicating 84% vs. DURING GAIT TO IMPROVE WALKING IN
16% activity. tDCS increased the left M1 HASV to 564 and decrease ADULTS WITH CHRONIC HEMIPLEGIA
the right M1 HASV to 19 (a 97% vs. 3% activation). Pulsed tDCS
increase both the left (698) and right (168) HASV while decreasing Gad Alon2, David G. Embrey1
the left M1 percentage to 76% and increasing the right M1 to 24%. 1
Good Samaritan Physical Medicine and Rehabilitation Center and
Conclusion: This maybe the first-ever in-vivo demonstration that 2
University of Maryland, School of Medicine, Department of Physi-
non-invasive tDCS can affect fMRI recording of the motor cortex’s cal Therapy & Rehabilitation Sciences (United States)
resting-state. tDCS and pulsed tDCS may have different effect on
fMRI derived hemodynamic response within the brain. Purpose: To determine if functional electrical stimulation (FES) timed
to activate the dorsiflexors and plantar flexors during gait, improves
the walking of adults with hemiplegia. Materials and Methods: A
0502I3FP
randomized cross-over trial. Twenty-eight adults with hemiplegia
EFFICACY OF A COMPUTERIZED ASSESSMENT (4.9 ± 3.8 years post-stroke). Intervention “A” included 3 months of
AND TRAINING SYSTEM FOR CHRONICALLY wearing the FES system which activated automatically the dorsi and
DIZZY PATIENTS plantar flexors during walking for 1 hours/day, 7 days/week. Interven-
tion “B” included 3 months of walking an hour/day, six days/week
Chung-Lan Kao1,2,3, Rai-Chi Chan1,2, Wan-Ling Hsieh1,3, without FES. Of the 28 patients who completed the study, 15 were
Shuu-Jiun Wang2,4, Shih-Jen Chen2,5, Shun-Hwa Wei3 randomly assigned to group A-B, and 13 to group B–A. Cross-over

Rehabilitation Technology and Engineering, Geriatric Rehabilitation, Complementaray and Alternative Medicine 67
occurred at 3 months. Outcome Measures: Variables were measured the dynamic cushion system could cyclically relief the shear stress
at pre-treatment, at 3 months, and at 6 months. Three primary out- at the skin as well as the peak stress in the deep soft tissue beneath
comes were selected a priori and included two functional variables: the ischial tuberosity. Therefore, this device could reduce the prob-
six minute walk (6MW), Emory Functional Ambulatory Profile (E- ability of pressure sore formation. In conclusion, this newly-designed
FAP); and one participation variable, the Stroke Impact Scale (SIS). dynamic cushion system can provide a means for preventing pressure
All tests were done without electrical stimulation. Results: At the end sores and the quantitative data of the current evaluation can provide
of phase one, (3 months) patients who received treatment A showed reference for clinician and biomechanics researchers.
significant improvement over patients who received treatment B on
6MW (p = 0.02), E-FAP (p = 0.08), and SIS (p = 0.03). In phase two,
the A-B group (without FES) maintained improvement in all three 0502I6FP
primary outcomes. Both groups improved significantly on all primary INTENSIVE TRAINING OF CHRONIC STROKE
outcome measures, comparing 6 month to initial measures (p≤0.05). ON A MOTORIZED CYCLE COMBINED WITH
Conclusion: An FES system that stimulates dorsiflexors and plantar
flexors while approximating the timing of typical adult gait, when FUNCTIONAL ELECTRICAL STIMULATION
combined with structured walking, can improve the walking ability (FES): EFFECT ON LOCOMOTION
of adults with chronic hemiplegia. Gad Alon, Vincent M. Conroy
University of Maryland, School of Medicine, Department of Physical
0502I5FP Therapy & Rehabilitation Sciences (United States)
THE EFFECT OF NEWLY-DESIGNED DYNAMIC Purpose: To document changes in locomotion of chronic hemi-
CUSHION SYSTEM ON DEEP TISSUE OF HUMAN plegia after intensive training using a motorized cycle combined
BUTTOCK: A 3D FINITE ELEMENT ANALYSIS with functional electrical stimulation (FES) system. Materials and
Methods: Ten subjects completed 24 sessions of 30 min, 3x per
Shih-Cherng Lin1,2, Fuk-Tan Tang1, Pai-Chu Chen1, week cycling on a stationary motorized cycling system combined
Yue-Xing Zhang2, Jiun-Jie Wang3, Yu-Chun Lin3, with FES (RT300™). The stimulation activated the knee and ankle
Weng-Pin Chen4 joints flexors and extensors using a stimulation pattern that assisted
1
Department of Physical Medicine and Rehabilitation, 2Department cycling motion of the paretic lower limb. Patients attempted to cycle
of Biomedical Engineering, 3Department of Medical Imaging and as close as possible to 60 RPM and the resistance to cycling was
Radiological Sciences, 4Department of Mechanical Engineering gradually increased. Results: No adverse reactions to the training
(Taiwan) or the FES were noted. Time to complete the get up and go test
improved from 45.4 ± 54.9 s to 34.0 ± 31.8 s (p = 0.03), and gait
Purpose: Pressure sore is a common complication for wheelchair- velocity increased from 0.4 ± 0.3 m/s to 0.5 ± 0.4 m/s (p = 0.01).
bounded persons with spinal cord injury. The effects of pressure and Active dorsiflexion (DF) with the knee in either 90 deg flexion
time are believed to be the major factors accounted for the formation of of fully extended improved statistically (Wilcoxon test p = 0.05).
pressure sores. Appropriate cushion are often used to reduce the pos- Plantar flexion, knee extension and knee flexion did not change.
sible damage that caused by excessive pressure on the weight-bearing Conclusion: Intensive training using a motorized cycle+FES ap-
soft tissue, and to prevent the development of pressure sores. There- pears safe and can improve selected variables of locomotion and
fore, the purpose of current study was to develop a newly-designed paretic lower extremity active range of motion.
dynamic cushion system, and finite element analysis was used to
evaluate its effect on deep tissue of human buttock. Materials and
Methods: This newly-designed dynamic cushion system consisted 0502I7FP
of an upper base, a lower base, a universal joint and four spring ele- MALNUTRITION AND REHABILITATION
ments. The upper base and lower base were assembled by the ball OUTCOME OF DISUSE SYNDROME: A
joint and socket which were located at the center of base respectively.
Four spring elements were set at the corner of upper and lower base RETROSPECTIVE COHORT STUDY
respectively for damping function. The principle of this design is Hidetaka Wakabayashi, Hironobu Sashika
to transfer center of pressure (COP) trajectory by the upper limb Department of Rehabilitation Medicine, Yokohama City University
movement and damping system. A computer aided design software Medical Center (Japan)
(Hypermesh) was used to construct the model of the dynamic cushion
system with spring elements. The magnetic resonance images of a Purpose: Disuse syndrome is defined as “a state in which an indi-
healthy male subject were also used to reconstruct the finite element vidual is at risk for deterioration of body systems as the result of
model of a human buttock. Besides, the Vicon motion analysis system prescribed or unavoidable musculoskeletal inactivity.” Concept of
and the Novel Pliance pressure measurement system were integrated disuse syndrome, deconditioning, and debility resemble each other in
to capture the kinematic and kinetic data of the same male subject in some respect. Some patients with disuse syndrome are malnutrition,
sitting posture in order to provide boundary and loading conditions for but association between disuse syndrome and malnutrition is unclear
computer simulation. Finally, the results from finite element analysis except body mass index. The purpose of this study is to determine
were compared with the data from pressure measurement to verify the whether malnutrition is associated with rehabilitation outcome of dis-
accuracy of computer simulation. Results: In terms of shear stress at use syndrome. Materials and Methods: A retrospective cohort study
skin beneath the ischial tuberosity, the shear stress of rigid cushion was performed in 223 inpatients admitted to university medical center
system was 5.45 kPa. The maximum shear stress of high stiffness and diagnosed disuse syndrome by physicians of the rehabilitation
and low stiffness cushion were 7.2 kPa and 7.3 kPa; the minimum department. All patients were prescribed physical therapy. Data was
were 5.1 kPa and 5 kPa, respectively. Even though the maximal shear collected from participants in a prospective cohort study of “clinical
stress resulted from dynamic cushion system was higher than rigid research for development of diagnostic criteria for disuse syndrome
cushion, the minimal shear stress was lower than that. According to in rehabilitation medicine”. Malnutrition was defined as body mass
the peak stress in the deep soft tissue beneath the ischial tuberosity, index was below 18.5 and/or moderately impaired biochemical meas-
the averaged peak von Mises stress of rigid cushion system was urements (hemoglobin below 10 g/dl, serum albumin below 3 g/dl,
10.65 kPa. The maximum peak von Mises stress of high stiffness or total lymphocyte count below 1200). Rehabilitation outcome was
and low stiffness cushion were 13.7 kPa and 14.1 kPa; the minimum defined as whether patients’ Barthel Index score during rehabilitation
were 8 kPa and 7.7 kPa, respectively. Although the maximal peak improved or not. Nutrition status at referral including hemoglobin,
von Mises stress resulted from dynamic cushion system was higher serum albumin, total lymphocyte count, body mass index, Onodera’s
than rigid cushion, the minimal peak von Mises stress was lower than prognostic nutritional index (serum albumin x 10 + total lymphocyte
that. Conclusion: Based on the results from finite element analysis, count x 0.005), age, sex, duration between admission and referral

to the rehabilitation department, and Barthel Index score at referral significance (p = 0.14). This may be due to small study numbers or
were assessed. Chi square test and logistic regression analysis were the lack of social support at home. The MMSE score was not dif-
performed with SPSS 17.0, and p < 0.05 was considered statistically ferent in those who passed and failed the disc test (MMSE of 20 for
significant. This study was approved by the ethics committee of the both groups; p = 0.69). Subjects who achieved independent mobility
institution. Results: There were 136 men, 87 women. Mean age was at discharge had a mean MMSE of 21, compared to mean score of
67.5 years. Median duration between admission and referral was 19 in those who did not achieve independent mobility (p = 0.26).
17 (25 percentile: 11, 75 percentile: 27) days, median rehabilitation The MMSE score, a commonly used global cognitive assessment
duration was 32 (16, 61) days. 202 patients (91%) were malnutrition. tool, did not reflect on the performance of the HDT or predict mo-
115 patients’ (52%) hemoglobin were below 10 g/dl, 163 patients bility outcomes after rehabilitation. This suggests that perhaps more
(73%) were hypoalbuminemia (below 3 g/dl), 103/198 patients’ emphasis should be placed on assessing one’s procedural learning
(52%) total lymphocyte count were below 1200, and 56 patients ability when considering cognitively impaired elders’ rehabilitation
(25%) were underweight (body mass index was below 18.5). Mean potential. Conclusion: The Hornsby Disc Test has a good predictive
prognostic nutritional index was 32.9 (standard deviation: 7.1), and ability in mobility outcomes in cognitively impaired elders requiring
122/198 (62%) patients were below 35. 135 patients (61%) improved rehabilitation, and can potentially be used as a bedside screening
Barthel Index score during rehabilitation. Rehabilitation outcome of tool to select candidates in this particular population who are more
malnutrition patients was poor compared to normal nutrition patients likely to achieve successful rehabilitation outcomes. There is a plan
(malnutrition: improved 118, not improved 84, normal nutrition: im- to replicate the study with a bigger sample size.
proved 17, not improved 4; relative risk (RR): 2.18, p = 0.04). Patients
with low hemoglobin (RR: 1.82, p = 0.001) and low total lymphocyte
count (RR: 1.46, p = 0.03) were associated with poor rehabilitation 0502I9FP
outcome. Serum albumin (p = 0.08) and body mass index (p = 0.78)
were not different significantly. Prognostic nutritional index below 35 WALKING AND BALANCE PERFORMANCE IN
was associated with poor rehabilitation outcome (RR: 1.64, p = 0.01). EXERCISE, LIFESTYLE ACTIVE AND INACTIVE
Logistic regression analysis (covariate was age, sex, hemoglobin, total ELDERLY
lymphocyte count) revealed hemoglobin was independently associ-
ated with rehabilitation outcome (OR 2.34, p = 0.005). Conclusion: Thiwaporn Thaweewannakij, Sugalya Amatachaya,
Malnutrition is common in patients with disuse syndrome. Patients Kitiyawadee Srisim, Katavut Phiwjinda, Sawitree
with low hemoglobin and prognostic nutritional index at referral Maharattanawongsa, Lugkana Mato
are related with poor rehabilitation outcome. Moderate and severe School of Physical Therapy, Faculty of Associated Medical Sci-
malnutrition may be associated with poor rehabilitation outcome in ences (Thailand)
patients with disuse syndrome.
Purpose: To compare walking and balance performance among exer-
cise, lifestyle active and inactive older adults. Materials and Methods:
0502I8FP The study recruited one-hundred and fifty healthy well-functioning
PERFORMANCE ON HORNSBY DISC TEST older adults, aged 65 to 80 years (30 females and 20 males per group)
PREDICTS REHABILITATION POTENTIAL IN from several communities in Thailand. The subjects were classified
into 3 groups which were exercise, lifestyle active and inactive groups
COGNITIVELY IMPAIRED ELDERS by using intensity, duration of performing activities per day, and
Jan Yueh-Chen Hong, Jane Wu frequency of doing activity a week. Subjects were measured their
Department of Rehabilitation & Aged Care Service, Hornsby Ku- walking speed by using the 10-meter walk test (10MWT), walking
ring-gai Hospital (Australia) distance by using the 6-minute walk test (6MinWT), and functional
balance by using the Berg Balance Scale (BBS). Findings of these
Purpose: To design a quick and easy-to-administer bedside screen- subjects were compared by using ANOVA and post-hoc test (p < 0.05).
ing tool to assist clinicians in selecting cognitively impaired elders Results: There were clearly significant differences of the outcomes
requiring inpatient rehabilitation who are more likely to achieve among the groups, particularly in female subjects. The walking speed
successful outcomes. Materials and Methods: The Hornsby Disc and distance of exercise and lifestyle active subjects were clinically
Test (HDT) is adapted by the authors from the Tower of Hanoi/ To- significant from those of inactive subjects (more than 0.1 m/s and
ronto which have evidence for testing procedural memory involved 50 m, respectively). In addition, the functional balance of exercise
in motor learning. There are also some evidence that cognitive subjects was significant difference from that of inactive subjects
procedural learning requires the intervention of nonprocedural cog- (p < 0.05), but not clinically significant. Conclusion: The findings
nitive functions, including episodic memory, working memory and indicated that participation in optimal physical activity or exercise
executive functions. HDT consists of a pegboard with 3 pegs and program is important for, particularly female, older adults to reduce
2 discs. Subjects are asked to move the discs to a certain position functional decline associated with aging, and improve mobility and
shown on a picture. The test takes less 5 min to administer. A cohort balance control. However, the program for older adults should em-
of 30 English speaking subjects with MMSE ≤24 admitted to an phasize on intensity, duration, frequency and types of activity.
inpatient general rehabilitation unit in Sydney, Australia, between
July to December 2009, were asked to participate. Data collected
on admission included premorbid mobility, self care, Barthel Index,
accommodation, social support, MMSE, and the conditions requiring Brain Disorders: Speech and Swallowing
rehabilitation. Discharge mobility, self care, discharge destination,
and FIM score were also collected on completion of rehabilitation.
Successful outcomes are defined as independent mobility and return 0502B1
to previous accommodation. Results: Premorbidly all subjects were NEW DEVELOPMENT IN DYSPHAGIA
mobile. 47% of subjects resided at home and the rest in low level EVALUATION
care facility (hostels). At completion of rehabilitation, 50% of the
subjects achieved independent mobility and 50% of the subjects Tai Ryoon Han, Han-Gil Seo, Ja-Ho Leigh, Byung-Mo
were discharged to their previous residence. Seventy-one percent of Oh
the subjects who completed the test correctly achieved independent Department of Rehabilitation Medicine, Seoul National University
mobility, in contrast with only 31% of the subjects who failed the test Hospital (Republic of Korea)
(p = 0.03). Sixty-three percent of the subjects who completed the test
correctly returned to previous accommodation, compared with 37.5% Purpose: For more objective analysis of the VFSS, we did the
of subjects who failed the test, though this did not reach statistical kinematic motion analysis of the VFSS in normal persons and

Brain Disorders: Speech and Swallowing 69
stroke patients. The first purpose is to evaluate the effect of the 0502B3
chin tuck maneuver kinematically and the second purpose is to Evaluation and management in
evaluate the longitudinal changes of the swallowing process in
subacute stroke patients with aspiration. Materials and Methods: irradiated NPC patients with dysphagia
For the kinematic evaluation of the VFSS, we digitized 7 points for Tyng-Guey Wang
motion analysis-tip of food bolus, anterior and posterior margin Department of Physical Medicine and Rehabilitation, National
of hyoid bone, anterior and posterior margin of vocal cord and tip Taiwan University Hospital (Taiwan)
and base of epiglottis. For the study of the effect of the chin tuck
maneuver, we recruited 23 normal volunteer and the kinematic Purpose: Nasopharyngeal carcinoma (NPC) is a common disease
data of the chin tuck maneuver and chin down position. For the among Southeast Chinese. Radiotherapy is the most common pri-
study of the longitudinal changes of the swallowing in subacute mary treatment for NPC with good outcomes reported, but complica-
stroke patients, we recruited 28 stroke patients who had the definite tions frequently arise. These include hearing loss, xerostomia, tris-
aspiration in the first VFSS. We did the follow-up VFSS 3weeks mus, local soft tissue fibrosis and dysphagia. Xerostomia, dysphagia,
later in average and we classified them into 2 groups- recovered and hearing loss most negatively impact quality of life (QoL).
group (14 pts.) and non recovered group (14 pts) . And we com- Dysphagia also increases the risk of aspiration, which may cause
pared the kinematic data between the first and the second VFSS. death. This purposes of this work are to quantitatively assessment of
Results: With the kinematic analysis of the chin tuck maneuver, swallowing function in irradiated NPC patients with dysphagia and
we found that horizontal movement of the hyoid bone was reduced to evaluation the efficacy of functional electrical stimulation (FES)
significantly compared to the neutral and chin down position. in this group of patients. Materials and Methods: Thirty-three NPC
Also, there was significant elevation of vertical displacement of subjects (25 men and 8 women) and ten normal subjects (7 men and
the base of the epiglottis with the chin tuck maneuver, however, 3 women) participated in the study. The displacement and velocity
there was no changes in epiglottic rotation. For the longitudinal of hyoid bone movement, the amount of pyriform sinus stasis, and
study of subacute stroke patients with aspiration, we found that the widest opening distance of the cricopharyngeal muscle during
most temporal variables of the hyoid bone and epiglottis were pro- swallowing. Another twenty NPC subjects with dysphagia were
longed in non-recovered group. Also we found that the epiglottic divided into a FES and a home rehabilitation program (HRP) group.
angle was significantly improved in recovered group compared to The FES group received FES of the supra-hyoid muscles over fifteen
the non compared group. Conclusion: The kinematic analysis of sessions. The HRP group performed self-swallowing exercises at
VFSS is a very useful evaluation in dysphagia evaluation in terms home. The evaluation parameters included the QoL questionnaire
of understanding of the swallowing process more objectively. Chin scores, the penetration-aspiration scale (PAS), the movement of
tuck maneuver is a very effective maneuver to prevent the aspira- the hyoid bone, and the amount of pyriform sinuses stasis were
tion and the basic mechanisms of the chin tuck maneuver are to performed at the commencement and the end of the procedures.
reduce the horizontal movement of hyoid bone and to elevate the Results: The displacement of the hyoid bone in the NPC patients
base of epiglottis. Delayed swallowing triggering at initial VFSS was significantly less than that of the normal subjects (1.58±0.59 vs.
might predict poor recovery from aspiration in subacute stroke 2.23±0.49 cm, p=0.0033). The forward displacement of the hyoid
patients. Also, sustained reduction of the epiglottic rotation could bone in the NPC patients was found to be less than that of the normal
be the main pathology of poor recovery of dysphagia in subacute subjects (0.85±0.50 vs. 1.65±0.51 cm), achieving statistic signifi-
stroke patients. cance (p<0.0001). The pyriform sinus stasis of the NPC subjects was
significantly more than that of the normal subjects (2.24±0.98 vs.
0.30±0.17 cm2, p<0.0001). Most swallowing outcomes of the FES
0502B2 group improved after FES. The QoL score (p=0.003), the duration
EFFECTS OF PNEUMATIC DILATION ON of the movement of thin barium through the hyoid (p=0.001), the
moving speed of paste barium through the hyoid (p=0.028), and the
CRICOPHARYNGEAL FUNCTION IN PATIENTS pyriform sinus stasis area of the paste barium (p=0.026) reached
WITH ACHALASIA significant difference in the FES group. Most swallowing outcomes
Zulin Dou, Yue Lan, Guifang Wang did not improve in the HRP group. Conclusion: The irradiated NPC
subjects with dysphagia experienced a reduction in hyoid bone
Department of Rehabilitation Medicine; The 3rd Affiliated Hospital; displacement, occurring in a forward direction. FES will improve
Sun Yat-sen University (China) the swallowing function of NPC patients with dysphagia and bring
Purpose: To investigate the efficacy of two different methods of about better QoL.
catheter pneumatic dilatation therapy to treat cricopharyngeal
achalasia and benign strictures, and analysis the correlation re-
lationship between pneumatic capacity and swallowing function 0502B4
in pneumatic dilatation therapy. Materials and Methods: 23 cr- SPEECH AND LANGUAGE PROBLEMS IN
icopharyngeal achalasia and 7 benign strictures of cricopharyngeal
muscles were diagnosed by videofluoroscopic swallowing study PRESCHOOL CHILDREN IN TAIWAN
(VFSS). All cases received active and passive dilatation pneumatic Pao-Chuan Torng
dilatation therapy combined with the manipulation treatment of Department of Speech and Hearing Disorders and Sciences, Na-
dysphagia, indirect training, direct training and feeding guide. tional Taipei College of Nursing (Taiwan)
Efficacy and correlation were evaluated by swallowing function
scale. Results: Two different methods of dilatation can come into Purpose: To study the speech and language problems in three- to
being different efficacy. Correlation analysis by SPSS15.0 showed six-year-old preschool children in Taiwan. Speech and language
that the related coefficient of pneumatic capacity and swallowing problems including articulation, voice, resonance, fluency, and
function is 0.921.Reevaluation by VFSS showed that the opening receptive and expressive language were analyzed from parent
of cricopharyngeal muscles were improved significantly. Conclu- questionnaires. In addition, articulation problems were further
sion: pneumatic dilation therapy was an effective treatment for examined and discussed. Materials and Methods: A two-year
cricopharyngeal achalasia and benign strictures. It has close cor- study was carried out to examine the speech and language
relation relationship between swallowing function and pneumatic problems in three- to six-year-old preschool children in Taiwan.
capacity. Comprehensive treatment for dysphagia will obtain the Nine thousand five hundred and ninety preschool children were
better outcomes. recruited from the northern, central, and southern part of Taiwan.

Speech and language assessment tools and testing procedures Molecules Biology
were established to identify children who need further serv-
ices in the areas of hearing, speech and language. A total of 60
speech language pathologists, audiologists, and speech language 0502F1
graduate students were trained to administrate testing and analyse The Effects of Ultrasound on Tendon
data. Results: Based on the parent questionnaires, 10.0% of the
Cells
preschool children had articulation issues, 12.7% voice issues,
2.3% resonance issues, 5.4% fluency issues, and 16.9% language Wen-Chung Tsai
issues. As for articulation issues, problems were further classified Department of Physical Medicine and Rehabilitation, Chang Gung
into eight phonological error patterns, including backing proc- Memorial Hospital (Taiwan)
ess, fronting process, stopping, affrication, unaspriation, initial
consonant deletion, final nasal deletion and others. Conclusion: Purpose: To investigate the effects and molecular mechanisms
This study provides an in-depth understanding of the speech and of therapeutic ultrasound on migration, proliferation and collagen
language problem in Taiwan. Results are essential in establishing expressions of tendon cells. Materials and Methods: Tendon cells
an early intervention program for preschool children with speech intrinsic to Sprague-Dawley rats after ultrasound treatment were
and language disorders. used. Cell viability was evaluated by MTT assay. Cell migration
was evaluated by transwell filter migration assay. The expression
of proliferating cell nuclear antigen (PCNA) protein and types I
0502B5 and III collagen in cells was evaluated by immunocytochemistry.
The mRNA expression of PCNA, α-smooth muscle (SM) actin,
RECENT TRENDS AND TOOLS IN THE α1(I) procollagen, α1(III) procollagen, and TGF-β were determined
ASSESSMENT OF APHASIA IN TAIWAN by reverse transcription-polymerase chain reaction (RT-PCR).
Furthermore, the concentration of TGF-β in conditioned medium
Lu Lu
was evaluated by enzyme-linked immunosorbent assay (ELISA).
Department of Physical and Rehabilitation Medicine, National Results: A dose-dependent increase in the cellularity of tendon cells
Taiwan University Hospital (Taiwan) by either pulsed or continuous mode ultrasound was demonstrated by
Purpose: To review the recent trends in the assessment of aphasia MTT assay. Ten minutes of treatment achieved maximum cellularity
and the current tools available in Taiwan. Aphasia is a common compared to 5-min of treatment time. Dose-dependent ultrasound
communication disorder after stroke or other brain disorders. The enhancement was demonstrated on the migration of tendon cells
assessment of aphasia can be done via many different approaches. through the transwell filter. Immunocytochemical staining revealed
Traditional aphasic batteries focus on the comprehensive assess- that ultrasound treated tendon cells were stained more strongly for
ment of the severity of impairment in various language compo- PCNA than were control cells. Up-regulation of PCNA at the mRNA
nents. There are also tests for specific language ability, and tests level was also confirmed by RT-PCR. Immunocytochemical stain-
exploring the underlying cognitive processing deficits. In recent ing also revealed that ultrasound-treated tendon cells were stained
years, assessment of functional communication ability and qual- more strongly for types I and III collagen than were control cells.
ity of life is more and more emphasized. There had been limited Upregulation of procollagen α1(I) gene, procollagen α1(III) gene,
assessment tools for aphasia in Taiwan. In recent years, several and TGF-β at the mRNA level was confirmed by RT-PCR. A dose-
assessment tools have been developed for the use in aphasic pa- dependent increase in the concentration of TGF-β in conditioned me-
tients in Taiwan and some related researches have been done, but dium obtained from cells treated with ultrasound was demonstrated
more are still needed. by ELISA assay. Conclusion: Ultrasound stimulates proliferation,
migration and the expression of types I and III collagen in a process
that is likely mediated by the up-regulation of TGF-β.
0502B6
LINGUAL KINEMATICS WHEN SPEAKING 0502F2
AT A FAST RATE IN DYSARTHRIC AND PROTEOMIC RESEARCH IN AGEING AND
NONDYSARTHRIC INDIVIDUALS POSTSTROKE REHABILITATION MEDICINE
Yea-Tzy Chen Carl P.C. Chen, Simon Fuk-Tan Tang
The Chung Shan Medical University (Taiwan) Department of Physical Medicine and Rehabilitation, Chang Gung
Memorial Hospital (Taiwan)
This study aimed to examine, using electromagnetic articulog-
raphy (EMA), tongue movement of speakers with and without Changes in cerebrospinal fluid (CSF) proteins are now widely used in
dysarthria poststroke when speaking at a fast rate. Three groups the diagnosis of central nervous system (CNS) age-related diseases.
of participants were included: stroke with dysarthria (Stroke+D, However, little is known about the changes in CSF protein concen-
n = 10), stroke without dysarthria (Stroke−D, n = 9), and a matched trations that occur during healthy ageing to help interpreting clinical
control cohort (n = 19). During tongue-tip and tongue-back studies. This talk will explore the use of neuroproteomics and in situ
sentence production, speed-related parameters (lingual veloc- perfusion of the lateral ventricle choroid plexus (CP) techniques in
ity, acceleration, and deceleration), duration of movement, and ageing studies and in rehabilitation medicine. Sheep of wide age range
distance of movement were measured. In both tongue-tip and (between 1–9 years) is a good model to be used to comprehensively
tongue-back, most kinematic results revealed significant differ- investigate the changes in CSF and plasma protein concentrations,
ences (p≤0.001) among groups. When compared to the controls, their CSF/plasma ratios and percentage of protein transport across the
Stroke+D patients demonstrated significant differences across blood-CSF-barrier (BCSFB) during healthy ageing. The proteomic
most parameters: increased duration of movement and decreased technique of 2-dimensional electrophoresis (2-DE) is an ideal tool to
speed-related parameters (p < 0.05); Stroke−D patients showed identify all the proteins in the CSF and plasma, and their relative con-
significant differences only in velocity and acceleration. In rela- centrations. The steady state in situ perfusion of the lateral ventricle
tion to the Stroke−D group, these impairments appear to be at a choroid plexus (CP) technique is a reliable method to measure the CSF
subclinical level. secretion rate and the amount of drug transport across the BCSFB. In

Molecules Biology 71
the process of healthy ageing, CP tissue weight increased significantly University, 4Department of Physiology, National Defense Medical
with age, while CSF secretion rates and CSF turnover were measured Center and 5Department of Physical Medicine & Rehabilitation,
to decrease substantially. Reduced CSF turnover was shown to be the Cheng Hsin General Hospital (Taiwan)
main modulator of the normal CSF proteome. Plasma-derived proteins
revealed elevated crossing from blood into CSF during ageing. The Purpose: Spontaneous intracerebral hemorrhage (ICH) is a global
production of brain-derived proteins decreased substantially with health problem with high mortality, accounting for 10–15% of
age. In the steady state in situ perfused CP technique, CP epithelial strokes. Despite its public importance, effective medical treatment
cells were shown to be leakier in the old age as compared to middle has been unsatisfactory, and the pathogenesis of ICH-induced
age, with increased protein transport across the BCSFB with age. brain damage remains incompletely understood. Caveolae is a
In rehabilitation medicine, 2-DE technique can be used to study the membrane microdomain within lipid raft. Caveolin-1 (Cav-1) is
proteome pictures relative to treatment effectiveness. For example, the major component of caveolae known for its role in regulating
the proteome of the synovial fluid in knee osteoarthritis patients can cholesterol homeostasis and signal transduction. Cav-1 has been
be analyzed using the 2-DE technique before and after hyaluronic reported to possess a physiological role in central nerve system
acid injections. The proteins that reveal significant changes in con- including maintenance of nerve architecture and regulation of
centrations after treatment can be correlated to the improved clinical neuronal plasticity. Cav-1 gene mutations were associates with
symptoms to thoroughly explore the pathophysiological functions Alzheimer’s disease and ablation of the Cav-1 gene increased the
of these proteins. extent of cerebral ischemic injury. However, the role of Cav-1 in
the pathogenesis of ICH remains unknown. In the present study, we
investigated the role of Cav-1 and its underlying mechanisms in the
0502F3 pathogenesis of ICH using a murine model of collagenase-induced
THE EFFECTS OF PHYSICAL AGENTS ON basal ganglion hemorrhage. Materials and Methods: ICH was
induced by microinjecting collagenase VII-S into the striatum of
MUSCULOSKELETAL CELLS both wild type (WT) and Cav-1 knockout (Cav-1 KO) mice. Brain
Chia-Hsin Chen injury and brain water content were assessed by macroscopic ex-
Department of Physical Medicine and Rehabilitation, College of vivo analysis, luxol fast blue and cresyl violet staining, and wet/dry
Medicine, Kaohsiung Medical University (Taiwan) method. Fluoro-Jade B (FJB) histochemistry and TUNEL staining
were performed to label degenerating neurons and apoptotic cells.
Physical agents are widely used in rehabilitation fields and sports ac- Nutrophil infiltration and reactive oxygen species production were
tivities to improve the damaged tissue. The agents include mechanical determined by myeloperoxidase and nitrotyrosine immunostain-
load, light, electromagnetic waves, and so on. Molecular studies by ing, respectively. Enzyme-Linked Immunosorbent Assay (ELISA),
using physical agents have been also developed. A goal of our research western blot and quantitative reverse transcriptase polymerase
is to apply physical agents to cells or animals. We attempt to search chain reaction (RT-PCR) were used to examine protein and mRNA
the mechanisms and effects after applying these agents in vitro or in expression of inflammatory mediators and heme oxygenase-1 (HO-
vivo. Achilles tendon problems are commonly encountered in sports 1). Enzymatic activity of MMP-9 was investigated by gelatin gel
medicine and low-level laser therapy is used in to decrease pain, reduce zymography. Results: Cav-1 was up-regulated in the peri-hematomal
inflammatory processes and promote tissue healing. We examined the area predominantly in endothelial cells. Co-localization of Cav-1
effects on the proliferation of porcine Achilles tendon fibroblasts and with neurons and microglia was infrequently seen. Cav-1 KO mice
gene expression, using different doses of low-level laser irradiation. had smaller hemorrhagic and injury volumes, less brain edema and
Whole-body vibration training is applied to improve muscle strength, neuronal death 1 day after ICH than WT mice. Mechanistically,
balance and flexibility. However, the molecular mechanisms of verti- Cav-1 KO hemorrhagic brain showed marked reduction in leukocyte
cal vibration training and their effect on the myogenesis of myoblasts infiltration, decreased expression of inflammatory mediators, includ-
remain undefined. This study was undertaken to address the hypothesis ing macrophage inflammatory protein-2 and cyclooxygenase-2, and
that vertical vibration (VV) can enhance the expression of extracellular reduced matrix metalloproteinase-9 activity. Moreover, deletion
matrix (ECM) proteins and myogenic regulatory factors (MRFs) in of Cav-1 suppressed heme oxygenase-1 expression and attenuated
myoblasts and, in turn, increase myotube formation.VV treatment at reactive oxygen species production after ICH. Conclusion: These
frequencies of 8 to 10 Hz can stimulate the expression of ECM proteins findings suggest a deleterious role of Cav-1 in ICH-induced early
and MRFs in myoblasts and, in turn, increase myotube formation. brain injury, which implies Cav-1 as a potential therapeutic target
Osteoporosis is characterized in decreased bone density and results for treatment of ICH.
in major morbidity and mortality in the elderly. Disused osteoporosis
is also found in immobilized patients leading many complications in
day life. Electromagnetic field can prevent osteoporosis in animal and 0502F5FP
human model. Pulsed electromagnetic field (PEMF) promoted fracture THE CROSS-TALK BETWEEN TRANSFORMING
healing in non-unions. It also can stop bone loss in sciatic neurectomy. GROWTH FACTOR-BETA1 AND ULTRASOUND-
However, it takes much time to obtain the beneficial effects. We develop
a novel high dose stimulator, single-pulse and short-duration of PEMF, INDUCED MATRIX CATABOLISM DURING
to increase bony density in animal and to compare the influence with MECHANOTRANSDUCTION OF RAT TENOCYTES
PEMF. While many clinical trials have already demonstrated positive Yuna-Hung Chao1,3, Ming-Hong Chen1, Jui-Sheng
results from the stimulation of physical agents in the musculoskeletal Sun2,5, Yang-Hwei Tsuang4
system, we provided some insight into how these clinically observed
beneficial effects occur in molecular levels.
1
Institute of Biomedical Engineering, National Yang-Ming Univer-
sity, 2Institute of Clinical Medicine, National Yang-Ming University,
3
Department of Physical Therapy, Taipei City Hospital, 4Department
0502F4FP of Orthopedic Surgery, Taipei City Hospital and 5Department of Or-
CAVEOLIN-1 DEFICIENCY REDUCES EARLY thopedic Surgery, National Taiwan University Hospital (Taiwan)
BRAIN INJURY AFTER EXPERIMENTAL Purpose: Therapeutic ultrasound (US) has been found to be an
INTRACEREBRAL HEMORRHAGE effectively non-invasive treatment for resolving various tendon
pathologies. However, scientific evidence of US therapeutic effects
Che-Feng Chang1,2, Song-Kun Shyue2, Tzong-Shyuan and biochemical mechanisms on tenocytes remain limited. This
Lee3, Szu-Fu Chen4,5 study aims to investigate the effects of US on matrix catabolism,
1
Graduate Institute of Life Sciences, National Defense Medical and the crosstalk mechanism between transforming growth fac-
Center, 2Cardiovascular Division, Institute of Biomedical Sciences, tor-β (TGF-β) and US-induced signaling pathways in cultured rat
Academia Sinica, 3Department of Physiology, National Yang-Ming tenocytes. Materials and Methods: Tenocytes were harvested from

Achilles tendons of Sprague-Dawley rats. Therasound 3.5 ultrasound and these could be real-time obtained and recorded by TPEM.
apparatus (Rich-Mar Corporation, Inola, USA) at a frequency of With the characteristics of deep penetration, less photo bleaching,
1.0 MHz was used for our study. Ultrasound treatments were per- less toxicity, and capability of auto-fluorescence excitation, TPEM
formed for 20 min at the intensity of 0.1 W/cm2 with three different enables the monitoring of long-term changes in certain types of cells
duty cycles (20%, 50% and 100%, respectively). Control samples in a living tissues or anmals whether by fluorescent staining or by
were prepared in the same manner without ultrasound exposure. auto- flourscent molecules; in this study, we showed that it could
Tenocytes viability and proliferation were assayed by colorimetric be a powerful tool in investigation of muscular patho-physiology
MTT (Tetrazolium) assay. Their genes expression was analyzed in molecular level.
by real-time polymerase chain reaction. The signaling pathways
were evaluated by western blotting of specific proteins. Results: In
the pilot study, 100 mW/cm2 was selected for this study since this Education and Ethics in Rehabilitation
parameter was the intensity that attained the highest viability. The
effects of ultrasound were first examined at transcriptional level on
the expression of MMP-8 and MMP-13 in rat tenocytes. It was found 0502J1
that US treatment (100 mW/cm2 for 20 min) significantly enhanced EVOLVING MEDICAL BOARD CERTIFICATION
MMP-13, c-Fos and c-Jun mRNA expression, whereas MMP-8 did
not show the same trend. In addition, US treatment increased JNK IN THE UNITED STATES
and p38, but not ERK1/2, phosphorylation at 5 min and sustained for Joel A. DeLisa
60 min following US, as shown by Western blotting analysis. JNK Department of Physical Medicine and Rehabilitation, UMDNJ-New
Inhibitor SP600125 and p38 inhibitor SB203580, but not ERK 1/2 Jersey Medical School (United States)
inhibitor PD98059, attenuated US-dependent induction of MMP-13
expression, indicating that the JNK and p38 pathways are required Purpose: Present a continuous process of assessing physician qual-
for US-induced MMP-13 expression in tenocytes. We also inves- ity of care beyond the basic Board Certification. Materials and
tigated the role of TGF-β on US-induced MMP-13 expression and Methods: Mandate Maintenance of Certification (MOC) process
found that SB431542 (TGF-β receptor kinases inhibitor) suppressed by the American Board of Medical Specialties. Results: The MOC
US-induced MMP-13 and c-Fos mRNA expression, and p38 phos- program consists of evidence of professional standing, evidence of
phorylation. Conclusion: This study revealed that US stimulated commitment to lifelong learning and involvement in a periodic self
MMP-13 gene expression through JNK and p38 signaling pathways assessment process, evidence of cognitive expertise (closed book
to regulate matrix catabolism. The crosstalk mechanism between proctored examination) and evidence of evaluation of performance
TGF-β and US-induced MMP-13 expression potentially involved in practice (1). Conclusion: MOC is a move to continuous assess-
p38 signaling pathway and c-Fos gene expression. ment of physician quality. Its goal is improved physician perform-
ance and improved patient outcomes.
Reference:
0502F6FP
1. DeLisa JA, Maintenance of Certification: Continuum, Assessment of
LIVING MUSCLE TISSUES IMAGING WITH Physician Quality with Respect to their Commitment to Quality Patient
AUTOFLUORESCENCE BY USING TWO PHOTON Care, Lifelong Learning, Ongoing Self-Assessment, and Improvement.
LASER EXCITATION MICROSCOPY (TPEM) Am J Phys Med Rehabil 2009; 88; 775–779.
Chien-Cheng Chen1, Szu-Fu Chen1, Fu Kang Liu1, Da-

Hsing Wang2, Chii-Wann Lin2 0502J2
1
Cheng Hsing Rehabilitation Medical Center and 2Institute of Bio- STRATEGIES FOR UNDERGRADUATE
medial Engineering, National Taiwan University (Taiwan) EDUCATION IN PRM
Purpose: Two photon laser excitation microscopy (TPEM) makes John L. Melvin, NS Ankam
it possible to image in real-time fluorescently labeled cells located Jefferson Medical College (United States)
in deep tissue environments and even those weak auto- fluorescent
molecules in living cells and tissues. We have successfully dem- Purpose: The purpose of this presentation is to provide information
onstrated real-time imaging ex-vivo living muscle tissues without that might 1) persuade medical school undergraduate curriculum
staining procedure by using TPEM, which provide the idea of direct committees to incorporate Physical and Rehabilitation Medicine
intra-vital observation of myocytes in molecular level with minimal (PRM) education into their curricula and 2) enable medical students
invasive procedure Materials and Methods: The microscope were to demonstrate the knowledge and attitudes needed to provide people
set as followings : exciting beam as 780 nm Ti-Sapphire pulse laser; with disabilities effective and understanding health care. Materials
Four different fluorescence light channel including: SHG, red light and Methods: The information the authors present is from their ex-
(560–680 nm), green light (495–560 nm) and blue light (435–495 periences as faculty members in medical schools with undergraduate
nm) were separated and acquired by dichroic mirror. Without PRM curricula, and from related published literature. One (JLM) has
extrinsic fluorescence staining, these signals present different chaired PRM departments in two different USA medical schools, both
auto-fluorescent moleculers or sub-organelles. In order to observe of which have formal PRM courses. The other (NSA) as Assistant
the reaction of muscle tissues to treatment, four different treat- Director of Undergraduate Education is directing the comprehensive
ment solutions were selected, these are Ginkgo extracts (EGb761); revision of the PRM curriculum at Jefferson Medical College. Results:
Potassium chloride (KCL); Phosphate buffered saline (PBS); and The following are observations regarding undergraduate medical
Normal Saline (NS) as controlled group, muscle samples were cut education that the authors believe are important when planning PRM
from anesthetized rats and immersed into solutions around 10 min curricula. 1) Students vary significantly in their perception of the
before scan. Results: At the advantage of minimal interference to relevance of rehabilitation to their future practices. 2) Students early
the tissues and continuous observation (time laps), real-time treat- in their medical education are more likely to see general principles
ment effects recordings became possible by using TPEM, we found of practice as relevant to their needs. 3) After they have identified
that the muscle cell membrane disrupted quickly in KCL group; their future specialties, students tend to focus on the knowledge and
On the other hand, The EGb761 group showed less contractility skills they believe necessary for them to practice their choices. 4)
and cells autolyzed in higher concentration; The other two groups A significant number of students choosing procedural specialties
showed intact myocyte with micro-peristasis of membrane last- fail to see the relevance of rehabilitation. 5) These students are also
ing over half an hour. Conclusion: KCL showed cyto-toxicity to likely to have the same views regarding the relevance of chronic
tissues as well-studied, EGb761 preserved or protected muscle disease care or geriatrics. 6) Rehabilitation teams have difficulty in
tissues at certain concentration, but not in higher concentration, integrating students into their clinical activities if the student assign-

Education and Ethics in Rehabilitation 73
ments are short. 7) Students in their last year of medical education for China’s innovation on the education and training of physiatrists;
value meaningful roles during their clinical assignments. 8) Brief 3) Based on the social culture and healthcare system of China to
exposure of medical students to PRM principles has limited value explore the characteristic and unique measures and educational goals
in changing their practice behaviours. 9) PRM faculty members are for physiatrists which China should adopt. Results: 1) According
particularly valuable resources for education in functional anatomy, to a rough estimate in 2009, The number of PM&R physicians in
neuromuscular and functional examinations including those of the mainland China is 14131, i.e. about 0.50% of the total number of
back and pain assessment and management. 10) Student assignments doctors in medical profession, while the PM&R physician manpower
to clinical rotations are not long enough for the students to follow need by 2010 should be 19000 in number; thus the gap is remarkable.
single patients through their full rehabilitation process. 11) Medical Significant shortage of physiatrists was felt by 81.5% of the general
education presents to students a linear approach to clinical problems hospitals in 1909; 2) Since 2008 China has started her residency
that they extrapolate to rehabilitation circumstances. From these program (3 years) to train physiatrists, along with the postgradu-
observations, the authors suggest the following strategies when ate master program (clinical) (also 3 years) of PM&R; 3) Various
advocating for and implementing undergraduate PRM curricula. 1) courses and practical training of clinical rehabilitation constitute
Provide curricular elements in each year of medical education. 2) the main contents of physiatrist residency program. In addition,
Incorporate PRM elements into the curricula of other departments, traditional Chinese medical rehabilitation and community-based
including those focusing on chronic disease care and aging. 3) Present rehabilitation are also included; 4) A complete system of national
required curricular elements in the early years of medical education examination and certification/registration for a qualified physiatrist
and make those in the latter years elective. 4) Design clinical edu- has to be established and carried out in mainland China. Conclu-
cational experiences in the last two years of medical education to be sion: Following the current international standards and practice,
at least three weeks long. 5) Include both in and outpatient clinical China has been making progress in recent years in setting up formal
experiences to students so they see the full continuum of rehabilitation system of residency training program to train physicians specialized
care. 6) Assure that students participating in these clinical educational in PM&R. However, much has to be done before a modernized,
experiences have meaningful roles in the care of patients. 7) Arrange complete and integrative system for the training and accreditation
for PRM faculty members and trainees to participate in the courses of PM&R physicians is established.
of other departments that include appropriate anatomy, introduction
to clinical medicine, physical diagnosis, pain management and other
areas of PRM faculty expertise. 8) Demonstrate the non-linear (ICF) 0502J6
conceptual basis of rehabilitation. Conclusion: PRM undergraduate RESIDENT AND TRAINING OF PMR IN TAIWAN
medical education will best succeed if its objectives are a part of those
of the curriculum as a whole, and the strategies of meeting those objec- Alice M.K. Wong
tives are integrated into the entire undergraduate experience. Chang Gung Memorial Hospital (Taiwan)
Due to the endemic infection of poliomyelitis, thousands of children
0502J3 in Taiwan became disabled during the 1950’s to 1960’s. Urgent
rehabilitation treatments and services were needed at that time. As
SUBMISSION AND PUBLICATION OF SCIENTIFIC a result, the department of Physical Medicine and Rehabilitation
ARTICLES IN REHABILITATION MEDICINE was established in National Taiwan University Hospital in 1963.
At that time, physiatrists were sent to the United States for board
Gunnar Grimby
certified rehabilitation training. The first program for resident train-
Rehabilitation Medicine, Institute of Neuroscience and Physiology, ing has been started in Department of PMR of National Taiwan
Sahlgrenska Academy at University of (Sweden) University Hospital in 1968. The duration of resident training is four
Aspects are given on: steps before writing and submitting an article, years basically. The training program for PMR resident has been
choice of journal for publication, arrangement of a manuscript, developed and improved during the past decades as the practice of
authorship requirements, conflicts of interest, copyright, editorial rehabilitation medicine became popular and mature in all levels of
handling of manuscripts, the peer review process, open access. Ex- hospital in Taiwan in 1980’s. Board examination for physiatrists was
amples from the publication of Journal of Rehabilitation Medicine hold since 1984. The basic requirements of training program for
will also be presented. physiatrists need at least three tutor physiatrists for each PMR teach-
ing hospital. The amount of residents is two for each year. Increase
number of one tutor physiatrist at that hospital, one more resident is
0502J4 able to be trained per year. The facilities for PMR training hospital
should include services of physical therapy, occupational therapy,
TITLE missing and speech therapy as well. They should provide out-patient clinics
Marta Imamura for four or more per week and have PMR in-patient service for 1%
of total beds in general hospital with at least ten beds in capacity
Abstract missing. with laboratory and research facilities. The qualification of training
hospital should be reviewed every 3 years. The core curriculum for
resident training in PMR includes followings:
0502J5
1. Skills of physical examination and evaluation of disability, ROM,
EDUCATION AND TRAINING OF PM&R MMT, ADL, gait, motor development, evaluation of speech,
PHYSICIANS IN MAINLAND CHINA swallowing, and bladder functions, etc.
Dahong Zhuo 2. Physical medicine; basic theory and clinical application.
3. Orthoses and prostheses
First Affiliated Hospital Sun-Yat Sen University (China)
4. Prescription of rehabilitation program.
Purpose: To identify the critical needs of qualified rehabilitation 5. Certification of disabilities.
physicians (physiatrists) in mainland China and to explore appro- 6. Rehabilitation for specific diseases, such as orthopedic condi-
priate approach to train physiatrist which meets the international tions, neurological disorders, cardiopulmonary disease, pediatric
standards and practice and adapts to the local situation of mainland conditions, sport injuries, geriatric conditions, and career reha-
China as an oriental developing country. Materials and Methods: bilitation, etc.
1) From the statistics of the population in need of rehabilitation to 7. Medical laws and ethics.
make a projection on the manpower needs for physiatrist in mainland 8. Laboratory techniques, including electro diagnosis (NCV, EMG),
China; 2) In comparison with the current international standards and sonography study for soft tissue injuries and cystometry.
practice of training physiatrists to identify the goals and pathway 9. Basic and clinical researches.

10. Elective courses, such as traditional medicine (acupuncture, 0502J8FP

manipulation), team physician in gymnastics and athletics. REHABILITATION DOCTORS’ ATTITUDES
PMR residents who have received training longer than 3.5 years
with at least one published paper can apply for board examination TOWARDS ETHICS ISSUES
hold by National Association authorized by Department of Health Julia Patrick Engkasan
in Taiwan. They should take written test with 200 questions which University of Malaya (Malaysia)
covered 28 subcategories in PMR. Oral tests in 8 stations can be
taken after passing the written test. Board certification for PMR Purpose: To explore rehabilitation doctors’ attitudes towards eth-
should be renewed every 6 years for each physiatrist with the re- ics issues faced in clinical practice. Material and Methods: This
quirement of 180 credit-hours of on-job training and 12 credit-hours is a descriptive survey conducted in a teaching hospital that has an
of medical laws and ethics training. Now, there are 38 teaching established Rehabilitation Medicine Unit. A self designed question-
hospitals with training program of PMR resident in Taiwan. As a naire was developed to gather basic demographic information and
result, rehabilitation services in Taiwan can be widely provided at to assess respondents’ attitudes on ethics issues. The questionnaire
local clinics, regional hospitals, tertiary hospitals, and long term care consists of 10 statements describing a clinical situation and the
facilities of the whole community including small satellite islands decision made in each situation. The respondents were asked to
in good quality. The prospect for PMR resident training program state whether they agree or disagree with the decisions made. The
should improve clinical service, level-up academic background, and given clinical situations covers ethics issues such as allocation of
strengthen research ability for continuous improvement of quality limited resources, suboptimal discharge planning, goal setting, truth
of training in the future. telling, decision-making, goal setting, autonomy, confidentiality
and advanced directives. The questionnaire was disseminated to
all rehabilitation physicians and Master of Rehabilitation Medi-
0502J7FP cine trainees through email and by hand. Results: Twenty (50%)
OLDER PEOPLE’S ACCEPTANCE OF FALLS questionnaires were returned. Ten of respondents are rehabilitation
PREVENTION EDUCATION physicians while another ten are trainees. The age ranges from 29
to 52 years old (mean 35.6). 50% had exposure in ethics during
Moreena Kwa1, Jane Wu2 their undergraduate training and from workshops. When given a
1
Rehabilitation Registrar, Westmead Rehabilitation Hospital and scenario of a vegetative patient, 65% agreed that therapy should be
2
Rehabilitation Physician, Westmead Rehabilitation Hospital kept to the minimum. If the patient does not take care of self, 55%
(Australia) will not refer patient for expensive procedure such as flap surgery.
Even though 60% agreed with the option of sending patient back to
Purpose: 1) To assess the knowledge of cognitively intact elderly a nursing home where they know the care is bad, it is not the same
at risk factors for falls and interventions for falls prevention. 2) when it comes to sending the patients home. 70% would go against
To examine the uptake of a falls prevention education programme the patient and family decision and would not send the patient home
in elderly patients with a recent history of falls. 3) To compare if the family is unable to care for the patient. In early phase of reha-
the characteristics between the attenders with the non-attenders bilitation, 63% think that it is not acceptable for doctors to act in the
of these education sessions. Materials and Methods: A survey best interest of patients. However, 50% agreed that the team should
was administered to 100 consecutive cognitively intact, com- set the goal for patient in post-acute rehabilitation because at this
munity dwelling patients aged 65 and older admitted to a general point of time the patient and the family might not understand the
rehabilitation unit May-November 2009 with a recent history of disease process or the impact of disability. When they are required
falls (last 12 months). They are offered to attend a falls prevention to communicate or write to the insurance company to get what’s
education session conducted by a multidisciplinary team in a small needed by the patients, 55% do not agree with ‘stretching’ the
group setting. Topics covered in the session include risk factors truth. In confidentiality issue, 72% will still reveal the information
for falls and how to minimise or correct these, how to get up from if it is pertinent to the rehabilitation process. 58% will not execute
a fall and fracture reduction strategies. Results: Overall, 75% of advance directives requested by patients. Conclusion: Ethics issues
the patients at risk of falls believed that falls can be prevented. drew varied responses from rehabilitation doctors and this may be
When given a list of 9 possible risk factors for falls, the patients related to ethics education.
could only correctly identify on average 3.3 factors (SD 2.0). When
given a list of 10 possible falls prevention strategies, the patients
could only correctly identify an average of 3.4 strategies (SD 2.7).
The perception of falling as a health problem is relatively low. Electrodiagnosis
Despite strong medical and therapist advice, only 60% of patients
were willing to attend a multidisciplinary education session on 0502C1
falls prevention. The attenders vs. the non-attenders were similar
in age (80 vs. 81 years, p = 0.81), prevalence of community am- PITFALLS AND PEARLS IN NERVE CONDUCTION
bulators (88% vs. 82%, p = 0.41), prevalence of independence in STUDY AND NEEDLE EMG
self-care (87% vs. 90%, p = 0.62), and the mean number of falls Shin J. Oh
in the preceding 12 months (2.4 vs. 2.2, p = 0.56). Attenders are
Distinguished Professor of Neurology,the University of Alabama
more likely to have a positive perception that falls can be prevented
(85% vs. 65%, p = 0.01); have a better pre-test knowledge of risk at Birmingham, (United States)
factors for falling (mean score 3.7/9 vs. 2.7/9, p = 0.016); have Nerve conduction represents the physiological status of fast-
a more positive perception of the usefulness of falls prevention conducting, largerdiameter nerve fibers. It is normal in small
education (mean VAS 6.5 vs. 2.6 out of 10, p < 0.01); have a higher fiber neuropathy. Focal segmental demyelinating is the basic
prevalence of fear of falling (38% vs. 20%, p = 0.05). Some of the pathological process in the entrapment neuropathy. Thus, the focal
reasons for non-attendance will be explored. Conclusion: Uptake slowing in NCV is typical of entrapment neuropathy. Diagnosis of
of falls prevention education by those elderly patients at risk is demyelinating and axonal neuropathy is usually detected by motor
suboptimal. Overall pretest knowledge of risk factors for falling nerve conduction study. This is because sensory compound nerve
and falls prevention strategies is low. More effort is required in action potential (CNAP) is usually unobtainable when a NCV is
promoting the message that falls are preventable and there are less than 20 m/sec with surface’ electrode. Conduction block and
many strategies for minimising or correcting the risk factors for dispersion phenomenon are two cardinal diagnostic hallmarks of
falling in the elderly population. demyelination. These may be the only findings in the entrapment

Electrodiagnosis 75
site. Uniform slowing is the electrophysiological hallmarks of CMT and the place of findings. A physician sending a peripheral nerve
IA. Nonuniform demyelinating neuropathy is the cardinal feature injury patient to the laboratory might expect a detailed study, and
of acquired demyelinating neuropathy, but is also the characteristic could interpret the results accordingly, whereas, an endocrinolo-
nerve conduction findings in Dejerine-Sottas disease, sex-linked gist sending a diabetic patient for a possible neuropathy probably
CMT lA, and hereditary pressure palsy. Absent sensory CNAP in the does not want a detailed study. Commonly, EMG reports are done
presence of normal motor nerve conduction is indicative of sensory in two ways: In the first one, numeric values are summarized fol-
neuronopathy (sensory gangionopathy). This is typically observed in lowed by a detailed interpretation or comments; the second, on the
Friedreich’as ataxia, sensory neuropathy associated with Sjogren’s other hand, includes detailed numeric values and a short diagnosis
syndrome, and paraneopasltic subacute sensory neuropathy. Absent or comment. The favourable one could be something between the
or low CMAP is not always due to axon loss. Absent or low CMAP two approaches. Some detailed reports bear the risk of inattention
response can be due to a total or partial conduction block in the dis- to some or most parts. In addition, only a minority of referring
tal segment or to severe atrophy of the recording muscles. F-wave physicians could understand the whole electrodiagnostic report,
prolongation is not always due to a proximal neuropathy. Since the especially the numeric data. Actually it is known that most doctors
F-wave pathway includes the terminal latency from the stimulating only read the comment, or the final diagnosis. Another point is to
site to the recording muscle, the F-wave prolongation may be mark- use common terms and to avoid exaggerated words or diagnoses. A
edly prolonged in severe carpal tunnel syndrome. Slow NCV in the good communication with the patient, understanding the problems
presence of fibrilliation and PSW in the needle EMG does not mean and fears of them, providing information about the study and obtain-
that the neuropathy is mixed (axonal and demyelinating). Criteria ing a verbal and/or written consent. As a result, a correct diagnosis
of demyelination should be present to justify such an interpreta- and preparation a good report are difficult and need experience in
tion. Needle EMG: All needle EMG parameters are useful for the electrodiagnostic evaluation.
diagnosis of neuromuscular diseases. Studies showed a concordance
between the clinical and EMG findings in 80–95% of patients with
myopathy and nearly all patients with denervation process. Myotonic 0502C3
potentials are the most specific needle EMG findings and sine qua POST POLIO – ETIOLOGY, DIAGNOSIS AND
non in myotonic syndromes. Fibrillations and positive sharp waves
(PSW) not always indicative of denervation process because they TREATMENT
are also observed in active myopathy. This is one of characteristic Gunnar Grimby
findings in inclusion body myopathy (IBM). With nerve injury, Rehabilitation Medicine, Institute of Neuroscience and Physiology,
PSW and fibrillations are time related: they are absent in the first 5 Sahlgrenska Academy at University of Gothenburg (Sweden)
days. Fasiculations are not always indicative of amyotrophic lateral
sclerosis. Fasciculations are rarely seen in normal individuals and Poliomyelitis is a virus mediated lower motor neurone disorder
common in demyelinating neuropathy. Small amplitude-short dura- affecting the anterior horn cells. Polio survivors may develop new
tion (SASD) MUPs are not always indicative of myopathy. They symptoms, an entity being post polio syndrome (PPS) define as
are also observed in neuromuscular transmission diseases such as prior paralytic polio with evidence of motor neuron loss and signs
MG, LEMS, and botulism, though they are classically varying in of denervation on EMG, a period of partial or complete recovery,
amplitude. High amplitude-long duration (HAL D) MUPs are not gradual or sudden onset of new muscle weakness or abnormal
always indicative of chronic denervation and are also observed in fatigability, muscle atrophy, or muscle and joint pain, and no other
IBM. In mixed pattern of SASD and HALD MUPs, IBM should causes of the symptoms. The etiology of the reduced muscle func-
be considered. HALD MUPs are the most crucial finding in type II tion is primarily due to an ongoing denervation / reinnervation,
and III spinal muscular atrophy. Usually fibrillation and PSW are which has reached its upper limit. Besides an increase in the size
not observed in these conditions. There is a definite limitation in of the motor units there is usually also a compensatory muscle
the pediatric needle EMG. fibre hypertrophy. There may be several factors leading to the
reduced number of motor units and muscle fibres, as inability to
maintain the increased metabolic demand of the enlarged motor
0502C2 units and all terminal axonal sprouts, enhanced aging effects, and
PERIPHERAL NERVOUS SYSTEM immunological factors. Pain may be due to different biomechanical
ELECTROPHYSIOLOGY: REPORTING factors and to overexertion. The diagnosis of PPS should be based
on the criteria above, keeping in mind that also polio survivors
PROCEDURES, AND PITFALLS not fulfilling the PPS criteria may need medical attendance for
Gülseren Akyuz their symptoms. After clinical history, specifically on post polio
Marmara University School of Medicine, Department of P.M.&R. symptoms, is taken the examination should include assessment of
(Turkey) muscle and respiratory function. Muscle strength should be meas-
ured and EMG recorded in relevant muscle groups. Measurement
The patients have been sent to the electrophysiology laboratories of the size of motor units will indicate risks for reduced function
with certain diagnoses or conditions like neck and/or arm pain, at very large motor units, Note that also muscles, which have been
low back and/or leg pain, carpal tunnel syndrome, peripheral neu- considered “normal” may show new muscle weakness, as they were
ropathy, and peripheral nerve injury. During the electrodiagnostic polio affected but well compensated. Causes of pain should be ana-
investigation, these problems have been classified and then, the lysed. Activity patterns should be evaluated. The treatment should
etiology, severity and sometimes the prognosis of the conditions be based on a multi professional team approach. Advices should
have been clarified. The electrodiagnostic investigation is very be given on the activity pattern in daily life. Most patients except
important, because the exact diagnosis will bring about the ef- those with most reduced function may benefit from some form of
fective treatment. Clinical examination is not very different then resistance and/or endurance training, This should be individually
those of other medical specialties. There are two important points chosen (also for specific muscles) after functional assessment. In
in putting the diagnosis: gathering the information and hypothesis the lecture advices on intensity will be given. Pool exercise has
testing. Information gathering starts with a detailed history taking shown to be beneficial. Measures should be taken to reduce pain.
and a good physical examination. The list of hypotheses will then Respiratory dysfunction may require ventilator assistance. There
form the differential diagnosis. Each hypothesis should be tested is no clear evidence for pharmacological treatment except recent
and verified or rejected. This process requires experience and positive results of intravenous immunoglobulin. Orthoses and
expertise. The array of referring physicians can be quite variable. assistive devices should be prescribed when indicated. Aspects
Some could easily interpret the findings of electrodiagnostic study, on adaptation in daily activities and need for changes in working
while others have a very limited information on the study process situation should be considered.

0502C4 needle electrode on the exposed nerve and by stimulating a sural

PERIPHERAL NERVE ELECTRODIAGNOSIS IN nerve over mid-calf with surface electrodes. We also performed
the conventional NCS (CV-NCS) with surface electrodes to record
REHABILITATION MEDICINE CNAPs in the sural nerve. In the sural nerve, we examine a correla-
Zongyao Wu tion with the density of large myelinated fibers (MF) and the ampli-
Department of Rehabilitation Medicine, Southwest Hospital tude of CNAP, and a correlation with the density of large MFs and
(China) the maximum NCV. In addition, we calculated the conversion factor
(CF) in normal and abnormal nerves. Results: Among the analyses
Purpose: To illuminate some confusion in peripheral nerve electro- in various different diameters, the best correlation was found in
diagnosis. Materials and Methods: Based on years experience in the density of MFs of more than 7 µm in diameter with the CNAP
treatment of peripheral nerve injury after civil and war events, we amplitudes (R2=0.749), and MFs of more than 8 µm in diameter with
emphasize some confusion in the use of electrodiagnosis. Results: the maximum NCV (R2=0.7663). This finding remained true even
Electrodiagnosis is neccesary in the whole course of rehabilitation. It with demyelination or axonal degeneration. In the density of MFs,
is used in determine if there is peripheral nerve injury and where it is? there was no significant difference between the plain correlation and
Is it neurapraxia? axonotmesis? or neurotmesis? Is the injury partial the log 10 correlation. When it was related to the maximum NCV. In
or complete. How to treat and how the rehabilitation treatment effect the sural nerve, number of MFs of more than 7µm in diameter is the
is? If the operation is necessary or not? If the surgery is success. Its key in the CNAP amplitude and number of MFs of more than 8 µm
most advantage is sensitive and prompt in detecting peripheral nerve in diameter is the key in the maximum NCV. The CF in normal sural
abnormal. It can find out the abnormals earlier than morphological nerves was 4.3 (n=2), and the CF in axonal neuropathy was close to
diagnosis, such as CT, MRI, and ultrasound. Every kind of electrodi- the normal value (3.85±0.55, n=4). However, the CF in demyelinati
agnosis may be useful in peripheral nerve injury treatment including neuropathy was smaller than the normal value (2.77±0.47, n=24),
electromyogram, nerve conduction and evoked potential study. Elec- indicating disproportionately slower conduction than expected from
trodiagnosis is popular and welknown among physiatrists. We shall the diameter of nerve fibers. We found that the CF was helpful in
emphasize some confusion often overlook. The one is mumber of differentiation demyelinating neuropathy from axonal neuropathy.
polyphase motor unit potential. It is defined as a motor unit potential From this, we propose that 36% decrease from the mean value of
changes direction once is a peak. Peak goes across baseline is a phase, NCV is a reasonable criterion for demyelination. The amplitude of
not across baseline is a turn. So that number of turns must be equal to or CNAPs was higher in the ON-NCS than the CV-NCS (p<0.001).
more than phase. A motor unit with more than 3 phases or more than 4 The duration of CNAPs was longer in the IO-NCS than the CV-
turns is polyphase or serrated. A muscle with too many polyphase unit NCS (p<0.001). However, there was no significant difference in the
or serrated is abnormal. The rate or polyphase or serrated potentials fastest or the negative peak NCV between the ON- and CV-NCS. In
in normal muscles is defferent from muscle to muscles But diferent the ON-NCS, in 12 cases, the CNAPs could be recorded due to the
author take different standards to identify a turn or phase. So as the proximity of recording electrode to the nerve when the CNAPs were
norms of polyphase potential in normal muscle is different and phases absent in the CV-NCS. The latency of the initial positive peak was
is more than turns in some case. In hundreds patients after operation determined with greater precision in the ON-NCS than the CV-NCS.
on lumbar disc hernia, we found that if we setup polyphase potential In 7 cases, we changed our interpretation by the IO-NCS, because
30% or more as abnormal, the consistency of electromyography and abnormal temporal dispersion was observed. Conclusion: 1) The
operation found is more than 90%. If we setup a standard of 20%, it ON-NCS is more accurate in identifying abnormality than the CV-
would be too many false positive diagnoses. The other confuse may NCS. 2) Numbers of Mfs of more than 7 or 8 µm are responsible for
be the volume conduction iand anastomosis influence in the electro- the NCV and CNAP amplitude; and 3) 36% decrase from the mean
diagnosis .Nerve conduction velocity varied a lot. Someone collected value of NCV is a reasonable criterion for demyelination.
a lot of normal value from different literatures. The range is so wide.
We have to take care of the normal limit in diagnosis More reliable is
compare the homonymy nerve or muscle in left and right, the involved
and not involved even though the EPs are used for detect the abnormal Pain Management: Part 3
in central nerve system, but it is also useful in confirm or negate a
diagnosis with peripheral nerve abnormal. Some peripheral nerve 0502G1
injury are denial by EP study in our cases. Conclusion: Even though
electrodiagnosis in peripheral nerve injury is well-known, how to use PAIN MANAGEMENT
it comprehensively and correctly is still a challenge. Marta Imamura
Collaborative Professor University of Sao Paulo School of Medi-
0502C5 cine, Department of Orthopaedics and Traumatology, Department
of Orthopaedics and Traumatology (Brazil)
On-Nerve Needle Nerve Conduction
Study: Histological Basis of NCS, Contemporary pain management has shifted from symptom control
Conversion Factor, and its Clinical to management based on the pathophysiological mechanisms of
pain. This has been associated with improvements in function and
Relevance health-related quality of life as well as avoidance of therapeutic tox-
Shin J. Oh icity. The clear understanding of the complex mechanisms involved
Distinguished Professor of Neurology,the University of Alabama at in pain generation, modulation, amplification and perpetuation plays
Birmingham, (United States) a critical role in a comprehensive pain control program for chronic
disabling pain patients. Recently, it has been recognized that constant
Purpose: For the recording of CNAPs, the use of surface electrodes and intense nociceptive sensory information generated by painful,
is widely accepted as the standard method. This method is easy and inflamed deep somatic structures produce significant neurochemical
less time consuming, but the amplitude of CNAPs is usually smaller and metabolic changes and reorganizations within corresponding
and small components are not recordable. When active recording spinal cord segments. These changes include an increased excit-
needle electrode is used instead of surface electrode and placed on ability of dorsal horn neurons producing pain hypersensitivity in
the exposed nerve to record CNAP, more accurate CNAP would be a segmental distribution. Together, these neurochemical changes
obtained. Materials and Methods: We performed the intra-operative suggest that pain induces and is partially maintained by a state of
on-nerve nerve conduction study (ON-NCS) in 54 patients with pe- central sensitization in which an increased transmission of nocicep-
ripheral neuropathy during the sural nerve biopsy. In the ON-NCS, tive information allows normally non-noxious input to be amplified
CNAPs were recorded antidromically by placing active recording and perceived as noxious stimuli. Once these complex mechanisms

are present, the rationale for treatment approaches should also target territory of the sensitized spinal segment leads to long term relief
the central nervous system structures rather than using local anti- of neuromusculoskeletal pain and dysfunction. The application of
inflammatory agents alone. Important to note, is that these spinal shockwave therapy to rat skin decreases calcitonin gene-related
cord changes may not be attenuated by blocking the original tissue peptide expression in dorsal root ganglion neurons and might also
damage and pain and refractory pain may persist even after the relief pain by decreasing central sensitization. Radial shockwave
removal of the etiological factors. In fact, changes in the central therapy seems to be better than placebo to decrease pain. There is
nervous system associated with chronic pain may cause peripheral also limited, however emerging evidence of the peripheral role of
inflammation. Diagnosis of central and peripheral sensitization is, botulinum toxin in the management of chronic neuromusculoskel-
therefore, very important because spinal cord neurons that normally etal pain. Finally, plastic changes in the spinal cord might induce
would only be activated by noxious stimuli are now activated by changes in other central nervous system structures such as the limbic
normally non noxious stimuli, a phenomenon widely known as and the somatosensory cortex. Both mechanisms, if not addressed
allodynia. Despite the clinical importance, negative functional properly may play a role in the maintenance of the chronic pain state.
and quality of life impact and the extensive research creating an Modulation of the primary cortex by non invasive brain stimulation
increasing body of knowledge in the field of chronic disabling pain techniques including high frequency repetitive transcranial magnetic
syndromes, the pathogenesis of fibromyalgia syndrome, for exam- stimulation, anodal transcranial direct current stimulation and new
ple, is not yet well understood. In fact, emerging evidence suggests alternate low frequency currents demonstrated to be superior to
that complex central nervous system (CNS) dysfunction involving placebo to achieve chronic pain relief.
changes in peripheral and central structures plays an important role
in the maintenance of chronic pain. Spinal Segmental Sensitization
(SSS) is a hyperactive state of the spinal cord caused by irritative 0502G2FP
foci sending nociceptive impulses from a sensitized damaged tissue THE APPLICATION OF SURFACE ELECTRO
to dorsal horn neurons. The clinical manifestation of dorsal horn
sensitization includes hyperalgesia of the dermatome, pressure MYOGRAPHY ON TREATING LUMBAR DISC
pain sensitivity of the sclerotome and myofascial trigger points HERNIATION
within the myotomes, which are supplied by the sensitized spinal Jing-Song Mu, Ni Chao-Min Ni, Qing Xia, Yun Miao
segment. Shah et al. (2005) found that active myofascial trigger
Department of Rehabilitation Medicine, Affiliated Provincial Hos-
points present lower pressure pain threshold when compared to
people with no pain or the presence of only latent trigger points. pital of Anhui Medical University (China)
They also demonstrated the distinct in-vivo biochemical milieu of Purpose: To explore the application of surface Electromyography
muscle with significant elevated levels of substance P, calcitonin (sEMG) on treating Lumbar Disc Herniation (LDH). Materials
gene-related peptide (CGRP), bradykinin, tumor necrosis factor-α and Methods: Fifty subjects with LDH underwent proprioception
(TNF-α) and interleukin-1β (IL-1β), serotonin, and norepinephrine enhancement training and Mckenzie therapy for one month.sEMG
in the vicinity of the active myofascial trigger point at the upper was used to record the activities of lumbar paraspinal muscles during
trapezius muscle. Overall, pH was significant lower in the active isometric contraction pre-treating and after 1 month. Results: After
trigger point. Treatment rationale and techniques may evolve from treatment, 16 cases are marked, 32 are effective, and 2 are invalid,
this information, and should be taken into account when dealing the rate of improvement is 54.25% ± 15.74%.There are significant
with chronic patients with amplified pain responses. Irritative foci difference for sEMG between healthy and suffered side before
in the form of myofascial trigger points (MTrPs) located within treatment (p < 0.05); absolute values of MFs for sacrospinal in the
the associated myotomes and tender spots in the supra/interspinous affected side were significantly reduced as compared to pre-treating,
ligaments (SSL/ISL) of the segment frequently lead to SSS. The AEMG of suffered side were increased (p<0.05);no statistical dif-
mechanism consists of the nociceptive stimuli generated in the ferences were observed after training between healthy and suffered
sensitized areas bombarding the dorsal horn of the spinal cord. side (p > 0.05). Conclusion: sEMG may be used as an objective tool
This causes central nervous system sensitization with resultant for evaluation of therapeutic effect of patient with LDH.
hyperalgesia of the dermatome and sclerotome and spreads from
the sensory component of the spinal segment to the anterior horn
cells, which control the myotome within the territory of the SSS. 0502G3FP
The importance of SSS is emphasized by the fact that it is consist- EFFECT OF SITTING POSTURES ON LUMBAR
ently associated with musculoskeletal pain. Patients with chronic MULTIFIDUS AND INTERNAL OBLIQUE FATIGUE
disabling neuromusculoskeletal pain due to moderate and severe
knee osteoarthritis presents hyperalgesia of central nervous origin Pattanasin Areeudomwong1, Rungthip Puntumetaku2,
that negatively impacts knee functional capacity and most aspects of Sawitri Wanpen2, Nareumon Leelayuwat2
quality of life. In fact, combined pressure pain thresholds measured 1
Division of Physical Therapy, Faculty of Associated Medical Sci-
by a pressure algometer over the patellar tendon, at S2 subcutaneous ences, Khon Kaen University and 2Back, Neck and Other Joint Pain
dermatome and at the adductor longus muscle were the best predic- Research Group, Khon Kaen University (Thailand)
tors for pain scores rated at a visual analogue scale, Western Ontario
and McMaster Universities Osteoarthritis Index, accounting for 61% Purpose: To investigate the fatigability of lumbar multifidus (LM)
of those scores in patients with knee osteoarthritis. The development and internal oblique (IO) muscles using a surface electromyography
or amplified activity of MTrPs is one of the clinical manifestations (sEMG). Materials and Methods: This study is a cross-over design.
of SSS. Failure to recognize and diagnose SSS often leads to only Twenty-three healthy Thai men aged 20 to 30 years were asked to
temporary deactivation of MTrPs, since physical therapy and trigger perform the crossed sitting and heel sitting postures for 30 min in
point injection procedures are aimed at treating the peripheral MTrPs each sitting posture on two occasions. Normalized median frequency
without addressing the segmental dysfunction. This may lead to slopes (normalized MF slope) of the muscles were recorded to
transient benefit rather than long term relief because MTrPs and their investigate their fatigue throughout 30 min. Results: The results
associated symptoms frequently recur. Eradication of the sensitized revealed that the normalized MF slopes of all muscles provided from
spinal segment by the technique of paraspinous block (PSB) with 1% the crossed sitting posture are significantly greater than those from
Lidocaine effectively desensitizes (reverses to normal sensitivity) the heel sitting posture (p = 0.014 in right LM, p = 0.044 in left LM,
the SSS by blocking the nociceptive impulses from the SSL/ISL p = 0.041 in right IO and p = 0.044 in left IO, respectively). Conclu-
and prevents afferent bombardment of the dorsal horn. Subsequent sion: We conclude that the crossed sitting posture provides greater
needling and infiltration of the SSL/ISL with 1% Lidocaine as fatigability of lumbar multifidus and internal oblique muscles than
well as needling and infiltration of MTrPs in the myotome of the the heel sitting posture does.

0502G4FP 1
INCREASED BOTH CONTRACTILE SUBUNIT Cheng Kung University, 2Department of Cell Biology and Anatomy,
National Cheng Kung University and 3Department of Physical
PROTEIN PHOSPHORYLATION SIGNALING
Therapy, Hungkuang University (Taiwan)
AND ENDPLATE NOISE PREVALENCE IN
MYOFASCIAL TRIGGER SPOTS OF RABBIT Purpose: MIRE, monochromatic infrared photo energy, is one kind
of photon therapy (890 nm of wave length). It has been reported
SKELETAL MUSCLE
that it is useful for the restoration of sensation and reduction of
Ta-Shen Kuan1, Shu-Min Chen1, Jo-Tong Chen1, Ping- pain in diabetic peripheral neuropathy. The vasodilatation effect
Yen Liu2, Chi-Hsien Chien3, Tsui-Ting Yeh4, Chang- of MIRE might play a major role in its therapeutic effectiveness.
Zern Hong5 The pathogenesis of myofascial trigger point (MTrP) has been
1
Department of Physical Medicine and Rehabilitation, National attributed to the “energy crisis” hypothesis (local hypoxia) from
current animal and human studies. The characteristic of electro-
Cheng Kung University, 2Division of Cardiology, Department of
myographic activities, the endplate noise (EPN), can be recorded
Internal Medicine, National Cheng Kung University, 3Department much more frequently from an MTrP locus than from other sites.
of Cell Biology and Anatomy, National Cheng Kung University, The prevalence of EPN has been proven to be highly correlated to
4
Yi-An Rehabilitation Clinic and 5Department of Physical Therapy, the irritability of an MTrP. Our previous study had shown that MIRE
Hungkuang University (Taiwan) could significantly inhibit the irritability of myofascial trigger spot
Purpose: Myofascial trigger point (MTrP) is a hyperirritable spot (MTrS; equivalent to MTrP in human) in rabbits. The objective of
located in the taut band of skeletal muscle. The characteristic this study is to compare MIRE and traditional physical therapy (tPT)
of electromyographic activities recorded from an MTrP locus is for their decreasing effect on the prevalence of EPN of an MTrS in
endplate noise (EPN). EPN is probably related to excessive leak- rabbit skeletal muscle. Materials and Methods: We investigated
age of acetylcholine in the neuromuscular junction, which causes 12 adult New Zealand rabbits (3~5 kg) and located MTrSs in their
focal contracture of myofibrils in the endplate zone and then the femoris biceps muscles. We randomly selected an MTrS in one side
formation of the taut band, and finally the MTrP. The pathogenesis of femoris bicep as the experimental group (treated with MIRE),
of MTrP could be attributed to the “energy crisis” hypothesis from and another MTrS on the other side of femoris biceps as the control
local hypoxia. Several subcellular contractile signaling pathways group (treated with tPT). The protocol for MIRE consisted of a
may be linked to focal contracture of the taut band. We thus hypoth- daily 40 min treatment, three times per week for 2 weeks. The same
esized that local hypoxia caused by focal subcellular contraction treating schedule was applied for tPT, except that the interventions
proteins’ activation could result in “energy crisis” in associated with were hot packing for 20 min and electrical stimulation for 20 min.
increased EPN numbers. The objective of this study is to measure The prevalence of EPN in an MTrS region (EPN mapping) was
the expression and phosphorylation of the proteins in an MTrP assessed before, immediately after, and one week after completion
rabbit model and also to delineate their association with MTrP. of the whole course of the intervention. Results: In the experimen-
Materials and Methods: Three adult New Zealand rabbits (3~5 Kg) tal group, the mean values of the prevalence of EPN in an MTrS
were investigated and their bilateral femoris biceps were exposed. before the intervention of MIRE, immediately after MIRE, and one
Three points in each femoris biceps were located and compared: week after MIRE were 13, 8, 9, respectively. In the control group,
Point A: a myofascial trigger spot (MTrS; equivalent to MTrP in the mean values of the prevalence of EPN in an MTrS before the
human MPS), a most irritable point on the taut band; Point B: a intervention of tPT, immediately after tPT, and one week after tPT
point on the taut band, but is not an MTrS; Point C: a point outside were 11, 11, 10, respectively. The decrease of EPN prevalence in
of the taut band, and is not an MTrS. The prevalence of EPN loci an MTrS was statistically significant in the experimental group
in each point was assessed (EPN mapping). Muscles around these (p < 0.01). Conclusion: Our study showed that the irritability of an
three points were biopsied for further analyses of the expression and MTrS could be inhibited significantly more by MIRE treatment than
phosphorylation of possible subcellular contractile proteins using by tPT. The result suggested that, compared to tPT, MIRE might be
Western blot method. Results: The prevalence of EPN was highest a more effective strategy for the management of MTrP.
in Point A (mean 3.8), which was followed by Point B (mean 1.7),
and then by Point C (mean 0.2). Compared with Point C, the degree 0502G6FP
of both phosphorylation and expression amount of the muscular
contraction proteins, including rho-associated coiled-coil contain- THE CHARACTERISTICS OF POLYSOMNO
ing protein kinase-2, mitogen-activated protein kinase, extracellular GRAPHIC FINDINGS AMONG THE PATIENTS
signal-regulated kinases 1 and 2, and JNK pathway were highest in WITH CHRONIC NECK – SHOULDER PAIN
Point A with greatest EPN numbers (3.15–4.03 times of Point C,
p < 0.01; 1.18–1.45 times of Point B, p < 0.05; n = 3, respectively) Hung-Sheng Chen1, Shih-Ching Chen1, Song-Hung
and followed by Point B with less EPN numbers (2.68–2.78 times Tseng1, Jiunn-Horng Kang1,2, Fu-San Jaw2, Hsu-Kuei
of Point C, p < 0.05; n = 3). Furthermore, the number of EPN was Lin3
well correlated with the degree of protein phosphorylation (p < 0.05). 1
Department of Physical Medicine and Rehabilitation, Taipei
Conclusion: This is the first study to demonstrate that the expres- Medical University Hospital, 2Institute of Biomedical Engineer-
sions and the degrees of phosphorylation of muscular contraction ing, National Taiwan University and 3Department of Electrical
associated proteins are increased and correlated with the prevalence Engineering, National Taiwan University (Taiwan)
of EPN in a rabbit MTrS model. It further supports our current
concept of the pathophysiology of MTrP and is emerged for the Purpose: Sleep problem is a common complaint among the patients
development of new strategy on treating MPS. with chronic shoulder neck pain. The bidirectional interaction was
also noted between chronic pain and sleep. Furthermore, although
the mechanism is unknown, increased surface electromyographic
0502G5FP (sEMG) activity during sleep among the patients with chronic neck-
COMPARISON OF MIRE AND TRADITIONAL shoulder pain has been reported. Polysomnography (PSG) is a well-
established objective tool to investigate the human sleep. The goal of
PHYSICAL THERAPY FOR THE INHIBITION OF this pilot study is to evaluate the characteristics of PSG findings over
THE IRRITABILITY OF MYOFASCIAL TRIGGER night among patients with chronic neck-shoulder pain. Materials
SPOT OF RABBIT SKELETAL MUSCLE and Methods: Patients who chronic neck-shoulder pain for more
than three months were included in this pilot study. We excluded
Wei-Chih Lien1, Shu-Min Chen1, Jo-Tong Chen1, Ta- the patients who had known systemic rheumatologic diseases, ma-
Shen Kuan1, Chi-Hsien Chien2, Chang-Zern Hong3 lignancy, previous neck trauma or surgery and co-existing cervical

radiculopathy. The overnight PSG were conducted according to the Objectives: Osteoarthritis (OA) is a major cause of musculoskel-
standard of American Sleep Medicine Association in a sleep lab in etal pain that causes morbidity, physical limitation associated with
eight patients with pain and eight healthy controls. Additional sEMG functional limitation and poor quality of life. The purpose of this
channels over bilateral neck-shoulder area (trapezius muscles) were study was to evaluate the pain reduction of botulinum neurotoxin
included during recording. Mann-Witney U test was performed to A (BoNT/A) intra-articular injection for advanced knee OA. Meth-
analyze the sleep variables between two groups. Fisher exact test ods: 24 patients (total 38 advanced OA knees) were enrolled in this
was computed to analyze the associated sleep conditions between study. The subjects were radiographically verified as stage III or IV
two groups. Alpha level was set as p < 0.05. Results: Although there according to Kellgren-Lawrence classification. We used WOMAC
is no difference of sleep efficiency between two groups, we found for pain measurement and then evaluate the therapeutic effects
significantly increased sleep fragmentation and spontaneous arousal every month for totally 6 months. BoNT/A (Botoxin 100 U) was
(21.0 ± 4.2/hour vs. 16.4 ± 5.4/hour, p = 0.03) in PSG among the reconstituted with 4.0 ml of saline and was injected to symptomatic
patient with chronic neck shoulder pain. Increased alpha intrusion OA knee joints after baseline evaluation and 3 months later. We also
of EEG (p < 0.01) and periodic limb movement index (16.8 ± 27.5/ measured the circumference of thigh to evaluate if there was any
hour vs. 4.2 ± 2.2, p = 0.02) were also noted among the patients with muscle. Results: The therapeutic effects of BoNT/A IA was clini-
chronic neck shoulder pain. The difference of apnea-hypopnea index cally significant but statistically significance was noted 3 months
between two groups was not significant. The root mean square of after first BoNT/A IA and maintained till the endpoint of our study.
SEMG of trapezius muscle during sleep was significantly higher The therapeutic effects were significant in stage III OA knee pain
among the patients with chronic neck-shoulder pain (3.4 ± 1.2% with statistically significance. There was no significant difference
peak vs. 1.8 ± 0.7% peak, p < 0.01). Conclusion: Our study indicated between stage III and IV groups. There was no difference in thigh
the objective sleep parameters could be altered among the patients circumference between study groups. Conclusions: BoNT/A IA
with chronic neck shoulder pain. Increased sleep fragmentation and injection can provide a new therapeutic option for refractory pain
sleep movement disorders were noted which could be associated in advanced OA knee patients. Though BoNT/A IA is effective and
with pathomechanism of chronic neck shoulder pain. We propose safe for the management to chronic advanced OA knees, the results
the central mechanisms could be involved in disturbance of sleep can not be generally used to patients with mild knee joint pain or
and pain development among these patients. non-specific soft tissue pain in knee joint region.
0502G7FP 0502G9FP
THE IMMEDIATE EFFECTS OF A SINGLE OCCIPITAL NERVE STIMULATOR THERAPY FOR
THORACIC MANIPULATION ON CERVICAL A REFRACTORY CERVICOGENIC HEADACHE
RANGE OF MOTION AND PAIN IN PATIENTS
Linqiu Zhou1,2, John Villanueva1, Christopher
WITH CHRONIC MECHANICAL NECK PAIN: A Hennesse2
RANDOMIZED CONTROLLED TRIAL 1
Jefferson Medical College, Thomas Jefferson University and 2Un-
Thavatchai Suvarnnato1, Rungthip Puntumethakul2, derwood Memorial Hospital (United States)
Yodchai Boonphakop2, Suphaporn Phadungkit2, Preeda Purpose: Cervicogenic headache (CeH) is a headache originating
Arayawichanon3 from the cervical spine. The treatment for CeH is challenging for
1
Physical Therapy Program, Graduate School, Khon Kean Uni- clinicians. This study is to assess the efficacy of occipital nerve
versity, 2Back, Neck and other Joint Research Group, Faculty of stimulator therapy for the treatment of refractory CeH. Materials
Associated Medical Sciences, Khon Kean Univers and 3Department and Methods: This is a retrospective chart review. 9 patients (3
of Physical Medicine and Rehabilitation, Faculty of Medicine, Khon male, 6 female, mean age = 46) with clinical diagnosis of CeH.
Kean University (Thailand) 8 patients had a history of cervical decompression and fusion and
1 had a history of cervical herniated nucleus pulposus. All failed
Purpose: To investigate the immediate effects of single thoracic conservative therapies (physical therapy, medications, and epidural
manipulation on cervical range of motion and pain level. Materials injections). All received temporary pain relief from cervical C1–2,
and Methods: Twenty subjects with chronic mechanical neck pain C2–3 facet and C2 and C3 spinal rami blocks. All then under-
participated in this study. Each subject was measured cervical range went a percutaneous occipital nerve stimulator trial. 8 patients
of motion by a Cervical Range of Motion (CROM) and assessed pain received > 50% and one had 20–40% of headache reduction dur-
level by a visual analog scale (VAS) immediately before and after ing this trial. Outcome Measure: The change from baseline head
treatment intervention. Subjects were randomly allocated into two pain intensity, rated using a numerical pain scale (NPS), and the
groups; single thoracic manipulation (intervention group) or prone duration of pain relief. Patients who received permanent implanta-
lying (control group). Results: The results demonstrated that subjects tion were followed up from 1 to 3 years. Methods: After routine
received single thoracic manipulation group showed a significant preparation and sedation, a 15 gauge 10 cm spinal needle was
increase in cervical range of motion in flexion (p = 0.004) and left rota- inserted 2 cm on the contralateral side (1 cm below the occipital
tion (p = 0.001) direction but no significance in pain level (p = 0.91). protuberance) towards the headache site until the needle tip was
Conclusion: In conclusion the results suggest that the single thoracic close to the posterior temporal fascia. If the patient had bilateral
manipulation results in increasing of cervical flexion and left rotation CeH, a second needle was inserted using similar technique. After
movements in patients with chronic mechanical neck pain. accurate position was confirmed fluoroscopically, an 8-electrone
spinal stimulator lead was inserted. The spinal needle was then
0502G8FP removed. Patients were awakened to test whether the stimulant
provided pain relief. Eight CeH patients from the trial, who re-
INTRA-ARTICULAR BOTULINUM ceived at least 50% of pain relief on the NPS, underwent bilateral
NEUROTOXIN TYPE A FOR ADVANCED KNEE stimulator implantation. This procedure involved anchoring the
OSTEOARTHRITIS stimulator lead to skull fascia with 1-0 silk suture after making a
5 cm “T” shape incision and blunt dissecting the skin and skull
Chen-Liang Chou1,2, Shin-Yo Lu1, Ko-Lun Tsai1, Chung- fascia (a precaution: avoiding damage to the occipital nerve and
Yu Ho1, Hsuan-Chu Lai1, Si-Huei Lee1,2 vessels). A pulse generator was then implanted. Results: Of the
1
Department of Physical Medicine and Rehabilitation, Taipei eight patients receiving permanent stimulator implantation, all had
Veterans General Hospital and 2Department of Physical Medicine at least 75% occipital and parietal headache relief, including two
and Rehabilitation, National Yang-Ming University, School of reporting 99% relief on the NPS. Four patients received > 50% of
Medicine (Taiwan) pain relief at the trigeminal nerve distribution. Four patients had

some pain relief at the supraorbital and temporal nerve distribution. group two receiving TENS + Ischemic compression, three times
All patients had decrease of the frequency and shortening of the in one week. Eighty patients were randomized into 37 patients
duration of headache and decreased taking pain medications. All receiving Ischemic compression and 37 patients receiving Spray &
eight returned to their normal activity level. Conclusion: Based Stretch for 5 consecutive days. Sixty patients were randomized into
on the International Headache Society (IHS) criteria, CeH presents 30 patients receiving hot packs therapy and 30 patients receiving
as a non-shifting unilateral or bilateral headache, originating from hot packs + ischemic compression therapy for 5 consecutive days.
the neck with radiation to the occipital parietal region. Some have Sixty four patients were randomized into 33 patients receiving Low
headaches similar to trigeminal neuralgia due to the greater, lesser Power Laser therapy and 31 patients receiving ischemic compression
and third occipital nerves (the occipital parietal region) converg- therapy for 5 consecutive days. Results: The 20 patients in group
ing with the trigeminal nerves in the lower brain stem and upper two receiving TENS + Ischemic compression with 54.53±14.45%
cervical spine. The treatment for CeH is challenging, as there are decrease in pain (VAS) was significantly better (p=0.001) than
no definite or effective modalities available. This study demon- the 21 patients in group one receiving TENS (36.67±12.52%)
strates that occipital nerve stimulators may provide satisfactory only. The PTM (Pressure threshold meter) score increased more
pain relief for a long duration of time. significantly (p=0.001) in the 20 patients in group two receiving
TENS + Ischemic compression (51.40±22.79%) compared to the
21 patients in group one receiving TENS (22.53±15.12%). The %
Pain Management: Part 4 decrease of VAS did not differ significantly (p=0.432) between the
37 patients receiving Ischemic compression (64.92±16.7%) and the
37 patients receiving Spray & Stretch (61.63±14.93%) and so was
0502K1 the PTM score (p=0.40) between the 37 patients receiving Ischemic
PICTORIAL GUIDES TO MYOFASCIAL PAIN compression (90.34±18.51%) and the 37 patients receiving Spray
& Stretch (85.96±20.91%). The VAS decrease significantly in both
Yoon Kyoo Kang the 30 patients receiving hot packs therapy (64.37±16.95%) and the
Dept. of Rehabilitation Medicine, College of Medicine, Korea 30 patients receiving hot packs + ischemic compression therapy
University (Republic of Korea) (72.02±23.36%) but did not differ significantly (p=0.151), while
the significant increase of PTM score differ significantly (p=0.019)
Purpose: Myofascial pain patterns are referred pain felt at a site in both the 30 patients receiving hot packs therapy (55.17±24.79%)
remote from the site of origin - trigger points. There is no general and the 30 patients receiving hot packs + ischemic compression
rule for guessing the referred pain pattern of an individual muscle. therapy (71.53±27.50%). The % VAS decrease did not differ sig-
Purpose of this study is to help understanding the myofascial nificantly (p=0.086) between the 33 patients receiving Low Power
pain, finding an easy way and to memorize the pain patterns from Laser therapy ( 43.40±11.02) and the 31 patients receiving ischemic
individual myofascial trigger point. Materials and Methods: I compression therapy (38.85±9.79). The % increase in PTM differ
try to classify the 169 referred pain patterns in volumes 1 and significantly (p=0.020) between the 33 patients receiving Low
2 of the Myofascial Pain and Dysfunction: the Trigger Point Power Laser therapy (59.25±31.97) and the 31 patients receiving
Manual by [Simons & Travell, 1989, 1999]. Classification was ischemic compression therapy (40.54±30.69). Conclusion: The
done in several ways, morphology and functions of the muscles application of various interventions in myofascial pain syndrome
and neurological myotome and dermatome. Referral patterns also involving the trapezius muscle showed different therapeutic effects.
analyzed distribution of the pain areas, especially LOCATION and All interventions decreased the pain (VAS decrease) and increased
shape. Results: Simons et al. reported as follows. Most common the pain threshold shown by the increase in PTM. Low power
direction of the referral is peripheral (to distal), 85%. 48% refer Laser therapy seems to have better results compared to Ischemic
only in the direction of the periphery. 20% of all patterns refer to compression therapy, although ischemic compression had better
both periphery and Center. 10% of the patterns have only a local results when compared to spray and stretch, TENS and hot packs,
pattern. And 5% refer only in a central direction (to proximal). either alone or in combination.
Pain is more likely to be projected distally than proximally in the
limb, and it is often to a joint moved by that muscle. Some of the
referred pain zones from trigger points overlap exactly with the 0502K3
dermatome of the corresponding spinal segment (myotome). Table PATHOPHYSIOLOGY OF MYOFASCIAL TRIGGER
on this slide shows summary of the Rules or Classes. The Most
Prevalent classification is ‘Over the TrP’ 59 patterns (35%). The POINT
second is ‘To the JOINT” 26 patterns (15%). 21 patterns belong Ta-Shen Kuan
to “Along TENDON’ (12%). 15 patterns were ‘Radiculopathic’ Department of Physical Medicine and Rehabilitation, College of
(9%). 40 patterns were unclassifiable (25%). Conclusion: Though Medicine, National Cheng Kung University (Taiwan)
this study is not a complete one, I found several trends in the
myofascial pain patterns. These finding would be helpful to study Myofascial pain syndrome (MPS) is characterized by the existence
the myofascial pain in the clinical practice. of a myofascial trigger point (MTrP). An MTrP has been defined
as a localized hyperirritable spot in a palpable taut band of skeletal
muscle fibers. It has been suggested that the minimal criteria for
0502K2 identifying an MTrP are “spot tenderness”, “pain recognition”, and
Various interventions in Myofascial “taut band”, and the confirmatory signs of an MTrP are “referred
Pain pain (ReP)” and “local twitch response (LTR)”. The characteristic of
electromyographic activities recorded from an MTrP locus is regarded
Yayat Hadiyat Lofriman, Darmadi J. Gunawan, Erwin as spontaneous electrical activity (SEA), which includes endplate
A.D. Nanulaitta, Angela B.M.Tulaar noise (EPN) and endplate spike. The pathogenesis of an MTrP has
Physical Medicine and Rehabilitation Department, Faculty of been postulated to be related to “energy crisis theory”, that is: muscle
Medicine, University of Indonesia (Indonesia) fibers overload results in dysfunctional endplates (EPNs), which
cause muscle fibers hypercontraction (taut bands) leading to local
Purpose: To study the various interventions in the management of hypoxemia and sensitization of nociceptive neurotransmitters. In an
Myofascial Pain Syndrome (MPS). Materials: Patients with Myo- MTrP region, multiple hyperirritable loci can be found and “Multiple
fascial Pain Syndrome and VAS (Visual Analog Scale) more than Loci Theory” has been proposed. It was hypothesized that each MTrP
5 involving Trapezius muscle. Methods: Forty-one patients were contains many basic units of an MTrP, the MTrP locus. Each MTrP
randomized into 2 groups, 21 patients in group one receiving TENS locus consists of a sensory component (a sensitive locus) and a motor
(Transcutaneous Electrical Nerve Stimulation) and 20 patients in component (an active locus). The sensory components of the MTrP

Pediatric Rehabilitation 81
locus are sensitized nociceptors that are responsible for pain, ReP, muscle tissue. Results: After histogram comparison, the path of
and LTR. The motor components, where SEAs can be recorded, are inserting needle, taut band, and localized twitch responses were
dysfunctional endplates that are responsible for taut band formation clearly visualized distinctively from the normal tissue. More specifi-
as a result of excessive acetylcholine (ACh) leakage. This MTrP cally, the initiations of localized twitch responses were observed
circuit is the connection among spinal sensory (dorsal horn) neurons near the epimysium area of the upper trapzius muscle. Conclusion:
responsible for the MTrP phenomena. It has been hypothesized that According to our pilot study, three-dimensional sonography is a
excessive ACh release, sarcomere shortening, and release of sensitiz- reproducible technique for morphologic assessment of myofascial
ing substances are three essential features that relate to one another taut band and localized twitch response, and is better visualized
in a positive feedback cycle. Therefore, the pathogenesis of MTrPs than the traditional 2D ultrasound method in real-time. Analysis
is probably related to sensitized nociceptors (sensory loci) associated with histograms of gray-scale value analyses is an effective method
with dysfunctional endplates (active loci). in identifying taut band, and localized twitch responses within sur-
rounding muscular tissues.
0502K4
DIAGNOSTIC ULTRASOUND TO MYOFASCIAL 0502K6
TRIGGER POINT AND TAUT BAND MYOFASCIAL TRIGGER POINTS IN THE EARLY
LIFE
Hsin-Shui Chen , Li-Wei Chou , Chang-Zern Hong ,
1 2 3
Mu-Jung Kao4 Mu-Jung Kao1,2, Ting-I Han3, Ta-Shen Kuan4, Yueh-

1
Department of Physical Medicine and Rehabilitation, China Ling Hsieh5, Bai-Horng Su6, Chang-Zern Hong4,5
Medical University, Bei-Gang Hospital, 2Department of Physical 1
Department of Physical Medicine & Rehabilitation, Taipei City
Medicine and Rehabilitation, China Medical University Hospital, Hospital, 2Department of Rehabilitation Medicine, College of
3
Department of Physical Therapy, Hungkuang University and Medicine, China Medical University, 3Department of Rehabilita-
4
Department of Physical Medicine and Rehabilitation, Taipei City tion Medicine, China Medical University Hospital, 4Department of
Hospital (Taiwan) Physical Medicine & Rehabilitation, College of Medicine, National
Cheng-Kung University, 5Department of Physical Therapy, Hung-
Purpose: To describe the morphology of myofascial trigger point kuang University and 6Department of Pediatrics, China Medical
(MTrP) and taut band with high-resolusion ultrasound (US). Ma- University Hospital (Taiwan)
terials and Methods: Twelve subjects with neck pain and shoulder
pain were eligible for this study. The inclusion criteria included Objective: This study is designed to see if latent myofascial trigger
neck and shoulder pain with active MTrP in the upper trapezius points (MTrPs) can be identified in normal infants and in normal
muscle. The identification of active MTrP in the upper trapezius adult subjects. Design: Sixty normal adults and 60 infants (age 0-
muscle was performed with palpation examination and EPN studies. 12 months) were investigated. An algometer was used to measure
Both PE and EPN studies were assessed by the same physiatrist. the pressure pain threshold (PPT) on three different sites, including
When the MTrP was indentified, a monopolar needle was inserted a mid-point (assumed to be the MTrP site), in the brachioradialis
into the marked MTrP region and the US study was performed to muscle. Results: It was found that the mean PPT values at the MTrP
assess the morphologic changes in bilateral upper trapezius muscles, site was significantly lower than the other sites in the adult muscles.
using 2D gray scale picture and Doppler studies (including color However, no significant differences in PPT values among these three
Doppler and power color Doppler). The GE logic 5 ultrasound sites were found in the infants. Taut bands were found in all the
machine and lineal probe were used. Results: All 12 active MTrP adult muscles but none in the infants. Conclusions: It was concluded
were assessed for the existence of EPN. All cases had increased that, in the adult subjects, the mid-point of brachiaoradialis muscle
EPN amplitude. Echogenicity changes including taut band, and was significantly more irritable than other sites and the mid-point
increased microvasculature flow were noted in the MTrP region, was probably a latent MTrP. However, in the infants with age less
but not in the surrounding non-MTrP regions. Conclusion: High- than one year-old, such phenomenon could not be observed in this
resolusion US may be used to identify the echogenicity change and study. It is very likely that the latent MTrPs might not exist in the
focal characterization, and taut band, in the MTrP region. early life, but develop in the later life.
0502K5
THREE-DIMENSIONAL REAL TIME Pediatric Rehabilitation
SONOGRAPHIC MORPHOLOGIC ASSESSMENT
OF HUMAN MYOFASCIAL PAIN DURING 0502D1
NEEDLING: DEMONSTRATION OF A PILOT GABAA RECEPTOR EXPRESSION IN PATIENTS
STUDY WITH SPASTIC CEREBRAL PALSY
Hung-Chih Hsu1,2 Chang-Il Park
1
Department of Physical Medicine and Rehabilitation, Chang Gung Department and Research Institute of Rehabilitation Medicine,
Memorial Hospital and 2Graduate Institute of Clinical Medical Yonsei University College of Medicine (Republic of Korea)
Sciences, Chang Gung University (Taiwan)
Periventricular leukomalacia (PVL), due to hypoxic ischemic
Purpose: The purpose of this study was to assess the reproducibility insults, has been known as a leading cause of motor and cognitive
and real-time characteristics of 3-dimensional (3D) sonography of dysfunction in patients with perinatal brain injury, especially in pa-
myofascial trigger point (MTrP) in human upper trapezius muscle tients with spastic cerebral palsy (CP) who were born prematurely.1
during needling by using gray-scale histogram method. Materials However, children with spastic CP do not always have PVL and the
and Methods: Three patients with myofascial pain involving the exact correlation between brain damage and motor impairments
upper trapezius muscle clinically diagnosed by an experienced still remains unclear. Despite the high incidence of white matter
physician were reevaluated by 2-D and 3-D ultrasound. During injury in children born prematurely with very low birth weight , the
needling, the 2-D and 3-D images of the needle path and localized incidence of spastic CP in this group was approximately 10%.2, 3 In
twitch responses induced by needling were recorded and analyzed. addition to morphological and anatomical abnormalities, various
Histograms in gray-scale value of taut band and areas twitch re- neurotransmitters are thought to be involved in the pathogenesis of
sponses were calculated and analyzed to differentiate with normal CP. For example, GABA is a well-known inhibitory neurotransmit-

ter in the human brain, but it is also known to generate excitatory risk factors for functional morbidity. Materials and Methods:
action in an immature brain and may lead to brain damage.4 In This was a multi-centered study that longitudinally assessed the
regards to the brain remodeling process after injury, perilesional developmental outcomes of VLBW preterm infants and term
or motor cortical GABAA receptor expression was reported to infants born between 1995 and 1997 in northern Taiwan. A total
decrease during the repairing process after brain injury for opti- of 238 VLBW children and 91 term children were prospectively
mal practice-dependent plasticity.5 In contrast, our previous study examined the functional status at 3 years of corrected age using
demonstrated a higher uptake of a non-selective GABAA receptor the Chinese Child Development Inventory and neurodevelopment
marker, 18F-fluoroflumazenil (18F-FFMZ), within the bilateral using the Bayley Scales of Infant Development, second version.
motor and visual cortices in patients with spastic CP compared to Of them, 130 VLBW preterm children and 59 term children
normal controls on statistical parametric mapping(SPM) analysis were assessed their intelligence using the Wechsler Intelligence
using delayed PET images.6 In a recent study, we investigated Scale for Children, 3rd Edition at 8 years of age. Perinatal and
the regional expression profile of the GABAA receptor within sociodemographic data were collected through review of medical
the motor cortical network zone in patients with perinatal injury records. Results: Functional limitation (defined as more than two
and spastic CP. We measured regional GABAA receptor binding standard deviations below the means of term infants) occurred
potential using a dynamic PET scan with 18F-fluoroflumazenil more frequently in VLBW children than in term children at pre-
(18F-FFMZ) in spastic CP. Twenty-nine patients with spastic school age: gross motor, 23% vs. 3%; fine motor, 12% vs. 1%;
CP had PVL and six did not have PVL on conventional MRI. expressive language, 21% vs. 2%; comprehension-conceptual,
SPM analysis was used to compare the receptor BP profiles of all 23% vs. 4%; situation comprehension, 17% vs. 4%; self-help,
spastic CP patients and patients without PVL (n = 6) with those 17% vs. 1%; and personal-social, 19% vs. 3% (all p<0.01).
of normal control. We obtained a functional connectivity map of Significant risk factors associated with functional morbidity in-
the primary motor cortex (M1) at a resting state with functional cluded gestational age <30 weeks, grade III–IV intraventricular
MRI in 21 patients and compared the connectivity map with the hemorrhage, chronic lung disease, stage III–IV retinopathy of
receptor binding potential map. The primary motor cortex has prematurity, male gender, and maternal education below high
extensive functional connections with the adjacent somatosen- school. Furthermore, there were significant differences in per-
sory cortex, cingulate gyrus, parietal cortex, visual cortex, basal formance IQ (90.16±17.05 vs. 108.51±15.65, p<0.001), verbal
ganglia, thalami, and cerebellum. The GABAA receptor binding IQ (97.43±15.62 vs. 111.78±13.65, p<0.001), full-scale IQ
potential in the spasticCP group diffusely decreased except for (93.14±16.33 vs. 111.05±14.81, p<0.001), verbal comprehension
the specific areas that were functionally connected with M1. In index score (98.06±15.53 vs. 112.47±13.74, p<0.001), percep-
addition, receptor binding potential was focally increased within tional organization index score (92.39 ± 17.13 vs. 109.42±14.87,
the paracentral lobule (including the lower extremity homuncu- p<0.001) and freedom from distractibility index score at school
lus), convexity of the motor cortex, visual cortex, and cerebel- age (98.34±17.71 vs. 110.53±10.94, p=0.008). There was no cor-
lum. The non-PVL group also showed a trend toward increased relation between perinatal outcomes and full-scale IQ in VLBW
BP within these regions. The etiological mechanisms of altered preterm children, however. Conclusion: VLBW preterm children
regional GABAA receptor binding in spastic CP patients are still had a higher risk of functional morbidity than their term coun-
unknown. However, these alterations of receptor binding might terparts at preschool age. VLBW children further demonstrated
play an important role in the pathogenesis of motor dysfunction significantly poorer IQ at school age compared with term children.
and spasticity in spastic CP. Children with functional limitations might require comprehensive
References: developmental assessment and continued follow-up.
1. Volpe JJ. Brain injury in premature infants: a complex amalgam of destruc-
tive and developmental disturbances. Lancet Neurol 2009; 8: 110–124.
2. Skranes J, Vangberg TR, Kulseng S, Indredavik MS, Evensen KA, Mar- 0502D3
tinussen M et al. Clinical findings and white matter abnormalities seen ADVANCES IN MEASUREMENT METHODS FOR
on diffusion tensor imaging in adolescents with very low birth weight. CHILDREN WITH DEVELOPMENTAL DELAY IN
Brain 2007; 130: 654–666.
3. Vangberg TR, Skranes J, Dale AM, Martinussen M, Brubakk AM, Har- TAIWAN
aldseth O. Changes in white matter diffusion anisotropy in adolescents Hua-Fang Liao1,2
born prematurely. Neuroimage 2006; 32: 1538–1548. 1
National Taiwan University and 2Department of Rehabilitation
Medicine; Physical Therapy Center, National Taiwan University
Hospital (Taiwan)
0502D2
Longitudinal studies on the Purpose: To introduce the reliabilities, validities of developmental
tests developed recently in Taiwan for children less than 6 year-of
developmental functions and clinical age. Materials and Methods: The screening tests include: Compre-
variables in children born with hensive Developmental Inventory for Infants and Toddlers, screen-
prematurity ing test (CDIIT-ST), Taipei Preschooler Developmental Checklist
2nd version (Taipei II), Simplified Child Developmental screening
Suh-Fang Jeng1,2, Kuo-Inn Tsou3, Chyong-Hsin Hsu4, Test (SiDesT), Developmental Surveillance Items of Child Health
Kuo-Su Tsou5, Li-Jung Fang6, Shu-Chi Mu7 Pamphlet (DICHP); The diagnostic test is CDIIT diagnostic test
1
School and Graduate Institute of Physical Therapy, National (CDIIT-DT). The reliability indices include: internal consistency,
Taiwan University College of Medicine, 2Physical Therapy Center, inter-rater and test-retest reliabilities (ICC, Kappa). Validities are
National Taiwan University Hospital, 3College of Medicine, Fu Jen presented by are concurrent and predictive validity indices (Pearson
Catholic University, 4Department of Pediatrics, Mackay Memorial correlation, ROC curve, ANOVA, Kappa, sensitivity etc). Results:
Hospital, 5Taipei Child Development Assessment Center, Taipei CDIIT diagnostic test and screening tests have acceptable reliability
City Hospital, 6Department of Neonatology, Branch for Women and validity. For children less than 2 years old, DICHP has accept-
and Children, Taipei City Hospital and 7Department of Pediatrics, able reliability and validity. Most scales of Taipei II in different
Shin-Kong Wu Ho-Su Memorial Hospital (Taiwan) age range have acceptable reliabilities and validities. Conclusion:
Reliabilities and Validities of CDIIT-DT, CDIIT-ST and Taipei II
Purpose: This study assessed the functional status of very low are acceptable. These tests can be used in clinics to help clinical
birth weight (VLBW) preterm infants (birth weight <1,500 g) and decision. More researches are needed for the validities and cost-
term infants from preschool to school age, and sought to identify benefits of multi-phasic tests.

0502D4 ND children. Linear regression analysis revealed that the GMFCS

Advances in the Application of levels had a negative relationship with femur BMD. However, all
bone metabolism variables were not related to the BMD. Correlation
Botulinum Toxin in Pediatric analysis revealed that the peak torques of knee extensor and knee
Rehabilitation flexor were correlated with femur BMDs. Our findings may suggest
Jeng-Yi Shieh the Gross Motor Functional Classification System (GMFCS) levels
significantly impact determination of the femur BMD. The me-
Department of Physical Medicine & Rehabilitation, National Taiwan chanical factors, including reduced mechanical loading from anti-
University Hospital (Taiwan) gravitational muscle contraction and reduced postural muscle activ-
ity, mainly contributed to BMD in ambulatory children with CP. The
Purpose: To review the applications of Botulinum toxin in pediat- motor disorders of CP are often accompanied by disturbances of
ric rehabilitation. Summary: Botulinum toxin has been applied in sensation, perception, cognition, communication, and behavior, by
many clinical conditions in rehabilitation. In recent years, there had epilepsy, and by secondary musculoskeletal problems. Speech and
been even more applications in pediatric population. This lecture language impairments are commonly associated with CP. These
will review the use of Botulinum toxin in the following subjects, communication disorders, especially poor speech production, may
spasticity, dystonia, drooling and contracture. result from disturbed neuromuscular control of speech mechanism.
Reduced intelligibility in children with CP can adversely impact
communication abilities and limit their vocational, educational, and
0502D5 social participation. Such limitations may consequently diminish
ADVANCES IN CURRENT INTERVENTION FOR these children’s quality of life. Our study investigated speech motor
control in children with CP using clinical and kinematic analysis.
CHILDREN WITH CEREBRAL PALSY Our results revealed high spatiotemporal indexes (STIs) values and
Chia-Ling Chen high variability on utterance durations in children with CP reflect
Physical Medicine and Rehabilitation, Chang Gung Memorial deficits in relative spatial and/or especially temporal control for
hospital (Taiwan) speech in the these children. Children with spastic CP may have more
difficulty in processing increased articulatory demands and resulted
Cerebral palsy (CP) describes a group of disorders of movement and in greater oromotor variability than normal children. Children with
posture, causing activity limitation, due to non-progressive distur- quadriplegic CP may use compensatory movement strategies,
bances in a developing fetal or infant brain. The affected areas vary greater jaw force to compensate for lip movement, to efficiently
from partial (e.g. diplegia) to total body (e.g. quadriplegia) involve- produce speech movement. These findings may suggest that treatment
ment. Moreover, gait performance also has wide variations such as strategies of spatiotemporal oro-motor stability training may benefit
equinus, scissored or crouched gait even the areas of the body involve- to improve speech intelligibility for children with CP. Coordination,
ment are the same such as spastic diplegia. Most children with CP communication, documentation, patient/client-related instruction,
who have upper limb disabilities encounter difficulties during certain and core interventions were the main components of rehabilitation
activities, especially computer operating activities, such as usage of programs. Core interventions consisted of movement therapy (such
pointing devices (computer mouse). The reasons for variations in as neurophysiological approaches), modality, manual therapy, and
clinical manifestations of motor deficits might be that there is a di- other therapies. Physical modality used as an adjunct to physical
versity of etiological factors, location of lesions, and mechanisms of therapy, such as electrical stimulation (ES), and biofeedback, and
underlying motor control in CP. Therapy to restore movement and Treadmill Training with Partial Body Weight Support (PBWS).
functional deficits in children with spastic CP is based on an under- Complementary and alternative medicine (CAM) is becoming in-
standing of the underlying mechanism in these deficits. To provide creasingly widespread in the USA for treatment of CP in addition to
more precise information about therapeutic requirements in children traditional rehabilitation programs. Hurvitz et al 6 found 56% of the
with CP, it is needed to determine objective assessment criteria for 235 families used one or more CAM techniques, which massage
planning optimal treatment strategies. Our previous studies suggest therapy (25%) and aquatherapy (25%) were the most common. Cur-
polyelectromyographic (PEMG) patterns correlate with motor deficits rent interventions on motor performance in CP may involve a vari-
and may allow us to plan treatment strategies based on underlying ety of therapeutic strategies such as constrain-induced therapy (CIT),
motor control in CP. Children with CP exhibited four distinct PEMG intensive Neurophysiological Rehabilitation System (INRS, Kozi-
patterns, ranging from partial reciprocal to complete synchrony.2 javkin method), FES, Treadmill Training with PBWS, adaptive
Lower PEMG pattern scores were significantly associated with bet- technology, BTA, CITB, combination therapies (such as FES and
ter ambulatory and functional capacities. Most children of spastic orthopedic surgery, BTA and casting), and CAM. Children with
diplegia with PEMG patterns II and III had independent ambulatory spastic CP usually exhibit motor deficits and limited daily activities.
capacities and mild limitation of functional capacity, whereas most Studies indicated that constraint-induced movement therapy (CIMT)
children with pattern of IV and V had no ambulatory abilities and no might improve motor performance in children with CP. Combining
independent functional capacities. Children with CP may be at in- kinematic analysis with clinical assessments, our study investigated
creased risk of poor bone health, especially those who experience the effect of modified CIMT (mCIMT) in four children with spastic
delayed growth, reduced physical activity or inadequate nutrition, as CP immediately and one month after treatment. During the 3-week
well as those who take anticonvulsant medications which may affect intervention, subjects underwent task-related training using the af-
bone development. The increased risk of fracture in children with CP fected hand with restraint of the unaffected hand. The experimental
is caused by “physiological osteopenia”, which is associated with results revealed the mCIMT therapy improved movement perform-
poorly and abnormally functioning musculature and related immobil- ance of the affected hand, bimanual coordination, and energy effi-
ity, both of which reduce the mechanical load on the developing ciency immediately and one month after therapy. The clinical impli-
skeleton and prevent healthy bone development. Low bone mineral cations are that, in comparison with CIMT, mCIMT is easier to be
density (BMD) are prevalent in children with moderate to severe CP. implemented and may improve compliance in children with CP as
Low BMD is linked with significant fracture risk. Repeated fractures well as parents or caregivers. Despite the commercial availability of
diminish the quality of life for these children, and increase their care numerous computer-pointing devices, many severely children with
requirements. Therefore, managing low bone density and quality in CP still rely on customized equipment to operate computers. We
children with CP is a significant issue. Our study investigated the developed a novel Integrated Pointing Device Apparatus (IPDA) that
BMD and bone metabolism in children with mild and severe CP and integrates numerous commercial pointing devices. The novel IPDA
explored the relationship of muscle strength and BMDs in ambula- is compatible with most tested computer-pointing devices and flex-
tory children with spastic CP. Our results revealed the BMDs vary ibly integrates commercial computer devices, tailoring them to suit
in children with CP with different motor severities. Severe CP group individual needs. The IPDA had the advantages of flexibility, low
had lower femur BMD and serum albumin level than mild CP and cost, and acceptable efficiency. The IPDA can help some children

with CP, who cannot utilize a commercial mouse alone, to achieve Our aim in this study was to analyze the footprint measurements and
acceptable operational efficiency. The operation methods for children grades of flat foot in a population of preschool children. Three foot-
with CP were determined by their underlying motor control. Severe print measurements, Clarke’s angle, Chippaux-Smirak index, and
spasticity in children with CP not only causes functional impairment, Staheli arch index were used for comparison with clinical diagnosis.
but also results in gait abnormalities. Botulinum toxin type A (BTA) Materials and Methods: A total of 855 children (414 girls and 441
or phenol injections, and selective posterior rhizotomy (SPR) are boys), aged from 3 to 7 years, from kindergartens in central Taiwan,
commonly used to reduce the spasticity. Our previous studies inves- were included in this study. Children’s footprints were recorded on
tigate the effectiveness of the BTA, phenol, and SPR using by clini- a Harris-Beath mat. A static footprint was recorded for each foot in
cal measures and gait analysis. Our study used a computer dynogra- a 100% weight-bearing/loaded position and then scanned to digital
phy (CDG) gait analysis system to assess the effects of SPR on the images. The plantar footprint was classified according to Denis and
gait in children with spastic CP. Our results showed the distribution the clinical experiences into three grades of flatfoot: grade 1 (mild),
of ground reaction forces improved significantly in children with CP in which the support of the lateral edge of the foot is half of that of
after SPR, although the temporal-spatial gait parameters did not the metatarsal support; grade 2 (moderate), in which the support
change significantly. In another study, the muscle tone decreased of the central zone and forefoot are equal; and grade 3 (severe), in
significantly in all muscles three months after BTA injection16 Our which the support in the central zone of the foot is greater than the
results revealed that BTA treatment could improve ROM, gross mo- width of the metatarsal support. We defined children who had a
tor, functional ability and gait by reducing the muscle tone. Weakness grade 2 or 3 plantar footprint as flatfooted, and compared them with
and widespread spasticity are the most significant determinant factors the others. Assessments were conducted with the digital images,
on motor performances. However, sometimes clinicians have difficul- and Clarke’s angle, Chippaux-Smirak index, and Staheli arch index
ties to identify the underlying weakness in spastic CP based only on were calculated by software. The receiver operating characteristic
the clinical observation. The interventions on the spasticity in CP (ROC) curve was used for selecting an optimal cut-off point for the
included medication, rehabilitation programs, serial casting, orthot- three measurements, and the area under the curve (AUC) was used
ics, intramuscular neurolysis such as phenol nerve block or BTA for comparing the accuracy of these tests. An AUC greater than 0.9
injection, continuous intrathecal baclofen (CITB), orthopedic surgery, has high accuracy; 0.7–0.9 indicates moderate accuracy; 0.5–0.7,
and SPR. Based on PEMG patterns, for example, children with mild low accuracy; and 0.5, a chance result. The positive predictive
spasticity may benefit from antispastic techniques such as stretch value (PPV) and the negative predictive value (NPV) of the optimal
exercises, therapeutic electrical stimulation (ES), or intramuscular cut-off point were used to reflect the probability that children with
neurolysis for normalizing muscle tone, followed by facilitation positive test results and those with negative test results were cor-
techniques and corrective insoles. Children with moderate spasticity rectly diagnosed. Results: The optimal cut-off point for Clarke’s
may need more invasive interventions, such as SPR or CITB. Children angle, Chippaux-Smirak index, and Staheli arch index were 14.84
with diffuse & widespread spasticity may not respond well to thera- degrees, 62.70% and 107.45%, all of them with high sensitivity:
py, although CITB or SPR may be tried to reduce spasticity in order 0.814, 0.872, and 0.878, respectively. The AUCs were 0.900 (95%
to improve handling or nursing care, rather than to improve ambula- CI: 0.886 to 0.914), 0.946 (95% CI: 0.936 to 0.956), and 0.917
tory capacity. Spastic children with underlying weakness may need (95% CI: 0.904 to 0.930), respectively. The positive predictive
strengthening, partial weight support training or facilitation tech- values of the optimal cut-off point were 0.861, 0.906, and 0.868,
niques, and ES, followed by long leg braces and adaptive devices for respectively, and the negative predictive values were 0.758, 0.830,
assisted standing or walking. CITB may be indicated for such cases, and 0.826, respectively, reflecting that all three measurements could
who use their spasticity to stand and walk, because its effects can be distinguish well between children with or those without flatfoot.
titrated. However, SPR should not be used for such cases because it Conclusion: This study demonstrated that footprint analysis could
has a permanent effect and may increase existing weakness. In the be used effectively for screening flatfoot in preschool children and
previous study, SPR did not improve or may even aggravate the that the grades of flatfoot of preschool children were different from
function in such cases. Thus, intramuscular neurolysis may be ben- those of others. All three measurements demonstrated high accuracy,
eficial for only in cases with more focal and localized spasticity. CITB and the Chippaux-Smirak index is superior as a screening tool for
and SPR may be tried for more widespread spasticity because they distinguishing children with or without flatfoot.
reduce spasticity not only in the local segments but also in suprasp-
inal segments. However, SPR or tenotomy should not used in spastic
CP co-existing weakness due to aggravation of irreversible weakness. 0502H2FP
Tendon lengthening or tenotomy may be more beneficial in cases
where reduced extensibility resulting from inappropriate muscle A CLINICAL RESEARCH ON FRONTAL LOBE
length. While serial casting may be indicated to increase extensibil- DEVELOPMENT DURING INFANTS AND YOUNG
ity in spastic children with underlying weakness. In conclusion, the CHILDREN PERIOD WITH QUANTITATIVE
treatment of motor dysfunction and associated problems in children ASSESSMENT OF CRANIAL MRI AND EARLY
with CP is based on the underlying mechanism of motor and func-
tional deficits. Future studies may be needed to develop a rational DETECTION OF COGNITIVE FUNCTION
basis and evidence-based medicine for current interventions in chil- Xiang Chen, Shuang Zhang
dren with CP. Department of Rehabilitation, The Second Affiliated Hospital &
Yuying Children’s Hospital of Wenzhou (China)
0502H1FP Purpose: To investigate the application of MRI methods to quanti-
FOOTPRINT MEASUREMENTS ANALYSIS OF THE tatively assess the situation of frontal lobe development after brain
FLATFOOT IN PRESCHOOL CHILDREN injury in early childhood, and combined with the assessment of
cognitive function to make a comprehensive analysis, with a view
Kun-Chung Chen1,2, Chun-Hou Wang2,5, Chih-Jung to contribute to the clinical assessment, diagnosis and rehabilitation
Yeh3, Li-Chen Tung4 treatment of brain development especially the frontal lobe devel-
1
Institute of Medicine, Chung Shan Medical University, 2Depart- opment. in infants and young children. Materials and Methods:
ment of Prosthetics and Orthotics, Chung Shan Medical University Screening of the children who were clinically diagnosed as frontal
Rehabilitation Hospital, 3School of Public Health, Chung Shan lobe dysplasia (FLD), a total of 23 cases for the observed group,
Medical University, 4Chi-Mei Medical Center and 5School of Physi- including male 14 cases, female 9 cases, 21.4–59.1 weeks old
cal Therapy, Chung Shan Medical University (Taiwan) (38.304 ± 11.753 w); children with normal physical examination or
with no obvious stunting, a total of 19 cases for the control group,
Purpose: Preschool children’s feet are not simply smaller versions including male 12 cases, female 7 cases, 25.5–59.6 weeks old
of adult feet, because their feet are still growing and developing. (40.832 ± 11.739 w). For all subjects to have cranial MRI checking

and Gesell development schedules (GDS) test. Measuring the vol- children and their families received the ICF linked developmental
ume of frontal lobe and relative cranial cavity by Image-Pro Plus6.0 tests by trained visitors and the parents completed the ICF linked
image analysis software used on cranial MRI, and calculating the questionnaires in a one-week period. All the 6 Body Function vari-
standardized individual frontal lobe volume. Linear correlation ables (r = 0.40-0.78, p < 0.05) and four of the environmental vari-
analysis is used between and total development quotient (DQ) ables (Involvement (e310), Learning material (e115), Inside space
score. And logistic regression analysis is used in high-risk factors (e155), and Fine motor toys (e115)) (r = 0.15-0.20, p < 0.05) were
that might affect cognitive function. SPSS13.0 software is used significantly correlated to the Maintaining position (d415) and were
for the statistical analysis. Results: The observed group average: used to test the hypothetical ICF-CY based models with Structure
1761.642 ± 24.577, the control group average: 2110.870 ± 79.375. Equation Modeling. Results: All the hypothetical models showed
The relative frontal lobe volume of the observed group is less than acceptable model fit according multiple fit indexes except involving
that of the control group (p < 0.001). Regarding the four functional balance as a Body Function predictor. The fit indexes of acceptable
areas of GDS (motor behavior, adaptive behavior, language be- models showed SRMR approaching 0.08, and any of NFI, CFI, IFI,
havior, personal-social behavior) and the total DQ, between the MFI over 0.95. The derived ICF-CY models were portrayed with
observed group and the control group has the obvious statistics dif- significant pathways between the ICF categories. Motor Severity
ference (p < 0.001). The value of and total DQ in the observed group could predict Body Functions and the motor outcomes. Environ-
and the control group has the linear correlation analysis, the Pearson mental Factors could be the mediators between the Health Condi-
correlation coefficient r is 0.905, 0.798, p < 0.001, respectively. 4. tion and some categories in Body Functions. One social aspect of
The possibility correlation factors that could affect the cognition Environmental Factors (Involvement (e310)) and three categories
function with Logistic regression analysis showed that the hypoxia of physical Environmental Factors (Inside space (e155), Fine motor
is the primary factor that enters the regression equation ( = 4.330, Toys (e115), and Learning material (e115)) was also the mediator
p = 0.037), the OR value of is 4.444. Conclusion: The degree of between Health Condition and the Maintaining position (d415)
the frontal lobe development (lobe volume) in FLD children is less outcome. One more complex mediating path may exist: Motor
than that in normal children. The GDS score of cognitive function severity would affect Environmental Factors, and then Body Func-
in FLD children is significantly lower than that in normal children. tions, and then the motor outcomes. However, Distal Environmental
There is a positive correlation between the frontal lobe volume Factors (Family Coping Strategies (e410) and Needs (e5)) were not
and early cognitive function score in infants and young children. correlated with the Maintaining position (d415). Conclusion: The
Hypoxia during the neonatal period is a high-risk factor that could derived ICF-CY based models provide a possible explanation for
affect the frontal lobe development and early cognitive function the basic motor outcome of maintaining a body position in infants
in infants and young children period. The method of quantitative and toddlers with motor delays. The multiple mediators, early social
measurement of frontal lobe volume by MRI combined with early and physical environmental factors, in the derived ICF based models
cognitive assessment enriches the clinical diagnosis of FLD. would help early interventionists to process clinical reasoning and
early intervention programs. Longitudinal follow up, however,
would be needed to verify the causal relationship between the early
0502H3FP motor predictors and later motor outcomes.
ESTABLISHING HYPOTHETIC MODELS BASED
ON “INTERNATIONAL CLASSIFICATION OF 0502H4FP
FUNCTIONING, DISABILITY, AND HEALTH – GENE EXPRESSION PROFILING IN CONGENITAL
CHILDREN AND YOUTH VERSION“ (ICF-CY) IN MUSCULAR TORTICOLLIS
INFANTS AND TODDLERS WITH MOTOR DELAYS
– WITH MAINTAINING A BODY POSITION (D415) Shin-Young Yim1, Il Yung Lee1, Dukyong Yoon2, Ki
Young Lee2, Il Jae Lee3, Myong-Chul Park3, Myung Ae
AS THE MOTOR OUTCOME
Lee4, Young-In Na5, Jae-Bum Jun5
Ai-Wen Hwang1, Hua-Fang Liao2, Li-Jen Weng3, Lu Lu4 1
Ajou Torticollis Clinic, Department of Physical Medicine and
1
Graduate Institute of Early Intervention, College of Medicine, Rehabilitation, Ajou University School of Medicine, 2Department of
Chang Gung University, 2School and Institute of Physical Therapy, Medical Informatics, Ajou University School of Medicine, 3Depart-
College of Medicine, National Taiwan University, 3Department ment of Plastic and Reconstructive Surgery, Ajou University School
and Graduate Institute of Psychology, National Taiwan University of Medicine, 4Brain Disease Research Center, Ajou University
and 4Department of Rehabilitation and Medicine, National Taiwan School of Medicine and 5The Hospital for Rheumatic Diseases,
University Hospital (Taiwan) Hanyang University (Korea)
Purpose: To establish and test the hypothetical ICF-CY based Purpose: While intrauterine malpositioning, birth trauma, and
models for explaining the antigravity gross motor outcomes (d415 ischemia resulting from vascular occlusion have been widely pro-
maintaining a body position) in infants and toddlers with motor posed for the cause of congenital muscular torticollis (CMT), the
delays. Materials and Methods: Systematic reviews were conducted pathogenesis of CMT still remains elusive. Furthermore, little has
to establish the hypothetical ICF-CY based models and to identify been known about the functional alteration within sternocleidomas-
the measures in ICF components for predicting motor outcomes toid muscle (SCM). Gene expression profiling is a useful marker
for infants and toddlers with motor delays. The measures included of functional alteration of CMT. However, there was no report on
developmental tests and questionnaires and were linked to the gene expression profiling of CMT. The objective of this study was
following categories in 4 ICF-CY components: (1) Health Condi- to investigate gene expression profiling of CMT as a marker of the
tion: Motor Severity; (2) Body Functions: Cognitive DQ (b117), functional alterations of CMT. Materials and Methods: This study
Motivation (b130), Muscle Power Functions (b730), Muscle Tone was conducted in a tertiary medical center. Seven subjects who
Functions (b735), Muscle Endurance Functions (b740), Balance underwent myectomy of SCM for CMT in 2008 and who agreed to
(b755); (3) Activities and Participation: the basic motor outcome participate in this study were included in this study. Muscle tissue
(maintaining a body position (d415)); and (4) Environmental was collected from CMT (T-CMT) and non-CMT (T-non CMT)
Factors: Motor Toys (e115), Learning Material (e130), Physical area which was in periphery of CMT for each subject. Total RNA
Home Environment Arrangement (e155), Relationships and Sup- was extracted from both tissues for each subject and was hybrid-
port (e310), Family Coping Strategies (e410), Needs (e5)). Only ized to Affymetrix GeneChip Human Gene 1.0 ST Array which
the measures with adequate reliability or validity were retained for offers whole-transcript coverage. Differentially expressed genes
data collecting. A convenient sample of infants and toddlers with (DEGs) were determined. Using Onto-Express Analysis (OEA)
motor delays (n = 146) aged 6–24 months and their families was and Ingenuity Pathway Analysis (IPA), top canonical pathways and
recruited from January 2007 to November 2009. All the enrolled functions of DEGs were identified. Results: Among 28,869 genes

on the array, 1.03% was identified as differentially expressed. 208 impairment (43.0%), epilepsy/seizure (26.6%), and swallowing
genes (60.47%) were up-regulated and 136 genes (39.53%) were problems (17.1%) were reported to be associated with CP as well.
down-regulated. 2. OEA shows that the genes most over-expressed Conclusion: This is the first nationwide report on characteristics of
in CMT were genes for extracellular matrix among several cellular children with CP in South Korea. We hope that these results would
components with p value of 0 such as the genes for thrombospondin be used as basic information for better rehabilitation intervention
4 (THBS4), fibromodulin (FMOD) and type XIV collagen, alpha and further research on cerebral palsy.
1(COL14A1) were most over-expressed. In terms of biological
function, genes related with adhesion such as cell-cell adhesion,
cell-substrate adhesion and regulation of adhesions were most 0502H6FP
over-expressed with p value of 0 including the gene for epidermal A STUDY OF THE PROTECTION OF BDNF ON
growth factor (EGF)-like repeats and discoidin I-like domains CORTICAL NEURONS
3 protein (EDIL3). IPA shows that fibrosis is the top canonical
pathway of CMT where that hepatocyte growth factor (HGF) plays Jiangbao Zhou, Pingyun Qiao
a main role. Conclusion: We used whole genome microarrays to Children’s Hospital of Chongqing Medical University (China)
characterize for the first time the transcriptome of human CMT
tissue from seven subjects with CMT, where data of CMT tissue Objective: To explore the protective effect of brain-derived neuro-
were co-analyzed with data from tissue of non-CMT area from same trophic factor (BDNF) on cultured rat cortical neurons cell against
subjects. Our current data indicated that CMT is a developmental injury induced by glutamate,and the methanism. Materials and
disorder characterized by fibrosis of SCM and HGF seems to play Methods: Primary cultured cortical neurons cell. The cortical neu-
a role in pathogenesis of CMT. rons were divided randomly into three groups: control group, Glu
group and BDNF group. Glu group need 50 µmol/ml glumate acid
in cells for half an hour, BDNF group need to exposed to 50 ng/
0502H5FP ml BDNF for 24 hours based on aboved, but the control group is
CHARACTERISTICS OF CHILDREN WITH cultured as usual with nothing. Cell viability were determined by the
colorimetric MTT assay. The morphological features of the neuron
CEREBRAL PALSY IN SOUTH KOREA cells were observed under fluoresecence with AO/EB. Expression
In-Young Sung, Shin-Young Yim, Myeong-Ok Kim, of p75NTR, JNK, Erk were observed using western blot analysis.
Bum-Sun Kwon, Jeong-Yi Kwon, Seong-Woo Kim, Results: There are 95% of the cells is cortical neurons cells, and
Joo-Hyun Park, Bong-Ok Kim, Yong-Beom Shin, Eun- they have plump and solid bodies and long axons which contacts
with each other and form a dense network. The primary cortical
Young Kang, Min-Young Kim, Zee-Ihn Lee, Chung-
neurons grew well, BDNF can protect cortical neurals cell from
Yong Yang, Sang-Joon Kim, Ji-Chan Chang glutamate. The mortality of neurons in BDNF group is lower than
Korean Society of Pediatric Rehabilitation and Developmental in the control group. The expression of p75NTR is higher in control
Medicine (Republic of Korea) group and BDNF group than in normal group; the expression of
JNK increase in the control group to the BDNF group; at the same
Purpose: There are wide variations in the use of terms regarding
time, the expression of ERK decrease in the control group to the
definition, classification, severity, and topographic distribution of
BDNF group. The difference between the control group and the
cerebral palsy (CP). In 2007, the task force team of Korean Da-
BDNF group have statistical significance. Conclusion: BDNF can
tabase of Cerebral Palsy (KDCP) was formed by KSPRDM. The
adjust the proportion between the p75NTR and the TrkB to protect
aim of the KDCP was to set up a nationwide multi-center cohort
the cortical neurons against neurotoxicity induced by glutamate. In
of children with CP, for better understanding of characteristics of
addition, enhance the survival and suppress the apoptosis by increas-
CP and for providing a framework for further research. A standard
ing the expression of the Erk downstream signal and decreasting
minimum dataset (KDCP1.0) had been developed in January 2009,
the expression of the Jnk downstream signal.
using the agreed criteria. The objective of this study is to report
the characteristics of children with CP in South Korea based on the
KDCP1.0. Materials and Methods: Data of children who met the 0502H7FP
diagnostic criteria provided in the KDCP1.0 were entered onto the
KDCP1.0, when the child is at least 12 month-old or older at the THE EFFECT OF THERAPEUTIC EXERCISE ON
time of registration. Anonymous data without personal identifiers BEHAVIORAL PERFORMANCE IN CHILDREN
such as name and address were sent to KDCP1.0 online by the WITH ATTENTION DEFICIT HYPERACTIVITY
regular members of KSPRDM. There were 15 mandatory variables
DISORDER: A SYSTEMATIC REVIEW
for subjects whose age is less than 48 month-old. For the children
whose age is 48 month-old or older, there were 16 mandatory items Chao-Chi Hong1, Alice M.K. Wong1,2
where MACS were added to 15 variables. Mandatory variables 1
Graduate Institute of Rehabilitation Science, Chang Gung Uni-
were about type of CP, GMFCS, birth weight, gestational age, versity and 2Department of Physical Medicine and Rehabilitation,
delivery mode, birth number, postnatal events causing CP, brain Chang Gung Memorial Hospital- Taoyuan Branch (Taiwan)
MRI findings, and associated problems. Results: Among the data
by June 2009, 612 subjects with CP (boy 56.4%, girl 43.6%) were Purpose: According to different symptoms, APA set up three
completed with all mandatory variables. Cases were well distrib- subtypes as following: inattentive type (ADHD-I), hyperactivity
uted nationwide. The distribution of CP subtypes showed 86.4% - impulsivity type(ADHD-HI), and In 2000, American Psychiatric
of spastic type, 4.7% of dyskinetic type and 1.8% of ataxic type. Association (APA) defined attention deficit hyperactivity disorder
GMFCS was 23.5% of level I, 27.1% of level II, 13.2% of level (ADHD) as a disorder of display difficulties with attention and/or
III, 15.4% of level IV, and 20.8% of level V. There were 58.8% impulsive control and hyperactive behavior of individuals combined
of children with CP who were born before 37 weeks of gestation. type(ADHD-C). ADHD people not only have high prevalence
Children with very low birth weight (1000–1499 g) were 19.9% around the world, but have a high ratio of comorbidity with other
and 9.2% of children had extremely low birth weight (<1,000 g). mental disorders, such as: anxiety, Bipolar I disorder, major depres-
Brain MRI showed abnormal findings in 90.7%, where periven- sive disorder, oppositional defiant disorder, and Tourette syndrome.
tricular leukomalacia (43.5%) and mal-development of the CNS Since ADHD have a deep impact to children, lots of researchers
(8.2%) were the top two findings. 12.4% of 612 subjects were have developed different treatment trials, from pharmacotherapy
CP of postnatal origin, where hypoxic ischemic encephalopathy (CNS stimulants), cognitive behavior therapy (CBT), therapeutic
associated with seizure (58.5%) was the most common cause. exercise, to neurofeedback training. The purpose of this study
Regarding associated problems, language impairment (56.5%) was to investigate the effect of therapeutic exercise on behavioral
and intellectual disability (49.9%) were most common. Visual performance in children with attention deficit hyperactivity dis-

order (ADHD). Materials and Methods: A systematic search in in GMFM (p < 0.001, power = 1) and the improvement in gait score
published and unpublished literature from 1977 to November 2009. (p < 0.001, power = 0.998) were encouraging. By comparing the
Comprehensive search was performed both in electronic databases, difference between time, optimal effect was seen on post-injection
PubMed, MEDLINE, PsyInfo, Cochrane library, CINAHL, ERIC, 2 week time (p < 0.001) and one month (p < 0.001) on the change
Scopus, CEPS and manual search in reference lists of articles. of muscle tone. The functional gain could be maintain throughout
According to the inclusion and exclusion criteria, the appropriate the 3 months period (p < 0.001). Conclusions: BTX-A injection
articles were selected. All included articles were rated with using is an effective means of spasticity management for children with
the PEDro scale. Reviewer determined study eligibility based on CP.Muscle tone reduction and joint range improvement are most
inclusion criteria, rated study quality, and extracted information on effective one month post injection.With intensive physiotherapy
study methods, design, intervention, and results. Results: Based on training, the functional gain could be maintained after the tone
the selection criteria, total 12 studies were included in this study. reduction effect subsided.
Most of the articles showed that therapeutic exercise had positive
effect either in increase attention or improve hyperactivity behavior.
The PEDro scores of included studies ranged from 3 to 5, that is 0502H9FP
moderate quality. The types of therapeutic exercises which were FUNCTIONAL OUTCOME OF ACUTE PHASE
used in these studies included yoga, martial arts, relaxation exercise, REHABILITATION BY GMFCS AND DISEASE
aerobic exercise, and ambulation. However, all of the articles in
this review only suggested that therapeutic exercise could improve PATTERN CLASSIFICATION FOR PEDIATRIC
the symptoms of ADHD, but could not distinguish which type of ACUTE ENCEPHALOPATHY PATIENTS
exercise could modify which kind of symptom in ADHD children. Kaoruko Takada1, Hidetaka Wakabayashi1, Hironobu
In clinical practice, children with ADHD also have a high prevalence
with developmental coordination disorder. It is important to offer Sashika1, Naohisa Kikuchi2
therapeutic exercise in this kind of children with ADHD, not only
1
Department of Rehabilitation, Yokohama City University Medical
to improve the behavioural performance od ADHD, but to improve Center and 2Dept. of Rehabilitation, Yokohama City University
the symptoms of developmental coordination disorder. Conclu- Hospital (Japan)
sion: In this review, therapeutic exercise had positive effect on
Purpose: To evaluate the functional outcome for pediatric acute
behavioural performance in children with ADHD. However, all of
encephalopathy by GMFCS (Gross Motor Function Classification
the articles in this review only suggested that therapeutic exercise
System) and disease pattern classification system. Setting & In-
could improve the symptoms of ADHD, but could not distinguish
tervention: University hospital, Rehabilitation therapy (PT&OT).
which type of exercise could modify which kind of symptom in
Materials and Methods: Retrospective study was performed for
ADHD children.
18 pediatric acute encephalopathy children (6 boys, 12 girls) who
admitted in the pediatric center of our hospital in 2000 to 2009
without history of epilepsy, cerebral palsy or other neuromuscular
0502H8FP
disease. Mean age at admission was 2.7 years old (10 months to 14
A REVIEW ON THE EFFECT OF BOTULINUM years old). Mean length of stay was 70.2 ± 73.3 days. Mean time at
TOXIN A INJECTION FOR CHILDREN WITH first rehabilitation referral was 15.3 ± 10.8 days. We used GMFCS for
CEREBRAL PALSY USING ICF FOR GOAL evaluating their motor function. We evaluated at first rehabilitation
time and at discharge. Then we divided recovery group (reach level
SETTING AND OUTCOME MEASURE 1 or 2) and non-recovery group (remain level 3, 4, 5) by GMFCS.
Nar-Chi Chan1, S.C. Lee1, K.L. Kwong2, W.K. Chak2 And we compared these two groups by disease classification system,
1
Department of Physiotherapy and 2Department of Paediatric and GCS (Glasgow Coma Scale) and speech function. The classification
Adolescent Medicine, (Hong Kong) system by MR imaging and clinical symptom had 3 disease patterns,
AEFCS (acute encephalopathy with febrile convulsive status), ANE
Objective: Botulinum toxin A (BTX-A) is widely used in the popula- (acute necrotizing encephalopathy), and non-applicable type. In
tion of Cerebral Palsy (CP) for spasticity management.The change AEFCS group, we compared recover with MR imaging. JMP 7.0
in muscle tone of the spastic muscle is definite. Based on the Inter- was employed to analyze statistically. Results: GMFCS level at the
naional Classification of Function, Disabilities and Health (ICF), first time rehabilitation, level 5: 15, level 4: 1, level 3: 1, level 2:
we need to set the goal of intervention based on the body function, 1. At discharge, level 5: 4, level 4: 4, level 3: 0, level 2: 2 and level
activity and participation. The personal and environmental factors 1: 8. 10 patients were divided into recovery group, and 8 patients
had also to be addressed. With the consideration of all these factors, were divided into non-recovery group. For the classification system,
we selected clients to receive the intervention with BTX-A therapy AEFCS: n = 9, ANE: n = 2, non-applicable type: n = 7. GCS at admis-
and follow up an intensive physiotherapy program. The aim of the sion, severe: n = 10, moderate: n = 6, mild: n = 2. 7 patients remained
present study is to review the effect of the program in changing the speech disorder, and 11 patients were normal speech at discharge.
body function and the activity of the children with CP. Methods: There was no significant difference between recovery group and
A total of 123 children with CP matched with the selection criteria non-recovery group by GCS. Existence of speech disorder was
were selected throughout the 7 years of period. BTX-A was used significant different between two groups (p < 0.05). There was no
and injected into the gastro-soleus, hamstrings and hip adductors significant correlation between GMFCS at discharge and disease
muscles of the children based on the functional goal set with the classification system. Also there was no significant correlation
physiotherapist in-charge of the client. Five repeated measures were between GMFCS at discharge and existence of speech disorder.
performed on pre-injection, post 2 week, one-month, two-month and Disease classification system was not significant different between
three-month. Assessment of outcomes on body functions included recovery group and non-recovery group. As for functional outcome,
(1) muscle tone by Modified Asworth Scale (MAS); (2) passive AEFCS group tended to recover well in motor and speech function.
range of motion (PROM) of lower limbs. The change in activity In AEFCS group, the patients who had bilateral and diffuse lesion
and participation include the measurement on the change in Gross were poor prognosis, but those who had unilateral or frontal lobe
Motor Function Measure (GMFM); and the change in gait by Ob- lesion were favourable prognosis (p < 0.05). However, the patients
servational Gait Score. Results: Over the 123 patients, 53% of them who had brain atrophy in frontal lobe lesion type at discharge re-
were belonged to spastic diplegia and 27% were spastic hemiplegia. mained mental retardation. Conclusion: It is important to classify
75% of them received BTX-A injection to gastro-soleus and 40% of pediatric acute encephalopathy patients into disease patterns by their
them received injection to medial hamstrings. There was significant clinical symptom, and findings from MR imaging. That is because
decrease in muscle tone (p < 0.001, power > 0.99) and improvement we can predict their prognosis by their disease patterns. GMFCS
in PROM of ankle dorsiflexion (p < 0.001, power = 0.98). The change may play an important part to predict their prognosis.

0502L1 during surgery. Changes of MEPs during surgery are believed to be

Mirror neurons, empathy, and autism more sensitive in detection of postoperative motor deficits if applied
appropriately than SSEP monitoring alone. Four methods are used by
Ya-Wei Cheng related professionals to interpret MEP response during intraoperative
Institute of Neuroscience, National Yang-Ming University (Tai- monitoring: 1) the all-or-nothing criterion, 2) the amplitude criterion,
wan) 3) the threshold criterion, 4) the morphology criterion. Detailed dis-
cussion of monitoring techniques will be elaborated in presentation.
Purpose: Autism spectrum disorder (ASD) is characterized by a broad The personnel that responsible for intraoperative neurophysiologic
range of difficulties in social interaction and communication, including monitoring need to work with surgeon, anesthetist as a team and know
deficit in empathy. While a lack of empathy is one of the main symp- very well of the unique strength and limitations of above mentioned
toms of ASD, its neural mechanism remains unclear. The perception modalities in use. Under many circumstances, different monitoring
of pain in others can be used as a paradigm to investigate empathy. modalities are applied in combination during spinal surgery so as to
Materials and Methods: Twenty-two male individuals with ASD take advantage of sensitivity and specificity of each modality, and to
(mean age 16.86±4.05 years) and twenty-one typically developing reduce false negative and false positive rate as well. Application of
controls (mean age 17.11±4.43 years) were presented with animated monitoring modalities alone or in combination depends mainly on
visual stimuli depicting faces and body parts in painful and non-painful surgical sites and particular neural tissues at risk. During surgery at
situations. Participants were also required to provide pain intensity cervical and thoracic levels, SSEP and MEP are applied to monitor
and pain unpleasantness ratings of the stimuli while eye-tracking was functional integrity of spinal cord mainly, but sEMG and tEMG can be
simultaneously recorded. Results: Individuals with ASD, as compared used to safeguard particular nerve roots as well. During lumbosacral
with the controls, showed reduced hemodynamic response in the spine surgery, neural tissues at risk are nerve roots instead of spinal
anterior cingulate cortex, anterior insula, medial prefrontal cortex, cord. Under that circumstance, SSEP, sEMG and tEMG are then ap-
temporo-parietal junction, and superior frontal gyrus while perceiving plied together to safeguard the functional outcome of this particular
facial expressions of pain, as well as body parts in pain. The activation surgery. We will present several cases as well to demonstrate how to
in anterior cingulate, insula, and inferior frontal gyrus was inversely perform intraoperative monitoring during spinal surgery.
correlated with the severity in their social reciprocity. Behaviorally, References:
individuals with ASD relative to healthy controls showed lower self- 1. Gonzalez AA, Jeyanandarajan D, Hanseb C, et al. Intraoperative neu-
reported ratings on pain intensity and unpleasantness despite of paying rophysiological monitoring during spine surgery: a review. Neurosurg
similar attention on the stimuli as indicated by eye fixation perform- Focus 2009; 27: E6-1-10.
ance. Conclusion: The study demonstrates that the individuals with 2. Nuwer MR. Intraoperative monitoring of the spinal cord. Clin Neuro-
ASD have broad impairments in both affective and cognitive facets physiol 2008; 119: 247.
of pain empathy. Atypical neural underpinning empathy may play a 3. Deletis V, Sala F. Intraoperative neurophysiological monitoring of the
role in the social impairments of ASD. spinal cord during spinal cord and spine surgery: a review focus on the
corticospinal tracts. Clin Neurophysiol 2008; 119: 248-64.
4. Calancie B, Molano MR. Alarm criteria for motor-evoked potentials:
0502L2
what’s wrong with the “presence-or-absence” approach? Spine 2008;
ADVANCES OF INTRAOPERATIVE 33: 406–114.
NEUROPHYSIOLOGIC MONITORING DURING 5. Fan D, Schwartz DM, Vaccaro AR, et al. Intraoperative neurophysiologic
SPINAL CORD AND SPINAL SURGERY IN detection of iatrogenic C5 nerve root injury during laminectomy for cervi-
cal compression myelopathy. Spine 2002; 27: 2499–2502.
CHILDREN 6. Tamali T, Kubota S. History of the development of intraoperative spinal
Tsui-Fen Yang1, Chi Kuang Feng2, Kwong Kum Liao3, cord monitoring. Eur Spine J 2007; 16 (Suppl 2): S140–146.
Rai Chi Chan1
1
Department of Physical Medicine and Rehabilitation,Taipei Veter- 0502L3
ans General Hospital, 2Department of Orthopedic, Taipei Veterans
General Hospital and 3Department of Neurological Institute, Taipei SPEECH AND LANGUAGE INTERVENTION
Veterans General Hospital (Taiwan) PROGRAM FOR PRESCHOOL CHILDREN IN
TAIWAN
There are several spinal surgical procedures that have potential risk
to vulnerable structures including spinal cord, nerve roots and related Pao-Chuan Torng
vascular supply in children. Scoliosis, due to neuromuscular disease, Department of Speech and Hearing Disorders and Sciences, Na-
congenital or is idiopathic in nature, frequently requires surgical cor- tional Taipei College of Nursing (Taiwan)
rection with instrumentation if magnitude of major curves reaches
more than 45 degrees. The force of distraction and derotation applied Purpose: This study aims to establish a language enhancement pro-
to the spine during correction can possibly jeopardize the functional gram to facilitate speech and language abilities for preschool children
integrity of related neural tissues with consequence of lower limbs in Nantou County, Taiwan. Materials and Methods: One hundred and
weakness, paralysis, sensory impairment, and bowel and bladder ninety five preschool children from 10 preschools participated in a
dysfunction as well. During surgical removal of spinal tumor and language enhancement program. All children were from the remote
repair of lipomyelomeningocele, surgeons face the similar situation mountain areas, and mostly of socially and linguistically disadvantage
that as much removal of tumor mass as possible and preservation of statues, in Nantou County, Taiwan. The “Responsive to Interven-
neural function with no residual deficits are both mandatory in every tion” (RTI) approach were incorporated in the language program. In
single case. Several neurophysiologic modalities are now available to addition, two language teaching strategies, the “Focus Stimulation”
safeguard the functional integrity of central and peripheral nervous and the “Language is the Key” models were also used. Story telling
systems during many neurosurgical, orthopedic surgery and other pro- activities were emphasized and brain-based teaching, including nov-
cedures. Somatosensory evoked potentials technique (SSEP) has been elty, intensity and motion, were utilized during speech and language
used for decades and remains the mainstay of spinal cord monitoring. intervention sessions. Three major goals, 1) vocabulary learning, 2)
It provides monitoring of the dorsal column-medial lemniscus pathway, sentence usage and 3) story grammar concept establishment, were
which mediates tactile discrimination, vibration sensation, form rec- targeted. Implication: This study provides a speech and language
ognition, and joint/muscle sensation. Motor techniques, both in forms intervention program for preschool children, especially children with
of motor evoked potentials (MEP), or spontaneous EMG (sEMG) and socially and linguistically disadvantage, as well as, at the remote areas.
triggered EMG (tEMG), are a more recent development and can moni- Teaching framework and language strategies are utilized to facilitate
tor function of corticospinal pathways and peripheral motor system the speech and language abilities for these children.

0502L4FP tion and frication than rural areas. The total amount of articulation
DEVELOPMENT OF REHABILITATION AND errors is in negative correlations with age and proportion of sub-
stituted phonological patterns (p < 0.01). However, it is in positive
SERVICES OF CHILD CEREBRAL PALSY IN correlations with frequency of incorrect phonological patterns
CHINA such as stop-plosive, affrication, frication, lateral, nasal, bilabial,
Xiao-Jie Li labial-dental, alveolar, lingua-alveolar, velar, palatal, retroflexes and
dental sibilants (p < 0.01). Conclusion: Associated factors such as
Children Neural Rehabilitation Laboratory of Jiamusi University; age, gender, parents’ nationality, dialectal variation, multi-cultural
Rehabilitation Medicine College (China) living district do affect the prevalence and various error patterns of
Purpose: To summary and discuss Chinese rehabilitation services articulation disorder in Mandarin-Speaking Children of Taiwan.
for children with cerebral palsy, identify the characteristics and
shortcomings and explore the direction of development, the cor-
rect ways and methods in the future. Materials and Methods: The 0502L6FP
following were summarized and discussed as the basic situation of PRACTICE PATTERN GROUPS IN THE
the child cerebral palsy, the history of setting up the first rehabili- PEDIATRIC INPATIENT PHYSICAL THERAPY
tation center, the basic situation of the rehabilitation and services, PROGRAMS – PRELIMINARY STUDY
the situation of the professional team, the situation of the education
and training, the academic organizations and conferences and the Hsu-Fan Chang-Chien1, Wen-Yu Liu1, Wei-Pin Huang1,
questions and challenges through the questionnaires, investiga- Kuo-Kuang Yeh1, Yung-Cheng Chen1, Shiau-Chian
tions and a large number of the references. Results: The incidence Jeng1, Alice MK Wong1,2
of CP was 1.8~4 ‰ and the prevalence of CP in 1~6 years was 1
1.92‰. The types of CP is divided into spastic, dyskinetic, rigid, Memorial Hospital, Lin-Kao Branch and 2Department of Physical
ataxia, hypotonic and mixed types currently. The first rehabilitation
Therapy, Graduate Institute of Rehabilitation Sciences, Chang
center for CP children was set up in 1987. There are three ways
of the rehabilitation and services and the two types of techniques Gung University (Taiwan)
and methods applied as Modern Rehabilitation Medicine (MRM) Background and Purpose: Pediatric inpatient physical therapy pro-
and the Traditional Chinese Rehabilitation Medicine (TCRM). It grams is one of the services which domestic most hospital usually
is clearly shows the team is lacking of the professionals with the provides, but because the most hospital pattern, pediatric inpatient
background of rehabilitation medicine and the highly educated physical therapy programs often merges in adult’s treatment service.
persons. Rehabilitation therapy education for undergraduate student Pediatric prognosis and demand often have a difference with the
has been started for nearly 10 years, and it was developed quickly adult, therefore understanding existing pediatric physical therapy
in recent years. TCM education has been long history and there is in hospital service pattern is basic one step to plan adequate inter-
a large number of the traditional Chinese medical therapy (TCMT) vention of pediatric physical therapy. American Physical Therapy
education exited. There are three main organizations for children Association proposed the physical therapy disciple pattern (preferred
rehabilitation in China and the national conference was held every practice patterns) which may use for the treatment method which
two years. Conclusion: Although the rehabilitation and the services differentiates the case demand, therefore this research’s goal is to
have made great achievements, it is still a distance between China describe the physical therapy disciple pattern and function change
and developed countries and a lot of questions and challenges we during hospital period in child who accept the pediatric physical
have to face. therapy in hospital service. Materials and Methods: Retrograde
reviews the medical record and reorganizes the case who accept the
pediatric physical therapy in Chang Gung Memorial Hospital – Lin-
0502L5FP Kao Branch from March to July in 2009, the collective data record
PREVALENCE AND ASSOCIATED FACTORS FOR from the first physical therapy service after admission to last physical
FUNCTIONAL ARTICULATION DISORDERS IN therapy service before discharge in inpatient child. The analysis was
MANDARIN-SPEAKING CHILDREN OF TAIWAN reorganization by the descriptive statistics. Results: A total of 71
children (35 boys, 36 girls) with average age 18.3+37.1 months (1
Isabel Tou, Hui-Chun Juan, Pei-Chi Hsiao, Yu-Lin day to 108 months old) accept the service and the interval between
Wang, Tsen-Jieu Ji, Ching-Chi Chen physical therapy service to admission was 23.6+33.7 days (1~165
Department of Physical Medicine and Rehabilitation, Chi Mei days). In the physical therapy disciple pattern, the total 71 children
Medical Center (Taiwan) has 10 (14%) belong to the musculoskeletal system, 58 (82%) child
belong to neuromuscular system, some 3 (4%) child belong to the
Purpose: This study was designed to evaluate the prevalence and cardiovascular/pulmonary system, 2 (3%) belong to pattern A with
associated factors for functional articulation disorders in Mandarin- primary prevention/risk reduction for cardiovascular/pulmonary
Speaking Children of Taiwan. Materials and Methods: In this disorders. And 29 (41%) child belong to pattern B with impaired neu-
study the associated factors and articulation error patterns of 153 romotor development was the most large group. In child who accepts
Mandarin-speaking children with functional articulation disorder physical therapy service , the total score of Barthel Index progresses
were described. Every child was tested by picture-naming task. 84 from 11.7+25.0 to 31.1+63.3(t = –2.6, p = 0.012). Conclusion: Based
pictures are selected to sample all the vowels and consonants in on this preliminary data , the result demonstrated a high variation
Mandarin. Quantitative measures (frequency of error) as well as in child’s age and the time to receive intervention in child who ac-
qualitative measures (phonetic and phonemic inventories; pho- cept inpatient physical therapy service. And there are many type
nological processes) were presented. Besides, the parents of the pattern , among which most the child who needs to accept inpatient
children completed a questionnaire investigating associated factors pediatric physical therapy service belong to impaired neuromotor
with articulation disorders. Results: For vowels and consonants development. The most child after accepting the pediatric physical
in Mandarin, female have higher frequency of error in pronounc- therapy service has the obvious motor function improvement, but the
ing /x/ than male. Children with mothers’ nationality of Mainland variation was high and this may response the difficulty of pediatric
China have lower frequency of error in pronouncing/ts/, and higher in patient physical therapy. More analyze for the demand of different
frequency of error pattern such as stopping in their production than type was necessary in the further. Clinical meaning: This prelimi-
children with mothers’ nationality of Taiwan. Children living in nary study’s result can use for the future pediatric physical therapy
urban areas have higher frequency of error patterns such as affrica- department service and the educational training plan.

0502L7FP 0502L8FP
SYSTEMATIC REVIEW AND META-ANALYSIS GROUP-BASED PHYSICAL THERAPY EARLY
OF HORSEBACK RIDING INTERVENTION ON INTERVENTION FOR INFANTS WITH
GROSS MOTOR CHANGE IN CHILDREN WITH DEVELOPMENTAL DELAY: TWO CASE
CEREBRAL PALSY REPORTS
Hung-Chou Chen1, Sung-Hui Tseng1, Ka-Wai Tam2 Szu-Chieh Lee1, Shiau-Chian Jeng1, Wei-Pin Huang1,
1
Department of Physical Medicine and Rehabilitation, Taipei Medi- Chin-Man Wang1, Jyh-Yuh Ke1, May-Kuen Wong Alice1,
cal University Hospital, 2Department of Surgery, Taipei Medical Fang-Chen Liang1, Wen-Yu Liu1,2
University Hospital (Taiwan) 1
Memorial Hospital, Linkuo Branch and 2Department of Physical
Purpose: The purpose of this study is to assess the efficacy of
horseback riding intervention for improving gross motor function Therapy, Graduate Institute of Rehabilitation Sciences, Chang
in children with cerebral palsy (CP). Materials and Methods: Arti- Gung University (Taiwan)
cles from the following data source were sorted: PubMed, Embase, Purpose: To report the effects of “group-based physical therapy
Ovid and Cochrane databases. Studies that reported quantitative early intervention” for two infants with developmental delay.
gross motor functional change in children with CP less than 18 Materials and Methods: Empowerment parenting is the key part
years old before and after horseback riding were selected for this of early intervention. We design to let patient’s caregiver involve
review. The following measurements were selected to evaluate the the rehabilitation programs more to improve empowerment parent-
efficacy of horseback riding intervention on gross motor change in ing. Two infants with developmental delay received group-based
children with CP: 1) Gross Motor Function Measure (GMFM), 2) physical therapy in physical therapy room, 30 min per time, once
asymmetry scores, 3) gait parameters and 4) posture. Pooled data per week, total for four weeks. Physical therapeutist taught their
were analyzed using the statistical Review Manager, version 5. Sta- care givers about home exercise. Then their care givers could ap-
tistical significance was p < 0.05. Results: 13 studies were included ply rehabilitation programs in activities of daily lives at home. The
for review. From the perspective of horseback riding intervention design of home exercise programs is: the first week focus on head
on gross motor function, muscle symmetry, and postural stability, control, the second week focus on rolling, the third week focus on
most of the studies suggest efficacy of the treatment. Pre-riding head elevation and elbow support at prone position, and the fourth
and post-riding data of total GMFM-66 score, total GMFM-88 week focus on head and neck control at sitting position. After four
score, GMFM-88 Dimension E score and Asymmetry score from weeks training, we re-evaluated the infants’ via AIMS (Albert Infant
7 articles were pooled for meta-analysis. Pooled Asymmetry score Motor Scale). In addition, their parents filled out the “parents satisfy
confirmed a substantial reduction of adductor muscle asymmetrical questionnaire.” (Designed by Liu etc, 2001). Results: After four
activity after short term horseback riding. Pooled GMFM data did weeks training, the AIMS score of infant A improved from 11 to
not confirmed a substantial improvement. Conclusion: Short term 22, and infant B from 19 to 27. In parents satisfy questionnaire, the
horseback riding is effective in reducing hip adductor asymmetrical parent of infant A felt much improvement in motor and interaction.
activity. The effect of long term horseback riding on gross motor The parent of infant B thought that there was much improvement in
function in children with CP was not significant. motor area. In addition, parents knew more about children’s motor
and posture training. Conclusion: Our results showed that both
infants had improvement in AIMS score after 4 weeks training.
However, we could not confirm the effect of “group-based physical
therapy early intervention” due to lack of control group. Because
of no adverse effects and good response from parents, this therapy
deserves further study.

Poster Presentations – April 30, 2010 91
Poster presentations (April 30, 2010)
0430PP1 nodule beneath the nail with hypervascularity under color or power
EFFECT OF REHABILITATION PROGRAM ON Doppler imaging, 2) bony erosion of the underlying phalangeal
bone. Results: Six patients including five women and one man with
HOSPITALIZED PATIENTS RECEIVING TOTAL pathological diagnosis of glomus tumor were recruited. Their ages
KNEE ARTHROPLASTY: AN ANALYSIS OF ranged from 23 to 53 years. The sizes of the tumors were measured
CLINICAL PATHWAY MANAGEMENT from 3 to 9 mm in greatest diameter. Three lesions involved the
right hand, two involved the left hand, and one involved the right
Shih-Wei Huang, Ta-Sen Wei, Po-Hung Chen, Ya-Hui big toe. Four patients had focal hypervascular mass under color
Chou, Tsung-Ju Wu and power Doppler. Three patients had focal bony erosion in the
Department of Physical Medicine and Rehabilitation, Changhua underlying phalangeal bone. Only one in the six patients met both
Christian Hospital (Taiwan) criteriae. Conclusion: In assessing the glomus tumor with High-
resolution ultrasonography, either criteria of focal hypervascular
Purpose: To get efficient and effective rehabilitation program for mass or bony erosion of the phalanageal bone under the nail could
total knee arthroplasty patients to decrease medical expenditure with make the diagnosis of the tumor.
maintenance of healthcare quality, clinical pathway was implemented
in knee osteoarthritis patients received total knee arthroplasty (TKA).
Materials and Methods: A total of 148 inpatients (113 women), aged 0430PP3
69.6 ± 7.0 years old with BMI 27.1 ± 4.3, underwent unilateral TKA
and subsequent rehabilitation program. Subjects were allocated into HEALTH PERCEPTION AND TIME OFF WORK IN
three groups: group 1 received 1 to 2 times of rehabilitation program DIFFERENT SEVERITY OF HAND INJURY
(once daily for 40 min); group 2 received 3 to 4 times, and group 3 Yueh-Hsia Chen1,2, Yuan-Hung Chao3, Hsin-Tai Lin2
received 5 to 6 times during hospitalization. Parameters evaluated in- 1
Plastic and Reconstructive Surgery Rehabilitation Center, Chang
cluded demographic data, length of stay (LOS), medical expenditure,
knee pain, knee range of motion (ROM). Ambulation ability when Gung Memorial Hospital, 2Graduate Institute of Rehabilitation
patient discharged was defined as the final outcome of rehabilitation. Counseling, National Taiwan Normal University and 3Institute of
Results: The LOS of patients was 7.6 ± 1.4 days with 3.6 ± 1.3 rehabili- Biomedical Engineering, National Yang-Ming University (Taiwan)
tation days, and the mean medical expenditure was one hundred and Purpose: Forearm, wrist and hand injuries account for the most
twenty-four thousand NT dollars which was significantly correlated frequent body part of vocational injury, and result in different sever-
with LOS and rehabilitation days. The variables measured before and ity of hand functional impairment. This study aims to investigate
after rehabilitation were: 3.6 ± 0.7 vs 2.4 ± 0.6 in VAS and 35.1 ± 19.5 self-perceived health among different hand injury severity workers
degrees in ROM. In bi-variate analysis of patient’s ambulation status before return to work, and time taken to return to work after injury.
(independent or dependent), there were significant difference between Material and Methods: A total of 120 clients were enrolled. All
groups in body height (p = 0.003), BMI (p = 0.034), rehabilitation clients were medical stable and prepared to return to work. Modi-
times (p = 0.008), ROM before rehabilitation (p = 0.001), ROM after fied Hand Injury Severity Score (MHISS) was measured to quantify
rehabilitation (p < 0.001), and ROM improvement (p < 0.001) but no hand, wrist and forearm injuries. SF-36 Taiwan version was self-
difference in LOS (p = 0.076) and medical expenditure (p = 0.315). administered as health perception. Pearson correlation coefficient
When comparing ROM before rehabilitation, after rehabilitation, was used as association between the MHISS, SF-36 and time off
and improvement among 3 groups, there was only one significant work. One-way ANOVA was used to compare the group difference
difference in knee ROM improvement which was between gruop1 among the 4 categories of injuries on their health status. Results:
and group 2 (p = 0.004). By multivariate logistic regression analysis, Mean time off work was 126.5 days for mild MHISS category, 108.4
it showed that knee flexion ROM after rehabilitation (adjusted odd days for moderate injury, 159.6 days for severe injury, and 236.1
ratio (OR), 8.1; 95% confidence interval (CI), 3.6-18.2, p < 0.001) and days for major injury. A statistically significant negative correlation
different groups of rehabilitation days (group 1 vs 3, OR, 0.078, 95% was found between the MHISS and self-perceived physical function-
CI, 0.016–0.387, p = 0.002; group 2 vs 3 OR, 0.4, 95% CI, 0.104- ing (r = –0.196, p < 0.05), and positive correlation between MHISS
1.544, p = 0.183) were independent predictors of ambulation ability and time off work (r = 0.459, p < 0.01). The results also showed that
when patient discharged. Conclusion: From this clinical pathway minor severity had poorer self-perceived social functioning com-
analyses, for better knee ROM improvement and ambulation ability pared with moderate or severe injury (p < 0.05). Time to return to
with less medical cost, 3 to 4 days of rehabilitation is appropriate to work was found significantly different between the major category
meet the goal of this study. with mild or moderate severity injury (p < 0.05). Conclusion: The
severity of hand injuries had moderate correlation with time off
0430PP2 work. Mean time to return to work increased from minor to major
ULTRASONOGRAPHIC APPEARANCE OF MHISS category and had significant difference between major with
mild or moderate injuries. Minor MHISS category had poorest self
GLOMUS TUMOR perception of social functioning before plan to return to work.
Yi-Pin Chiang, Chia-Yu Hsu, Yao-Chia Chuang, Gwo-Chi
Hu, Li-Ru Chen 0430PP4
Mackay Memorial Hospital (Taiwan)
EFFECTS OF TAI CHI EXERCISE ON JOINT
Purpose: To analyse the sonographic criteria for diagnosis of dig- PROPRIOCEPTION AND STABILITY IN ACL
ital glomus tumors. Materials and Methods: Ten patients of the
RECONSTRUCTION SUBJECTS
medical centre with clinical suspicion of digital glomus tumor were
referred for the high-resolution ultrasound examination in the year Linrong Liao, Ju Wang, Haibin Liu, Dan Tang, Yata
2009. Eight out of the ten patients received surgical excision for Ouyang
the tumors. All the specimens were sent for pathological diagnosis Guangdong Provincial Work Injury Rehabilitation Hospital
and six of them were proven to be glomus tumor. The sonographic (China)
pictures of the patients were reviewed to correlate with the patho-
logic finding. Whether presence of the following pictures under Purpose: To determine whether a Tai Chi exercise was effective to im-
ultrasound was recorded: 1) a small ( < 1 cm) solid homogeneously prove the knee joint proprioception and standing balance control than

control subjects. Material and Methods: Tai Chi and control subjects 0430PP6
(n = 30 each, aged 32.4 ± SD 5.5 and 38.3 ± 6.1 years, respectively) THE EFFECT OF TRIAMCINOLONE ACETONIDE
were matched with respect to age, sex, and physical activity level.
Passive knee joint repositioning was used to test joint proprioceptive INJECTION TO THE BURN SCAR
acuity. Balance function was evaluated by functional balance testing Jianxin Li, Luxi Zhang, Baoyun Huang, Pengdong Li
and single leg standing test. Results: Tai Chi practitioners were found Guangdong Provincial Work Injury Rehabilitation Hospital
to have better knee joint proprioceptive acuity, in that they made less (China)
absolute angle error (3.2 ± 1.5 degrees) than control subjects (5.0 ± 4.8
degrees, with p = 0.018) in passive knee joint repositioning. Significant Purpose: To investigate the effect of Triamcinolone Acetonide Injec-
difference was found of the distance of functional reach of Tai Chi tion to soften the burn scar tissue. Material and Methods: Random se-
exercise group (p﹤0.05). and Significant difference was found of the lect 20 patients with small burn scar tissue which is less than 5×5 cm2
duration of one-leg standing in TC exercise group (p ﹤ 0.05). Conclu- and not be suit to pressure treatment due to the special part, such as
sion: These results demonstrate that long-term Tai Chi practitioners mandible, infront part of neck, etc. To add Triamcinolone Acetonide
had improved knee joint proprioception and can improve balance Injection 40 mg into 2% lidocaine hydrochloride, making of 1ml
function and the duration of one-leg standing. turbid liquor, and separating it to 5–6 parts to inject point to point
with non-pinhead injector into scar tissue. Results: Among all the
20 patients receiving the Triamcinolone Acetonide Injection, 5
0430PP5 cases were recovered, 9 cases were prominently effective, 3 cases
THE KINEMATICS FEATURE DURING WALKING were effective, 3 cases were invalid. Conclusion: Triamcinolone
AND OBSTACLE CROSSING FOLLOWING TOTAL Acetonide Injection can significantly soften the burn scar tissue,
and the effective percentage can reach 85%.
HIP ARTHROPLASTY
Na-Ling Lin1, Jen-Suh Chern1, Shiuann Sheng Lee2,
Simon Fuk-Tan Tang2, Susan Chang3, Hsieh Ching Chen4 0430PP7
1
Chang Gung University. 2Chang Gung Memorial Hospital, Linkuo THE EFFECT OF TAI CHI EXERCISE ON BALANCE
Branch, 3Yang Ming University and 4Chaoyang University of Tech- OF PATIENTS WITH LOWER LIMB FRACTURE
nology (Taiwan)
Hao Liu, Jun Wang, Dan Tang
Purpose: Total hip arthroplasty (THA) effectively relieve pain Guangdong Provincial Work Injury Rehabilitation Hospital
caused by hip joint arthritis and/or fracture. But it is not clear (China)
to what extend the THA restores patients’ balance function dur-
ing walking and obstacle crossing. The aim of this study was to Purpose: To investigate the influence of Tai Chi on the balance
examine the balance function during walking and obstacle cross- ability of patients with lower limb fracture. Material and Methods:
ing before and after THA by kinematic analysis. Material and 49 subjects which suffered the lower limb fracture were assigned to
Methods: 14 patients with unilateral hip arthritis and/or fracture control group (23) and Tai Chi group (26). The patients with fresh
planning to accept THA participated in the study. The balance and unstable fracture were excluded from this study. Both two group
function during walk and obstacle crossing were measured with a patiens were received the movement therapy which include muscle
three-dimension (3D) motion analysis system at one week before strengthening exercise, balance exercise, ROM exercise, and so on.
and 3 months after surgery. Three different obstacle heights (10, The Tai Chi groups patients also do the Tai Chi exercise three times in
20, and 30 cm) were used to grade the balance challenges. The one week. Functional reach in standing position and single leg stand-
subjects were instructed to perform the tasks at a self-selected ing were assessed in two groups 1 month later. Results: Compared
comfortable speed. Lower limb trajectory and end-point variables with Tai Chi group and control group, the distance of functional reach
(joint crossing angles) together with 3D joint kinematics of both the and the duration of single leg standingin in Tai Chi group patients
leading- and trailing-limbs were analyzed. Paired t-test was used are significantly more than the patients in control group (p < 0.05,
to compare the walking performance before and after surgery. The p < 0.05). Conclusion: Tai Chi exercise is an effective way to improve
obstacle height effects on the crossing angles for each periods were the balance of patients with lower limb fracture.
tested using repeated measures analysis of variance (RMANOVA)
with a polynomial test to determine the trend (linear and quadratic,
0430PP8
? = 0.05) and using leg length as a covariance. Independent t-tests
were used to compare between before and after surgery for each THE EFFECT OF WORK-HARDENING PROGRAM
obstacle height conditions Results: Step time(s), step length (%, ON RETURN-TO-WORK FOR LABORS WITH
normalizes with leg length) and walking speed (s/m) as not dif- HAND INJURY
ferent significantly between limbs and between two time periods
while walking. Hip flexion, hip adduction and knee flexion angles Min-Yuan Yu1, Hsiao-Wei Hsu1, Jer-Hao Chang2, Jui-Kun
of the affected leading limb before surgery was smaller but pelvic Chang1
tilt, pelvic obliquity, and pelvic rotation angles was larger of the 1
Rehabilitation Department, Kaohsiung Chang Gung Memorial
affected leading limb for all height than after surgery. While the Hospital and 2Occupational Therapy Department, National Cheng
unaffected leading toe was above the obstacle of 20 cm and 30 Kung University (Taiwan)
cm high, hip extension of the affected stance limbs was larger
and ankle dorsiflexion for all height was larger after surgery Purpose: Forearm, wrist and hand injuries are the most common
than before surgery period. Hip flexion and adduction for 30 cm work-related injuries and often result in different severity of hand
height obstacle of the unaffected swing limb was smaller before dysfunction. The purpose of this study is to examine the training effect
surgery than after surgery. Conclusion: The gait parameters of the of work hardening program for the functional hand capacity and return
affected and unaffected limb were not different before and after to work. Material and Methods: Fourteen labors with occupational
surgery, indicating that the surgery did not influence the balance hand injury were referred for work hardening program for return-
control during walking. The kinematic features of the affected to-work. Twelve were males and two were females. Their average
limb, including hip flexion, external rotation, knee flexion, ankle age at the time of work hardening program was 40 years old (range:
dorsiflexion, pelvis anterior-posterior tilt, pelvis lateral tilt changed 19–61 years). The average time from injury to receive work hardening
significantly 3 months after surgery comparing with before surgery, program was 26.72 weeks (range: 3.29–76.57 weeks). The average
indicating that the surgery improved the balance functions while duration in receiving training program was 7.64 weeks (range: 4-10
crossing obstacles of patients underwent THA, especially under weeks). Statistical analysis was performed by paired-t test to examine
conditions with high balance demands. the difference of hand strength (grasp power and pinch power) and

functional capacity (The Purdue Pegboard Test and The Complete Purpose: To examine the effects of continuous passive motion
Minnesota Dexterity Test [CMDT]) before and after work hardening device (CPM) on knee proprioception via: 1) evaluating the influ-
program. Results: All cases had improvement in hand strength and ence of repetitive active movement (RAM) and repetitive passive
some functional capacity. The statistically significance presented in movement (RPM) on knee proprioception, 2) comparing the effects
gasp power (p = 0.0082), pinch power (p = 0.0006) and The Purdue of RPM with different angular velocities on knee proprioception,
Pegboard Test (p = 0.0015). In addition, the statistically significance and 3) studying the influences of rapid RPM on knee proprioception
was found in bilateral hand turning (p = 0.0102) in CMDT. Conclu- in the elderly. Material and Methods: All the three experimental
sion: Because both the hand strength and functional capacity meet the studies measured active repositioning and kinesthesia as proprio-
trainees’ individual work demand after work hardening program, all ceptive indicators. The two indicators were presented with error
patients returned to full-time work. scores before and after the movement intervention. Fifteen healthy
young volunteers were recruited for the first two studies. Study 1
utilized a quasi-experimental design with repeated measure on two
0430PP9 forms of knee joint movement (RAM and RPM in 120°/s with 60
EFFECT OF TREADMILL RUNNING ON THE repetitions over a 10°–100° range) in two consecutive days with a
VERTICAL SPINAL CREEP RESPONSE: A counter-balanced manner. Study 2 was a quasi-experimental design
with repeated measure on movement velocity (0˚/s, 2˚/s, 90˚/s, and
RANDOMIZED CONTROLLED TRIAL 150˚/s with 30 repetitions over a 10°–100° range) with counter-
Jutarat Adirek-Udomr1, Rungthip Puntumethak2, balanced sequence in four successive days. So far Five elderly
Wantana Siritaratiwa2, Rosalai Kanlayanapho2 participated in study 3. Study 3 used the same RPM protocol in
study 2 to evaluate the effects of rapid RPM on the elder popula-
1
Physical Therapy Program, Graduate School, Khon Kean Univer-
tion. Results: Results from study 1 showed a statistically significant
sity and 2Back, Neck and Joint Pain Research Group, Khon Kean increase in error scores following RAM, but a decrease in error
University (Thailand) following rapid RPM intervention (p < 0.05). Results from study 2
Background: Vertical spinal creep (VSC), measured as the loss of revealed a significant decrease in error scores in both active repo-
spinal height change, is assumed to provide a measure for spinal sitioning and kinesthesia measurements with rapid RPM velocities
loading. The spinal loading commonly occurs in a range of sporting (90˚/s, and 150˚/s ) (p < 0.05); however no significant change was
activities and this could result in injuries, especially running. Although seen with static condition (0˚/s ) or with the velocity of 2˚/s. Results
the previous studies have demonstrated that the VSC response is influ- from study 3 also demonstrated a decrease in error scores after rapid
ence by several activities, such as weight training, running, walking, RPM intervention among the elderly. Conclusion: We concluded
those studies were not a randomized controlled trial study. Purpose: that rapid RPM was capable of improving knee proprioception,
The aim of the study was to determine the magnitude of VSC response specifically in active repositioning and kinesthesia measurements.
compared between treadmill running and control groups. Material Although it is unknown at this point whether subjects with pathology
and Methods: This study was a randomized controlled trial. Sixty or injury would respond similarly to the healthy subjects with the
healthy participants, aged 20 to 39 years, were randomized into the proposed intervention, the results of this study suggested rapid RPM
running group (n = 30) and control group (n = 30) by using block provided by the CPM device could serve as a potential rehabilitation
randomized allocation with block sized of 2, 4, and 6. Each subject tool for enhancing joint proprioception. Further investigations on
was asked to attend for two separate occasions. The first occasion subjects with pathology or injury, or subjects with proprioceptive
was for a familiarization session and the second occasion was for an impairment are warranted.
experimental session. For the running group, each subject was asked
to lie down in a Fowler’s position for 20 min in order to minimize
0430PP11
any effects of preloading on the spine before the experiment. After
that, each subject was measured their VSC response using a height SAFETY OF LOW-DOSE ORAL ADMINISTRATION
loss measuring stadiometer for 2 min (the first measurement) then OF DANTROLENE SODIUM ON HEPATIC
the subject was asked to perform the running process for 41 min FUNCTION
(2-min for general stretching, 3-min for warm up, 30-min for run-
ning, 3-min for cool down and 3-min for breathing recovery). After Jung Yoon Kim1,2, Sewoong Chun1,2, Moon Suk Bang1,2,
that, the subject was measured the VSC response again (the second Hyung-Ik Shin1,3, Shi-Uk Lee1,3
measurement). For the control group the process of the experimental 1
Department of Rehabilitation Medicine, Seoul National University
was similar to the running group except the subject in the control College of Medicine, 2Department of Rehabilitation Medicine, Seoul
group was asked to continue their normal daily activities, instead of National University Hospital and 3Department of Rehabilitation
running on the treadmill, the same amount of time. Results: Paired Medicine, Seoul National University Bundang Hospital (Republic
t-test demonstrated a significant increase of VSC response in a running of Korea)
group (p = 0.007) but not a control group. Unpaired t-test demonstrated
that running on treadmill provided greater VSC response than normal Purpose: To investigate the incidence of hepatobiliary dysfunction
daily activities, however no significant difference between groups was after low-dose (≤400 mg/day) oral administration of dantrolene
found (p = 0.87). Conclusion: In conclusion, the results support that sodium. Material and Methods: A retrospective survey of medical
treadmill running could affect the VSC, but not significantly greater records was performed in one secondary and two tertiary hospitals.
than normal daily activities in this study group. A total of 243 patients (144 men, 34 children, aged 46.4 ± 21.6 years)
who were administered a daily dose of 12.5400 mg of dantrolene
for ≥4 weeks from January 2005 to February 2009 were included.
0430PP10 Liver function test results recorded were serum total bilirubin, AST,
IS CONTINUOUS PASSIVE MOTION DEVICE A ALT and ALP before and at least 1 month after the initial dose of
POTENTIAL PROPRIOCEPTION ENHANCEMENT dantrolene. In cases of cessation, the reason why was investigated.
Significantly elevated LFTs were defined as ≥2 times of upper
TOOL FOR CLINICAL REHABILITATION – referent limits. Results: Administration duration of dantrolene
RESULTS FROM THREE EXPERIMENTAL was 268.0 ± 428.5 days (range 28–2,517 days) with daily dosage of
STUDIES 65.2 ± 44.7 mg (range 12.5–400 mg). At the end of investigation,
95 (18.5%) patients had been lost to follow-up, 105 had stopped
Hsin-Yi Cheng1, Yan-Ying Ju2 dantrolene for any reason. The reasons for cessation were improved
1
Graduate Institute of Early Intervention, Chang-Gung University spasticity (42.9%), no effect of medication (27.6%) and other
and 2Graduate Institute of Rehabilitation Science, Chang-Gung medical problems (5.7%). Seven patients (6.7%) showed weakness,
University (Taiwan) however, did not have elevated levels in liver function tests. One

patient stopped dantrolene owing to asymptomatic elevation of AST 21th day after treatment than that before treatment were significantly
43 days after the initial dose, although it was less than 2 times of decreased comparing with pre-treatment and the decrease was
upper referent limits. Liver function test results before and after the statistically significant, p < 0.05. Conclusion: The electromagnetic
administrations were available in 93 subjects (16 children, 77 adults) extracorporeal shock wave is a safe and effective non invasive
and these patients were aged 46.4 ± 21.6 years (8.9 ± 4.1 in children, method in the management of periarthritis of shoulder.
54.2 ± 14.3 in adults). There were significant difference between
children and adults in post-administration serum total bilirubin
(0.48 ± 0.19 vs. 0.64 ± 0.28, p = 0.028 by t-test) and pre- and post- 0430PP14
administration ALP (198.21 ± 136.17 vs. 100.41 ± 91.30, p = 0.001 TAYLOR SPATIAL FRAME IN THE LOWER LIMB
and 176.31 ± 55.67 vs. 97.24 ± 68.55, p < 0.001, respectively). All – A CASE REPORT
the other patients did not show any significant elevation in serum
bilirubin, AST, ALT and ALP. Conclusion: No significant hepatic Yasutaka Takagi1, Hiroshi Yamada1, Yoshimitsu
dysfunction was noted in 243 patients after at least 4 weeks’ admin- Kanazawa1, Wataru Nasu1, Hiroyuki Tanaka1, Shingo
istration of low dose oral dantrolene. Low dose dantrolene could be Shimozaki1, Kenji Kagechika2, Hiroyuki Tsuchiya3
used safely with clinical and laboratory monitoring. 1
Tonami General Hospital, 2Kanazawa Medical University and
3
Kanazawa University (Japan)
0430PP12 Purpose: The Taylor Spatial Frame (TSF) is a modern multiplanar
MODIFIED DYNAMIC TRACTION SPLINTS FOR external fixator that combines the ease of application and computer
INTRA-ARTICULAR FRACTURE–DISLOCATIONS accuracy in the reduction of fractures. We report a case of tibia
fracture with Taylor Spatial Frame whose treatment period was
OF INTERPHALANGEAL JOINT very short. Case Description: 47-year-old man suffered his left tibia
Jui-Kun Chang, Yee-Hwa Wu fracture when 800 kg metal frame dropped at his lower leg. His left
Rehabilitation Dept., Kaohsiung Chang Gung Memorial Hospital leg showed remarkably swelling but open wound and compartment
(Taiwan) symdrome were not recognized. X ray showed intraarticular fracture
and metaphyseal fracture. Immediately we fixed the fracture with
Purpose: Follow-up outcomes of cases using modified dynamic the TSF and fracture displacement was measured and corrected by
traction splints for the treatment of unstable intra-articular fracture- the computer program. In two weeks, complete reduction of fracture
dislocations about the interphalangeal joint. Materials and Meth- was obtained and partial weight bearing was started. Rehabilitation
ods: 1) The patients with near-digital-joint fracture or comminuted of early ROM exercise in knee and ankle joint was done. In nine
intra-articular fracture of the PIP and MCP joints were treated by weeks after the TSF fixation, we obtained bone union and the TSF
dynamic traction splinting and early active mobilization. 2) Surgery was removed. The TSF has two rings and six struts that are expand-
involved the placement of a pin for traction. The traction splints able. It can correct every deformity simultaneously: angulation,
were fabricated by occupational therapists after or before pinning. translation, rotation, elongation, and shortening. The TSH is sup-
3) The most of the traction splints we used consist of U-shape ported with software available on a web site to analyze the deformity
(modified from ring-shape loop) aluminum wire, elastic band, and parameters of interest. Conclusion: We can treat high energy trauma
tab. Distal traction was provided by 2 rubber bands connecting in minimum invasive method with the TSF. We believe the TSF is
the transosseous pin to the tab around the forefront of U-wire. 4) an excellent and useful tool for acute fracture.
Under exact alignment of digital traction, active ROM exercise of
fracture site was carried out on a timed schedule. 5) The splints and
transosseous pins were removed after 6-8 weeks. The follow-up 0430PP15
evaluation of hand function was arranged. Results: At follow-up EFFECTS OF REHABILITATION ON HEALTH
assessment, most of cases had good results in ROM and hand OUTCOMES AND MEDICAL EXPENSES AFTER
function after splints removed. X-ray films revealed good results
of fracture union, joint remodeling, and preservation of joint space. TOTAL KNEE REPLACEMENT
Conclusion: 1) Adequate alignment, traction and active ROM Hui-Wen Chen1,2, Ching-wen Chien2
exercise can be effective treatment for near-digital-joint fracture 1
Far Estern Memorial Hospital and 2National Yang Ming University
or digital intra-articular fracture. 2) The modified simple U-shape (Taiwan)
wire dynamic traction splint design is recommended.
Purpose: Taiwan has became an aging society. An increase in the
elderly population inevitably result in a rise in the expenditure of
0430PP13 medical care utilization, especially total knee replacement (TKR).
APPLICATION OF ELECTROMAGNETIC Although TKR is one Case Payment System in November 1997, a
EXTRACORPOREAL SHOCK WAVE IN THE complete study on rehabilitation on TKR has never been studied. This
study aims at comparing different time moment of receiving rehabili-
TREATMENT OF PERIARTHRITIS OF SHOULDER tation and the consequence in cost and quality of medical utilization.
Rongqiu Mao, Ying Chen, Huiliang Si, Xinping Wang Materials and Methods: A retrospective study of comparing TKR
The First Affiliated Hospital of Guangxi Medical University patients’ medical utilization, abstracted from 2003–2006 National
(China) Health Insurance Research Database (NHIRD), for one year after dis-
charge was conducted. All medical utilization in outpatient, inpatient
Purpose: To observe the clinical effect of electromagnetic extra- and emergency care were collected and aggregated by each subject’s
corporeal shock wave in the treatment of periarthritis of shoulder. de-identification number. ANOVA and t tests were major data analysis
Material and Methods: Sixty cases of periarthritis of shoulder, methods. Results: During 2004–2005, there were 21,243 patients
aged 24–65 years ,were treated with electromagnetic extracorporeal taken total knee replacement and 15,898 (75.19%) were female. They
shockwave. The electromagnetic lithotripter was used to produce were further divided into three groups: no rehabilitation after TKR,
the shock wave impact on the spur, and 9.0–16.0 Kv of the work rehabilitation within 2 weeks of discharge and rehabilitation after
voltage and 1000–1200 times of impact dose were chosen,. and 2 weeks of discharge. The outcomes were measured by outpatient,
every treatment have a break of 7 days, a total of 3 times. We will inpatient, emergency care and overall medical expenditures for one
have a evaluation and assessment of pain and the range of shoulder year. Incidence of venous thrombosis and infection with admission
and activities of daily living in pre-treatment and after treatment a were used as measures of quality. After controlling for patient demo-
week. Results: Of sixty cases , pain scores, shoulder joint activity graphic characteristics and severity of illness, the group who received
scores and ADL scores of test group in the 7th day–14th day and the rehabilitation within TKR 2 weeks spent least medical resources and

the incidence of venous thrombosis was significant differences than patients became no effective. Conclusion: In a word, keritherapy
other groups (p < 0.0001). Conclusion: Early rehabilitation is the relieve the clinical symptoms of patients with Takayasu arteritis,
most effective method in reducing expenditure and increase quality which deserve to further study and popularize.
for TKR patients. The rehabilitation should be included in minimal
requirements standard for TKR patients. The Department of Health
(DOH) should establish a clinical database which collects all follow- 0430PP19
up data for TKR patient’s quality of care. IS SYMPTOM DURATION AN OUTCOME
PREDICTOR OF CARPAL TUNNEL SYnDROME
0430PP16 TREATED WITH NIGHT SPLINTING?: AN
ULTRASONOGRAPHIC FOLLOW-UP STUDY
THE EFFECTS OF THE ANKLE FUNCTION AND
DONOR-SITE MORBIDITY AFTER MANDIBLE Lin-Yi Wang1, Ting-Yuan Liu1, Yu-Chi Huang1,2, Yiu-
RECONSTRUCTION WITH DIFFERENT FIBULA Chung Lau1,2, Wun-Schen Chen2,3, Henry L. Lew4, Ya-
FLAPS IN HEAD AND NECK CANCER Ping Pong1
1
Department of Rehabilitation, Chang Gung Memorial Hospital-
Yu-Chi Huang, Yi-Ta Tsai, Yur-Ren Kuo, Chau-Peng Kaohsiung Medical Center, 2Department of Rehabilitation, Chang
Leong Gung University College of Medicine, 3Department of Orthopedics,
Chang Gung Memorial Hospital, Kaohsiung Medical Center Chang Gung Memorial Hospital-Kaohsiung Medical Center (Tai-
(Taiwan) wan) and 4PM&R Service, VA Boston Health Care System, Harvard
Medical School (United States)
Purpose: The aim of this study is to compare the difference of the an-
kle function and the donor-site morbidity between two different fibula Purpose: To investigate whether the symptom duration of carpal
flaps in mandible reconstruction. Material and Methods: Twenty-one tunnel syndrome (CTS) is an outcome predictor of night splinting,
patients with oral cancer who received mandible reconstructions with and to evaluate the potential value of ultrasonography (US) as an
the free fibula graft were recruited in this study. The original fibular objective outcome measure of CTS treated with splinting. Material
osteocutaneous flap was done in 13 of these patients and the fibula and Methods: Thirty-five subjects diagnosed with mild to moderate
osteocutaneous flap with a sheet of the soleus muscle (chimeric flap) CTS were evaluated before and after 6-month night splinting. The
were performed in 8 of the patients. Point Evaluation System (PES) subjects were divided into two groups according to their symptom
questionnaire for the donor-site morbidity and isokinetic testing (peak duration: the short duration (SD) group, symptom duration ≤ 12
torque and total work) of the affected ankle were completed for each months, and the long duration (LD) group, symptom duration > 12
patient at least 3 months after surgery. Results: The comparison of months. Three outcome measures were: (1) symptom severity scale
the ankle peak torque and total work between the patients receiving (SSS) of CTS, (2) the onset sensory distal latency of the median
the original or chimeric fibula flap while doing ankle plantarflexion/ nerve (SDL) in nerve conduction study, and (3) the cross-sectional
dorsiflexion and inversion/eversion revealed no significant difference area of the median nerve at the pisiform level (P-CSA) on US.
(p = 0.12~0.85). No significant difference was found in the mean Within-group and between-group comparisons were made for the
points of the PES questionnaire between the original or chimeric corrected data. Results: A total of 27 subjects completed the study.
fibula flap (p = 0.45). Conclusion: The chimeric fibula flap could not Twenty-three hands were categorized in the SD group and 15 hands
contribute to more attenuation of the ankle force and endurance while in the LD group. For SSS, there were significant improvements in
performing ankle plantarflexion/dorsiflexion and inversion/eversion both groups after splinting, with a trend toward better outcomes in
than the original flap. Furthermore, the chimeric flap could provide the SD group (p = 0.079). For SDL and P-CSA, there were significant
sufficient bulk and tissue for filling dead space and decreasing the improvements after splinting only in the SD group; and significant
chances of neck wound infection and post-operative hematoma. better outcomes were observed in the SD group (p = 0.002 for SDL,
and p = 0.012 for P-CSA). Moreover, while comparing the percent-
age of change, significant better outcomes were observed in SD
0430PP17 group for all the three outcome measures (p < 0.001). In addition,
EFFECT TO CLINICAL EFFICACY OF SSS, SDL, and P-CSA correlated to each other significantly. Conclu-
sion: Mild to moderate CTS with shorter symptom duration (≤ 12
KERITHERAPY TO PATIENTS WITH TAKAYASU months) could be treated with night splinting. P-CSA on US could
ARTERITIS be an objective outcome measure of CTS treated with splinting.
Yan Wang1, Qing Tang1, Juan Li2
1
Second Affiliated Hospital of Heilongjiang University of Tradi- 0430PP20
tional Chinese Medicine and 2Chinese and Mongolian Medicine
Hospital of Inner Mongolia (China) PREVALENCE OF FRAIL FRACTURE IN WESTERN
CHIAYI COUNTY
Purpose: To investigate the function of keritherapy, to patients
with takayasu arteritis. Material and Methods: 22 patients with Chu-Hsu Lin1, Tung-Jung Huang2, Hung-Chih Hsu1,
Takayasu arteritis (T A) were treated in our rehabilitation medicine Kai-Hua Chen1, Chien-Min Chen1, Wei-Chi Hsieh1, Wen-
center in the past 5 years. They were 4 men and 18 women. The age Ming Chang1, Kuan-Ming Fang1
of development TA was between 19 to 67 years old. The courses of 1
the disease were between 1 to 5 years. The patients were treated by Memorial Hospital, Chiayi and 2Division of Chest, Department
keritherapy, 30 min per time and 1 time per day, 6 times per week of Internal Medicine, Chang Gung Memorial Hospital, Chiayi
and a course of treatment was made up of 4 weeks. The melting (Taiwan)
point of medical paraffin we selected was 56o. Putting the melting
paraffin to a special plate to cool off and made it to round and flat Purpose: Chiayi County is one of the most serious counties with ag-
which is called “wax cake”, then putting the wax cake to back and ing of the population in Taiwan and osteoporosis related frail fracture
four limbs of the patients’ body. Meanwhile, to stop intake adrenal may be a major medical problem to the residents. The present study
cortical hormone and immunosuppressor. Besides, they could be is to investigate the prevalence of frail fracture in western Chiayi
treated for relieving some symptoms, such as reducing blood pres- County and its possible association factors. Material and Methods:
sure and platelet aggregation inhibitor and so on. Results: After This is a subproject of a community-based study with investigation
4 weeks treating, a patient became clinical recovery, 11 patients on hypertension, metabolic syndrome, serum uric acid level, frail
became markedly effective, 8 patients became effective and 2 fracture and chronic obstructive lung disease of residents of western

Chiayi County including Dongshi, Budai, Lucao, Xingang, Liujiao, Medical University Hospital (Taiwan), 2School of Health Sciences,
Yizhu and Shuishang Township, Puzi and Taibao City. People older University of Southampton (United Kingdom), 3School of Chinese
than 45 years old, who attended the morning health examination Medicine, College of Chinese Medicine, China Medical University
held by local public health centers of western Chiayi County were and 4Department of Physical Therapy, China Medical University
asked whether to join such a study Totally 1,800 cases would be (Taiwan)
recruited and interviewed with a common questionnaire designed
for all subprojects. The questions asked, including fracture history Purpose: The abdominal muscles, in particular the transversus
(fracture sites and causes), past systemic disease, life style (diet and abdominis (TrA) muscle, are considered to be stabilizers of the
exercise habits) and medical care habits. The data of blood pressure, spine in the lumbo-pelvic region. The TrA can become wasted
body height, body weight, circumference of waist and hip, serum and its activity pattern relative to other muscles may be altered
examination including of Bun, creatinine, cholesterol, LDL, HDL, during functional tasks in people with low back pain. Rehabili-
triglyceride, glucose, glycohemoglobin (HbA1c), urine microalbumin tative ultrasound imaging (RUSI) offers a non-invasive way to
and creatinine were also collected. Frail fractures were defined as visualize and measure muscles. However, research has mainly
fracture due to falling down from standing, walking, running, jump- been limited to Western populations and the abdominal muscles
ing and slow bicycling. The association of frail fracture and all the have not yet been examined in Taiwanese women. A preliminary
other factors were analyzed statically using SPSS 12.0. Results: At study has shown that the reliability of RUSI in Taiwanese women
present, 1396 (male 520, female 876) cases were recruited. Eighty- was sufficiently high enough (ICC > 0.75) to apply the technique
six percent of the cases were older than 55 years old. There were in further studies. The present study aimed to characterize the
263 (18.8%) cases had fracture history and 101 (7.2%) cases were morphometry of TrA in Taiwanese women of different ages, both
assumed to have frail fractures. Wrist was the most common site at rest and during a functional activity using the active straight
of frail fracture with 44 people involved, and then in turn are spine leg raise (ASLR) test to produce abdominal muscle contraction.
(27 people), hip (21) and proximal humerus (15). The prevalence of Material and Methods: Thirty-three healthy Taiwanese women
frail fracture of each site is around 1.0%~2.3%. Four hundred and aged 18 to 65 years were studied; 16 participants were recruited
forty six people (31.9%) had been informed to have osteopenia or through the Taiwanese Student Society at the University of South-
osteoporosis by health-care personnel, most of them diagnosed by ampton UK, to establish the reliability of the RUSI technique, and
ultrasonography (69.3%), then in turn are X ray examination (21.7%), 17 participants were recruited at the China Medical University
DEXA (5.6%), X-ray revealed osteoporotic fracture (2.0%), and Hospital (CMUH) in Taiwan as part of an age-matched control
diagnosed clinically only (1.3%). Totally, only 92 people (6.6%) had group for coccydynia. In each session, the lateral abdominal wall
received Dual energy X-ray absorptiometry (DEXA) before. Female was scanned bilaterally, twice at rest and twice during a unilateral
was at higher risk of health-care personnel informed bone loss (odds ASLR. The mean values for the two scans taken in each contrac-
ratio male/female: 0.62, 95% CI: 0.52–0.74, p = 0.00*) and higher tion state were used in the analysis. In Southampton, an Aquila
rate of frail fracture (7.9% V.S 6.2%) but not statically significant (Pie Data) ultrasound scanner with a 6 MHz linear probe was
(p = 0.23). People older than 55 years old had higher risk of frail used to obtain images. In Taiwan, a GE ultrasound scanner with
fracture compared to younger group (8.2% V.S. 1.8%, p = 0.01*). a 7L linear probe (2.5–7 MHz) was used. All images were stored
Body weight and body mass index seemed not affect the rate of and muscle thickness was measured off-line using Image J soft-
frail fracture. People who had been health-care personnel informed ware. Results: Due to the age differences between the two study
bone loss had higher risk of frail fracture (Odds ratio: not informed cohorts in the UK and Taiwan, the muscle thicknesses results are
bone loss/informed bone loss: 0.52, 95% CI: 0.36–0.76, p = 0.001*). presented for the two groups separately. In the younger group
Residents of Yizhu and Lucao townships had higher rate (11.9%, (mean age = 25.9 ± SD 3.3 years), TrA thickness was smaller than
11.6%, respectively) of frail fracture than other areas (p = 0.046*). in the older group (mean age = 43.6 ± SD 12.8), both at rest and
Coffee, alcohol consumption, smoking, vegetarianism, eating out, during the ASLR (right TrA thickness at rest, mean ± 1 standard
history of diabetes, hypertension, dyslipidemia, liver disease and renal deviation; 2.1 ± 0.7 mm and 4.8 ± 2 mm, respectively; during
disease had not thing to do with frail fracture although people who ASLR 2.1 ± 0.7 mm young group and 6.1 ± 3.3 mm older group).
drank tea every day seemed to have lower rate of frail fracture but The younger group did not appear to recruit their TrA during the
not statically significant (odds ratio no tea/tea every day: 1.74, 95% ASLR test. The thickness of TrA was similar on both sides at rest
CI: 0.97–3.14, p = 0.057). Blurred vision is an important risk factor and during contraction in both groups. Conclusion: This study
to predict frail fracture in female older than 55 years old (odds ratio provides normal reference values for TrA muscle thickness in
good vision/blurred vision: 0.32, 95% CI: 0.17–0.61, p = 0.001*). healthy Taiwanese women of different ages as a basis for studying
Laboratory examination including serum Bun, creatinine, cholesterol, pathological groups. The findings in the younger women show
LDL, HDL, triglyceride, glucose, glycohemoglobin(HbA1c), urine smaller values than in Western women of similar ages. The larger
microalbumin and creatinine had nothing to do with frail fracture, values in the older Taiwanese women may reflect their higher
however, in male older than 55 years-old group, people who had body weight. The present findings confirm the symmetry of TrA
lower albumin creatinine ratio seemed to have higher frail fracture thickness between the two sides of the body found in Western
risk (26.2% V.S 12.3%, p = 0.02*). Occurrence of fracture might populations. The lack of change in TrA thickness during the
change medical care behavior since people with fracture history had ASLR in young women warrants further study of motor control
higher rate of DEXA examination (24.2% vs 5.3%, p = 0.00*) and mechanisms in this age group.
calcium tablet intake (21.3% vs 13.6%, p = 0.002*). Conclusion: The
estimated frail fracture prevalence in western Chiayi county is about
7.2% of which wrist fractures are the most common site involved. 0430PP22
Health-care personnel informed bone loss and blurred vision were COMBINED HOME EXERCISE IS MORE
important risk factor to predict frail fracture. EFFECTIVE THAN RANGE-OF- MOTION HOME
EXERCISE IN PATIENTS WITH ANKYLOSING
0430PP21 SPONDYLITIS ─ A RANDOMIZED CONTROLLED
REHABILITATIVE ULTRASOUND IMAGING TRIAL
OF TRANSVERSAL ABDOMINIS MUSCLES IN Lin-Fen Hsieh1,3, Ching-Shiang Tseng1, Hsin-Yi Lee2,
TAIWANESE WOMEN: EFFECTS OF AGE AND Chih-Cheng Chuang3,4, Wen-Shan Chen1, Ching-Chou
DIFFERENT CONTRACTION STATES Cheng1
1
San-Pei Chen1,2, Li-Wei Chou1,3,4, Maria Stokes2 Wu Ho-Su Memorial Hospital, 2Institute of Occupational Medicine
Department of Physical Medicine and Rehabilitation, China
1
and Industrial Hygiene, College of Public Health, National Taiwan

University, 3School of Medicine, Fu Jen Catholic University and Purpose: To present a case of shoulder calcific tendinitis with
4
Department of Allergy, Immunology and Rheumatology, Shin Kong resorption of the calcific spot after ultrasound-guided acupuncture.
Wu Ho-Su Memorial Hospital (Taiwan) Material and Methods: A 40-year-old female patient suffered
from shoulder pain for several months. Musculoskeletal ultrasound
Purpose: To compare the effectiveness of combined home exercise depicted a one centimeter calcific deposit in her supraspinatus
(COMB) and range-of- motion home exercise (ROM) in patients tendon. She received physical therapy with ultrasound diathermy
with ankylosing spondylitis (AS). Material and Methods: This is a for two months but the calcific spot remained. Acupuncture with a
single-blind randomized controlled trial. Nineteen subjects with AS two-inches-long needle was arranged under ultrasound guidance.
completed either COMB (9) or ROM (10) program. The COMB pro- In-and-out and twist technique were applied for needling to the
gram included range-of-motion, strengthening, and aerobic exercise calcific spot. During the acupuncture procedure, patient felt nausea
while the ROM program consisted daily range-of-motion exercise and dizzy about 2 min after beginning of needling. The needle was
only. After exercise instruction, subjects in each group performed immediately removed and the patient was carefully put in supine
home exercise for 3 months. Assessment included exercise tolerance position. The symptom became better in about 5 min and the patient
test, pulmonary function test, spinal mobility measurement, chest no longer felt discomfort. The vital sign was stable before she could
expansion, Bath Ankylosing Spondylitis Functional Index (BASFI) stand and walk. Results: The patients returned to the clinic for follow
and other functional ability tests, and laboratory tests. Results: After up three months after acupuncture. The calcific deposit completely
exercise, the COMB group showed significant improvement in peak disappeared under X-ray and ultrasound. Conclusion: Ultrasound-
oxygen uptake (12.3%, p = 0.008) and BASFI (p = 0.028), and the guided acupuncture may be one of the method for treating calcific
changed score between pre- and post-exercise data was significantly tendinitis of the shoulder. The mechanism for enhancement of
greater in the COMB group regarding peak oxygen uptake and BASFI. resorption of calcific lesion was not yet fully understood.
Significant improvement in finger-to-floor distance after 3-month
exercise was found only in the COMB group (p = 0.033). There was
no significant difference with regard to most of the spinal mobility 0430PP25
tests, pulmonary function tests, and laboratory tests, either within- FIBULAR OSTEOCHONDROMA ASSOCIATED
group comparison or between-group comparison. Conclusion: In
Chinese patients with AS, a 3-month combined home exercise pro- WITH COMPRESSION NEUROPATHY OF
gram provides beneficial effects in aerobic capacity and BASFI, and COMMON PERONEAL NERVE: A CASE REPORT
combined home exercise was more effective than range-of-motion Shu-Hua Lin1, Eou-Ting Hsieh1, Chein-Wei Chang2, Jen-
exercise alone. It is also suggested that range-of-motion or stretching Li Pan1, Chien-Huang Kuo1, Tai-Yi Wu1
exercise should be started in the early course of the disease. 1
Department of Physical Medicine and Rehabilitation, Long-Tong
Pohai Hospital and 2Department of Physical Medicine and Reha-
0430PP23 bilitation, National Taiwan University Hospital (Taiwan)
CLINICAL AND SONOGRAPHIC APPEARANCE Purpose: To report a rare case of fibular osteocondroma associated
IN PATIENTS WITH INTRAMUSCULAR with a compression neuropathy of common peroneal nerve. Material
and Methods: A 13 year-old boy was noted to have a progressive left
HEMANGIOMA lower extremity weakness and drop foot for two weeks. A series of
Shiau-Fu Hsieh, Yu-Chung Hong, Yao-Chia Chuang, examinations including electrophysiological study, roentgenography
Gwo-Chi Hu, Li-Ru Chen, Yi-Pin Chiang and magnetic resonance (MR) image were performed, and the diag-
Mackay Memorial Hospital (Taiwan) nosis was made with a osteochondroma at fibular head associated
with a compression neuropathy of common peroneal nerve. Surgical
Purpose: To determined the clinical and sonographic appearance in decompression was done then after, and the histopathology of the
patients with intramuscular hemangioma. Material and Methods: removed specimen approved the diagnosis. Results: Electrodiag-
From Nov. 2004 to Oct. 2009, patients with hemangioma as di- nostic findings demonstrated a common peroneal neuropathy with a
agnosis or one of the choices of diagnosis in our musculoskeletal major involvement of deep peroneal nerve branch. A bony exostosis
ultrasound examination were reviewed. There were twenty-eight appeared at proximal fibula in roentgenography. Continuity of the
patients met the criteria. In which, twelve patients were confirmed cortical and medullary bone in a bone tumor with the parent bone
to have intramuscular hemangioma by either MRI or tissue proof. was found in MR image. Osteochondroma was confirmed by the
Results: The clinical setting and sonographic appearance were histological examination of proximal fibula. After decompression
analyzed. There were 10 female and 2 male patients with average surgery of the tumor and an intensive course of comprehensive
age of 24.1 ± 14.2 years (ranged from 9 to 58 years ). Nine of the rehabilitation, the patient’s neurological symptoms subsided and his
lesions located in the lower extremities while three of them were in neurological functions improved leading to a good prognosis. Con-
upper extremities. Nine of the patients experienced palpable mass in clusion: In comparison with adult, children have higher incidence
their limbs but limb pain was the only complaint of the other three of osteochondroma. Peroneal nerve mononeuropathy occurred in
patients. Well-margined localized mass with rich vascularity were children should be considered as an associated bone tumor in the
noted in all the 12 patients. All the masses were easily compressed diagnosis. Surgical decompression is always required and expected
and echogenic phlebolithes were noted in only two patients. The to have a good outcome.
size, shape, echogenecity and vascularity were then compared with
MRI findings. Conclusion: Intramasuclar hemangioma could be
diagnosed under ultrasonography and the sonographic findings had 0430PP26
good correlation with MRI studies. SUPERFICIAL RADIAL NERVE AND CEPHALIC
VEIN: AN ANATOMIC STUDY BY CADAVER
DISSECTION
0430PP24
Soon Hee Yoo, Joon Sung Kim, Myung Eun Chung, Ju
ULTRASOUND-GUIDED ACUPUNCTURE Sun Oh
FOR TREATMENT OF SHOULDER CALCIFIC Department of Rehabilitation Medicine, College of Medicine, The
TENDINITIS: A CASE REPORT Catholic University of Korea (Republic of Korea)
Yi-Pin Chiang, Yao-Chia Chuang, Gwo-Chi Hu, Li-Ru Purpose: To acquire normal anatomy of superficial radial nerve and
Chen cephalic vein and identify the optimal site for venipuncture of cephalic
Mackay Memorial Hospital (Taiwan) vein at wrist to decrease the damage of superficial radial nerve. Mate-

rial and Methods: We examined the anatomic relationships of the discuss the impact of flatfoot on teenagers. Material and Methods:
superficial radial nerve, cephalic vein, styloid process of radius in 6 Five hundred and forty-four 12 to 14-year-old teenagers in Taoyuan
hands from 4 cadavers. The distances were measured from the styloid were enrolled in this study. Footprint Analysis methods was used
process of radius to the point at which the superficial radial nerve to diagnose flatfoot (plantar arch index more than 1.15 OR Denis
pierced fascia, and to the crossing point of superficial radial nerve with grade equal or more than grade1 OR Footprint index less than1cm
cephalic vein. Results: The mean distance from the styloid process of OR Footprint angle less than 30 degree). Clinical symptoms of
radius to the point at which the superficial radial nerve pierced fascia foot and endurance were collected by questionnaires. Results: The
was 75.5 ± 11.1 (60~88) mm and from the styloid process of radius to prevalence of flatfoot in Taoyuan teenagers was 11.6% to 61.2%.
the crossing point of superficial radial nerve with cephalic vein was This variation is attributed to the different footprint analysis meth-
22.8 ± 5.9 (13~30) mm. Conclusion: The most optimal injection site ods used. While using the diagnostic criteria of plantar arch index
for venipuncture of cephalic vein at wrist was located 30 mm more (PAI) or Denis grade or Footprint index (FI), the flatfoot teenagers
proximal area from styloid process. experience greater pain when standing and walking and less en-
durance when standing and running. However, if using Footprint
angle (FPA) less than 30 degree as diagnostic criteria, there is no
0430PP27 significant difference between flatfoot patients and the control group
MAGNETO THERAPY EFFECT ON ANKLE STRAIN unless the measurement standard is changed to Footprint angle less
than 20 degree. Conclusion: Teenagers in Taoyuan with flatfoot
Yenny Lindoyo diagnosed by footprint analysis mediated PAI or Denis grade or
Setia Medika Medical Rehabilitation Clinic (Indonesia) FI showed more clinical symptoms than FPA, and should consider
further evaluation and intervention. Flatfoot diagnosed by FPA
Introduction: Magneto therapy is a therapy that utilizes the static (either less than 30 degree or less than 20 degree) may need further
magnetic fields to assist in rehabilitating body metabolism. The most evaluation and research.
important phenomenon that occurs in biological tissue exposed to a
pulsed magnetic field is the onset of induced micro currents. Protein
macromolecules, called biopolymers have piezoelectric properties 0430PP29
and behave as transducers, so that magnetic field applied will cause USE OF BAYESIAN MODELING TO ESTIMATE
a variation in their electric states. Trauma can cause a depolarisation
of these protein structures and reduce the transmembranous electric THE ACCURACY OF ULTRASONOGRAPHY
potential of the cell. The micro currents induced by the magnetic AND MAGNETIC RESONANCE IMAGING IN
therapy repolarise the biopolymers, re-establish the correct electrical DIAGNOSING MENISCAL TEAR
potential, accelerate ionic movement and resume enzymatic kinetics,
re-integrate tissue functions. The utilized static magnetic fields have Ya-Ning Chiu1,2, Tyng-Guey Wang1, Kai-Min Chang1,
a low frequency from 0 to 100 Hz with intensity range between 5 Shin-Liang Pan1
and 100 Gauss. A strain is an injury to the muscle–tendon unit, it 1
may be caused by acute overload or repeated submaximally activity. Taiwan University Hospital and 2North Coast Jin-Shan Hospital
Acute injuries is classified from first to third degree. First degree is a (Taiwan)
microscopic injury to ligament or muscle–tendon. Second degree is a
macroscopic injury with fiber continuity (partial tear). Third degree is Purpose: This study aimed to determine the diagnostic accuracy of
a severe injury with fiber discontinuity (full tear). The main interest both ultrasonography (US) and magnetic resonance imaging (MRI)
of this case is to test the effect of magnetotherapy on ankle strain on for meniscal tear of knee when the information of gold standard
elderly people (63 years old). Case: Male, 63 years old, with chief was incomplete. Material and Methods: A total of 140 knees
complaint pain on his left ankle. He felt suddenly pain on his ankle underwent both US and MRI for the diagnosis of meniscal tear
when he played basket ball. He is unable to walk on his toes. The were reviewed. Twenty-one of these 140 knees underwent surgical
ankle became swollen and redness. He felt that his left foot became exploration regarded as the gold standard for diagnosing meniscal
weak. Physical examination: Antalgic gait, at regio left foot look tear. Bayesian estimation was used to determine the sensitivity,
oedem, color, dolor and functiolaesa on left ankle, pain on movement specificity and likelihood ratio for US and MRI simultaneously
in all direction, limited range of motion, positive Thompson’s test. given the incomplete information of gold standard. Results: For
Supporting examination: Ultra Sono Graphy: Left ankle strain grade the US, the estimated sensitivity was 0.61 (95% confidence inter-
II (partial tear) Rehabilitation medicine programs are magneto therapy val (CI): 0.48 to 0.74), the specificity was 0.87 (95% CI: 0.81 to
with the power 80 Gauss, frequency 50 Hz, duration 20 min, 3 times 0.92), and the likelihood ratio for a positive test was 4.9. For the
a week. At this stage, patient was using Ankle Foot Orthose. Results: MRI, the estimated sensitivity was 0.88 (95% CI: 0.79 to 0.95), the
At the third week of treatment, USG result was minimal tear. After 6 specificity was 0.71 (95% CI: 0.62 to 0.80), and the likelihood ratio
weeks treatment, USG result was no more tear, the new formation of for a positive test was 3.1. Conclusion: Although the sensitivity
fibrin tissue was shown. The therapy was continued 2 times a week, of US was lower than MRI, the specificity of US was significantly
started with gentle stretching, and then followed by gradual strength- higher than MRI. This contributes to a high likelihood ratio for US
ening exercises. On the third month, patient was able to run without in comparison with MRI.
pain. On the fourth month, patient played basketball again without
any problems. Conclusion: Low frequency magneto therapy works 0430PP30
on strain grade II case. It accelerates the healing process.
ALTERATION OF POSITIONAL CONTROL IN
ORTHOSTATIC ERECT IN PATIENTS WITH
0430PP28 RETICENT TYPE OF SPINAL DYSRAPHISM, TYPE
PREVALENCE OF FLATFOOT AND ITS CLINICAL 1 AND TYPE 2
CORRELATION IN TAOYUAN TEENAGERS Shin-Tsu Chang, Shang-Lin Chiang, Tsung-Ying Li,
Huan-Jui Yeh, Huei-Yu Lo, Yau-Wai Wai, Wai-Keung Heng-Yi Chu, Liang-Cheng Chen, Ming-Fu Hsieh,
Lee Cheng-Chiang Chang, Min-Hsin Lai
Taoyuan General Hospital (Taiwan) Department of Rehabilitation, Tri-Service General Hospital, NDMC
(Taiwan)
Purpose: To establish a database of prevalence of flatfoot among
Taiwanese local teenagers and make a comparison between different Purpose: To examine if a posture for upright control is wors-
measurement methods, relevance of clinical foot symptoms and to ened in subjects with reticent type of spinal dysraphism (SD) by

comparing the testing during orthostatic erect and vision input. SEQ masculine rate decreased from 31.94% to 5.20% (the score
Material and Methods: A total of 80 SD patients, 38 in type 1 was decreased from 7.15 ± 4.72 to 2.91 ± 3.21, p < 0.01), while no
SD and 42 in type 2 SD, was enrolled in the experimental group, special psychological intervention was included in the therapy.
where a group of healthy subjects as a control. We performed 10 Conclusion: While rehabilitation help improved motor function
tests while orthostatic erect on a platform with 0 degree level and and index of life quality amongearthquake victims, their mental
tilting surface (10 and 20 degrees) in the foot dorsiflexion and health was also greatly promoted.
plantarflexion, together with eyes open and closed in each. We
recorded a series of sway parameters (sway area, intensity, mean,
and velocity) via a force platform to stand for the orthostatic erect. 0430PP32
Results: SD subjects within the type 1 and type 2 groups had higher REHABILITATION OF TETANUS: A CASE REPORT
values of sway area while compared with the control. Taken from
comparison within the group differences at baseline, there was a Kang-Ming Huang1, Jo-Tong Chen1,2, Shu-Min Chen1,2
higher sway area at 10 degrees at all three groups, and the differ- 1
Department of Physical Medicine and Rehabilitation, NCKU
ences of sway intensity were significantly decreased at 10- and Hospital and 2Department of Physical Medicine and Rehabilitation,
20-degrees, respectively. There was non-significant difference in College of Medicine, NCKU (Taiwan)
sway mean at 10 degrees but significant difference sway mean at
20 degrees. With respect to sway velocity, the differences of type 2 Despite routine immunization, tetanus is still occasionally seen
SBO group were significantly decreased at different tilting degrees in Taiwan. Tetanus is a nervous system disorder characterized by
when compared with type 1 SBO and control groups, whereas the trismus, dysphagia, opisthotonus and severe generalized muscle
difference in type 1 SBO was only significant at 0º when compared spasm. It’s caused by the neurotoxin which is produced by Clostrid-
with control. Group differences (type 1 SBO vs. control, type 2 ium tetani. The treatment consists of immediate active and passive
SBO vs. control) showed a significant decrease in sway velocity immunization, parenteral antibiotics, and early tracheostomy with
when comparing at 10º than at 0º and at 20º than at 0º. In all type mechanical ventilation in the intensive care unit. After the acute
with SBO, the sway intensity/velocity values obtained with open episode, long-term neurological and musculoskeletal sequelae are
eyes and with plantarflexion had lower values, when compared with common. Individuals may encountered deconditioning, general-
values obtained with closed eyes and with dorsiflexion. Conclu- ized muscle wasting, decreased respiratory capability, multiple
sion: Our study suggests that reticent type of spinal dysraphism, joint contractures, decubitus ulcers, dysphagia and even psychotic
irrespective of type 1 or type 2, results in impairment of postural syndrome. Although, this kind of disease could gradually and totally
dysfunction information for controlling orthostatic erect in resting recovered in a neurological respect, early physiatrist intervention,
as well as in challenging postures. not only prevents complications mentioned above, but also would
help the individual more fully and safely restored previous capacity
of daily living. This report presented a description and discussion of
0430PP31 the rehabilitation program for a 76-year-old female tetanus patient,
and a review of articles as a reference resources for the clinicians.
RELATIONSHIP BETWEEN FUNCTIONAL
IMPAIRMENT OF EARTHQUAKE VICTIMS AND
THEIR REHABILITATION EFFECTS 0430PP33
Xiang Wang1, Quoxin Wang1, Dianhuai Meng1, Qiumin ELBOW FLEXION CONTRACTURE IN A PATIENT
Zhou1, Tong Wang1, Min Xiao2, Zhide Jiang2, Xun Yu2 WITH MUSCULAR TUMOR-SUCCESSFUL
1
Dept. of Rehabilitation Medicine, the First Hospital of Nanjing TREATMENT WITH BOTULINUM TOXIN AND
Medical University and 2Jiangsu Disabled Persons Federation SERIAL CASTING
(China)
Yen-Jung Chen1, Jeng-Yi Shieh1, Wen-Ji Tsai2, Ting-
Purpose: We analyze the rehabilitation effects of 1196 filed Ming Wang2
stroke victims transferred to Jiangsu province to provide effective 1
Department of Physical Medicine & Rehabilitation, National Tai-
rehabilitation service, allocate medical resources in an reason- wan University Hospital and 2Department of Orthopedic Surgery,
able way,and decrease the disability level of wounded. Mate- National Taiwan University Hospital (Taiwan)
rial and Methods: The information of 1299 earthquake victims
transferred to nine cities in Jiangsu province was recorded. Motor Purpose: To treat elbow flexion contracture in a patient with mus-
function,social adaptive capacity,index of life quality and ADLs cular tumor with Botulinum Toxin and serial casting. Material and
were analyzed among those victims to analyze their function im- Methods: A girl, at age 2, was found to have a mass at her right
pairment as well as the effects of rehabilitation therapy. Results: arm. MRI showed a 4x2.5x1.5 cm mass in the brachialis muscle.
71% of all earthquake victims suffered from Fracture , which is A biopsy was performed and pathology revealed myofibromatosis.
the most common type of injury, and it is followed by soft tissue No further surgery was taken afterwards. With growth, progressive
injury, peripheral nerve injury and amputation for the number loss of extension range at the elbow joint developed. Repeated MRI
of victims. The impacts of earthquake on victims, function were at age 8 suspected local recurrence near the distal humeral shaft
motor function: 55%, social adaptive capacity: 48%, index of and adhesion of brachialis tendon. At her age of 12, the physical
life quality: 42%, ADLs: 33% (from strong to weak). 31.94% of examination showed that she could do full flexion of the elbow but
those wounded showed psychological problems. Among the items the extension range was limited to 90 degrees (–90 to full exten-
assessed, motor function was significantly improvede after reha- sion). The supination and pronation ranges were within normal
bilitation training with 31% increasement (the score was increased limits. Forceful stretching of the elbow induced discomfort of the
to 13.7 ± 4.6 from 8.1 ± 6.23), while social adaptive capacity, arm muscles. There was no sensory nor motor deficit. With the
index of life quality and ADLs increased by 23% (the score was intent to increase extension range, we decided to use serial casting
improved from 4.74 ± 2.31 to 6.77 ± 2.2, p < 0.01), 21% (the score and combine Botulinum Toxin for relaxation of the elbow flexors,
was improved from 8.11 ± 3.47 to 10.56 ± 2.5, p < 0.01), and 21% which might serve as an opponent during casting. With sonography
(the score was improved from 5.83 ± 2.61 to 7.89 ± 2.8, p < 0.01), as guidance, 200 U Botulinum Toxin type A (BOTOX) was injection
respectively. The ability of standing, transferring, walking up and into the normal elbow flexor muscles. Long arm cast was applied and
down stairs, wash, toilet, household chores, participation in social changed every two weeks. Results: There was no adverse reaction to
life or collective activities showed the most significant improvent Botulinum toxin. Extension range of the elbow increased gradually.
among the function advancement in earthquake victims. With the Three months later, the elbow extension range became 165 degrees
improvement of social adaptive capacity, index of life quality and (–15 to full extension). Conclusion: Botulinum toxin as an adjunct
ADLs, the psychological problems were also solved partly with the to serial casting was effective in treating elbow contracture.

0430PP34 Purpose: To clarify the current clinical and radiological charac-

COMPLETE TEAR OF THE COMMON FLEXOR teristics of joint involvement in young haemophilic patients in
Taiwan. Material and Methods: From September 2006 to August
TENDON FOLLOWING YOGA AND LOCAL 2009, a total of 40 young patients followed at outpatient department
CORTICOSTEROID INJECTION: A CASE REPORT of haemophilic comprehensive care center were studied. Factors
Ke-Vin Chang1, Tian-Shin Yeh2, Tyng-Guey Wang2 examined including age, haemophilia type, disease severity, body
mass index (BMI), receiving prophylactic treatment and inhibitor
1
Department of Physical Medicine & Rehabilitation, National status. Bilateral shoulder, elbow, hip, knee and ankle joints were
Taiwan University Hospital Yun-Lin Branch and 2Department of evaluated as range of motion (ROM). Radiological score as the
Physical Medicine and Rehabilitation, National Taiwan University Arnolde–Hilgartner scale and the Pettersson Score of each joint were
Hospital (Taiwan) obtained. Results: All of the forty patients are boys with a mean
Severe tear of the tendons around the elbow is rare even in athletes, age of fifteen. Thirty-five of them are the patients of haemophilia A
especially referring to the common flexor tendon of wrist. Few and five are the haemophilia B patients. There are five patients with
literatures have mentioned the common flexor tendon tear and most mild haemophilia, seven patients with moderate haemophilia and
of them focus on the image studies only. We reported a 52-year-old twenty-eight patients with severe haemophilia, three of the severe
housewife who complained of bilateral medial elbow pain after force- haemophilia patients presenting with inhibitors. Mean BMI is 19.18
fully extending her wrist and elbow while practicing Yoga. Repetitive (kilogram/meter square). Four hundred joints were measured and the
corticosteroid injections were applied over her right medial elbow at abnormal Arnolde–Hilgartner scale presented in forty-three joints,
the orthopedic clinic. Her pain was relieved temporarily but recurred ROM limitation in fifty-eight joints and abnormal Pettersson Score
later. She visited our rehabilitation outpatient department and the in fifty-four joints. Ankle joints are most frequently involved (n = 22,
physical examination revealed weakness when performing right 51.16% in abnormal Arnolde–Hilgartner scale joints; n = 30, 51.72%
wrist flexion and forearm pronation. Sonography was thus arranged in ROM restricted joints; n = 25, 46.30% in abnormal Pettersson
which revealed a hypoechoic area and soft tissue indentation within Score joints.) The second frequently involved joint is the elbow
the right common flexor tendon. The following magnetic resonance joint and the third is the knee joint. All of the patients younger then
imaging demonstrated a focal area with hyperintense signal in Fast 12-year-old presented as normal radiology score and joints ROM. No
STIR images around the medial epicondyle. Both image studies abnormal data was obtained in those with mild haemophilia, as logi-
favored the complete tear of the common flexor tendon and the surgically extrapolate, more abnormal joints (n = 33, 11.79% in abnormal
cal exploration confirmed the tentative diagnosis. We speculated the Arnolde–Hilgartner scale joints; n = 47, 16.79% in ROM restricted
eccentric loading and valgus stress during Yoga plus the weakened joints; n = 44, 15.71% in abnormal Pettersson Score joints) in severe
tendon tissues after repetitive corticosteroid injections resulted in the haemophilic patients than in moderate haemophilic patients. The
infrequent presentation of medial elbow injury. influence of BMI in haemophilic arthropathy was not significant,
which may relate to no obesity patient was included. Conclusion:
Our report demonstrates the current clinical and radiological data
0430PP35 of haemophilic arthropathy in young male. Recent investigation
revealed the most frequently involved joint in bleeding site chang-
THE EFFECTS OF PROPRIOCEPTION ing from the knee joint to the ankle joint, which was compatible
STRENGTHENING TRAINING ON KNEE to our result. The majority factor including disease severity and
OSTEOARTHRITIS younger age. There is a clear cut in age between present or absent
haemophilic arthropathy, which is well-matched to the beginning
Zunke Gong, Hongwei Zhai, Wei Chen, Jie Sun, Haiyan of our national health insurance.
Wang
Central Hospital (China)
0430PP37
Purpose: To observe the therapeutic effect of proprioception
strengthening training on knee osteoarthritis. Material and Methods: INCREASED UPTAKE OF SACROILIAC JOINT
Based on clinical diagnostic criteria, 80 patients with knee osteoar- RESULTED FROM MECHANICAL ORIGIN BY
thritis were randomly divided into a treatment group (41 cases) and HEMIVERTEBRA IN LUMBAR SPINE
a control group (39 cases). The patients in the treatment group were
administered proprioception strengthening training, muscle strength- Shao-Chi Lu1,2, Yung-Tsan Wu1, Min-Hsin Lai1, Wei-I
ening exercise and treatment with sodium hyaluronate injection of Su1, Shin-Tsu Chang1, Wen-Chi Hou2
knee joint, while the patients in the control group were administered 1
Department of Physical Medicine and Rehabilitation, Tri-Service
muscle strengthening exercise and treatment with sodium hyaluro- General Hospital and 2Department of Physical Medicine and Reha-
nate injection of knee joint. Before and after the treatment, knee bilitation, Hualien Armed Forces General Hospital (Taiwan)
function were assessed with Lysholm Assessment Standard on knee
function. Results: The patients in both groups scored significantly Purpose: Sacroiliac joint disorder had many different etiologies.
higher on Lysholm on knee function. The patients in the treatment No previous lecture revealed the relationship between sacroiliac
groupare better than the patients in the control group. Conclusion: disorder and hemivertebra. We report a young adult with hemiver-
Proprioception strengthening training can improve the knee function tebra in the lumbar spine, which resulted in increased uptake in
and it is a valid method to treat knee osteoarthritis. the joint. Material and Methods: A 24-year-old young male who
did not recall any specific trauma and systemic disease presented
with progressive low back pain about half a year ago prior to visit
0430PP36 us. The patient was well before and performed normal daily life.
CHANGING PATTERN IN HAEMOPHILIC He denied any birth injury or systemic disease. Medication such
as non-steroid anti-inflammatory drug was prescribed but the
ARTHROPATHY: REPORTING CLINICAL AND symptoms bothered him off and on, thus he came to our outpatient
RADIOLOGICAL DATA FROM A SINGLE CENTER clinic for help. On examination, his vital sign was stable and mental
IN TAIWAN status was normal. Grossly there were no abnormalities could be
found on the waist skin. There were tenderness at posterior superior
Shao-Chi Lu1,2, Tsung-Ying Li1, Yung-Tsan Wu1, Min- iliac spine and muscle spasm at lower paraspinal musculatures. The
Hsin Lai1, Shin-Tsu Chang1, Wen-Chi Hou2 patient showed limited range of motion on flexion and extension
1
Department of Physical Medicine and Rehabilitation, Tri-Service due to pain. There were no radiating pain to leg while performing
General Hospital and 2Department of Physical Medicine and Reha- straight leg raising test, but positive findings in Mennell’s test
bilitation, Hualien Armed Forces General Hospital (Taiwan) and Patrick’s test (FABER test). Thigh thrust test and the sacral

thrust test showed positive as well. Results: The plain film showed patellar tendinopathy with foreign body incarceration and patellar
hemivertebra of the fifth lumbar spine and butterfly anomaly in tendon partial tear was diagnosed. Conclusion: Tiny translucent
the fourth lumbar and the tenth thoracic vertebral bodies, which foreign-bodies and related lesions are difficult to detect by physical
abnormality was associated with cervico-thoraco-lumbar scoliosis. examination, plain-film x-ray, and even by direct observation during
The magnetic resonance imaging of lumbar spine did not showed surgical debridement. High–resolution ultrasonography is a good
any significant abnormality. There were negative findings in measure of diagnosis for this clinical condition.
serology tests, e.g. HLA-B27, rheumatoid factor, antistreptolysin
O titer, antinuclear antibody titer. Technetium-99m methylene
diphosphonate (Tc-99m MDP) quantitative sacroiliac scintigraphy 0430PP39
showed increased uptake in the both SI joints. The patient received HAEMOPHILIC SHOULDER ARTHROPATHY:
medication for pain relief and received rehabilitation program for
relief muscle tightness, the symptoms of pain relief gradually. CLINICAL, RADIOLOGICAL AND
Conclusion: Sacroiliac joint disorder might be considered in ULTRASONOGRAPHIC CHARACTERISTICS
cases of hemivertebra, even insidious. MRI should be performed FROM A SINGLE CENTER IN TAIWAN.
in hemivertebral cases in order to evaluate spinal anomaly. A con-
currence of hemivertebra and sacroiliitis is practically likely. This Tsung-Ying Li, Liang-Chang Chen, Min-Hsin Lai, Yung-
is the first case revealing the relationship between hemivertebra Tsan Wu, Shao-Chi Lu, Shin-Tsu Chang
and sacroiliitis. Tri-service general hospital (Taiwan)
Purpose: To evaluate clinical, radiological and ultrasonographic
0430PP38 characteristics of shoulder joint in haemophilic patients in Taiwan.
Material and Methods: From Aug 2008 to Oct 2009, a total of 70
DIAGNOSIS OF CHRONIC FOREIGN-BODY patients followed at outpatient department of haemophilic care and
INCARCERATED PATELLAR TENDINOPATHY research center were studied. Factors examined including age, hae-
WITH PATELLAR tendon PARTIAL TEAR BY mophilia type, disease severity, body mass index (BMI), handedness,
HIGH-RESOLUTION ULTRASONOGRAPHY: A receiving prophylactic treatment, inhibitor status, age of shoulder first
bleeding and bleeding frequency. Bilateral shoulders were evaluated
CASE REPORT as range of motion (ROM), visual analog scale (VAS), and Oxiford
Tung-Liang Lin1, Howard Haw-Chang Lan2, Yu-Chun Lee1, shoulder score. Radiological evaluation was performed based on
Sen-Wei Tsai1, Chin-Teng Chung1 Pettersson classification. Ultrasonography (USG) evaluation was
1
Department of Physical Medicine and Rehabilitation and 2Depart- done in standard technique using a 5–12 MHz linear transducer.
Results: Sixty-nine male and one female were included in the study
ment of Radiology, Taichung Veterans General Hospital (Taiwan)
with a mean age of thirty-three. Sixty-six of them are the patients
Purpose: To report a rare image finding of chronic patellar tendi- of haemophilia A and four are haemophilia B patients. There are
nopathy with foreign body incarceration combined with patellar five patients with mild haemophilia, seven patients with moderate
tendon partial tear. Material and Methods: We report a 25-year-old haemophilia and fifty-eight patients with severe haemophilia, four of
male patient with good physical condition before. He suffered from the severe haemophilia A patients presenting with inhibitors. Mean
falling down and kneeling onto the ground scattered with countless BMI is 23.1 (kilogram/meter square). Thirty-five severe and moderate
tiny chips of glass. Multiple wounds over both knees were noted and haemophiliacs have past history of shoulder bleeds (bilateral = 21,
he was brought to the emergency department. Numerous pieces of right = 8, left = 6) and all abnormal Pettersson Score shoulders (n = 23)
glass incarcerated into the skin and subcutaneous tissue were noted are in the 56 haemarthrotic shoulders (HS). Thirty-nine HS and one
over both knees. Surgical removal of the glass chips was performed non-haemathrotic shoulder are symptomatic. ROM limitations are
as much as possible, but due to the size, number, and the translucence observed in thirty-five shoulders, especially in internal rotation and
entity of glass material, it was believed that a certain amount of tiny abduction. USD detected tenosynovitis of long head biceps tendon in
chips still remained unremoved. The patient started to experience 37/140 shoulders (HS group = 35), bony irregularity in 35/140 humeral
weakness, tightness, and soreness of his left knee after the accident. heads, joint synovitis in 14/140 glenohumeral joints and rotator cuff
He can still walk but had difficulty in jumping, squatting, and climbing tear in 32/140 shoulders (HS group = 30). A good correlation between
up and down the stairs. He thought that the symptoms may recover cartilage damage in USG and progression of bone changes in radio-
spontaneously and returned to work. However, the symptoms remained logical evaluation was found. Conclusion: Our report demonstrates
unchanged. He re-visited the hospital 1.5 months after the accident. the haemophilic shoulder arthropathy characteristics in our center.
Multiple scars were noted over left knee with granulation tissue forma- USG is useful in detecting the hypertrophic synovium, effusion, and
tion and mild local heat over the area of left patellar tendon. Physical cartilage change of shoulder joint in haemphiliacs before radiological
examination disclosed left patellar tendon tightness and mild limited examination showing abnormalities. Rotator cuff tears are common
left knee joint flexion range of motion (supine position : 0-108 degree, in haemophilic arthropathy of the shoulder.
and prone position : 0-112 degree), which was regarded as tight patellar
tendon related. Plain-film X-ray disclosed increased soft tissue density
and radio-opaque substances over left infra-patella region. Soft tissue 0430PP40
ultrasonography of left knee was performed about 2.5 months after the EFFECTS OF PULSED ELECTROMAGNETIC
injury which disclosed multiple tiny irregular echogenic spots located FIELD AND EXERCISE ON BONE MINERAL
in the subcutaneous tissue over the anterior aspect of the knee close to
DENSITY OF RATS WITH OSTEOPOROSIS
the anterior tibial tuberosity, and over the distal portion of the patellar
tendon, in favor of residual foreign body (FB) glass fragments. The Wenhua Chen, Bo Yu, Zhihao Liu
distal half of the patellar tendon is thickened and hypoechoic. Color The Department of Rehabilitation Medicine, Shanghai First Peo-
Doppler utlrasound revealed blood flow signals throughout the tendon. ple’s Hospital (China)
Several small FB fragments were also noted over the distal quadriceps
tendon which is of normal echogenecity. These findings suggested Purpose: To observe the effects of pulsed electromagnetic field
chronic partial tear with fibrosis and granulation over the distal half (PEMFs) or/and exercise on the area bone mineral density (aBMD)
of the patellar tendon and multiple FB fragments are still noted in the and volume bone mineral density (vBMD) of rats with osteoporosis
subcutaneous tissue over anterior aspect of the knee, distal portion induced by tretinoin gastric perfusion. Material and Methods: 100
of the patellar tendon, and the quadriceps tendon. No abnormal fluid female SD rats were randomly divided into 5 groups with 20 rats
accumulation was found in the knee joint. Results: After a series in each group: PEMFs group, exercise group PEMFs plus exercise
of history taking, clinical examination, and image survey, chronic group, osteoporosis group and healthy control group. Except for the

healthy control group, the osteoporosis models of other 4 groups by CNS are all in favour of stabilization of the movement of limbs.
were built by tretinoin gastric perfusion. After the building of models, The perspective of regarding the role of TrA as a bilateral stabilizer
each group was intervened with different treatment. In the 4th, 6th and should be modified in anticipatory adjustments. Future research needs
8th week after treatment, relevant results of aBMD and vBMD were to be done to explore the application in clinical works.
tested. Results: Compared with the osteoporosis group, the AD of
the rats of PEMFs group, exercise group, PEMFs plus exercise group
significantly increased significantly (p < 0. 05) in the 6th week, 4th week 0430PP43
and 4th week after treatment respectively. In the 6th and 8th week there EFFECT OF BOTULINUM TOXIN INRA-
was no significant differences among the PEMFs plus exercise group,
the exercise group and the PEMFs group (p > 0.05). Conclusion: ARTICULAR INJECTION IN THE TREATMENT OF
PEMFs can increase the BMD of the rats with osteoporosis as well KNEE OSTEOARTHRITIS
as exercise, PEMFs takes effect slower than exercise. Shih-Hui Wu, Lin-Fen Hsieh
Shin Kong Wu Ho-Su Memorial Hospital (Taiwan)
0430PP41
Purpose: The purpose of this study was to investigate the effects of
EFFECT OF BOWEN TECHNIQUE TO INCREASE IABOTOX for subjects with KOA. Material and Methods: Nineteen
HAMSTRINGS FLEXIBILITY subjects with symptomatic KOA with grade II–III on Kellgren/Law-
rence scale were collected. They received intra-articular injection of
Uraiwon Chatchawan, Wichai Eungpinichpon, Thanita 100 units botulinum toxin to the affected knee. All of the assessments
Thivato, Nareerat Santakit, Salinee Kakaew were performed before, one week and six months after IABOTOX.
Division of Physical Therapy, Faculty of Associated Medical Sci- Assessments included evaluation of range of motion over knees
ences, Khon Kaen University (Thailand) and ankles, visual analogue pain scale, and questionnaires of func-
tional status including Lequesne index and Western Ontario and
Purpose: Bowen therapy is a dynamic remedial bodywork technique McMaster Universities Osteoarthritis Index (WOMAC). Results:
that works on the connective tissue structures of the body. It may The short-term results showed KOA subjects had moderate knee
relatively increase the flexibility of muscle and the whole body. pain (5.03 ± 1.06) before the intra-articular Botulinum injection and
There is very little scientific evidence to support its use. The aim of the pain significantly decreased after the injection (2.89 ± 0.90). The
this study to verify the effectiveness of Bowen therapy to increase short-term result implicated 40% pain reduction after IABOTOX.
hamstring flexibility. Material and Methods: Thirty subjects with The average onset time for pain relief was 5.35 ± 2.09 days. With
hamstring tightness (straight leg raise or SLR between 40–70 de- regard to the functional questionnaires, both Lequesne (13.11 ± 2.53
grees) were randomly allocated to receive either Bowen therapy vs 9.94 ± 3.25) and WOMAC (37.21 ± 5.94 vs 25.88 ± 8.52) index
or control group (resting on bed), only one treatment for 30 min. significantly decreased after the injection. There was no significant
Each subject was assessed the outcome measures before e and after improvement in lower limb range of motion after the injection.
treatment. The primary outcome measure was SLR in both legs. Conclusion: IABOTOX provided the subjects of knee osteoarthritis
The secondary outcomes were body flexibility measure by using with not only pain relief but also functional abilities improvement in
sit and reach box, heart rate, respiratory rate and blood pressure. short-term effects. Further follow-up will provide more information
The pair t-test and analysis of covariance (ANOVA) was performed. about the long-term effects.
Results: Results show that the average of SLR in each leg of both
groups was slightly increase when compare to baseline. Comparing
between two groups, SLR in each side was no significant difference 0430PP44
(p-value = 0.556 on left leg and 0.171 on right leg respectively). In
addition, the trunk flexibility was increase significant among the RANDOMIZED DOUBLE-BLIND PLACEBO-
subjects in Bowen therapy group after treatment (p > 0.002), but CONTROLLED TRIAL ON THE POTENTIAL
there is no significant difference when comparing it with the other MODES OF ACTION OF SHEAFLEX70TM IN
group. Conclusion: This study concluded that, there is not enough OSTEOARTHRITIS
evidence to support the effectiveness of single Bowen therapy with
any significant increase hamstring flexibility. We therefore recom- Phillip Cheras1, Stephen Myers1, Peta-Anne Paul-Brent2,
mend that need further studies. Kerry Outerbridge3, Gary Nielsen4
1
NatMed-Research, School of Health and Human Sciences, South-
ern Cross University, 2The Australasian Kidney Trials Network,
0430PP42 University of Queensland, Brisbane, 3Division of Orthopaedics,
EFFECT OF TRANSVERSUS ABDOMINIS ON THE Greenslopes Private Hospital, Brisbane and 4Orthopaedic Surgery,
MOVEMENT OF LIMBS Mater Health Services, Brisbane, (Australia)
Dong-Liang Shi, Hui-Juan Pan, Hui-Fang Wang, Yu-Bin Purpose: Extracts from the seed of the African shea tree Vitellaria
Wang paradoxa C.F. Gaertn have been used traditionally for the treatment of
Dong Fang Hospital,Tongji University (China) arthritic conditions. However, little is known about the mechanisms
by which benefi t is conferred. Material and Methods: This single-
Purpose: To evaluate the effect of transversus abdominis(TrA) on site, 15-week randomized, double-blind, parallel, placebo-controlled
the movement of limbs. Material and Methods: 59 valuable reviews study examined a range of biomarkers in 89 patients with osteoarthri-
or articles were found in PubMed or ISI from January 1985 to De- tis of the knees and/or hips to determine potential modes of action
cember 2008 through key-word searching. These medical literature of SheaFlex70TM, a triterpene-rich extract of Vitellaria paradoxa.
concerning the TrA were reviewed in the aspects of the effect and Two measures of clinical outcome were employed, WOMAC and
underlying mechanism of TrA during limbs moving. Results: TrA COAT respectively. Biomarkers were assessed to gain insight into
was one of the local stabilizing muscles of core muscles,which kept the modes of action of SheaFlex 70 within the total placebeo and
the stabilization of lumbar by increasing abdominal pressure or the treatment groups and also in the subset of these groups defined as
tension of thoracolumbar fascia. TrA had the ability of maintaining those with upper quartile levels of the biomarkers which generally
dynamic stability when it was stabilizing the lumbar by the contraction correlate with increased risk of OA. These included measures of
in advance when upper or lower limbs were moving. Furthermore,the inflammation, cartilage synthesis and degradation and bone borma-
contralateral feedforward of TrA of moving upper limb was earlier tion. The statictical program SPSS Version 11.0 was used. Results:
than the ipsilateral one,which was controlled by central nervous In the group of participants with levels of osteoarthritis biomarkers
system (CNS). Conclusion: Various feedforwards of TrA controlled in the upper quartile at baseline, there were signifi cant decreases in

infl ammation and cartilage breakdown and trend level decreases 1

Rehabilitation Medicine, West China Hospital of Sichuan Uni-
in bone remodeling in the SheaFlex70TM group versus placebo versity (China) and 2Department of Rehabilitation Science and
between commencement and completion of the study. Infl ammation Occupational Therapy, The Hong Kong Polytechnic University
marker TNF-alpha fell 23.9% vs 6% (treatment vs placebo), p = 0.041. (Hong Kong)
Cartilage degradation marker CTX-II fell 28.7% vs an increase of
17.6% (treatment vs placebo), p = 0.018. This marker also showed Purpose: To observe the effect of PEMFs on muscle strength and
signifi cant falls across the entire study group, 10.6% vs an increase muscle endurance in post-menopausal women with osteoporosis.
of 11.6%, (treatment vs placebo), p = 0.016. Osteocalcin levels fell Material and Methods: 43 patients were randomly divided into
9.2%, p = 0.014 (treatment) vs 1.2%, ns (placebo), p = 0.096 (treat- experimental group (n = 24) and control group (n = 19). Both groups
ment vs placebo). Conclusion: These findings indicate that in patients received conventional drug therapy. Meanwhile, experimental
with the highest levels of osteoarthritis biomarkers, SheaFlex70TM group was treated with PEMFs once a day, for 30 days. Results: In
demonstrated multiple beneficial activities consistent with slowing experimental group, the muscle strength of back muscle, abdomi-
the disease process. nal muscle, quadriceps femoris and the muscle endurance of these
muscles were significantly increased after treatment (p < 0.05). In
control group, only the increase of abdominal muscle had statisti-
0430PP45 cal significance (p < 0.05). Between the two groups, the increase
THE EFFECT OF PULSED ELECTROMAGNETIC of back muscle and abdominal muscle in experimental group was
higher than control group (p < 0.01). Conclusion: PEMFs could
FIELDS ON THE EXPRESSION OF OPG AND improve the muscle strength of back muscle and abdominal muscle
RANKL IN OSTEOBLAST AND BONE TISSUE of post-menopausal women with osteoporosis. PEMFs combined
FROM OVX-INDUCED OSTEOPOROSIS RATS with drugs could improve muscle strength of quadriceps femoris and
muscle endurance of back muscle, abdominal muscle and quadriceps
Hongcheng He1, Yujun Hu2, Lin Yang1, Ling Wang1, femoris of post-menopausal women with osteoporosis.
Zhongjie Lei1, Chengqi He1, Li Deng3
1
Rehabilitation Medicine, West China Hospital of Sichuan Univer-
sity, 2Rehabilitation Medicine, Guangxi Zhuang Autonomous Region 0430PP47
People's Hospital, 3Laboratory for Tissue Engineering, West China FLEXNOW RELIEVE THE SYMPTOMS OF
Hospital of Sichuan University (China) OSTEOARTHRITIS IN JAPANESE PATIENTS
Purpose: The purpose of this research was to observe the ef- Mitsuhiro Kawano
fect of PEMFs for the expression of OPG, RANKL mRNA on Kanazawa University Hospital (Japan)
osteoblasts and the bone tissue from ovariectomized rats with
osteoporosis and to explore the possible mechanism of PEMFS Purpose: To determine the safety and efficacy of sheanut oil
for osteoporosis patients. Material and Methods: 1) Experi- (FlexNowTM) in Japanese osteoarthritis patients. Material and
ment in vivo: 48 3-months-old female SD rats were randomly Methods: A two sites 12 week observational study was conducted.
divided into SHAM control group, OVX experimental group, For the primary outcome, efficacy was assessed by Comprehensive
OVX estrogen group, OVX control group. After experimental Osteoarthritis Test (COAT). The secondary outcome was evaluated
model were made, exposed the OVX experimental group rats by safety measurements including laboratory data and adverse
to pulsed electromagnetic fields (8 Hz, 3.8 mT), 40 min/day; events. Results: There were 35 patients with osteoarthritis enrolled
OVX estrogenic group rats were given Premarin see conjugated in this study. Twenty-five patients completed the trial and no se-
estrogen lavage (0.065 mg/kg/day). After 30 days, use actual time vere side effects were observed. COAT scores were significantly
fluorescent quantitation PCR instrument to detect the expression improved after consumption of FlexNow in patients whose baseline
of OPG, RANKL mRNA on iliac bone tissue in each group rats. COAT scores were more than 30 (inclusion criteria). Hence pain was
2) Experiment in vitro: The osteoblast cells in SHAM group, OVX ex- reduced by 27.7%% (p = 0.0241), stiffness by 25.9% (p = 0.1346),
perimental group, and OVX control group were isolated from calvaria physical disability by 26.5% (0.0307) and overall symptoms by
of ovariectomized rats with osteoporosis by sequential digestion. Ex- 24.4% (p = 0.0276). No clinically relevant changes were noted for
posed OVX experimental group to PEMFs (8 Hz, 3.8 mT), 40 min/day; safety markers of the hematpoietic, liver, or renal systems. Con-
after 5days use actual time fluorescent quantitation PCR instrument clusion: Shea nut oil is safe for Japanese osteoarthritis patients. In
to detect the expression of OPG, RANKL mRNA on iliac bone tis- addition, it is effective in about 46% of patients.
sue in each group rats. Results: Experiment in vivo: Compare with
OVX control group, OPG mRNA expression in OVX experimental
group increased significantly, RANKL mRNA expression was no 0430PP48
significant difference; Experiment in vitro: Compare with OVX con-
trol group, RANKL mRNA expression in OVX experimental group ULTRASOUND-GUIDED INJECTION OF
reduced significantly, OPG mRNA expression was no significant PLATELET-RICH PLASMA FOR CHRONIC ELBOW
difference. Conclusion: PEMFs reduce the expression of RANKL TENDINOSIS
mRNA on osteoblasts from OVX osteoporosis rats and increase the
OPG mRNA expression. PEMFS affect the signal transmission of Joon Beom Hong, Il Young Jung, Keewon Kim, Kwan Sik
OPG-RANK-RANKL system in OVX osteoporosis rats that maybe Seo, Sun Gun Chung
one mechanism of PEMFS for osteoporosis treatment. Seoul National University College of Medicine, Department of
Rehabilitation Medicine (Republic of Korea)
0430PP46 Purpose: To evaluate the effect of ultrasound-guided autologous
platelet-rich plasma (PRP) injection for Chronic elbow tendinosis in
THE EFFECT OF LOW-FREQUENCY PULSED the aspects of pain, function and structure. Material and Methods:
ELECTROMAGNETIC FIELDS ON MUSCLE 7 elbows from 5 patients with chronic epicondylar pain (5 right and
STRENGTH AND MUSCLE ENDURANCE 2 left) were evaluated. 3 ml Platelet-rich plasma was obtained for
OF PATIENTS WITH POST-MENOPAUSAL each patient. Patients underwent sonographic evaluation prior to
OSTEOPOROSIS injection with PRP. PRP was injected into the site of tendon defect.
Measures of Visual Analogue Scores (VAS), Modified Mayo Clinic
Hongchen He1, Chengqi He1, Jian Xu1, Yan Zhang2, Lin Performance Index for the Elbow, Nirschl score were taken pre- and
Yang1, Zhongjie Lei1, Wei Xie1, Yonghong Yang1 8 weeks post procedure. Results: Following PRP injection, Visual

Analogue Scores at rest and action were decreased from 32.29 (SD the supraspinatus, and tendinopathy of the Achilles tendon, and it is
24.76), 68.86 (SD 17.11) at pre-procedure to 10.71 (SD 16.61), considered to be an effective and safe procedure. Minor complica-
25.71 (SD 26.51) at 8 week post-procedure, respectively. Modified tions, such as pain, local soft-tissue swelling, cutaneous erosions,
Mayo Clinic Performance Indexes for the Elbow were increased and erythema, and major complications, such as tendon rupture
from 67.14 (SD 10.84) to 86.79 (SD 11.15). Nirschl scores were de- and osteonecrosis have been reported. We present a case of calcific
creased from 6.00 (SD 1.15) to 4.29 (SD 1.70). Reduction of tendon Achilles tendinitis with following Achilles tendon partial tear after
thickness was observed from 3.9 mm (SD 0.9) to 3.6 mm (SD 1.1) the ESWT treatment. The patient received emergent tendon repair
at 8 week post-procedure. Conclusion:Autologous PRP injection after being diagnosed and recovered well.
reduced pain, improved activity of daily living and decreased size
of interstitial tendon defect. But statistical significance was not
determined because of the small sample size. Further researches 0430PP51
with larger group of patients are required.
THE EFFECT OF DIFFERENT STRETCHING
METHOD ON FLEXIBILITY OF LOWER LIMBS
0430PP49
Tsung-Ching Lin1,2, Shao-Yi Liu3, Tzyy-Yiang Shiang2,
NEEDLE INSERTION INTO THE TIBIALIS Chen-Ming Chiu1
POSTERIOR USING ANTERIOR APPROACH: 1
Department of Physical Medicine and Rehabilitation, Far Eastern
ULTRASONOGRAPHIC EVALUATION Memorial Hospital, 2Institute of Exercise & Sport Science, National
Taiwan Normal University and 3Institute of Physical Education,
Sang Chul Lee1, Dong-Wook Rha2, Dong Jin Kim2
National Taiwan Normal University (Taiwan)
1
Department of Physical Medicine and Rehabilitation, Myongji Hos-
pital, Kwandong University. College of Medicine and 2Department Purpose: Effect of different stretching method on flexibility of
and Research Institute of Rehabilitation Medicine, Yonsei University lower limbs and range of motion of hip joint in elite male taekwondo
College of Medicine (Republic of Korea) athletes. Material and Methods: Eighteen elite male taekwondo
athletes were recruited in this study and randomly divided to two
Purpose: Electrodiagnostic evaluation of tibialis posterior is groups. Self static stretching (SS) group (age = 20.2 ± 1.3 yrs; body
particularly useful in patients with a foot-drop for differentiat- height: 176.4 ± 7.9 cm; body weight: 64.9 ± 4.7 kg) and vibration
ing peroneal neuropathy and L5 radiculopathy. Moreover, this stretching (VS) group (age = 20.4 ± 1.1 yrs; body height:173.4 ± 9.0
muscle is frequently targeted for botulinum toxin injections to cm; body weight: 68.9 ± 10.1 kg).Three types stretching exercise
reduce the abnormal hypertonicity and to correct equinovarus (straight–leg raise of left and right leg, both hip abduction) were
deformity in patients with spastic paralysis. Although needle applied to two groups. The SS group stretched with the device turned
insertion into the tibialis posterior is usually performed with off ; The VS group stretched with the device turned on. Simultane-
the guidance of anatomical landmarks, the tibialis posterior is ous vibration (30 Hz) and stretching was performed in VS group.
considered by some to be the least accessible muscle for needle The frequency of training is twice a week, 3 repetitions per time,
placement as it is located deep within the lower leg. Therefore, stretching time is 30 s with 1 min of rest in between for 6 weeks.
in order to determine the most appropriate needle insertion point, Leg flexibility is evaluated by measuring the height of self straight-
the ultrasonographic anatomy of the lower leg was investigated leg raise. The increment of height of self straight-leg raise adjusted
for safe and accurate needle placement into the tibialis posterior leg length and range of motion of bilateral hip joint was measured
via the anterior approach. Material and Methods: We examined pre-, immediate and post- 2, 4, 6 week training. Within-group dif-
a total of 62 normal subjects (30 men, 32 women). The safety ferences were analyzed by paired t-test. The differences between
window (the tibia to the neurovascular bundle) and the depth to the pre- and post-test scores were analyzed by independent t-test.
the midpoint of the safety window (skin to the tibialis posterior) The significant level was set at 0.05. Results: There is statistically
at the upper third and the midpoint of the tibia were measured on significant difference in increment abduction range of motion of hip
the transverse ultrasonographic scan to avoid the neurovascular joint between VS and SS group at immediate period. Both groups
bundle in the anterior approach. Results: The safety window at had statistically significant increase in leg flexibility and range of
the upper third of the tibia was significantly larger than that at the motion of hip joint after 6 weeks stretching training. In SS group,
midpoint (p < 0.01). The safety window ranged from 0.64 cm to the increment percentage after 6 weeks training of left, right leg
2.13 cm at the upper third tibias point, and ranging from 0.32 cm flexibility and range of motion are 7.6%, 5.3% and 11.9%. In VS
to 1.30 cm at midpoint. The depth to the tibialis posterior at the group ,the increment percentage after 6 weeks training of left ,right
upper third of the tibia was significantly deeper than that in the leg flexibility and range of motion are 4.7%, 6.4% and 13.8%. But
midpoint (p < 0.01). The depth ranged from 2.47 cm to 4.66 cm there is no statistically difference between two groups at 6th week.
at the upper third tibias point, and ranging from 2.35 cm to 4.28 Conclusion: This study showed both static and vibration stretching
cm at the midpoint. Conclusion: The anterior approach using ul- training had benefit in flexibility of lower limbs and range of motion
trasonography on the upper third of the tibia offers the advantage of hip joint in elite male taekwondo athletes after 6 weeks training.
of a larger safety window for needle insertion into the tibialis Simultaneous vibration and stretching had more immediate effect
posterior than on the midpoint. The method using ultrasonography than self static stretching in increasing abduction range of motion
suggested in current article can be used for the needle insertion of hip joint. Acknowledge: Thanks for Tonic Fitness Technology,
into the tibialis posterior and deserves more widespread use in INC provide the equipment. Key words: Stretching, vibration, range
clinical practice. of motion, flexibility.
0430PP50
0430PP52
ACHILLES TENDON TEAR AFTER SHOCK WAVE
EFFECT OF ULTRASOUND PARAMETERS ON
THERAPY FOR CALCIFIC TENDINITIS OF
ENHANCEMENT OF FRACTURE HEALING
ACHILLES TENDON:A CASE REPORT
Chien-Hung Lai1,2, Walter Hong-Shong Chang1, Chiung-
Tsung-Ching Lin, Cheng-Yuan Lin, Cheng-Min Chiu
Cheng Chuang1, Chih-Wei Peng2, Jiunn-Horng Kang2,
Far Eastern Memorial Hospital (Taiwan)
Shih-Ching Chen2
Extracorporeal shock wave therapy (ESWT) has been advocated 1
Department of Biomedical Engineering, Chung Yuan Christian
for treating a number of soft tissue conditions, including plantar University and 2Department of Physical Medicine and Rehabilita-
fasciitis, lateral epicondylitis, calcific and noncalcific tendonitis of tion, Taipei Medical University and Hospital (Taiwan)

Purpose: The aim of this study is to investigate four ultrasound was 1 inch above the umbilicus (p = 0.013) and the other at its up-
stimulated parameters to enhance the bone fracture healing. Material per margin (p = 0.002). The strength and endurance of abdominal
and Methods: Fifteen New Zealand white male rabbits were used muscle groups have significant improvement (all p < 0.05). The total
for animal experiment.These 15 rabbits were randomly divided into IRD change of four locations was correlated with the improvement
5 groups of 3 animals each; one control group (CA0) and 4 experi- of trunk flexors strength between 6 weeks and 6 months postpar-
mental groups underwent ultrasound (US) treatment with various tum (Spearman = 0.38, p = 0.04). The IRD change at 1 inch below
frequencies (0.5 (TB0.5), 1.0 (TC1.0), 1.5 (TD1.5), and 2.0 (TE2.0) the umbilicus was significantly correlated with improvement of
Hz, respectively). Histologic evaluation of bone growth was per- trunk rotators strength (Spearman = 0.45, p = 0.01). After 6 months
formed by fluorescent labelling of callus in fibulae. Three different postpartum, these postpartum women still had greater inter-recti
fluorochromes were sequentially injected on the 3rd, 10th, 17th, and distances (range from 1.16 ± 0.58 to 2.13 ± 0.65 cm) than those of
24th postoperative day in control and 4 US-treated groups. Results: nulliparaous females (range from 0.43 ± 0.17 to 0.99 ± 0.31 cm) (all
Our result showed that US-treated side was significantly higher than p = 0.00), with the greatest difference found at the upper margin of
that of the contralateral sham-treated side in all groups at the end of the umbilicus. The abdominal strength and endurance were also less
treatment (p < 0.05). Interestedly, our result also revealed that there than those of nulliparaous females (all p = 0.00) Conclusion: In the
are different efficacies toward enhancing bone healing at each week present study we found that the natural resolution of diastasis recti
while applying four US frequencies. For the bone growth of week 1, abdominis was not complete at 6 months postpartum. Significant
US-treated side was significantly higher than that of the contralateral reduction in IRDs was found at two locations above the umbilicus,
sham-treated side only in 1.5 and 2.0 MHz groups (p < 0.05). During and these changes were correlated with strength of trunk flexors and
the period of week 2, US-treated side was significantly higher than rotators. Our results strongly indicate that routine physical therapy
that of the contralateral sham-treated side in all groups (p < 0.05). intervention even just for home exercise instruction may be neces-
Only 0.5 MHz group was enhancing bone growth during the third sary for postpartum women to facilitate the recovery of their trunk
week while compared with contralateral sham-treated side (p < 0.05). muscle function. Further studies are necessary to investigate the
Conclusion: This study showed that US can enhance bone formation efficacy of physical therapy intervention.
in a rabbit model. Our results also implied that higher frequency
such as 1.5 and 2.0 MHz promote bone growth during the first two
weeks, whereas relatively lower frequency, for example 0.5 MHz, 0430PP54
enhance bone growth since second weeks. PNEUMOTHORAX ASSOCIATED WITH
NONINVASIVE INTERMITTENT POSITIVE
0430PP53 PRESSURE VENTILATION IN DUCHENNE
CHANGES IN INTER-RECTI DISTANCE MUSCULAR DYSTROPHY – A CASE REPORT
AND ABDOMINAL MUSCLE FUNCTIONS IN Soon-Kyu Lee, Seung-Ho Choi, Won-Ah Choi, Seong-
POSTPARTUM WOMEN: A 6-MONTH FOLLOW-UP Woong Kang, Jong-Hoon Baek
STUDY Gangnam Severance hospital (Republic of Korea)
Lih-Jiun Liaw1,2,3, Ar-Tyan Hsu1,5, Mei-Fang Liu2,3,4 Introduction: Duchenne muscular dystrophy (DMD) is a severe
1
Institute of Allied Health Sciences, College of Medicine, National recessive X-linked disorder characterized by rapid progression of
Cheng Kung University, 2Department of Physical Therapy, College muscle wasting and weakness. Long term noninvasive intermittent
of Health Science, Kaohsiung Medical University, 3Department of positive pressure ventilation (NIPPV) is an important treatment for
Rehabilitation Medicine, Kaohsiung Medical University Hospital, neuromuscular patients with chronic respiratory failure. NIPPV
4
Institute of Biomedical Engineering, College of Engineering, Na- is easy to administer and life-threatening complications are rare.
tional Cheng Kung University and 5Department of Physical Therapy, We report two cases of pneumothorax associated with long term
College of Medicine, National Cheng Kung University (Taiwan) NIPPV in DMD. Case 1: A 24 year old DMD patient with NIPPV
application via nasal mask 24 hours a day visited Gangnam Sever-
Purpose: The increase in inter-recti distance (IRD) around linea ance Hospital complaining of dyspnea and left sided chest pain.
alba was called diastasis recti abdominis. This phenomenon indi- Leukocytosis was observed on lab results and decreased breathing
cates a history of prolonged abdominal muscle lengthening, and sounds were auscultated at the left chest area. Chest X-ray showed
consequently force production capacity of the abdominal muscles left lung volume loss of over 50% warranting chest tube insertion
might become impaired. This research project was aimed to study and IV antibiotics infusion. Dyspnea and chest pain subsided 4
natural recovery of IRD, if ever, by investigating changes in inter- days after treatment. Left lung volume loss was reduced to 10% on
recti distance, abdominal muscles strength and endurance in women follow-up chest X-ray. The chest tube was removed and the patient
between 6 weeks and 6 months postpartum, and comparing them was discharged. Through 20 months of follow-up period, NIPPV
with nulliparaous females in order to find out whether spontaneous application was reinstated and no consequent pneumothorax de-
recovery would actually occur after 6 months postpartum. Material velopments were manifested. Case 2: A 26-year-old DMD patient
and Methods: From June 2006 to September 2008, 43 postpartum with NIPPV application via nasal mask 24 hours a day visited
women and 20 nulliparaous female controls from communities in Gangnam Severance Hospital complaining of dyspnea, chest pain
Kaohsiung were recruited. The inter-recti distance of linea alba at and cough. Decreased breathing sounds were auscultated at the
four locations (1 inch above and below the umbilicus, upper and left chest area. Chest X-ray and CT showed left lung volume loss
lower margin of the umbilicus) were measured with a 7.5 MHz of over 30% warranting chest tube insertion and negative pressure
linear ultrasound scanner in a supine position. Data of abdominal maintenance along with pleurodesis, despite which no improve-
functions obtained by using Manual Muscle Testing and by cal- ments were observed. Thus the patient was discharged with the
culating the holding time and the number of repetitions during chest tube inserted. 4 months later, pneumothorax recurred at the
the performance of curl-ups to objectively determine the strength right lung prompting chest tube insertion and negative pressure
and endurance of trunk flexors and rotators. All evaluations were maintenance once again. Dyspnea and chest pain subsided after
conducted twice in postpartum women, at 6 weeks and at 6 months treatment but pneumothorax itself was not resolved, and thus
after childbirth; and once in the nulliparaous female controls. the patient was discharged in bilateral chest tube state. The right
Results: Among the 43 postpartum participants, 30 completed the chest tube was removed 6 months later but the left chest tube was
6 month postpartum follow-up. During the period of follow-up, 6 retained. Conclusion: Given the increasing utilization of chronic
weeks to 6 months postpartum, the inter-recti distance (IRD) at NIPPV, we suggest that care givers and patients must be aware of
two locations investigated have became significantly reduced, one this potentially life-threatening complication.

0430PP55 significantly improved between before surgery and 3 weeks, 3

OUTCOMES OF LOW-LEVEL LASER TREATMENT months and 3 weeks and 3 months after surgery. The mean motor
nerve conduction amplitude (MA) and sensory nerve conduction
FOR CLOSED BONE FRACTURE OF HAND AND latency (SL) were significantly improved between before surgery
FOREARM and 3 weeks, 3 months after surgery. The mean CSA of maximal
Wen-Dien Chang1,2, Yi-Jing Chu2, Jih-Huah Wu3, Joe-Air swelling site was significantly improved between before surgery
and 3 weeks, 3 months and 3weeks and 3 months after surgery.
Jiang2 Ratio of MS/12CM was significantly improved between before
1
Department of Rehabilitation Medicine, Da Chien General Hos- surgery and 3 weeks, 3 months after surgery. The ML, SL, SA
pital, 2Department of Bio-Industrial Mechatronics Engineering, were correlated with MS of median nerve before surgery. The ML
National Taiwan University and 3Department of Biomedical Engi- were correlated with ratio of MS/2CM, 12CM and the SL were cor-
neering, Ming Chuan University (Taiwan) related with ratio of MS/12CM before surgery. The improvement
of ML was correlated with ratio of MS/12CM between initial and
Purpose: The aim of this study was to investigate the efficacy of 3 weeks after surgery and with ratio of MS/2CM between 3weeks
low-level laser therapy (LLLT) in the treatment of closed bone and 3 months after surgery. The improvement of SL was correlated
fracture of hand and forearm. The closed bone fracture of hand is with ratio of MS/2CM, 12CM between 3 weeks and 3months after
usually remedied by the cast, splint, or medication, but it is less surgery. Conclusion: The CSA ratio between maximal swelling
to cure the fracture area directly. Past researches confirmed that and non swelling point of median nerve, and mean absolute CSA of
low-level laser could increase the osteocyte quantity in animal maximal swelling site were significantly improved within 3 weeks
experiment, but human’s studies were few reported and the suitable after surgery. However, ratio of area was not superior to absolute
parameters of LLLT were unconfirmed. Material and Methods: In CSA at maximal swelling point.
our study, we recruited 9 subjects who had closed bone fracture
without surgery. The programs of LLLT (10 Hz, duty cycle 50%,
60 mW, 9.7 J/cm2, 830 nm) were performed for two weeks and 0430PP57
five treatments were conducted each week. We evaluated the pain
(Visual Analog Scale, VAS), functional disability (Quick Disabilities SUBJECTIVE AND OBJECTIVE OUTCOMES
of the Arm, Shoulder, and Hand questionnaire, Quick DASH), and AFTER METACARPAL FRACTURES
user satisfaction before and after treatment, as well as two-week Jen-Mu Chang, Yueh-Hsia Chen, Shwu-huei Lien
follow-up. We also assessed to observe the absence of the fracture
line and find the cortical bridging on the fracture sites in X-ray Plastic and Reconstructive Surgery Rehabilitation Center, Chang
image. Results: After two-week laser treatment, swelling and pain Gung Memorial Hospital (Taiwan)
of the recruited patients with closed bone fracture were reduced Purpose: Disability of the Arm, Shoulder, and Hand (DASH)
significantly. Furthermore, we also found one case of the fracture questionnaire, have been developed that appreciate the limita-
healing via X-ray image inspection. The subjective satisfaction of tions patients experience in everyday life. And objective outcome
applying LLLT was recorded after two-week treatment. After treat- evaluation is performed mostly by range of motion and strength
ment, LLLT could significantly reduce pain (p < 0.05) and decrease after metacarpal fracture. In this study, the correlation between
disability of involved hand (p < 0.05). Conclusion: The efficacy of subjective and objective outcomes were assessed 3 months after
LLLT had pain relief and beneficial result to treat CBF of hands and metacarpal fractures patients. Material and Methods: Twenty-one
forearms. However, the promotion of healing closed bone fracture subjects with metacarpal fractures were recruited from August
by LLLT was still unrecognized due to insufficient evidence of 2008 to October 2009. Patients with tendon or phalangeal bone
radiographic signs. The more studies to confirm the effect on bone injury other than metacarpal fracture were excluded. The recruited
healing should be conducted in future. subjects were received physical therapy and regular follow more
than 3 months. 3 months after injury, the validated Chinese version
of the full DASH questionnaire was used as subjective outcome.
0430PP56 Grip strength, pinch strength and active range of motion were
FEASIBILITY OF ULTRASONOGRAPHIC measured simultaneously. Data were analyzed by SPSS 12.0
EXAMINATION AFTER SURGERY IN CARPAL version. Correlation analysis was performed using the Pearson
correlation coefficient. The ‘‘open/close fracture type’’ and ‘‘with/
TUNNEL SYNDROME without articular injury’’ groups were separately compared by
Joon Shik Yoon, Sei Joo Kim, Byung Kyu Park, Kyu Hun independent t-tests. All tests with a p-value of less than 0.05 were
Sim, Sun Jae Won, Jung Mo Cho, Jin Seok Jeong considered to be statistically significant. Results: Overall DASH
Department of Physical Medicine and Rehabilitation, Korea Uni- score was 11.5 (SD 10.76). The average grip strength and pinch
versity College of Medicine (Republic of Korea) strength of the injured hands was mean of 87% (SD 23.5) and
71% (SD 22) of the uninjured hand. The mean total active range
Purpose: To verify the feasibility of ultrasonographic value of cross of motion was 256.4 (range 200~275, SD 16). DASH disability
sectional area (CSA) and CSA ratio at normal segment/maximal score exhibited a moderate negatively correlation with % grip
swelling of median nerve after surgery in CTS and to determine strength (r = –0.45, p = 0.005), and was not correlated with % pinch
which measurement increase the diagnostic accuracy compared strength (r = –0.31, p = 0.08), or %TAM (r = –0.054, p = 0.80). The
to absolute maximal CSA. Material and Methods: This study DASH work score of optional DASH module were statistically
was carried out on 33 consecutive hands. The diagnosis was made significant in correlation with grip strength (r = –0.32, p = 0.01), but
according to American Association of Electrodiagnostic Medicine only few cases answered DASH sports/performing arts score. The
criteria (AAEM). The protocol included Boston questionarre, Elec- group with open fracture type or intra-articular fracture obtained a
trodiagnosis (EDx), and ultrasound evaluation, at the time of prior higher DASH disability score than the group with close fracture or
to surgery and at 3 weeks and 3 months after surgery. Three sites non-articular joint involved (p = 0.01; p = 0.03). Conclusion: The
were chosen to visualized the median nerve in axial scan: 1) point of patient’s subjective evaluation of their function after metacarpal
maximal swelling (MS), 2) 2 cm proximal to MS (2CM), 3) 12 cm fractures by means of the DASH score, when combined with an
proximal to MS (12CM). The CSA ratio between maximal swelling objective assessment, represents a valuable comparative methods.
and non-swelling point of median nerve, and each absolute mean The correlation between grip strength, fracture type and DASH
CSA were measured. Results: The mean motor nerve conduction scores emphasizes the relation between subjective and objective
latency (ML) and sensory nerve conduction amplitude (SA) were outcomes.

0430PP58 than 60 min, but after treatment it was not statistically significant
CAHNGES IN KNEE SENSORY FUNCTION shorter. Conclusion: According to our findings we recommended
application of physical treatment in patient with RA.
AND HIP MUSCLE STRENGTH IN PEOPLE
WITH UNILATERAL PATELLOFEMORAL PAIN
SYNDROME 0430PP60
Chich-Haung Yang , Jen-Ju Huang , Chung-Chao
2 1 ALTERED AUTONOMIC NERVOUS FUNCTION IN
Liang1, Tzai-Chiu Yu3, Lan-Yuen Guo4 SUBJECTS WITH MECHANICAL NECK DISORDER
1
Department of Physical Medicine and Rehabilitation, Tzu-Chi Su-Ya Lee1, Chich-Haung Yang2, Yi-You Hou1, Sheng-Kai
General Hospital, 2Department of Physical Therapy, Tzu-Chi Col- Chen1, Lan-Yuen Guo1
lege of Technology, 3Department of Orthopedic Surgery, Tzu-Chi 1
Department of Sports Medicine, College of Medicine, Kaohsiung
General Hospital and 4Faculty of Sports Medicine, College of Medical University and 2Department of Physical Therapy, Tzu-Chi
Medicine, Kaohsiung Medical University, (Taiwan) College of Technology (Taiwan)
Purpose: The present study aimed to use quantitative sensory test- Purpose: Mechanical neck disorder (MND) is increasingly prevalent
ing such as pressure pain threshold, thermal detection threshold, in spinal disorders in our modern lifestyle. Weak deep neck flexors
thermal pain threshold and vibration sense to identify the pain may play a major role for a poor posture with head forwarded, which
intensity and sensory function around the knee in people with is an increased extended neutral position in upper cervical spine.
and without unilateral patellofemoral pain. In addition, we also These changes may affect the normal function of the autonomic
examine the hip muscle strength in people with patellofemoral pain nervous system, which is possible a vicious cycle for the consistent
syndrome (PFPS). Material and Methods: A total of 36 volunteers symptoms. We aimed to examine any alteration of autonomic func-
(age 22 ± 3.9 years, BMI 22.5 ± 3.3 kg/m2, male: female = 1:1) were tion alternation in individuals with MND. Material and Methods:
recruited by physicians’ referrals, consisted of 18 individuals with Forty participants were voluntarily recruited to two groups (MND
unilateral PFPS and 18 age- and BMI-matched healthy controls. A group 27 subjects and 13 controls). Electrocardiograph was used
pressure algometer (Somedic Co., Sweden) was used to examine the to determine the heart rate variability (HRV) for subjects at differ-
PPT over specific location around the knee. A thermal pad (Medoc ent head and neck positions. Meanwhile, laser doppler flowmetry
Advanced Medical Systems, USA) was used to examine TPT applied (LDF) was used to monitor their effects on the microcirculation of
on patella. A quantitative sensory testing system (TSA II, Medoc, ? at different head and neck positions. Results: Individuals with
USA) was used to test warm detection threshold, cold detection MND group had significant (p < 0.05) increased myogenic activity
threshold. A vibrameter was used to testing vibration sense on the and decreased heart activity in LDF during all cervical movements
specific location over patellofemoral joint on affected and unaffected compared to healthy controls. Interestingly, MND group had sig-
sides. Hip muscle strength in abduction, extension and internal/ nificant (p < 0.05) increased HF% and decreased (p < 0.05) LF/HF
external rotation were examined using a hand-held dynamometer. ratio in HRV in rotation to right, neutral and full flexion positions.
Two-way repeated measures ANOVA (SPSS 15.0, SPSS, Inc., USA) Conclusion: Subjects with long-lasting improper head and neck
was used to examine any significant difference between groups in posture could affect their function in autonomic nervous system or
pain intensity and sensory measures and hip strength. Significance circulatory system. The findings may provide in-depth knowledge
level was set up as 0.05. Results: Significant reduced warm detec- for clinicians to classify the different type of MND and determine
tion threshold and cold detection threshold were found in affected the different interventions for people with MND.
compared to unaffected side in individuals with PFPS and healthy
controls (p = 0.001, p = 0.000, respectively). Reduced hip strength
in abduction and external rotation were found in affected side of
0430PP61
PFPS group compared to unaffected side of PFPS group and healthy
controls (p < 0.05). There was significant reduced PPT in affected AMELIORATIVE EFFECTS OF FACILTATION
side of PFPS group compared to healthy controls (p < 0.05), regard- THERAPY ON MOTOR FUNCTION OF UPPER
less of no significant difference between affected and unaffected LIMB IN PATIWENTS WITH HEMIPLEGIA AND
sides in PFPS group. Conclusion: Our results showed reduced hip
joint strength in abduction and external rotation as well as deficits SHOULDER PAIN
in sensory function and pain in people with unilateral PFPS. Qingfa Chen
(China)
0430PP59 Purpose: To observe the effects of combining with Transcutanaeous
MANAGING REHABILITATION OF PHYSICAL Electrical Nerve Stimulation device (TENS) and nerve facilitation
THERAPY IN TREATMENT OF PATIENTS WITH rehabilitation in the treatment of hemiplegia and shoulder pain in
stroke patients. Material and Methods: Sixty stroke patients with
RHEUMATOID ARTHRITIS hemiplegia and shoulder pain , treated in Wuxi No.2 People’s Hos-
I. Mircea, S. Birsan, F. Cioara pital from March 2007 to November 2008 were selected. Accord-
Oradea University School of Medicine (Romania) ing to the serial number of therapy sheet, they were assigned into
facilitation device group and control group with 30 in each group.
Purpose: The aim of study was to evaluate effect of the combina- The patients in the control group were treated with nerve facilitatior
tion physical therapy and medical treatment in patients with RA. technique(30 min every time once a day). Those in the facilitation
Material and Methods: We examined 25 patients 47.16 years old, device group were treated with TENS plus facilitatior technique
with predomination of female (80%), who suffered from RA 14.24 Firstly, the spinal cord was treated with electrical for 15 min, and
years (which was RF positive in 70% patients). All patients were then upper and lower limb were treated with electrical treatment,
treated with analgetic electrotherapy, magnetotherapy, kinetotherapy respectively, for 15 min in each limb. The treatment was once a day,
and massage. Results: Duration of the application physical therapy 10 min as a course, totally for 3 courses. Before and after treatment
was approximately 14 days. After treatment we have statistically all the patients were treated with Fugl-Meyer assessment to the
significant improvement in patient’s state of health in 86.29%. RA evaluate motion and ache of shoulder joint. Meanwhile, the motor
changes was classified with Stein-Brocker’s criteria and we found function of the upper limb was assessed with Fugl-Meyer motor
that 72% of our patients were in Grade 2 and 28% were in Grade 3. function assessment scale. Results: According to the intention-to-
We found significant improvement in functional status of patients treat analysis, 60 patients in the two groups were all involved in the
after treatment. Morning stiffness was in 24% of patients was longer result analysis. 1) the total integral in 30 patients of the facilitation

device group after treatment was higher significantly than that in the munication partners of aphasic patients during an interviewed con-
control group (160 vs 116 points, p < 0.01). 2) The total integral in versation, and the influences of the aphasic patients’ speech fluency
30 patients of facilitation device group after treatment was higher and naming ability on their partner’s conversational participation
significantly than in the control group (162 vs 78 points, p < 0.01). 3) behaviours. Material and Methods: Twenty-six pairs of subjects, 52
The score in the facilitation device group after treatment was higher in total, were recruited in this study. The aphasic group was composed
significantly than that in the control group (X2 = 11.12 , p < 0.005) . of 17 aphasic patients of mild to moderate severity (2 or above in
Conclusion: The nerve facilitation technique integrated with TENS the severity scale of Boston Diagnostic Aphasia Examination) and
can relieve the hemiplegia and shoulder pain after stroke, and im- their close relatives with intact communication abilities. The control
prove the motor function of upper limb in patients. group was composed of 9 pairs of normal subjects both with intact
communication abilities. Semi-structured interviews were conducted
to each pair to collect conversation speech samples for discourse
0430PP62 analysis. The number of participations and the type of participations
THE EFFECT OF ACCELERATED of the communication partners were compared between the two
REHABILITATION ON THE RECOVERY OF groups. The aphasic patients’ speech fluency and naming ability as
assessed by utterance length and the Chinese Picture Naming Test
KNEE FLEXION FUNCTION AFTER TOTAL KNEE score were further correlated with their partner’s participation behav-
REPLACEMENT (TKR) iours. Results: The results showed that the communication partners
Ming Wu, Wenxiang Fan, Xifu Shang of the aphasic patients had significantly more frequent conversational
participations, both active and invited ones, and in all types of par-
Department of Rehabilitation Medicine, Anhui Provincial Hospital ticipation behaviors (“speaking for”, conversational repair, and other
(China) behaviors). Furthermore, the communication partners of non-fluent
In order to study the effect of accelerated rehabilitation on the aphasia patients had significantly more frequent total conversational
recovery of knee flexion function after total knee replacement participations, active participations and “speaking for” behaviors.
(TKR), the 61 knees in 56 patients (cases) were chosen. Cases are The patients’ naming abilities were negatively correlated with the
divided into two groups. One is called pro-operation accelerated frequency of their communication partners’ repairing behaviors.
rehabilitation group (30 knees in 27 cases) and the other is called Conclusion: Our result showed that aphasic patient’s communica-
comparison group (31 knees in 29 cases). The observations for the tion partners often intervened, sometimes inappropriately, while the
knee flexion function were made a week, two weeks, and six months patients were speaking with others, especially for nonfluent patients
after the operation. The knee joints were evaluated based on the with poorer naming ability. This might have clinical implications in
ROM estimation. Evaluation results were analyzed statistically. It the treatment for aphasia.
indicates there are no difference between two groups according to
ROM estimation before the operation (p > 0.05). The knee flexion 0430PP65
function in the accelerated rehabilitation group is obviously better
than the comparison group after the operation. The difference is EFFECTS OF REPETITIVE TRANSCRANIAL
efficient statistically (p < 0.01). It is concluded that accelerated MAGNETIC STIMULATION ON UPPER
rehabilitation can improve the knee flexion function after total knee EXTREMITY MOTOR FUNCTION IN STROKE
replacement (TKR).
PATIENTS: A META-ANALYTICAL REVIEW
I-Ning Tang1, Hen-Yu Lien1, Alice MK Wong1,2
0430PP63 1
DEVELOPMENTS FOR THE RESEARCH OF TKA versity and 2Department of Physical Medicine and Rehabilitation,
PERIOPERATIVE REHABILITATION Chang Gung Memorial Hospital-Taoyuan Branch (Taiwan)
Ming Wu, Hao Fu, Xifu Shang Purpose: Cerebrovascular accidents (CVA) is the major cause of
Department of Rehabilitation Medicine, Anhui Provincial Hospital disability worldwide. According to Department of Health, Taiwan,
(China) 13,000 people died of CVA in 2008. For survivors, recovery of up-
per extremity motor function is usually incomplete. Current treat-
Total Knee Replacement (TKR) has been used widely. The peri- ment protocols largely depend on therapeutic exercise. However,
operative rehabilitation has important affection on the total effect novel interventions like restoring interhemispheric balance after
of the TKR. The accelerated rehabilitation to improve the function stroke by providing different types of brain stimulation have been
of the knee joint has been emphasized. In this paper, overviewing applied to improve motor function recently. Repetitive transcranial
the researches of comprehensive estimation of perioperative cares, magnetic stimulation (rTMS) is a non-invasive brain stimulation
psychological rehabilitation, improvement of the joint activity, technique which can alter excitability in the motor cortex, and
muscle training, proprioceptive training, walking training, the pre- is a potential treatment for motor impairment in stroke patients.
vention of the important complications and the important roles of rTMS can either facilitate or inhibit motor cortices of the brain,
the treatments in the TKR, shows that perioperative rehabilitation depending on the stimulation frequency. High frequency rTMS
can improve the effect after the TKR. ( > 1 Hz) produces excitatory effect and low frequency (1 Hz)
rTMS exerts inhibitory effect. However, there is no consensus on
the treatment effect of rTMS in stroke patients’ upper extremity
0430PP64 function. The purpose of this study was to perform a systematic
PARTICIPATING BEHAVIORS OF APHASIC review and meta-analysis on the effectiveness of rTMS on up-
PATIENTS’S PARTNERS DURING INTERVIEWED per extremity motor function in stroke patients. Material and
Methods: A comprehensive literature search up to October 2009
CONVERSATION
was performed on following computer databases: PUBMED, The
Ai-Hua Li1, Lu Lu2 Cochrane Library, CINAHL plus with FT, and Chinese Electronic
1
Graduate Program of Communication Disorders, Taipei Municipal Periodical Services (CEPS). Besides, the references of articles
University of Education and 2Department of Physical Medicine and obtained from these searches were examined for retrieving ad-
Rehabilitation, National Taiwan University Hospital (Taiwan) ditional articles. Key words for the broad search were stroke,
cerebrovascular accident (CVA), transcranial magnetic stimula-
Purpose: Communication partner’s attitude is an important environ- tion (TMS), repetitive transcranial magnetic stimulation (rTMS),
mental factor to consider in the treatment of aphasia. The purpose and brain stimulation. Each study was assessed by Jadad scale
of this study was to investigate the participation behaviours of com- basing on three criteria: 1) randomization 2) double blinding and

3) withdrawals or drop outs. The comprehensive meta-analysis than the control group, Barthel index were significantly different
version 2.0 software (Biostat US & UK) was used to perform (p<0.01). Conclusion: Early rehabilitation can significantly improve
meta-analysis. Results: Eleven studies were included in this meta- the soldier, hemiplegia patient ADL and reduce disability, improve
analytical review. All subjects recruited suffered from cortical and life quality, high levels of clinical value, and to shorten treatment to
subcortical strokes. Outcome measures of upper extremity motor reduce costs, would be effective in enhancing economic and social
function after stroke were grip strength, nine hole peg test (NHPT), benefits, it is worth promoting. Key-words: Early rehabilitation,
Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), stroke, hemiplegia.
Jebson-Taylor Test of Hand Function, Fugl-Meyer motor score, and
finger tapping frequency. The overall fixed effects model revealed
significant positive treatment effect of rTMS applied on primary 0430PP68
motor cortex (M1) (Hedges’s g = 0.650, 95% CI = 0.459~0.842, A FMRI STUDY ON A PATIENT WITH CENTRAL
p = 0.000). In subgroup analysis, low frequency rTMS (1Hz) ap- POST-STROKE PAIN
plied on contralesional M1 revealed a significant positive treatment
effect (Hedges’s g = 0.930, 95% CI = 0.599~1.261, p = 0.000), and Yongmei Li1, Feifei Yang1, Lijuan Ao2, Jin Chen2, Jie
high frequency rTMS (10 Hz and 20 Hz) applied on lesional M1 Wang2
also has significant positive treatment effect (Hedges’s g = 0.509, 1
Department of Rehabilitation, the second Affiliated hospital of
95% CI = 0.274~0.745, p = 0.000). The fail-safe analysis showed Kunming college and 2Department of Rehabilitation, the second
that 160 null effect studies were needed to overthrow the overall Affiliated hospital of Kunming college (China)
fixed result of rTMS. Conclusion: rTMS applied on primary motor
cortex is effective for improving upper extremity motor function Purpose: To explore the expression of neural activity of differ-
in cortical and subcortical stroke patients. Using either low fre- ent brain area on a patient with central post-stroke pain by using
quency rTMS on contralesional motor cortex or high frequency fMRI. Material and Methods: The patient 62 years old man was
on lesional motor cortex can enhance functional motor recovery. included in this study. He was suffered from left thalamus hemor-
Further studies are needed to explore possible combined effect of rhage for 4 months and right hand neurapathetic. A detailed clinical
using low frequency and high frequency rTMS on bilateral motor assessment of somatic sensory function was examed, including
cortices at the same time, and to evaluate if rTMS has remote effect tactile sensory, acupacture sensory, warm and cool sensory and
for infratentorial lesions. two-point discrimination sensory. The MRI and fMRI scan was
carried out using 1.5T High-Speed scanner. The functional scan
were collected using blood oxygen level dependent contrast
0430PP66 (BOLD) protocol with a T2-weighted gradient echo-planar
imagingsequence(TR = 2000 ms, TE = 50 ms, 64*64).The warm
ETIOLOGICAL ANALYSIS AND REHABILITATION
stimulation at 50o and cool stimulation at 5o was applied in the
NURSING OF POST-STROKE DEPRESSION palmaris surface of right hand finger of the patient. Results: sen-
Yanjing Qin, Dongyu Wu, Hailing Li, Li He sory testing: Most of sensory including tactile sensory, acupacture
The Department of rehabilitation Medicine, xuanwu hospital capital sensory, two-point discrimination sensory showed diminishing.
However, the patient felt allodynia at the 5o and 50o. Functional
medical university (China)
imaging: the intensive activations were showed in the posterior
Purpose: To investigate and analyze the etiology of depression central gyrus of left parietal cortex (Brodmann 1 area) when
for patients with stroke and provide corresponding rehabilitation cold stimulation were exerted on the the affected side (right side
nursing methods. Material and Methods: 348 patients with stroke hand).The mild activation lied in the posterior central gyrus of
were evaluated with Hamilton Rating Scale for Depression (HAMD) left parietal cortex (Brodmann 40 area) when warm stimulation
and Self-rating Depression Scale (SDS), and etiology analysis was were exerted in the same site. Mild actvation were found in the
performed in 156 of them who were diagnosed depression. Results: middle frontal gyrus of the right cortex (Brodmann 2 area) and
Patients with stroke had obvious psychological problem and 44.8% (Brodmann 8 area) when cold stimulation were exerted on the
of them suffered from depression to a varying degree. Severity the unaffected side (left side finger). Less mild activation lied in
of neurological impairment was the main etiology of depression. cuneate lobe of the left parietal cortex (Brodmann 18 area) when
Influencing factors of depression for patients with stroke also in- warm stimulation were exerted in the same site. Conclusion: In
cluded whether the patient could go to work and financial burden. this patient with CPSP, the activation area and intensity with cold
Conclusion: Uses should master certain psychological knowledge. stimulation is more than that of warm stimulation. With the same
Strengthening psychological nursing and early rehabilitation training stimulation, activation area in the cortex is less in the affected side
were effective to improve mood of depression and quality of life than the unaffected side.
for patients with stroke.
0430PP69
0430PP67 THE CHANGE AND SENSE OF MICROGLIA CELLS
THE EARLY REHABILITATION OF PATIENTS DIE IN PENUMBRA FOLLOWING FOCAL CEREBRAL
ADL PARALYSIS IN THE OBSERVATION ISCHEMIA IN RATS OBSERVED BY LASER
CONFOCAL MICROSCOPY
Xiaoying Shang, Shoubin Lu, Qiuhong Cui, Xiaoming
Zhu, Hao Feng, Lu Gan, Bo Wu, Yaotao Zhao, Fei Xu, Xiang Chen, Suzheng Han
Yandong Liu Department of Rehabilitation, The Second Affiliated Hospital &
Heilongjiang Provincial Hospital (China) Yuying Children’s Hospital of Wenzhou (China)
Purpose: Observation of the early rehabilitation of patients die Purpose: To study the change and sense of microglia cells in penum-
paralysis in the capacity of the daily life activities. Materials and bra following focal cerebral ischemia in rats observed by Laser Confo-
Methods: The study 66 patients with stroke were randomly divided cal Microscopy. Material and Methods: The transient focal cerebral
into rehabilitation and control groups, 34 patients recovered, in neu- ischemia-reperfusion model was established with modified method of
rology given acupuncture treatment plus routine medication based insertion of thread fish nylon into and staying for two hours and then
on the week after the intervention in the rehabilitation hospital; withdrawing it from middle cerebral artery in rats. Thirty six male
the control group 32 cases, simply to conventional drugs and acu- Sprague-Dawley rats were randomized into 6 groups: sham-operated
puncture neurological treatment outcomes were compared between group (S, n = 6), model group (group M6h, group M24h, group M48h,
the two groups. Results: Rehabilitation group had better effects group M72h, group M7d, n = 6). For monocyte labeling, Rhodamine

6G was retrogradely injected through the tail artery at the start of treated with physical therapy of Bobath and Vojta methods. Results:
the surgery,and was repeated after the first 12 hours. The neurologi- The total effective rate acupuncture and rehabilitation-training group
cal behavior scores were valued after animals waked up and before were obvious higher than that of rehabilitation-training group. After
killed. All of animals were transcardial perfused and fixated to study treatment the DQ value of rehabilitation-training + acupuncture group
the invading monocytes and brain derived microglia by FITC-islectin were higher than that of rehabilitation group (p < 0.01). In acupuncture
B4 histochemistry under CLSM. Results: The number of ILB4+ cells and rehabilitation-training group were higher than that of rehabilita-
in penumbra in group M were remarkably higher than one in group tion group (p < 0.01). In acupuncture and rehabilitation-training group,
S (p < 0.01). The number of ILB4+ cells in penumbra in group M7d, improvement rate of brain dysphasia, brain atrophy in skull CT and
group M72h and group M48h were significantly higher than ones in recovery normal rate of skull SPECT were obvious higher than that
group M6h (p < 0.01) and group M24h (p < 0.01). Compared for the of rehabilitation-training group(t = 4.731, t = 5.971, p < 0.01). Conclu-
ratio of brain-derived microglia to blood-borne monocytes in penum- sion: Acupuncture can obviously increase cerebral blood flow (CBF)
bra, ones in group M72h were significantly higher than ones in group and improve cerebral cell metabolism, promote partial or complete
M6h (p < 0.01) and group M24h (p < 0.05). Compared for the ratio of compensation of cerebral function and the restoration and function of
brain derived microglia to blood-borne monocytes at the border areas plasticity of cerebral tissue in children with cerebral palsy.
of the infarct, ones in group M72h were higher than ones in group M6h
(p < 0.05) and group M24h (p < 0.05). Conclusion: A part of microglia
cells derived from the invading monocytes in blood circulation. There 0430PP72
was a distinct increase of the movement of microglia in penumbra,
the population of cells was even higher at 72 hours after MCAO, and CONTRAST RESEARCH ON EFFECT OF TUINA
the morphology was more about ameboid. There was a correlation (CHINESE TRADITIONAL MEDICINE MASSAGE)
between the changes of microglia in penumbra and neuroreparation AND CHIROPRACTIC ON BALANCE AND BASIC
following focal cerebral ischemia in rats. ACTIVITIES OF DAILY LIVING (B-ADL) AFTER
STROKE
0430PP70 Jianzhuo Yang, Jinglong Liu, Yu Guo
REHABILITATION OF STROKE PATIENTS IN Heilongjiang Province Rehabilitation Hospital (China)
THREE TREATMENT EFFECT ANALYSIS
Purpose: Contrast research on Effect of Tuina (Chinese traditional
Yuan Dawei medicine massage) and Chiropractic on balance and basic activi-
Le Du Hospital (China) ties of daily living (B-ADL) after stroke .To evaluate outcome of
two different treatments. Material and Methods: 60 patients with
Objective: To investigate the rehabilitation of stroke patients in three problem of balance were recruited to this study. Inclusion criteria:
research programs whether it is effective rehabilitation treatment first-event stroke; no ill-controlled serious underlying systemic
programs. Methods: The subjects for the April 1, 2004 to February disease; no aphasia; no dementia; no subarachnoid hemorrhage
28, 2007 in hospital in line with the conditions selected patients with (SAH) and 4 weeks after onset. The score of Fugl-Meyer balance
acute cerebrovascular disease were 80 cases, male 56 cases, female assessment were no more than 6. The patients were randomly divided
24 cases; the average age of 65.04 ± 5.19 years; Infarction 40 cases of into two groups: group A (n = 30, age: 57.67 ± 10.26) and group B
cerebral hemorrhage 40 cases, of which 2 cases were lost because of (n = 30, age: 59.27 ± 7.85). Both groups do following treatment: daily
complications. Were randomly divided into rehabilitation group and physiotherapy, occupational therapy, and other therapy according
control group, the rehabilitation group was given standard three-stage to individual needs. Patients in the group A received traditional
rehabilitation treatment, the control group without any rehabilitation Chinese medicine massage (Tuina), but group B do the treatment
treatment, but does not rule out the traditional rehabilitation on their of Chiropractic The subjects received 30 min daily treatments of
own, such as acupuncture, integrated functional evaluation. Method Tuina and Chiropractic, 6 times per week. The Modified Barthel
for Evaluation of therapeutic effect, in the selected time and three Index (MBI) and Fugl-Meyer balance assessment was respectively
rehabilitation therapy at the end (the first six late onset) were evalu- used to assess patients’ capacity in B-ADL and balance . Assessment
ated to carry out three rehabilitation effectiveness analysis. When the was done upon admission to rehabilitation and 6 weeks afterwards.
results of selected rehabilitation group and control group differences SPSS12.0 was used for statistic. Results: After 6 weeks, perform-
in the measurement scale was no significant (p > 0.05); rehabilitation ance in the entire patient group increased (paired samples t test:
unit through the standard three-stage rehabilitation treatment, the t = 32.44, p < 0.001). At that time, the difference in Fugl-Meyer
measurement scale score was significantly higher than that, the dif- balance assessment scores of 2 groups was not significant (inde-
ference was significant if the sex (p < 0.001), the measurement scale pendence samples t test:t = 1.378, p > 0.05), but MBI was (t = 2.384,
score is also significantly higher than the increase in value (p < 0.001). p < 0.05). Conclusion: Standard rehabilitation treatment including
Conclusion: The rehabilitation of stroke patients in three research measures of both Tuina and Chiropractic has a beneficial effect on
program is an economical and remarkable efficacy of rehabilitation the functional capacity of stroke patients with problem of balance
treatment programs. and outcome is similar. But in B-ADL, Tuina maybe better.
0430PP71 0430PP73
EFFECT OF CLEARING THE GOVERNOR VESSEL TEMPORAL MEASURES OF SWALLOWING IN
AND REFRESHING THE MIND NEEDLING ON POST STROKE INDIVIDUALS RECOVERED FROM
HEAD SPECT AND CT SCANNING OF KIDS WITH DYSPHAGIA
CEREBRAL PALSY
Kumar B. Radish, S. Bhat Jayashree
Zhenhuan Liu Kasturba Medical College (India)
Nanhai Affiliated Maternity and Children’s Hospital of Guangzhou
University of Traditional Chinese (China) Purpose: The swallowing problems after acute stroke are often
temporary but sometimes leads to various complications such
Purpose: To investigate action and value of acupuncture in cerebral as aspiration pneumonia, dehydration and death. Though these
palsy rehabilitation. Material and Methods: 100 spasm cerebral palsy individuals recover from swallowing disorder, it is not known if
patients from 2 to 7 years old were randomly divided into two groups. they have recovered completely. Previous studies in individuals
Acupuncture group: 50 patients were treated with head acupuncture with dysphagia used quantitative measurements like amplitude of
and body acupuncture; Rehabilitation-training group: 50 patients were EMG muscle activity during swallow, time duration for which the

activity is present, swallowing apnea duration, etc in the assess- adults & healthy aged population indicating that the apnea duration
ment of individuals with swallowing disorders. The present study is prolonged in healthy aged population. There was no significant
administered timed test of swallowing was administered to identify difference observed between the means of swallow apnoea duration
swallowing problems, if any, in six months post stroke individuals. across different food consistency and volume. Also, it was found
This measure is useful in identifying those at risk of dysphagia or its that swallow apnoea occurred at the expiratory phase predominantly
complications, and also in monitoring the progress. Hence, it was followed by inspratory expiratory cusp, expiratory inspiratory cusp
chosen for this study. Material and Methods: The study followed and the inspiratory phase in both the groups although the higher oc-
a case control design. Participants were divided into two groups. currence of expiration braketting the swallow is observed in healthy
Group 1, clinical group, comprised of thirty individuals, who had aged population. Conclusion: The present study investigated the
a history of dysphagia during the acute period of stroke six months swallow apnoea duration in healthy aged population and the results
ago in the age range of 40 to 60 years. Group 2, control group, revealed a significant increase in the swallow apnoea duration in the
consisted of thirty healthy age matched adult volunteers. All the healthy aged population. Also, swallow apnoea occurred at the ex-
participants were asked to drink 150 ml of water from a plastic piratory phase in many individuals followed by inspratory expiratory
beaker ‘as quickly as possible’. All the participants were able to cusp, expiratory inspiratory cusp and the inspiratory phase in both
hold the beaker of water to their mouth and drink. A stopwatch was the groups. Increased apnoea duration and the higher occurrence
started when the water first touched the lower lip, and stopped when of expiration braketting the swallow in the healthy aged population
the larynx came to rest, ensuing the last swallow. The number of may be compensatory protective mechanism rather than the result
swallows performed by the participants was counted by observing of decreased muscle mobility or reaction times, and not indicative
the movement of the thyroid notch along with the time taken to of impairment. Early detection of swallowing impairment, includ-
completely drink 150 ml of water. Volume per swallow, time per ing breathing and swallowing disco-ordination that contributes to
swallow and the swallowing capacity was calculated in both the aspiration, may lead to prevention of pneumonia. The findings of
group of participants. Results: The results of independent t-test the current study represents an initial step toward this far-reaching
revealed a significant difference between the means for both the objective that has high clinical relevance in aging population.
group of participants, at p < 0.05 for all the three indices of timed
test of swallowing, suggesting that the clinical group exhibited
lower volume per swallow, increased time per swallow and a lower 0430PP75
swallowing capacity in each swallow than control group. Conclu- SPATIAL BIASES IN PROCESSING NUMBERS BY
sion: The present study investigated the swallowing problems in DEVELOPMENTAL DYSCALCULIC CHILDREN
six months post stroke individuals using timed test of swallowing.
The results revealed a significant difference between the means for N. Devadiga Deepa, Kumar B. Radish, S. Bhat Jayashree
both the group of participants, at p < 0.05 for all the three indices Kasturba Medical College (India)
of timed test of swallowing, suggesting lower volume per swallow,
increased time per swallow and a lower swallowing capacity in post Purpose: Numbers consist of a unique feature which represents a
stroke individuals in comparison with the control group. Hence, the particular aspect of quantitative information. Studies indicate that
timed test of swallow can be used as a clinical tool for identifying the quantitative representation of numbers has a spatial structure, and
swallowing problems in post stroke individuals. that it may orient from left to right. Since developmental dyscalculia
(DD) is a specific learning disability affecting the normal acquisition
of arithmetic skills, it is hypothesized that they may be lacking abil-
0430PP74 ity to represent and manipulate numerical magnitude nonverbally on
RESPIRATORY SWALLOW COORDINATION IN an internal number line (Butterworth, B, 2005). Hence the present
study was attempted with the aim of observing spatial biases if any
HEALTHY AGED POPULATION in children with developmental dyscalculia. Method: Participants
S. Bhat Jayashree, Kumar B. Radish consisted of 12 children with developmental dyscalculia and 12
Kasturba Medical College (India) typically developing children in the age range of 9–10 years. Each
participant received four white pages containing written instructions
Purpose: A variety of age-related changes occur in the oral pha- on the first page; and the other 2 pages contained 16 strings of digits
ryngeal mechanism, with some affect on the coordination between in one and the other with 16 lines. Two sets of digits represented small
swallowing and breathing is reported in the literature. Also, the (1.2) and large (8.9) magnitudes. From each of these four digits, two
incidence of swallowing disorders rises sharply with advanced age strings were generated, containing an odd (17 digits) or even (18
along with problems in breathing. As the population ages, by 2010, digits) number of elements yielding 52 mm and 55 mm, respectively.
16.5 million persons in US are estimated to have dysphagia and will The 16 control stimuli (87 mm and 84 mm) were horizontal black
require treatment. The present study was planned to investigate the lines that matched the digit strings with respect to their length and
differences between respiratory swallow coordination in healthy positions on the page. All the stimuli were presented in midsagittal
aged Indian population. The differences if any in the respiratory plane. All participants were instructed to bisect each stimulus in the
swallow coordination across various food consistencies and the middle. The distance between a bisection mark and both ends of a
volume of food consumed was also aimed at. Material and Methods: line was determined to the nearest millimeter, yielding a left and
15 healthy aged individuals in the age range of 50–69 years & 15 right interval for each stimulus. The difference score (left interval
adults in the age range of 18–40 years participated in the study. The minus right interval) yielded a negative value when performance was
swallowing examinations were recorded on a Digital Swallowing biased to the left and a positive value when performance was biased
Workstation (Model 7200; Kay Elemetrics Corporation) coupled to to the right. Results: The average bisection scores for lines in the
the swallowing signals lab. Nasal respiratory flow was captured by developmental dyscalculia and the typically developing group were
using a standard 7-ft nasal cannula coupled to the Swallow Signals –2.67 and –1.50, respectively and there was no statistically significant
Lab (Model 7120 Kay Elemetrics Corporation) module to create difference between the two groups at p > 0.05. The average bisection
a digital display of the respiratory phase and the swallow apnea scores for small and large numbers in the control group were 0.1208
duration. The participants were requested to swallow the bolus in and 0.2028, respectively, and there was no significant difference be-
one complete action in the following order: Dry swallow, 5 ml and tween the bisection scores for small and large numbers. Comparisons
10 ml of thin liquid, followed by 5 ml and 10 ml of thick liquid. across lines and numbers in the control group revealed significant
Respiratory measures(inhalation/exhalation) were recorded for all differences. The average bisection scores for small and large num-
swallowing attempts. Swallow apnoea duration was calculated from bers in children with developmental dyscalculia were –0.0870 and
these measurements. Obtained data was analysed statistically using –1087, respectively and there was no significant difference between
three way repeated measure ANOVA. Results: The results of apnea the bisection scores for small and large numbers. Comparison across
duration revealed significant differences between the means for lines and numbers revealed no significant differences in children with

developmental dyscalculia. Conclusion: In summary, the results re- of every stage obviously. Key-words: standardized three stages’
vealed no evidence of SNARC effect in both the groups of children, rehabilitation; stroke; hemiplegia; comprehensive function.
i.e., normal controls exhibited a right handed bias for both small and
large numbers and left handed bias for lines whereas children with
developmental dyscalculia exhibited a left sided bias for both lines 0430PP78
and numbers. The present observations, if substantiated by further RELATIONSHIPS BETWEEN FORWARD REACH
research, may be useful for the diagnosis of number comprehension
skills in children with developmental dyscalculia. AND THE SIT-TO-STAND ACTIVITY IN PATIENTS
WITH STROKE
Chen-Yin Chen1, Ray-Yau Wang2
0430PP76 1
Department of Physical Therapy, Chang Gung Memorial Hospital
EFFECT OF NEUROMUSCULAR ELECTRICAL and 2Institute of Physical Therapy and Assistive Technology, Na-
STIMULATION WITH TRAINING OF tional Yang-Ming University (Taiwan)
SWALLOWING ON SWALLOWING FUNCTION
Background and Purpose: Sit to stand is one of the most important
IN PATIENTS WITH CEREBRAL VASCULAR activities of daily living. It requires coordination, balance, mobility,
ACCIDENT and strength. The ability of reach while in sitting is also important
for an independent living. Trunk forward and loading body weight to
Zunke Gong, Wei Chen, Jie Sun, Cheng Quan
the feet, both are key components for reaching a distant object. Both
Central Hospital (China) are also important components in the early phase of the sit-to-stand
Purpose: To observe the effect of neuromuscular electrical stimula- activity. The purpose of this study is to investigate the relationships
tion with training of swallowing on swallowing function in patients between the reaching activity in sitting and the ability of sit-to-stand
with cerebral vascular accident. Material and Methods: Seventy in patients with stroke. Study design: A cross-sectional, exploratory
dysphagia patients caused by stroke were randomly divided into a study was carried out in a medical center. Subjects: Thirty-three
treatment group (35 cases ) and a contrast group (35 cases ). All the patients with hemiparesis resulting from cerebral vascular disease
patients were given routine medication treatment, training of facial participated in the study. Measurements: The forward reach distance
and masticatory muscles, training of swallowing, and so on. The in sitting was measured by a displacement transducer. With regard
patients in the treatment group were given electrical stimulation. to the sit-to-stand activity, a ‘fail’ was marked if the patients cannot
Then, the swallowing function and curative effect are analyzed complete the activity. Once the patient can succeed in the activity,
statistically. Results: After 15 days of treatment, the swallowing the time needed to complete the sit-to-stand was recorded by a stop-
function of all the patients has been improved (p < 0.01), and the watch. The trunk movement was recorded by video camera during
treatment group is more distinct than the contrast group (p < 0.05). the reaching and sit-to-stand activities, and was analysis by kinview
The effective rate in the treatment group is 88.56 per cent, while that 2.0 to determine trunk forward angle. Statistical analysis: The in-
in the other group is 71.44%. There is significant difference between dependent t-test was used to compare the differences in the forward
the two groups. Conclusion: Neuromuscular electrical stimulation reach distance and trunk flexion angle between subjects who failed
with training of swallowing can improve the movement of facial and and subjects who succeeded in the sit-to-stand activity. Further, the
masticatory muscles, and help the patients build up good swallowing Pearson correlation was used to examine the relationships between
reflex, reduce complication and improve their living. the forward reach distance and the time needed to complete the sit-to-
stand activity and between trunk flexion angle and the time needed to
complete the sit-to-stand activity. The lever was set at 0.05. Results:
0430PP77 There were significant difference in reaching distance between
subjects who failed and subjects who succeeded in the sit-to-stand
CLINICAL STUDY OF STANDARDIZED THREE activity. But there were no correlation between reaching distance and
STAGES’ REHABILITATION PROGRAM IN the time needed for the sit-to-stand activity. There was no significant
PROMOTING COMPREHENSIVE FUNCTING IN difference in trunk flexion angle between the two groups during the
STROKE PATIENTS WITH HEMIPLEGIA sit-to-stand activity. Significant correlation was found between trunk
flexion angle and the time needed to complete the sit-to-stand activ-
Jirong Zhang, Shuang Wu, Yu Huang, Lili Feng, ity. Discussion and Conclusion: The forward reach activity was an
Tingfeng Chen, Yan Long, Mei Li, Ling Li, Li Ma, important component for preparing the sit-to-stand activity. When
Lianfang Wang, Xiaomin Feng performing the sit to stand activity, the more trunk flexion forward,
Department of Rehabilitation Medicine, Teaching Hospital, Guiyang the shorter the time needed to complete the task. The results of our
Medical College (China) study can provide information to clinicians. The patients can practice
forward reach in sitting for preparing a sit-to-stand activity. Trunk
Purpose: To explore the effects of standardized three stages’ re- forward, which is the key component for sit-to-stand, can also practice
habilitation on the comprehensive function in steoke patients with during the reaching activity.
hemiplegia. Materials and Methods: 80 cases with acute brain
vascular disease (male: 58, female: 22; average age: 62.94±8.59;
brain infarction: 44cases, brain hemorrhage: 36 cases; 2 died) have 0430PP79
been divided rando mly into 2 groups : the treatment group and the UTILITY OF CUEING HIERARCHY AS AN
control group. The treatment group has been treated with THREE EFFECTIVE TREATMENT APPROACH IN ANOMIC
GRADES regular rehabilitation treatment whereas the control
received no rehabilitation [1] treatment unless treated with acu- APHASIA
puncture or massage by patients themselves. Both groups received Sudhin Karuppali1, Buddhima Samaraweera2, B.S.
routine treatment of internal medicine. Both groups have been Premalatha2
evaluated with simplified Fugl-Myer scale, simplified ADL scale 1
Kasturba Medical College and 2Dr. S.R.Chandrasekhar Institute
and comprehensive functional scale at the beginning and the end of Speech and Hearing (India)
of the treatment. Results: All the scales of two groups showed no
significant difference at the beginning (p>0.05). But the scales of the Purpose: The principle deficit in anomic aphasia is the difficulty in
treatment group were significantly higher than those of the control naming. Since the naming plays an important role in language, naming
group (p<0.001) and the increasing rate were significant higher than disturbances have to be treated systematically. The symptoms of the
those of the control group. Conclusion: Standardized three stages’ presenting case includes circumlocution, difficulty in defining refer-
rehabilitation can promote stroke patients’ comprehensive function ence, confrontation naming, categorical naming, automatic closure

naming. There are several approaches to train access to the lexicon. Purpose: To investigate activation patterns of motor cortex in
Among them, cueing is a common technique which facilitates word patients with cerebral infarction by BOLD-fMRI, and to explore
retrieval. Cueing may be of different types which are selected ac- the brain functional reorganization mechanism. Material and
cording to the patient’s severity of the lexical access and the effects Methods: Sixteen patients (12 men and 4 women, age from 37 to
may vary across the population. Hence the present study attempted 80 years old, mean 61.0 ± 11.3) with subcortical infarction within
to evaluate the effectiveness of an intervention program focusing 3 months were included. All the patients received fMRI scanning
on the cueing hierarchy as a primary treatment method for Anomic during passive movement for both affected and unaffected wrested
Aphasia. Material and Methods: The present study is a prospective separately clenching. Brain functional mapping was acquired with
single case study. The subject who had come with a complaint of SPM2, and different activation patterns of brain were compared
unclear speech after Cerebrovascular Accident was evaluated using between affected and unaffected hand. Results: The volume
the Western Aphasia Battery and was found to have relatively good and intension of activated areas of fMRI in stroke patients were
auditory verbal comprehension and repetition, but severe naming diversity, however, showing some orderliness. The fMRI map
deficits, placing him under the category of Anomic Aphasia. His showed a general hyperactivation when the affected hand was
response time for several naming categories was recorded in the moved. When the unaffected hand moved the contralateral M1
first session after which, Cueing hierarchy had been introduced as a and S1 were activated. Conclusion: After cerebral infarction,
primary treatment strategy to elicit verbal fluency and also auditory brain cortex showed compensatory changes. Register as the main
recall tasks to improve memory. Post therapy evaluation was done motor cortex (M1) unactivated and the non-main motor cortex
after 15 sessions to monitor his response time for the same naming such as PMC, SMA, CMA, IPL, PFC, CRB activated. Besides,
categories. Results: Significant improvement was seen in response the motor areas activated shift to area around the lesion, also the
time for confrontation naming (nouns and verbs), defining referents non-motor area activated.
and automatic closure naming tasks after 15 sessions of therapy
using the cueing hierarchy. The Auditory recall tasks did not show
significant improvement. Conclusion: Selecting a cueing hierarchy 0430PP82
to improve lexical retrieval is an effective approach for rehabilitat- RISK FACTORS OF FALLS IN HOSPITALIZED
ing anomic aphasics. Therefore the cueing hierarchy selected for the STROKE PATIENTS
intervention process should be individual specific.
Zong-Han Yang, Ta-Sen Wei
Changhua Christian Hospital (Taiwan)
0430PP80
STUDY OF THE CONGENITAL BLIND READING Purpose: Falling is a high risk, high volume and multi-factorial
problem in stroke patients. We aimed to identify the risk factors
BRAILLE IN FMRI of falls in hospitalized stroke patients received rehabilitation
Guangyao Wu, Junmo Sun, Li Wei program. Material and Methods: This case-control study enrolled
Department of Radiology, Zhongnan Hospital of Wuhan University stroke inpatients with one case (faller) matching 2 controls (non-
(China) faller). Variables measured included demographic data, type of
stroke, first ever or recurrent stroke, hospitalization length, Mini-
Purpose: Cerebral activation areas will be displayed in fMRI during Mental state examination, depression status, trunk control ability,
the congenital blind reading Braille. To explore occipital cortical func- Brunnstrom’s stage of extremities, and functional independence
tional reorganization of the congenital blind. Material and Methods: measure (FIM). Besides, indwelling catheters (nasogastric tube
Right-handed the congenital blinds (n = 10) performed reading Braille or Foley catheter), other complications (pneumonia, urinary
and the differentiation senseless dots. Freshmen as control group tract infection, etc.) and co-morbidities (hypertension, diabetes
(n = 10) performed touching Braille. Acquisition of FE-EPI images. mellitus, etc.) were also recorded. Results: A total of 192 stroke
The data was processed and analyzed in software of Medx3.2. Results: patients (64 fallers), aged 65.8 ± 12.8 years were enrolled with
1) Both side primary visual cortex V1 and supplementary visual cortex BMI 23.6 ± 3.9 kg/m2, length of stay 24.1 ± 5.8 days, and MMSE
V2+V3 were activated during the congenital blind (n = 10) reading 18.3 ± 8.8. The initial FIM was 61.7 ± 20.4 (35.8 ± 14.8 in motor
Braille. Left and Right V1 activated extensions were 20 and 19 pixels subscale and 26.6 ± 8.2 in cognition subscale, while the discharged
respectively; (V2+V3) were 44 and 50 pixels; (V2+V3) > V1. Right FIM was 73.7 ± 19.9 (44.9 ± 15.7 in motor subscale and 29.0 ± 6.4
total (V1+V2+V3) was 69 pixels, T value was 9.8; Left total was 64 in cognition subscale). By bivariate analysis, there were signifi-
pixels, T value was 9, no significant difference. 2) Both visual cortical cant difference between groups in discharged total FIM score
scattered activated clusters were appeared during identifying senseless (p = 0.026), ability of sit-up and stand-up (p = 0.019 and 0.048,
dots. Right total (V1+V2+V3) was 16 pixels, T value was 4.1; Left respectively), and depression or not (p = 0.009). Conclusion:
total was 64 pixels, T value was 3.8. There was significant difference For appropriate fall-prevention in hospitalized stroke patients,
between reading Braille and identifying dots (p < 0.001). 3) Additional it is crucial to facilitate patients’ trunk control ability, promote
activated areas during reading Braille included BA4, BA3, BA7, their activities of daily living, and well manage the psychologi-
SMA and left inferior frontal gyrus and so on. 4) During the control cal problems.
group touching Braille, there were activated no visual cortex but two
side areas such as BA4, BA3, BA7, BA6 et al. Conclusion: Reading
Braille of early visual deprivation person can cause the activation of 0430PP83
visual cortex. Visual cortical function happens reorganization, which
THE CLINICAL STUDY ON POST-STROKE
involves the process of complex language cognition.
PATIENT REHABILITATION OF APPLYING WITH
WORKING MEMORY AND MENTAL PRACTICE
0430PP81
Yanming Zhang, Jie Dai, Long Qian, Weiqun Song
THE FMRI STUDY OF BRAIN FUNCTIONAL
Department of Rehabilitation Medicine, Xuanwu Hospital Capital
REORGANIZATION IN PATIENTS WITH Medical University (China)
CEREBRAL INFARCTION
Purpose: To study the relationship between working memory and
Xi-Quan Hu1, Rui-Shu Jiang1, Ya-Dan Zheng1, Zhuang motor function improvement obtained from applying with mental
Kang2 practice and physiotherapy on post-stroke patient rehabilitation.
1
Department of Rehabilitation Medicine, the Third Affiliated Hos- Material and Methods: 40 post-stroke patients were measured
pital of Sun Yat-sen University and 2Department of Radiology, the the Kinesthetic and Visual Imagery Questionnaire (KVIQ) and
Third Affiliated Hospital of Sun Yat-sen University (China) working memory before treatment. They were divided into normal

working memory group (21 cases) and impaired working memory 0430PP85
group (19 cases). The two groups were measured the Fugl-Meyer THE EXERCISE EFFECTS ON EXPRESSION OF
of lower limb and loading of the affected lower limb before and
after treatment which were trained with mental practice and the SYNAPOTOPHYSIN AROUND HEMOTOMA AFTER
general rehabilitation for 4 weeks. Results: 40 post-stroke patients ICH IN RATS
were measured the Kinesthetic and Visual Imagery Questionnaire Hongling Li, Huiping Zhang, Yanping Liu, Gang Huang,
(KVIQ) and working memory before treatment. They were divided
into normal working memory group (21 cases) and impaired work- Xinping Xue, Changchun Wang
ing memory group (19 cases). The two groups were measured The Second Hospital of Hebei Medical University (China)
the Fugl-Meyer of lower limb and loading of the affected lower Purpose: To investigate the exercise effects on expression of synapo-
limb before and after treatment which were trained with mental tophysin around hemotoma after intracerebral hemorrhage (ICH) in
practice and the general rehabilitation for 4 weeks. Conclusion: rats Material and Methods: The 95 male SD rats (weight, 270 to
There is evident effect that mental practice and physiotherapy 300 g) were divided into three groups, trial group (ICH-induction
treat the lower function of post-stroke patients, and the effect and exercise group, n = 20), control group (ICH-induction group,
depends on the ability to maintain and operate information in n = 20) and sham operated group (no ICH without exercise, n = 20).
working memory. The rats brains were removed at 7d, 14d, 21d, 28d after operation.
The other 35 rats were divied into 7 groups (6 h,12 h, 24 h, 48 h, 72
h after ICH, no ICH and normal). The activation of synapotophysin
0430PP84 was measured by Immunohistochemistery. The rats in trial group
A PILOT STUDY OF A HAPTIC KNOB FOR HAND begin cage-running exercise at 72 h after operation. The others live
REHABILITATION IN CHRONIC POSTSTROKE in the standard cags. Results: Synapotophysin-positive cells appeared
around the hematoma and cortex. There is no expression in the centre
HEMIPLEGIA
of hematoma. The number of synapotophysin-positive cells in ICH
Karen Sui Geok Chua1, O. Lambercy2, L. Dovat2, C.W.K. group was less than the sham-operation and normal group from 6 h
Kuah1, Hong Yun1, S.K. Wee1, C.L. Teo1 to 24 h. there is a rising again in 48 h, increasing in 7 days, high peak
1
Dept of Rehabilitation Medicine, Tan Tock Seng Hospital and- in 28 days.That of trial group has a more notable expression increase.
2
Dept of Mechanical Engineering, National University of Singapore There was a significant difference compared with control group,
(Singapore) p < 0.05. Compared with sham operated group the trial and control
group have a highly significant difference, p < 0.01. Conclusion: The
Purpose: The Haptic Knob (HK) is a novel 2 degree of freedom results suggested that synapotophysin participated in neuron plastic-
portable upper limb robotic device with haptic visual feedback ity after ICH, but exercise training (cage-running) can accelerate the
used to train pronation-supination and hand opening-closing in expression of synapotophysin, thereby improve function recovery.
either arm. We conducted a pilot clinical trial from April 2008
to May 2009 to study the clinical effects on motor impairment
reduction, safety and acceptability of the HK for hand reha- 0430PP86
bilitation in 15 subjects with chronic poststroke hemiplegia in EFFECTS OF KINESIO TAPING FOR PARETIC
a single tertiary rehabilitation centre. Material and Methods: UPPER LIMB IN CHRONIC STROKE PATIENTS
Inclusion criteria included subjects with first-ever confirmed
stroke diagnosis who were at least 9 months poststroke, with Rong-Bin Hong1, Jeng-Feng Yang2, Yi-Ru Chen1, Da-Fang
upper extremity Fugl-Meyer assessment (FMA) scale (0–66) of Chan2, Willy Chou1, Chen-Yu Chou3, Lin-Yen Chang1
10–45, and shoulder-elbow motor power of 3-5/5. Exclusion cri- 1
Department of Physical Medicine and Rehabilitation, Chi Mei
teria included those with severe arm pain, arm spasticity, neglect Medical Center, Yong Kang Campus, 2Department of Physical
or medical contraindications to intensive training. The training Therapy, National Cheng Kung University and 3Department of
protocol consisted of 60 min of therapist and engineer-supervised Physical Medicine and Rehabilitation, Chi Mei Medical Center,
outpatient exercise on the HK 3 times per week for 6 weeks. In- Liou Ying Campus (Taiwan)
dependently scored outcome measures included the FMA score,
Motricity Index (MI), grip strength, Modified Ashworth Scale Purpose: The purpose of this study was to evaluate the effects of
scores for spasticity and pain using the Visual Analogue Scale Kinesio taping (KT) on motor recovery of paretic upper limb in the
(VAS) and Functional Test of the Hemiplegic Upper Extremity chronic stroke patients. Material and Methods: A pre-post design
(FTHUE) at week 0, 6 and 12. Results: Altogether, 15 subjects was used for the study. Three tests were conducted for assessing the
(mean age 55.5 years, 7 males, 8 females) with a mean duration motor functions of the paretic upper limb before and after KT applied
of 597.5 days poststroke were recruited. The mean FMA scores at and at 3 weeks follow-up. All subjects received regular rehabilita-
weeks 0, 6 and 12 were 32.5 (SD 10.5), 34.9 (SD 11.2) and 36.7 tion throughout the experiment. KT was applied to the upper trunk
(SD 10.6) respectively and the gains were significant at weeks 6 and shoulder of the subjects in addition to regular rehabilitation for
and 12 (p < 0.05, p < 0.001 respectively). Both proximal and distal 3 weeks between the first and the second tests. Then, the subjects
FMA improved significantly by 10.1% at 6 weeks with main- received only regular rehabilitation for 3 weeks between the second
tainence of gains at week 12. Mean affected hand grip strength and the third tests. For each test, the movement amplitudes of active
at weeks 0, 6, and 12 was 3.2kgf (SD2.7), 3.3 kgf (2.2) and 3.7 shoulder flexion and abduction, Fugl-Meyer Motor Assessment,
kgf (2.2), respectively and the gains from week 0-6 and 0–12 Wolf Motor Function Test, and Motor Activity Log were measured.
were significant (p < 0.001). FTHUE scores were not significantly Results: Ten chronic stroke patients with upper limb paresis were
improved from their baseline scores of 3.0 (SD 0.65). There was recruited. These patients were at least at Brunnstrom’s stage III and
no increase in upper limb spasticity or pain scores (baseline VAS were able to voluntarily move their arms to some extent. Our results
1.1) at weeks 6 or 12. No adverse events related to training were showed a trend of increase, but not statistically significant, in the
reported. 75% of subjects rated their training with the device as movement amplitude of shoulder flexion and abduction after applica-
good or excellent. Conclusion: Based on this pilot study, we tion of KT, compared to before application of KT. Fugl-Meyer Motor
conclude that the HK has potential as a novel robotic device for Assessment for upper limb, Wolf Motor Function Test (except the
reduction of motor impairment in chronic hemiplegia with little item of circle drawing), and Motor Activity Log were not significant
carryover to upper extremity functional skills. It also has a good changed across the three tests. The significant reduction in the time
safety and acceptability profile. Future larger controlled studies of circle drawing was mainly occurred at 3 weeks follow-up. Half
on long term clinical effects are needed. of our subjects reported their subjective feeling of easier to move

their arms while KT was applied. Conclusion: The effects of apply- tissue susceptible to the thermal fluctuation from thermal harm.
ing KT to improve motor functions were not significant according Purpose: 1) Realizing the mechanism for termination of the
to our objective measurements. However, the subjective report of pathological yawning. 2) Connecting the central modulation of
favoring KT from our subjects may be worth to consider using KT pain evoked from MTP and excessive yawning Material and
for other clinical applications to the stroke patients. Methods: Case 1: The frequency of yawning gradually decreased
within hours following the tracheostomy in a patient with locked-in
syndrome which is near the central location of yawning control:
0430PP87 presumably close to or within medullary respiratory and vaso-
IMPROVED MOTOR AND BALANCE FUNCTION motor centers. The premier emergence of yawning was seen in
a 15-week-old embryo. Frequency of yawning decreases with
BY THERMAL INTERVENTION ON MODERATELY brain maturation when the limbic system and the forebrain areas
TO SEVERELY PARETIC LOWER LIMB OF ACUTE are already connected. Larger total dead space of the respiratory
STROKE system in pediatric subjects would also make them more prone to
yawn. In addition, vagus nerve manipulation or stimulation might
Jia-Ching Chen1,2, Chung-Chao Liang1,3, Chun-Hsiang occur during the tracheostomy, which possibly had influence on
Lin1,2, Qi-Xing Zhang1, Yu-Chun Wei1, Yi-Win Huang1 the touching off or even cease of pathological yawning. Case 2:
1
Department of Rehabilitation Medicine, Buddhist Tzu Chi Gen- Excessive yawning developed whenever a 44-year-old woman was
eral Hospital, 2Department of Physical Therapy, Tzu Chi College performing self-myofascial-release in our physiotherapy room who
of Technology and 3Department of Medicine, Tzu Chi University has had severe muscle tightness in upper trapezius, levator scapu-
(Taiwan) lae, scalenes and the suboccipital extensors pain with subcutaneous
posterior cervical and thoracic trigger points for months. Niddam
Purpose: The effectiveness of Thermal Stimulation (TS) has et al. suggested that intervention of MTP partially involves su-
been demonstrated on motor function of upper limb; however, praspinal pain control through midbrain periaquaduct gray (PAG).
there is unknown for that in the lower limb in people with acute Besides, van der Plas et al. concluded the PAG involving in the
post-stroke. The present study aimed to examine whether TS, hypotensive pathway could be affected by the electrical stimula-
given during acute stroke, was more effective in facilitating motion of hypothalamic areas. Results: Three possible points of view
tor and balance function of the paretic lower limb than standard on the termination of the pathological yawning: 1) Reduction of
rehabilitation group without TS. Material and Methods: A total the dead space. 2) Vagus nerve stimulation. 3) Thermoregulation
of 36 patients, with a history of within one month after stroke influenced by hypothalamus. The relationship between MTP and
causing moderate to severe leg paresis (Brunnstrom stage ≤3 [Br excessive yawning. Central modulation of pain evoked from
stage, 0 to 6]), were randomly assigned to standard rehabilitation MTP might be connected to excessive yawning via spinothalamic
treatment and standard treatment in combination with TS (30 min tract, PAG and hypothalamus. Conclusion: Pathological yawning
daily for 6 weeks). Both groups received similar treatment duration terminated following tracheostomy possible results from certain
in one session. Thirty-three patients completed the experiment. factors. Pain associated with MTP might be connected to excessive
Outcome measurements consisted of Fugl-Meyer Assessment for yawning via the neural tract.
Lower Extremity (FMA-LE) motor control, Medical Research References:
Council scale for Lower Extremity muscle power (MRC-LE), the l. Cheng-Chiang Chang, Shin-Tsu Chang, Hsaio-Ying Chang, Kao-Chung
Modified Motor Assessment Scale (MMAS) for motor functions. Tsai. Amelioration of pathological yawning after tracheostomy in a patient
Balance was assessedusing the Postural Assessment Scale for with locked-in syndrome. Eur J Neurol 2008; 15: e66–e67.
Stroke Patients Trunk Control (PASS-TC) and Berg Balance Scale 2. Prasad H. Amelioration of pathological yawning after tracheostomy in
(BBS); Functional Ambulation Category (FAC) and gait speed for a patient with locked-in syndrome: a thermoregulatory approach. Eur J
walking ability and muscle tone by the Modified Ashworth Scale. Neurol 2008; 15: e114.
All measures were performed at baseline, the fourth and sixth 3. Cheng-Chiang Chang, Shin-Tsu Chang. Amelioration of pathological
week after intervention. Results: No significant differences were yawning after tracheostomy in a patient with locked-in syndrome: a ther-
found in the baseline measurements between two group patients. moregulatory approach–authors’ reply. Eur J Neurol 2008; 15: e115.
After TS intervention, the performance of FM-LE, MRC-LE and 4. Gallup AC, Gallup GG Jr. Medical implications of excessive yawning in
FAC were improved significantly at 6-week (p < 0.05). The altera- relation to thermoregulatory dysfunction. Eur J Neurol 2009; 16: e120.
tions in all motor functions, balance and FAC at TS group were 5. Cheng-Chiang Chang, Shin-Tsu Chang. Excessive yawning induced by
significantly greater than those of the control group at both 4 and stimulation of myofascial trigger point–case report . Eur J Neurol 2009;
6 weeks (p < 0.05), except for PASS-TC and gait speed. Interest- 16: e118–e119.
ingly, the higher percentage of independent walker at TS group
(88.2%) compared to the control group (56.3%) without TS after
6-week intervention (p = 0.06). Similar muscle tones were found
in both groups, and no adverse effect occurred. Conclusion: The 0430PP89
findings in this pilot study indicate that TS on the paretic lower TENSION PNEUMOCEPHALUS AFTER
limb is a feasible and effective treatment for the early-phase stroke HYPERBARIC OXYGEN THERAPY IN A PATIENT
patients with moderate to severe motor impairment.
WITH TRAUMATIC BRAIN INJURY
Lin-Chien Lee, Szu-Fu Chen, Fu-Kong Lieu
0430PP88 Cheng Hsin General Hospital (Taiwan)
ROLE OF PATHOLOGICAL YAWNING IN
Pneumocephalus is not uncommon in patients with skull bone
REHABILITATION fracture after head trauma. The presence of a cerebrospinal fluid
Cheng-Chiang Chang, Shin-Tsu Chang (CSF) shunting system causing a decrease in intracranial pres-
Tri-Service General Hospital, National Defense Medical Center sure and co-existed craniodural defect were postulated to be the
(Taiwan) pathogenesis. Tension pneumocephalus, causing a mass effect
and increased intracranial pressure, may lead to neurological
Background: Chang et al. described how pathological yawning was compromise, brain herniation and death if not treated emergently.
terminated following tracheostomy in a case of locked-in syndrome. We report a patient with traumatic brain injury (TBI) who had ten-
In response, Prasad stated a relationship between the disappearance sion pneumocephalus after hyperbaric oxygen therapy (HBOT).
of symptoms and selective brain cooling via the upper respiratory A 25-year-old male presented with left occipital bone fracture,
tract due to the cooling mechanism, which seems to prevent the brain subarachnoid and subdural hemorrhage after being hit by a car.

He had craniectomy with removal of hematoma the next day. CSF 0430PP91
diversion with a ventriculo-peritoneal shunt was created 4 months THE EFFECT OF COMBINED TRADITIONAL AND
later because of hydrocephalus, and subsequent cranioplasty was
also performed. Bilateral hemiplegia, communication disorder VIDEO EDUCATION OF SHOULDER EXERCISES
and dysphagia were complicated. Due to pneumocephalus and IN HEMIPLEGIC SHOULDERS AFTER ACUTE
subdural empyema, he underwent craniectomy again with follow- STROKE
ing cranioplasty 14 months after trauma. He received HBOT to
promote neurological recovery 15 months after trauma. Sudden Ya-Ping Pong, Cheng-Hao Tseng, Yu-Chi Huang
onset of consciousness disturbance and generalized tonic-clonic Chang Gung Memorial Hospital-Kaohsiung Medical Center
seizure were noted after decompression out of hyperbaric oxygen (Taiwan)
chamber. He also developed subcutaneous emphysema over left
face, periorbital area and eyelid. A computed tomography (CT) Purpose: To investigate the effect of the video education combined
scan of brain disclosed tension pneumocephalus over bilateral with traditional education for shoulder range of motion (ROM)
frontal regions with mass effect. Burr hole drainage to evacuate exercise in hemiplegic shoulder pain (HSP) and upper extremity
the intracranial air was performed emergently, and antiepileptic neurological recovery after acute stroke Material and Methods:
medications were administered. He underwent ligation of CSF We enrolled 48 hemiplegic acute stroke patients with hemeiplegic
shunt 8 days after the onset of tension pneumocephalus, and the shoulders admitted to the rehabilitation department of the Chang
follow-up brain CT showed evidence of resolution of intracranial Gung Memorial Hospital. The motor levels of all hemiplegic shoul-
air and mass effect. He was discharged home 2 weeks after the final ders were Brunnstrom motor recovery (BMR) stage I, II, III, or IV.
operation, and has remained asymptomatic for more than 2 years. Twenty five patients were placed in the control group (traditional
In our clinical practice, patients with central nervous system injury education only) and 23 patients were allocated to the experiment
such as traumatic brain injury or stroke tried HBOT as adjuvant group (the video education combined with traditional education).
treatment to facilitate neurological recovery. Unrepaired skull The traditional education included appropriate hemiplegic shoulder
base fracture with or without coexisting CSF diversion system positioning, transfer techniques and performing shoulder passive
should be evaluated before HBOT carefully to identify patients ROM exercise which were educated by nurses. All of patients and
with high risk of tension pneumocephalus. Repair of air entry site caregivers were asked to carry out passive shoulder ROM exercises
is suggested before HBOT. for 10 to 15 min every time and four times every day. In addition
to traditional nursing education, we arranged the video education
3 times in first week to educate appropriate shoulder positioning,
0430PP90 transferring techniques and the same ROM exercises for the experi-
ment group. The therapist rechecked the techniques of all exercise
STUDY ON THERAPEUTIC EFFECT OF after comleting the video education. Hemiplegic shoulder motor
HEAD ACUPUNCTURE COMBINED WITH function level (BMR), shoulder motion, sensation, spasticity, the
ACCELERATION TECHNIQUES ON STROKE presence and severity (VAS) of HSP were recorded by one therapist
PATIENTS USING THE SIAS APPRAISAL TABLE on admission and 1 week before discharge. The shoulder sonography
was performed with a 5–12 MHz linear-array transducer (t3000,
Yanli Xing, Qiang Tang, Tie Hua Wei Terason, USA) by the same physiatrist both on admission and 1
The second attached hospital of Heilongjiang University of Chinese week before discharge. We compared the physical (shoulder sensa-
Medicine (China) tion, spasticity, motor recovery, shoulder motion, presence and VAS
score of HSP) and sonographic findings before discharge between
Purpose: To study and analyze the validity of cluster needling the control and experiment groups. A statistical significance was
of scalp point combined with acceleration techniques on stroke defined as p < 0.05. Results: There were no significant differences in
patients. Material and Methods: Using the SIAS appraisal table the demographic, clinical characteristics, physical and sonographic
,adopt the method of comparison and observation of three treat- findings between two groups at admission. Before discharge, there
ment groups (cluster needling of scalp point combined with fa- were no significant differences in shoulder sensation, spasticity,
cilitation techniques group, facilitation techniques group, cluster presence and severity of HSP, shoulder motion, sonographic findings
needling of scalp point group) to assess impairment conditions at between two groups. However, the motor recovery of hemiplegic
stroke patients before and after treatment. Results: The conditions shoulders was significantly improved in the experimental group
of patients’ movement function, myodynamia, physical balance, (p < 0.05). Conclusion: The combined traditional and video educa-
ROM and pain had significant difference in the cluster needling tion of appropriate shoulder positioning, shoulder ROM exercises
of scalp point combined with facilitation techniques group and and transferring techniques can enhance shoulder neurological motor
other groups(p < 0.05); patients’ movement function had signifi- recovery in stroke patients with poor shoulder motor function when
cant difference in cluster needling of scalp point combined with compared with the traditional education only.
facilitation techniques group and other two groups (p < 0.05),there
was insignificant difference between facilitation techniques group
and cluster needling of scalp point group (p > 0.05). Conclusion:
This study shows that there is significant effect for the patients 0430PP92
of acupuncture and rehabilitation group for their joint pain THE CORRELATIONS BETWEEN PHYSICAL/
relief and joint activities. Research proves to cluster needling SONOGRAPHIC FINDINGS AND HEMIPLEGIC
of scalp point that can produce stimulation for cerebral cortex, SHOULDER PAIN IN STROKE
change corticocerebral cells’ excitability, correct suppressant
generalization, strengthen the coordination and compensatory Ya-Ping Pong, Yu-Kuang Chen, Yu-Chi Huang
for the corticocerebral domain, promote function restructuring, Chang Gung Memorial Hospital-Kaohsiung Medical Center
and improve the corresponding clinical disorders. While cluster (Taiwan)
needling of scalp point change method of traditional acupuncture
that important is development muscle strength, in the process of Purpose: To clarify the correlation between the physical/sono-
CongCi with Bobath therapy that can inhibit the paralysis of the graphic findings and hemiplegic shoulder pain (HSP) in both acute
body’s synkinesis and simultaneous reaction, promote the normal and chronic stages. Material and Methods: We enrolled 76 hemiple-
mode, prevent pervasive syndrome, expedite the brain function gic stroke patients admitted to the rehabilitation department of the
of recuperation , improve the quality of life. Acupuncture and Chang Gung Memorial Hospital. Motor function level (Brunnstrom
rehabilitation method can improve the cerebral apoplexy patients’ motor recovery stage; BMR), shoulder motion and sensation,
function and relieve their pain. spasticity, glenohumeral subluxation and the presence of HSP were

recorded by one therapist and shoulder sonography was performed Purpose: To investigate the effects of aerobic exercise on Liver
by the same physiatrist 1 week before discharge (acute stage) and 6 tissue and cytochrom P450 2E1 (CYP2E1) in rat with nonalcoholic
months after discharge(chronic stage). The shoulder sonography was fatty liver disease (NAFLD)induced by high fat diet. Methods:
performed with a 5–12 MHz linear-array transducer (t3000, Terason, The rats were randomly divided into normal group, model group
USA). The correlation between HSP and BMR stages, spasticity, and model + exercise group. Aerobic exercise intervention was
and glenohumeral subluxation of hemiplegic shoulder, abnormal applied on the model + exercise group for 4 weeks.Total choles-
sonographic findings were analyzed by Point-biserial correlation terol (TC), triglyceride (TG),liver pathological changes and liver
test. Pearson correlation coefficient test was used to analyze the cor- tissue CYP2E1 expression in each group. Results: After six weeks
relation between HSP and shoulder motion. A statistical significance lipid emulsion gavage, the level of body weight,TG and TC rised
was defined as p < 0.05. Results: Seventy-six patients completed all evidently, p < 0.05 the liver pathological changes indicated NAFLD
evaluations and sonography examinations at both acute and chronic model was produced successfully,the level of hepatic cytochrome
stage. At acute stage, significant correlations (all p < 0.05) were P450 2E1 rised evidently compared with control group, p < 0.05.
found between HSP and shoulder motor function level (r = –0.30), After four-week aerobic exercise, the exercise liver histopathologi-
shoulder motion limitation (flexion/ extension/abduction /external cal changes significantly, the level of TG, TC and cytochrome P450
rotation/internal rotation; r = –0.25 to –0.57), and sonographic 2E1 declined evidently, p < 0.05, and the liver pathological changes
subscapularis tendinopathy(r = 0.33). At chronic stage, we found improved significantly. Conclusion: Aerobic exercise not only
significant correlation between HSP and shoulder motor function improve hyperlipidemia, but also can reduce cyp2E1 expression,
level (r = –0.28), shoulder motion limitation (flexion/ extension/ prevent and therapy oxidative injury of liver tissue in NAFLD.
abduction /external rotation; r = –0.38 to –0.61), shoulder spasticity
(r = 0.28), abnormal sonographic findings (r = 0.45), sonographic
biceps or supraspinatus tendinopathy(r = 0.24, 0.25). Conclusion: 0430PP95
For both acute and chronic stroke patients, there are moderate to PERSPECTIVE OF CHINESE GRADUATE
high correlations between shoulder motion limitation and HSP; STUDENTS THE DEVELOPMENT OF THE
low to moderate correlation between poor shoulder motor function
level and HSP. In chronic stage, we also found moderate correlation JAPANESE RESPIRATORY REHABILITATION
between HSP and abnormal sonographic findings; low correlation Xiaoying Shang1, Kenji Kagechika2, Yasutaka Takagi3,
between HSP and shoulder spasticity. Therefore, we consider that Akira Shimasaki3
restricted shoulder motion may play the most important role for 1
Rehabilitation Hospital of Heilongjiang (China), 2Kanazawa Medi-
both acute and chronic stroke patients with HSP. Patients with poor
shoulder motor function should be cautious of HSP in both stages. cal University Hospital and 3Tonami General Hospital (Japan)
However, soft tissue injuries and spasticity of hemiplegic shoulders This article by the author in Japan, the rehabilitation and study the
are associated with HSP in only chronic stroke patients. experience of the Japanese breathing the concept of rehabilitation
of historical development and evaluation, treatment and clinical
practice on the Japanese In particular early from bed status as a
0430PP93 Japanese breathing rehabilitation of the view that the clinical ap-
SPONTANEOUS INTRAVENTRICULAR plication higher value in recent years has gradually been accepted.
HEMORRHAGE CAUSING PERSISTING ALEXIA The early from bed status is not only technology, but also against all
bed status of the patients for treatment. breathing rehabilitation The
WITHOUT AGRAPHIA: A CASE REPORT study will be the latest opinion early from the bed for surgery and
Wen Hui Hsueh, Nai-Hsin Meng diseases such as a result of the bed state patients, as far as possible
Department of Physical Medicine and Rehabilitation, China Medi- as early as possible to take place, the exercise and capacity improved
cal University Hospital (Taiwan) guidance. Breathing rehabilitation particularly early from bed state
perspective, not only in Japan, in my country is also very clinical
The syndrome of alexia without agraphia is caused by lesions involving value, is worthy of promoting rehabilitation treatment.
the temporooccipital region (occipital lobe and splenium of posterior
corpus callosum) in the territory of posterior cerebral artery of the
dominant cerebral hemisphere. Intraventricular hemorrhage without 0430PP96
extending into the brain parenchyma seldom causes prominent and THE EFFECTS OF STRENGTH TRAINING ON
persisting neurologic deficits. To the best of our knowledge, there has
been no report of intraventricular hemorrhage which induces persisting C-REACTIVE PROTEIN AND PLASMA FIBRINO
alexia without agraphia in medical literature. We report a 56-year-old GEN IN UNTRAINED YOUNG ADULT MEN
male dentist with spontaneous intraventricular hemorrhage which Heshmat Alah Parsian1, Khosro Abrahim2, Hojat Alah
manifested with right hemiparesis, decreased visual acuity, color ano- Nik-bakht3, Shahram Soheily4, Samaneh Parsian5,
mia and alexia without agraphia. He underwent endoscopic removal of
hematoma and extraventricular drainage about 2.5 hours after onset, Fataneh Khanali6
and his limbs weakness, color anomia and decreased visual acuity
1
Islamic Azad University (Azadshahr Branch), 2Shahid Beheshtiy
resolved within 2, 6, and 8 weeks post-onset respectively. However, his University, 3Islamic Azad University (researches & sciences branch),
reading ability improved slowly and still prevented him from resuming
4
Islamic Azad University (Shahriar Ghods branch), 5Islamic Azad
his clinical practice 6 months after onset of the intraventricular hemor- University and 6Tehran University (Islamic Republic of Iran)
rhage. We also discussed the probable pathophysiolgical mechanism
and the strategies of rehabilitation for this patient. Purpose: The purpose of this study was to investigate the effect of
strength training on C-reactive protein and plasma fibrinogen in un-
trained young adult men. Material and Methods: The subjects of this
0430PP94 research consisted of twenty-four healthy student men with mean age
(25 ± 1.19) years, weight (74.37 ± 5.38) kg, height (174.70 ± 5.51)
EFFECT OF 4-WEEK AEROBIC EXERCISE INTER cm which were divided randomly into two groups : strength group
VENTION ON RATS NON-ALCOHOLIC FATTY (n = 12) and control group (n = 12). The strength training was con-
LIVER AND LIVER CYTOCHROME P450 2E1 sisted of 12 weeks, 3 days per week in circuit pattern in 6 stations.
Each training session included three sets with (70, 80, 90%) intensity
Hongling Zhang, Yanli Shi of one maximum repetition (1RM) with (12, 10, 8) repetitions in
Department of Health Science and Nursing Wuhan Polytecnic every station, respectively.The blood samples were gathered in pre
University (China) and post of training. Hs-CRP and fibrinogen were measured with

ELISA kits and immunoturbidimetric assay. Data were analyzed by and two for hemiparesis. Nordic walking session was employed in
t-test ( ). Results: Results showed that strength training cause no 18 patients (75%). An 83-year-old woman after surgical therapy
significant decrease in C-reactive protein, fibrinogen, weight and of an aneurysm of aortic arch employed Nordic walking as a
body mass index (5.47, 5.12, 1.9, 3.57%, respectively), significant main exercise session. She could walk only 30 m with a T cane
decrease in body fat percent (12.28%) and no significant maximum when she arrived, and could not ride an ergometer because of the
oxygen consumption in untrained young adult men. Conclusion: malfunction of the artifitial joints in both knee. After 5weeks of
strength trainings have inverse effect on CRP and fibrinogen, so it Nordic walking program, a six-min-walk test with Nordic poles
can be used as predictors of coronary heart disease. was 162 m and that with T cane was 111 m. Walking with Nordic
poles resulted in better posture than that with T cane. Eight out of
eighteen continued Nordic walking after discharge, six continued
0430PP97 ergometry and four stopped exercise. All the sixteen patients
THE RELATIONSHIP BETWEEN THE QUALITY improved in exercise capacity after the program. Conclusion:
The Japanese style Nordic walking is a feasible and appropriate
OF LIFE AND THE AEROBIC CAPACITY program for cardiac rehabilitation. The patients in rehabilitation
OF THE PATIENTS ENTERING PHASE II program were easier to start walking sessions with Nordic Walk,
CARDIOPULMONARY REHABILITATION and the recovery of walking speed was earlier than usual. As Nor-
PROGRAM dic Walk demands 20% more oxygen uptake than that of walking
with the same speed, even a slow and deliberate Nordic walking
Yi-Chieh Chou1, Chen-Liang Chou1,2, Si-Huei Lee1, session results in an effective aerobic exercise.
Su-Ying Hung1, Shun-Ping Cheng3, Cheng-Ming Chiu4,
Ko-Lun Tsai1, Po-Chin Strong1
0430PP99
1
Department of Physical Medicine and Rehabilitation, Taipei Veterans
General Hospital, 2Department of Physical Medicine and Rehabilita- THE EFFECTS OF SWIMMING EXERCISE ON
tion, School of Medicine, National Yang-Ming University, 3Department THE NEUROTROPHIN-3 LEVELS IN SKELETAL
of Health at Lo-Sheng Sanatorium and 4Department of Physical Medi- MUSCLES OF DIABETIC RATS
cine and Rehabilitation, Far Eastern Memorial Hospital (Taiwan)
Zhongli Jiang, Hongwei Li, Feng Lin
Purpose: This cross-sectional study aimed to examine 1) the relation- Nanjing Medical University (China)
ships between patients’ aerobic fitness and general health perceptions,
and 2) the relationships between their functional aerobic impairment Purpose: The purpose of this study was to explore the effects of
and general health perceptions. Material and Methods: 105 patients swimming exercise on the levels of Neurotrophin-3 (NT-3) in
(99 male and 6 female adults) who underwent coronary artery by- skeletal muscles in streptozotocin-induced diabetic rats. Mate-
pass (CABG) surgery participated in this study. They completed a rial and Methods: Sixteen diabetic rats induced by streptozotocin
version of the World Health Organization Quality of Life brief form (STZ, 55mg/kg) were randomly divided into diabetic group with
(WHOQOL-BREF, short form) questionnaire and then underwent exercise for 8 weeks (A: n = 6), diabetic group with exercise for 4
maximum graded exercise tolerance testing to determine their aerobic weeks (B: n = 5) and diabetic control group without exercise (C:
fitness. We used Pearson’s and Spearman’s correlation analysis to n = 5). Twelve SD rats with euglycemia were randomly divided to
assess the associations between variables of the WHOQOL-BREF control group without exercise (D, n = 6) and control group with
questionnaire and patients’ aerobic fitness. Results: Pearson’s cor- exercise for 8 weeks (E, n = 6). The exercise rats were forced to
relation coefficient demonstrated a significant association between swim 60 min/day with 5 day/week. The levels of NT-3 in skeletal
the patients’ WHOQOL-BREF scores and peak VO2 in the physical muscle were measured by ELISA method. Results: The NT-3 levels
domain (p = 0.01, facets: energy, mobility and activity). It also showed of muscles were lower in group C than in groups with A, D and E
a significant association between the patients’ WHOQOL-BREF (p < 0.05). There were no statistical significance in the NT-3 levels
scores and FAI in the facets of energy (p = 0.014), and information of muscles between groups B and C (p = 0.051). The NT-3 levels
(p = 0.048). Conclusion: Our results indicated that impaired aerobic were a significant positive correlation with the CNCV at 8 weeks
fitness influenced many facets of the patients’ quality of life, especially (r = 0.405, n = 28, p < 0.05). Conclusion: The increase in NT-3 levels
in the physical domain. Thus, phase II cardiopulmonary rehabilitation of skeletal muscles induced by exercise could contribute partially
(CR) that focuses on improving the physical fitness of the patient is to the improvement of diabetic neuropathy.
essential to improve the quality of life in these patients. Besides, we
should also emphasize rehabilitation programs that focus on psycho-
logical support and environmental adaptation to further improve the 0430PP100
quality of life in patients underwent CABG surgery. REHABILITATION APPROACH AND ADL CHANGE
FOR THE PATIENTS WITH PRIMARY BRAIN
0430PP98 TUMOR
THE JAPANESE STYLE NORDIC WALK IN Akiyoshi Nagatomi1, Hiroaki Kimura1, Mitsuo Ochi2
CARDIAC REHABILITATION PROGRAM
1
Department of Rehabilitation Medicine, Hiroshima University
Hospital and 2Department of Orthopedics, Hiroshima University
Motohiro Kawauchi, Munemoto Endo, Keisuke Ueda Graduated School (Japan)
IMS Itabashi Rehabilitation Hospital (Japan)
Purpose: Operation and/or conservative therapy including chemo-
Purpose: To evaluate the feasibility of the Japanese style Nordic therapy and radiation therapy are performed for curing patients
Walk, a revision of European style Nordic Walking by the Japanese with primary brain tumors. These patients with brain tumor have
Nordic Walking Federation, in Cardiac Rehabilitation Program. many problems about functional impairments and Activities of
Material and Methods: Twenty-four cardiac rehabilitation patients Daily Living (ADL) during and after those therapy courses so that
who admitted our hospital between June 2009 and December 2009, rehabilitation therapy is required and performed. The aim of this
and participated in the Japanese style Nordic walk program, were study was to evaluate and follow these patients’ ADL change dur-
enrolled in this study. The patient’s ages were between 62 and 93 ing rehabilitation courses. Material and Methods: From January
(mean 76), and there were ten males and 14 females. Original 2001 to December 2006, sixty-nine patients with primary brain
diseases were ischemic heart disease (6), aortic aneurysm (14) tumor were undergone rehabilitation including physical, occupa-
and valvular heart disease (4). Results: Six patients (25%) were tional and speech therapy during operation and/or conservative
not able to do Nordic walking, four for too heavy heart failure therapy courses (40 men and 29 women, mean age 49.3 ± 19.9

years) in our hospital. We evaluated patients’ histological and to be the highest in all groups (Group C: 21.2 ± 1.9 cells/HFP).
clinical diagnosis, length of hospital stay from the date of reha- However, there were no significant difference between EPCs pro-
bilitation start to that of discharge. To measure ADL change, we liferation and apoptosis founded in the groups. Conclusion: Our
followed patient’s Barthel Index (BI) during rehabilitation course. results indicate that physiological ischemic exercise training could
Results: Forty-seven patients were diagnosed as brain tumor for enhance the migration capacity of EPCs, but had no significant
the first time and were undergone operation therapy. Underlying effects on proliferation and apoptosis of them.
pathology in those patients was glioma (n = 26), meningioma
(n = 6), neurinoma (n = 4), and others (n = 11). Mean length of
Rehabilitation therapy was 69.1 days after operation. During this 0430PP102
period, mean BI score of these patients changed from 47.8 before EXPERIMENT TREATMENT OF VIRAL
rehabilitation therapy to 72.5 after rehabilitation. After discharge,
29 patients went back home and 17 patients went to other hospi- MYOCARDITIS INDUCED BY COXSACKIE VIRUS
tal or nursing home. Range of Motion (ROM) exercise, muscle B3 WITH ULTRASHORT WAVE IN MICE
training, gait exercise and ADL exercise were mainly prescribed. Yan-Li Shi1, Hong-Ling Zhang1, Cui-E Li2
Twelve patients were diagnosed as brain tumor for the first time but
undergone conservative treatment. Underlying pathology in those
1
Department of Health Science and Nursing, Wuhan Polytech-
patients was glioma (n = 4), malignant lymphoma (n = 3), benign nic University and 2The People’s Hospital, Wuhan University
tumor (n = 2) and others (n = 3). Mean length of Rehabilitation (China)
therapy was 56.4 days. Mean BI score of these patients changed Objective: To investigate the effects of ultrashort wave in viral
from 36.5 before rehabilitation therapy to 46.3 after rehabilita- myocarditis of mices induced by Coxsackie virus B3. Design:
tion. After discharge, 4 patients went back home, 5 patients went Randomized controlled animal experiment. Setting: Laboratory
to other hospital or nursing home and 3 patients were dead. Ten of rehabilitation therapy, Wuhan Polytechnic University; Basic
patients were diagnosed as recurrent brain tumor. Five of them Laboratory, Medical College Wuhan University. Materials:
were undergone operation and most of them were diagnosed as Twenty -three healthy male Balb/c mices, ‘aged 4–6 weeks were
glioma. Mean length of rehabilitation therapy was 60 days after involved and randomized into 3 groups: control group (n = 7), vi-
operation. Mean BI score of these five patients changed from 58 ruses + ultrashort wave group (n = 8) and viruses group (n = 8). The
to 60. Other five patients were treated conservatively. Mean length mice of three groups were raised in the same condition. Methods:
of rehabilitation therapy was 109 days after operation. Mean BI Control group: Micess was not intervene. Viruses + Ultrashort
score of these five patients changed from 40 to 51. Among recur- wave treatment group and virus infection were given the CVB3
rent cases, exercise and activities were performed for about 40 virus l00TCID50 intraperitoneal injection of 0.1 ml. The mices of
min per day. ROM exercise, sitting exercise and best supportive ultrashort wave were placed in ultra-high frequency electric field
cares were mainly prescribed. Conclusion: Among patients di- 24×12 cm plastic baskets, the electrodes 24 × 15 cm, polar distance
agnosed as brain tumor for the first time, operation may improve 18 cm, no temperature 50 mA, 2 times a day (8 am, 4 pm and 1
most patients’ ADL and the aim of rehabilitation exercise may times), every 8 min, a total of 6 days of treatment. 7 days later the
be to improve functional impairment and ADL. Among patients mice were killed to detect. Main outcome measures: Determina-
with recurrent tumors, rehabilitation exercise may play a role to tion of cardiac LDH, CK levels. Observed under light microscope
maintain their ADL. morphological changes of myocardium. Results: Ultrashort wave
therapy group and the virus group between the control group were
significantly different in the levels of myocardial LDH and CK,
0430PP101 the difference was significant (p < 0.01). The release of LDH and
THE INFLUENCE ON MIGRATION, PROLIFER CK of myocardium in Ultrashort wave treatment group declined
ATION AND APOPTOSIS OF ENDOTHELIAL evidently than virus group (p < 0.05). Under light microscope, the
control group showed normal myocardial cells; ultrashort wave
PROGENITOR CELLS BY PHYSIOLOGICAL
treatment group shows a little of myocardial inflammatory cell
ISCHEMIC EXERCISE TRAINING infiltration; mononuclear cell infiltration and necrosis developed
Chengjian Yang1, Chunxiao Wan1,2, Jianan Li2 in all the survived mices of viruses group. Conclusion: Ultrashort
1
Wuxi No.2 Hospital Affiliated with Nanjing Medical University wave therapy could improvethe conditions of viral myocarditis
induced by CVB3.
and 2Nanjing Medical University (China)
Purpose: The aim of this study was to investigate the migration,
0430PP103
proliferation and apoptosis of endothelial progenitor cells (EPCs)
in response to physiological ischemic exercise training in rab- POST-EXERCISE ANKLE-BRACHIAL INDEX AND
bits with myocardial ischemia. Material and Methods: Eighteen ENDOTHELIAL FUNCTION IN POSTMENOPAUSAL
male adult New Zealand rabbits were randomly divided into FEMALES
three groups (six rabbits per group): Group A was a sham oper-
ated; Group B had the myocardial ischemia (MI); while Group C Shinji Sato1, Shingo Otsuki1, Shiro Tanaka1, Ryuji
received the physiological ischemic exercise training in condition Nohara2
of MI. Physiological ischemic exercise was induced by electrical 1
Osaka Sangyo University, Department of Sport and Health Science
stimulation (40% maximum current strength, 1 ms, 40 Hz) for and 2Kitano Hospital Heart Center (Japan)
4 min twice a day, 5 days a week, for 4 weeks. Pathological MI
was induced by left ventricular branch intermittent occlusion for Purpose: We investigated the alteration in post-exercise ankle-
2 min, twice a day, also for 4 weeks. 20 ml blood was drawn from brachial index (ABI) and endothelial function in postmenopausal
ear central artery just at the end of the experiments for all groups. females. Material and Methods: In 15 postmenopausal females
Endothelial progenitor cells (EPCs) were calculated and identified (mean age: 69 years), the ABI was measured at rest and immediately
by double-positive staining with 1,1’- dioctadecyl- 3,3,3’,3’-te- post exercise. Endothelial function was assessed by measuring flow-
tramethylindocarbocyanine-labeled Ac-LDL(Dil-Ac-LDL) and mediated vasodilation (FMD) in the brachial artery using ultrasound
Ulex europaeus agglutinin-I (UEA-1). Migration was detected imaging. Results: There was a poor correlation between FMD and
by a modified Boyden chamber assay. Proliferation was analyzed ABI at rest. However, good correlation was observed between FMD
by MTT, and EPCs apoptosis was evaluated by flow cytometric and post-exercise ABI (r = 0.70, p = 0.04). Conclusion: A reduction
analysis. Results: EPCs were characterized by Dil-Ac-LDL and of post-exercise ABI over baseline readings are associated with
UEA-1 double staining. Migration capacity in Group C was found decreased FMD.

0430PP104 when they return to the clinic. Besides, all patients underwent routine
INSPIRATORY MUSCLE TRAINING IS EFFECTIVE cardiac rehabilitation after the surgery. Results: 66.7% of the patients
in the experimental group were relatively higher educated with above
IN PATIENTS WITH BRONCHIECTASIS: A high school degree and no patient in the control group were educated
PROSPECTIVE RANDOMIZED CONTROLLED above high school. The results show the quality of life was improved
STUDY in both experimental and control groups (p = 0.01). The anxiety level
was higher in both groups post-CABG when compare to before the
Mei-Yun Liaw1, Meng-Chih Lin2,3,4,5, Yu-Chin Tsai3, Kuo- surgery. The trait anxiety level was higher in the experimental group
Tung Huang, Pei-Wen Chang42, Yu-Hsiu Chung2,3, Yi-Hsi after the intervention (p = 0.08). Post hoc interviews was conducted to
Wang2,3 clarify the rationales of this result. Conclusion: Although the anxiety
1
Department of Physical Medicine and Rehabilitation, Chang level did not decrease as time pass by in both groups when compare
Gung Memorial Hospital-Kaohsiung Medical Center, 2Division of to before the surgery. The participants stated that the training program
Pulmonary and Critical Care Medicine, Department of Internal did help them reduced their anxiety level and improve their coping
Medicine, Chang Gung Memorial Hospital, 3Department of Respi- ability according to the post hoc interviews.
ratory Therapy, Chang Gung Memorial Hospital-Kaohsiung Medi-
cal Center, 4Department of Respiratory Care, Pulmonary Disease 0430PP106
Research Center, Chang Gung Institute of Technology, (Taiwan),
5
Department of Physical Medicine and Rehabilitation, Xiamen PREDICTING MAXIMUM HEART RATE
Chang Gung Hospital (China) EQUATION AMONG PATIENTS WITH RECENT
MYOCARDIAL INFARCTION
Purpose: This study aimed to investigate the efficacy and feasibility
of home-based IMT in patients with bronchiectasis. Material and Tung-Liang Lin1, Yan-Wen Chen2, Sen-Wei Tsai1
Methods: A prospective, single-blind, randomized-controlled study 1
Department of Physical Medicine and Rehabilitation, Taichung
was conducted in the outpatient clinic of a tertiary care medical center. Veterans General Hospital and 2 Department of Physical Therapy,
Twenty-six patients with bronchiectasis were randomly divided into the Taichung Veterans General Hospital (Taiwan)
IMT or control group. In the IMT group (n = 13), the training program
started with an intensity of 30% maximal inspiratory pressure (MIP), Purpose: The maximal heart rate prediction equation for post-myocar-
which was increased by 2 cm H2O each week, for 30 min daily, five dial infarction in clinical cardiac rehabilitation is not valid. Material
days a week for 8 weeks under supervision and monthly monitoring. and Methods: Design: Prospective study in post myocardial infarc-
The control group (n = 13) did not receive IMT but the same measure- tion cardiac rehabilitation programs. Setting: Rehabilitation center
ments were taken, which included spirometry, resting oxyhemoglobin outpatient clinics. Subjects: Patients with recent myocardial infarction
saturation by pulse oximetry (SpO2), lowest SpO2 and Borg’s scale who completed cardiopulmonary exercise tests. Seventy-three subjects
evaluation during six-min walking test, six-minute walking distance were recruited from cardiac rehabilitation programs. Intervention:
(6MWD), six-minute walking work (6MWORK), MIP, maximal ex- Cardiopulmonary exercise test. Main measurements: The maximal
piratory pressure (MEP), and St George’s respiratory questionnaire. heart rate during exercise test. Results: In final, 51 subjects (45 males)
Results: There were statistically significant improvements in MIP, completed cardiopulmonary exercise test. There were no differences
MEP, 6MWD, 6MWORK and the symptom scores of SGRQ after the of VO2max (p = 0.19) and MET level (p = 0.2) between groups. There
8-week IMT, and significant difference of symptom, activity and total is the tendency that HRmax decreased when age is increased. The dif-
scores of SGRQ within the control group. Borg scale in IMT group ference of HRmax was noted between young (age 31–60) groups and
was significant improved as compared to that of control group. There old (61–90) groups (p = 0.000). In each age group, the differences
were significant difference in FEV1 (% predicted), FEV1/ FVC (%), were all significant between equation (220 – age) predicted and actual
MMEF (%) between groups at baseline data and at end of study and measured HRmax. A new estimated equation of (170 –0.9 x age) was
there was no difference in heath-related quality of life between both obtained from the linear regression analysis of HRmax versus age
groups. Conclusion: An eight-week home-based inspiratory muscle (coefficient r is 0.6). The effect of beta-blocker in HRmax showed
training supports that IMT is effective in improving respiratory muscle there is no difference (p = 0.4) between groups with or without beta-
strength, walking ability in patients with bronchiectasis. blocker. Conclusion: The HRmax prediction equation (220 – age) is
not suitable for clinical use in post MI cardiac rehabilitation exercise
prescription, and HRmax = 170 – 0.9 x age is a valid equation for post
0430PP105 MI patients. Beta-blocker did not have influence in HRmax.
THE EFFECTS OF PSYCHOLOGICAL, COGNITIVE-
BEHAVIORAL AND PATIENT EDUCATION 0430PP107
INTERVENTIONS ON RECOVERY FROM POST-
EFFECTS OF EXERCISE TRAINING ON
CORONARY ARTERY BYPASS GRAFT SUGERY
PERIPHERAL CIRCULATION IN PATIENTS
Willy Chou1, Heng-Hsin Tung2, Cheng-Hsin Lin3, Tou WITH PERIPHERAL ARTERIAL DISEASE: A
Isabel Tou1, Ching-Ching Wang1, Shu-Yu Yang1, Chen-Yu SYSTEMATIC REVIEW AND META-ANALYSIS
Chou1
1
Department of Physical Medicine and Rehabilitation, Chi Mei Wan-Ju Chao1, Ying-Tai Wu1,2, Cian-Ci Liou1
Medical Center, 2Graduate Institute and School of Nursing, National
1
Taipei College of Nursing and 3Department of Cardiovascular Medicine, National Taiwan University and 2Department of Physical
Surgery, Chi Mei Medical Center (Taiwan) Medicine and Rehabilitation, National Taiwan University Hospital
(Taiwan)
Purpose: To evaluate whether post-CABG patients who are provided
information and emotional support to help them cope with the medical Purpose: Exercise therapy, mainly aerobic training, has been proved
crisis do better than patients who receive only routine care. Material to be effective in improving the walking capability in patients with
and Methods: A total of thirteen post-CABG patients were enrolled peripheral arterial disease (PAD). Resistance exercise has been intro-
in this study. There are six in the experimental group and seven in the duced and used in individuals with cardiovascular diseases, including
control group. The experimental group received adaptation training PAD in recent years. However, the effect of exercise on peripheral
program. The program consist of eight sections, which lasted approxi- circulation was inconclusive. The purpose of this study was to re-
mately 90 min per section, and each section will be held once a week. view the evidence of aerobic and resistance training on parameter of
Thus, the program will last for a total of two month. Post hoc interviews peripheral circulation and make meta-analysis in patients with PAD.
were conducted in the experimental groups about 15 min in person Material and Methods: A systematic review and meta-analysis were

conducted, after searching for randomized controlled trials (RCT) of alone increased 6-minute walking distance but had no additional
comparing supervised exercise therapy with usual medicine regimens effects on heart function, exercise capacity, or quality of life than
between 1989 and 2009. Main outcome measurements included aerobic training only in patients with chronic heart failure.
indices of peripheral circulation. Data were analyzed by Review
Manager (RevMan) Version 5.0 (The Nordic Cochrane Centre, The
Cochrane Collaboration, Copenhagen 2008). Results: Eleven articles 0430PP109
published were included, while one article investigated the effects OVERWEIGHT AFFECT LUNG-TO-HEART RATIO
of aerobic and resistance training respectively comparing with the IN ASYMPTOMATIC PHYSICAL INACTIVE
control group. It made 9 studies in aerobic exercise (n = 291) and 3 POSTMENOPAUSAL WOMEN
studies in resistance exercise (n = 97). In most studies, participants
were older adults and the exercise programs ranged from 6 weeks Chen-Lin Chien1, Ying-Tai Wu1, Pan-Chyr Yang2,3,4, Wei-
to 12 months with the majority of 3 months or 6 months. Aerobic Shiung Yang2,3,4, Yen-Wen Wu2,3,6, Hui-Min Su5
training significantly improved maximal hyperemic calf blood flow 1
by 2.83 ml/100ml/min (95% CI 0.18 to 5.49), but not the resting or Medicine, National Taiwan University, 2Department of Internal
post-exercise ABI. No beneficial effects on limb blood flow or ABI at Medicine, National Taiwan University Hospital, 3College of Medi-
rest or post-exercise were found after resistance training. Conclusion: cine, National Taiwan University, 4Graduate Institute of Clinical
Aerobic exercise training increased maximal hyperemic calf blood
Medicine, and Department of Medicine, National Taiwan Univer-
flow in PAD patients. More RCTs are needed to provide evidence of
effects on peripheral circulation, especially the resistance training. sity, 5Department of Physiology, College of Medicine, National
Taiwan University, 6Department of Nuclear Medicine, National
Taiwan University Hospital (Taiwan)
0430PP108
Purpose: The incidence of coronary artery disease (CAD) in women
EFFECTS OF RESISTANCE TRAINING ON HEART increases dramatically after menopause and becomes the major cause
FUNCTION, EXERCISE CAPACITY, AND QUALITY of mortality among postmenopausal women. Evidence demonstrated
OF LIFE IN PEOPLE WITH HEART FAILURE: A physical inactivity not only associated with central obesity but also
hypertension, diabetes and dyslipidemia, all of which increased the
SYSTEMATIC REVIEW AND META-ANALYSIS risk of CAD. However, the change of myocardial perfusion and cardiac
Chueh-Lung Hwang1, Chen-Lin Chien1, Ying-Tai Wu1,2 function in physical inactive postmenopausal women was unknown.
1
School and Graduate Institute of Physical Therapy, College of This study was designed to investigate the impact of physical inactivity
Medicine, National Taiwan University and 2Department of Physical in postmenopausal women with normal weight. In addition, the effect
Medicine and Rehabilitation, National Taiwan University Hospital of overweight in physical inactive postmenopausal women was exam-
(Taiwan) ined. Methods: A total of 60 postmenopausal women with no angina
symptoms or clinical history suggesting of CAD were recruited. The
Purpose: The major symptoms in patients with chronic heart failure participants were considered as physical active if they have regular
(CHF) are easily dyspnea, fatigue, exercise intolerance, or functional physical activity, performing moderate-intensity aerobic physical
limitations that all account for poor quality of life. Resistance train- activity for a minimum of 30 min five days or vigorous activity for a
ing could improve muscle strength but the effects on other outcomes minimum of 20 min three days weekly according to the latest update
remain controversial. The purpose of this study was to perform a physical activity recommendation by American Heart Association and
meta-analysis to systemically examine the effects of resistance train- American College of Sports Medicine in 2007. Normal weight was
ing with or without aerobic training compared with aerobic training defined if body mass index (BMI) between 18.5~23.9, while BMI
or non-training on heart function, exercise capacity, and quality of ≥24 was considered as overweight. Subjects who were physical active
life in people with CHF. Material and Methods: The randomized but overweight were excluded because of the small sample size. The
controlled trials were searched mainly from electronic databases recruiting subjects were divided into groups of: physical inactive over-
with PubMed, MEDDLINE, EMBASE, Chinese Electronic Periodi- weight (n = 26, 58.5 yrs), physical inactive with normal weight (n = 13,
cal Service (CEPS), CINAHL, and Cochrane Library Register of 57.2 years), and physical active with normal weight (n = 15, 60.9 yrs).
Controlled Trials. The keywords were used in our searches as the All postmenopausal volunteers were with low Framingham risk (mean
following: heart failure, heart dysfunction, ventricular dysfunction, 2.1 ± 1.5%). Clinical characteristics were collected, cardiopulmonary
resistance training, strength exercise, strength training, weight- function test, and ECG-gated 201Tl SPECT using 8 frames per cardiac
lifting, and weight training. Included studies consisted of comparing cycle at rest and post-stress were performed. Group comparisons by
resistance training with non-training or resistance combined aerobic t test, Chi-square tests or Fisher exact measures for continuous or
training with aerobic training in adult patients with CHF. The effect categorical variables were performed. A p value < 0.05 was considered
size for each outcome was calculated by weighted mean difference statistically significant. Results: Clinical characteristics and results of
(WMD) or standardized mean difference (SMD) and 95% confidence cardiopulmonary function did not differ in either group comparisons.
interval (CI). A Chi-square heterogeneity test was used, a random The active women with normal weight had lower resting HR (67.2 ± 8.9
effect model adopted in case of significant heterogeneity or else a vs 75.5 ± 7.8 bpm, p < 0.05) and higher level of exercise capacity than
fixed effect model applied. Results: Eight randomized controlled inactive women. The overweight inactive women exhibited signifi-
trials with 241 participants were included. Most participants were cantly lower level of exercise capacity and higher lung-to-heart ratio
male with mean age of 58-65 years and New York Heart Associa- (the ratio between lung uptake and myocardial uptake, representing
tion Class I to III. The length of training ranged from 2 to 6 months the pulmonary wedge-pressure, and an index of severe and extensive
with most programs consisting of three times a week, 2 sets of 8–12 coronary heart disease) at rest (0.41 ± 0.05 vs 0.35 ± 0.05, p < 0.05) and
repetitions for 5–6 exercises including large muscle groups of upper post-stress (0.36 ± 0.06 vs 0.31 ± 0.04, p < 0.05) than normal weight
limbs, trunk and lower limbs at the moderate intensity or intensity of women. Abnormal myocardial perfusion was noted in 4 (27%) of
50-75% of 1 repetition maximum. Resistance training significantly the physical active with normal weight group, 5 (38%) in physical
increased 6-minute walking distance by 51.7 m (WMD, 95% CI inactive with normal weight group, and 12 (46%) in physical inactive
18.7 to 84.7, p < 0.05) but not peak VO2 (WMD 1.4, 95% CI –0.3 overweight group. Conclusion: A trend of abnormal SPECT-based
to 3.1). Combined resistance with aerobic training showed similar myocardial perfusion and impaired cardiac function were noted in
improvement in peak VO2 (WMD –0.7, 95% CI –2.3 to 1.0), left physical inactive and overweight postmenopausal women despite
ventricular ejection fraction (WMD –0.5, 95% CI –4.3 to 3.3) or the they were asymptomatic and with low Framingham risk. Overweight
score on Minnesota Living with Heart failure Questionnaire (WMD affects lung-to-heart ratio and might further impair cardiac outcome
–0.9, 95% CI –5.4 to 3.7) as aerobic training only. Conclusion: Re- in physical inactive postmenopausal women. Cardiovascular health
sistance training alone or in combination with aerobic training was in postmenopausal women should be addressed especially those who
considered safe in chronic heart failure patients. Resistance training are inactive and overweight.

0430PP110 he discharged in tracheostomy state. Fourteen months after the initial

EFFECTS OF TRADITIONAL CHINESE MEDICAL surgery (at his third admission), the concerns were resolved, and the
patient was sealed off. As he was able to maintain sufficient ventila-
EXERCISE PRESCRIPTION ON QUALITY OF LIFE tion without ventilatory support, he was weaned off completely. At
IN PATIENTS WITH COPD out-patient follow-up, approximately two years after initial surgery,
Wen Zhang, Wenhua Chen pulmonary improvement was observed. VC improved to 1740 ml
(53.3% of predictive value) and PCF improved to 290 l/min. Other
Rehabilitation Department of Shanghai First People’s Hospital pulmonary complications were not noticed. Conclusion: By applying
(China) NIPPV to a BPP patient, in need of ventilatory support, the duration
Purpose: To investigate the effects of traditional Chinese medical of IPPV was minimized, reducing its disadvantages, and the transition
exercise prescription on quality of life in Patients with COPD. Mate- to ventilation weaning was facilitated.
rial and Methods: Fifty-six patients with stable moderate COPD were
randomly divided into control group (CG) and traditional Chinese 0430PP112
medicine group (TG). Specific traditional Chinese medical exercise
prescription was written to the patients in TG groups individually. IMPROVEMENT OF CARDIORESPIRATORY
The TG groups took part in two months of intensive training course CAPACITY FOR PATIENTS WITH SEVERE HEART
at home under the guidance of one doctor. Results: 6MWD in TG FAILURE AFTER LVAS IMPLANTATION
group increased from 337.68 ± 59.18 to 386.14 ± 76.71 meters while
the Borg scales dropped from 3.14 ± 1.94 to 2.32 ± 1.25. SGRQ scores Shigeru Makita, Ryusei Uchida
also showed statistical significant difference. All these evaluations Department of Cardiac Rehabilitation,Saitama International Medi-
showed us some favorable efficiency in TG group compared to the CG cal Center, Saitama Medical University (Japan)
group. Conclusion: Traditional Chinese medical Training Prescription
can improve the exercise tolerance and decrease dyspnea in COPD Purpose: Cardiac rehabilitation for patients who received LVAS (left
patients in stable stage. It also can improve the quality of life. ventricular assist system) is important because those patients have
extreme low level exercise capacity due to severe heart failure. The
purpose of this study is to evaluate progress of cardiorespiratory ca-
0430PP111 pacity for LVAS patients. Material and Methods: 14 (39.0 ± ischemic
NONINVASIVE RESPIRATORY MANAGEMENT cardiomyopathy 11/1/2, LVEF 20.5 ± 8.1% ) end-stage severe heart
failure patients who received LVAS (Toyobo Ltd. Japan) participated
OF THE PATIENT WITH BILATERAL PHRENIC in exercise training program using cycle ergometer at the intensity of
NERVE PALSY – A CASE REPORT AT (anaerobic threshold : 68.5 ± 11.1 % of peak VO2) level. Endurance
Seung-Ho Choi, Seong Woong Kang, Jae Ho Moon, Won- exercise training was carried out 3–5 times weekly for 30 min. Before
the training (A) and 1 month (B) and 3 months (C) after the beginning
Ah Choi, Soon Kyu Lee of exercise training, symptom-limited cardiopulmonary exercise test-
Yonsei University College of Medicine (Republic of Korea) ing (CPX) were done in order to evaluate peakVO2, peak watt and AT.
Introduction: Bilateral phrenic nerve palsy (BPP) is an extremely During CPX capillary blood was taken for the measurement of blood
rare but serious complication that occurs after open cardiac surgeries, lactate concentration every one minute. Results: Peak VO2 (12.2 ± 2.8
leading to respiratory failure or cardiopulmonary arrest. Patients with (A), 14.3 ± 3.3 (B), 15.3 ± 3.5 (C) ml/kg/min; p = 0.044 ANOVA) and
BPP must rely on ventilatory support until spontaneous recovery of peak workload (53.4 ± 10.9 (A), 69.71 ± 15.2 (B), 76.9 ± 17.1 (C)
their respiratory function. Although noninvasive intermittent posi- watt; p = 0.0004) increased significantly during training period. The
tive pressure ventilation (NIPPV) has been known to be an effective changes of blood lactate concentration between rest and exercise at
management method for BPP, it has not yet been attempted in Korea. the intensity of 40 watt showed significantly decrease (0.9 ± 0.8 (A),
Case: A 76-year-old male had a history of elective aortic valve re- 0.4 ± 0.4 (B), 0.3 ± 0.3 (C) mmol/l; p = 0.022). The improvement of
placement and thymic resection under hypothermic cardiopulmonary peak VO2 between A and B was 17.5% and between B and C was
bypass. Despite otherwise unremarkable postoperative recovery, 7.6%, respectively. Conclusion: The improvement of exercise capac-
the patient received tracheostomy after several times of extubation ity of LVAS patients is detected by long-term aerobic exercise training.
failure, and was in ventilator dependent state. A chest radiograph These findings suggest that peripheral skeletal muscle metabolism can
and electro-diagnostic study of the phrenic nerve confirmed the ameliorate though cardiac function of these LVAS patients shows no
diagnosis of bilateral phrenic nerve palsy. Invasive intermittent significant increase in 3 months after LVAS implantation.
positive pressure ventilation (IPPV) was applied in the intensive care
unit. Approximately six months following injury (at first admission 0430PP113
to our hospital), he showed generalized muscular weakness (fair to
good grade of muscle power on the manual muscle test) as a result TRANSPOSING OTOLISHS FROM THE ANTERIOR
of prolonged treatment in the intensive care unit, and was in trache- CANAL TO THE POSTERIOR CANAL IN
ostomy state and had an indwelling Levin tube. Arterial blood gas BENIGN PAROXYSMAL POSITIONAL VERTIGO
analysis (ABGA) results showed hypercapnia (PaCO2 = 54.2 mmHg),
SYNDROME – 2 CASES REPORT
and desaturation (minimal O2 saturation = 93%) and hyperventila-
tion (respiratory rate = 29/min) was noted on gas exchange analysis Xin-Xian Lee1, Pei-Chen Sun2
(GEA). Pulmonary assessment such as vital capacity (VC) and peak 1
Cender General hospital and 2Dacun Junior High School (Taiwan)
cough flow (PCF) was not available due to mechanical ventilatory
support. On full-inspiratory chest radiograph both hemidiaphragms It is generally recognized that benign paroxysmal positional vertigo
were elevated. Extensive pulmonary rehabilitation including NIPPV (BPPV) syndromes result from the otoliths deposited in semicircular
was performed. General condition improved and he was transferred canals (canalith) or attached to cupulae (cupulolith). The posterior
to general ward, where he received comprehensive rehabilitation. canal BPPV is by far the most common and can be easily treated
Approximately nine months after injury (at second admission), he with ipsilateral Epley’s maneuver.However, we found 2 patients with
showed improvement of general condition, and used NIPPV only ipsilateral anterior canal-BPPV which are similar to the contralateral
during night time. On pulmonary function evaluation, VC was 1000 posterior canal-BPPV on presentation but poorly responded to con-
ml (26.6% of predictive value) and PCF was 210 l/min. The follow- tralateral Epley’s maneuver. Fortunately, the otoliths in the ipsilateral
up chest radiograph showed remarkable improvement of initially anterior canal can be transposed to the ipsilateral posterior canal in
elevated hemidiaphragms and ABGA and GEA results were within ipsilateral hyper-extended head hanging position. After the transpo-
normal range. He could have been sealed off, but he and his family sition, the patients were successfully treated with ipsilateral Epley’s
refused, as they were concerned about possible complications, and maneuver quickly and easily.

Poster Presentations – May 1, 2010 123
Poster presentations (May 1, 2010)
0501PP1 training (p < 0.01). 2) Statistically significant improvements were

RARELY RECURRENT CEREBELLAR observed only in 6mWT (p < 0.05) in control period after 2 weeks
training. 3) Statistically significant differences were shown in all
HEMORRHAGE IN AN UNUSUAL PERIOD: A CASE parameters when comparing the degree of changes of parameters
REPORT between the experimental and control period during the respective
Yung-Tsan Wu, Ming-Fu Hsieh, Heng-Yi Chu, Tsung- 2 weeks period (p < 0.05 in MAS, p < 0.01 in the rest parameters).
Conclusion: we think the sliding rehabilitation machine can be a
Ying Li, Shin-Tsu Chang useful tool for the improvement of balance and gait ability in chronic
Department of Physical Medicine and Rehabilitation, Tri-Service hemiparetic patients.
Purpose: To report a rare case of cerebellar hemorrhage (CH) that 0501PP3
recurred in other hemisphere after 4 months of the first attack due
to irregular intake of anti-hypertensive regimens and emphasize CURATIVE EFFECTIVENESS OF ACUPUNCTURE
the importance of blood pressure control. Materials and Methods: POINT INJECTION OF DANGGUI FOR STROKE
A 58-year-old man had a 41 mm hematoma in the right cerebel- CONVALESCENTS
lum with intraventricular extension. After the emergency surgical
intervention and intensive rehabilitation, the satisfactory outcome Zuo Nian
was observed. Results: After discharge, the patient irregularly took Wuhan University (China)
the anti-hypertensive regiments. Four months after first attack, the
Purpose: Curative Effectiveness of Acupuncture Point Injection of
recurrent hematoma in left cerebellum was noted. The well recovery
Danggui for Stroke Convalescents Materials and Methods: Fifty-
was obtained under the conservative treatment. Conclusion: The
five stroke convalescents were recruited randomly divided into
rare case is only the second one thus far in which CH recurred in
observation group A (n = 28) and control group B (n = 27).Group A
the other hemisphere. Further, no patient of CH has been reported
with Danggui (1 ml) was injected into acupuncture points Zusanli
to have a recurrence in such a short period after the first onset. We
and Quchi of paralytic side, once every other day, with one week
discuss the risk factors associated with such events and the impor-
rest every 10 treatments. Results: Quality of life was assessed
tance of blood pressure control.
by stroke specific form SS-QOL and factor scores (except visual
score) were significantly increased in both groups after treatment
(p < 0.01 and p < 0.05). upper-extremity were significantly increased
0501PP2 in observation group as compared with control group (p < 0.01,0.05).
EFFECTS OF COLSED KINETIC CHAIN EXERCISE Conclusion: Combination of Danggui acupuncture point injection
ON BALANCE AND GAIT ABILITY USING SLIDING with conventional rehabilitation treatment can improve the clinical
symptoms of stroke convalescents.
REHABILITATION MACHINE IN STROKE
PATIENTS
0501PP4
Yang-Soo Lee1, Dong-Hyup Kim1, Seung-Deuk Byun2
1
Kyungpook National University Hospital and 2Fatima Hospital XINGNAO KAIQIAO ACUPUNCTURE ON THE
(Korea) REHABILITATION OF LIMB FUNCTION IN
STROKE PATIENTS
Purpose: The purpose of this study was to investigate the effects
of closed kinetic chain exercise on balance and gait in hemiparetic Yang Qiming
patients, using the sliding rehabilitation machine which newly Wuhan University (China)
developed by department of rehabilitation medicine in kyungpook
national university hospital and enables forced use of affected lower Purpose: To observe the curative effectiveness of Xingnao Kaiqiao
limb. Subjects and Methods: This study was fulfilled using cross acupuncture along meridians on rehabilitation of limb function in
over training protocol. Thirty chronic hemiparetic patients (more stroke patients. Materials and methods: 36 patiens with stroke
than 6 months) whose Berg balance scale score less than 44 were were randomly group A (observation group) subject to Xingnao
involved in this study. They were divided into two groups of 15 Kaiqiao acupuncture group B(treatment group) subject to ordinary
and underwent 4 weeks training with different protocol. One group and combined with massage along meridians. Results: group A
(group A, n = 15) underwent training with the sliding rehabilita- were significantly increased as compared with groups B (p < 0.01).
tion machine for 30 min/day, 5 day/week for 2 weeks in addition Conclusion: Xingnao Kaiqiao acupuncture can effectively promote
to concurrent conventional training, and subsequently underwent the rehabilitation of limb function in patients with stroke.
only the conventional training for another 2 weeks. The other
group (group B, n = 15) underwent only the conventional training
for initial 2 weeks, and subsequently underwent training with the 0501PP5
sliding rehabilitation machine for another 2 weeks in addition to THE IMPACT OF OCCUPATIONAL THERAPY AND
concurrent conventional training. Experimental period (n = 30) was THERAPEUTIC EXERCISES ON ADL OF PATIENTS
defined as sum of 2 weeks period used the machine in each group WITH HEMIPLEGIA
(group A&B), and control period (n = 30) was defined as sum of
2 weeks period not used the machine in each group. Functional Jihong Wang2, Wei Chen1, Chengwei Kuai2, Qiuyang
Ambulation Category (FAC), Berg Balance Scale (BBS), 6 minute Zhang2
Walking Test (6mWT), Timed Up and Go (TUG), modified Barthel 1
People’s Health Publishing House and 2Rehabilitation Medicine
Index (MBI), modified Ashworth scale (MAS), and manual muscle Xuzhou Center Hospital (China)
test (MMT) were the tools used for evaluating balance, gait abilities
and Activities of daily living. All participants were assessed before Purpose: To observe the impact that the occupational therapy and
training, and at 2 and 4 weeks of training. Results: The results Therapeutic exercises on activities of daily living (ADL) of stroke
were as following: 1) Statistically significant improvements were patients. Materials and Methods: Since October 2005 to October
observed in all parameters in experimental period after 2 weeks 2007, I selected the 60 patients with stroke that admitted to my

rehabilitation department, stroke was diagnosed according to WHO Department of Rehabilitation Medicine, Showa University School
diagnostic criteria, and was confirmed as stroke crossing head CT or of medicine (Japan)
MRI, eliminated the possibility significant disturbance of conscious-
ness and serious complications in patients with the same time, there is Purpose: TIMP (Therapeutic Instrumental Music Performance) has
life past to exclude the disabled. Observation group of 30 patients aged been established as a neurologic music therapy in sensorimotor reha-
29–71 years, mean 51.60 years old, 11 cases of cerebral hemorrhage, bilitation. However, it is not popular in the field of stroke rehabilita-
cerebral thrombus in 19 cases, of which 14 cases of right hemiplegia, tion. We tried upper limb rehabilitation for cerebrovascular accident
left hemiparesis in 16 cases. The control group of 30 patients aged hemiplegia patients by therapeutic electronic instrumental music
28–71 years, mean 51.20 years old, 13 cases of cerebral hemor- performance and thereby were able to obtain some paralytic im-
rhage, cerebral thrombus in 17 cases, of which 15 patients with right provement. We herein discuss the effectiveness of this method based
hemiplegia, left hemiparesis in 15 cases. Evaluation Method: Both on our results. Materials and Methods: We trained the hemiplegic
groups used Barthel Index score, before treatment and after treatment upper limbs of seven cerebrovascular accident patients (ranging
two weeks, four weeks after treatment two groups were compared from 21 to 59 years of age, with three in the chronic stage and four
to carry out activities of daily living score. 1.3 Treatment: Clinical in the subacute stage) by therapeutic electronic instrumental music
addition to conventional treatment groups, the control group only to performance at a rehabilitation hospital. The musical instruments
take simple Therapeutic exercises, while the observation group was which we used were an electric guitar, an electric guitar YAMAHA
treated with occupational therapy and Therapeutic exercises at the EZ-AG which was equipped with a microcomputer, digital percus-
same time. Control group: That was an independency Therapeutic sion DD-55 and electric drums Roland RMP-5. The patient played
exercises. To give good limb position, passive joint movement, bridge a guitar and drums with the paralyzed hand. We used the EZ-AG in
activity, sitting balance, standing balance, gait training, a daily 40- 6 of 7 patients because it could change the chord automatically by
min treatment for 4 weeks as a course of treatment.Observer Group: means of the built-in computer. Therefore, even patients who had no
namely, occupational therapy and Therapeutic exercises co-therapy. experience playing the guitar were able to perform the therapeutic
In addition to the contents of Therapeutic exercises have also been exercise. DD-55 and RMP-5 were performed with sticks which pa-
adopted the following methods of treatment given early stand up, tients held in their paralyzed hand. We used the upper limb items of
feeding, washing, dressing, transferring, going to the toilet training. the Fugl-Meyer Assessment (FMA) to evaluate the hemiplegic upper
Into the recovery focus on strengthening the capacity of upper limb limbs. Results: The mean FMA scores which was determined before
coordination and hand fine features practice, selective treatment of training was 79.7 ± 14.2. After training it improved to 91.1 ± 16.8
the operation of topics, such as wood, paper cutting, weaving, when (p < 0.05, Wilcoxon signed-rank test). TIMP is still not popular in
necessary, Kin-limb compensatory day, 45 min, occupational therapy, the field of stroke rehabilitation because it is difficult for elderly
exercise therapy 40 min, morning and afternoon hours to complete. patients to perform. Another reason for its lack of popularity is
4 weeks as a course of treatment. Statistical analysis: t test was used due to the fact that there are also few music therapists and there
to compare between the two groups p < 0.01, significant difference. are a limited number of suitable musical instruments. However,
Results: The Group’s activities of daily living (ADL) score was the people who used to listen to the Beatles have now reached the
significantly higher (p < 0.01). Conclusion: Occupational therapy age where the occurrence of stroke is not uncommon. As a result,
is of great significance to improving ADL of stroke patients with most elderly people generally enjoy music. Neither the patients nor
hemiplegia and patient quality of life. the therapists were required to be competent musicians since the
musical instruments used in this therapy had a built-in computer.
Therefore many patients had a strong motivation to participate
0501PP6 and some became easily absorbed in this training. As a result, an
improvement in the upper limb function was observed. Conclu-
THE MULTIPLICITY ON PERSISTENT
sion: Generally speaking, obtaining a functionaly improvement of
VEGETATIVE PATIENTS TO COME AROUND paralyzed limbs depends on the quantity of training. Patients can
Yong-Hui Wang, Yang Zhang, Shou-Wei Yue, Juan Huai therefore increase their quantity of training by the use of therapeutic
Department of Rehabilitation Medicine, QiLu Hospital, Shandong electronic instrumental music performance due to the fact that this
training is enjoyable and the patients can also observed their own
University (China)
progress. Therapeutic electronic instrumental music performance
Purpose: To observe the effect of comprehensive rehabilitation is therefore expected to become an effective method for upper limb
approaches on persistent vegetative patients (PVS) and to analyze physical exercise by stroke patients in the future.
the factors that contribute to come around from PVS. Materials and
Methods: Sixty patients with PVS were treated with comprehensive
rehabilitation approaches which included wake-up therapy, domes- 0501PP8
tic treatment, physical therapy, acupuncture and moxibustion and THE OBSERVATION OF THE EFFECT BY
neurotrophy drugs for 3 months to 1 year. The PVS were evaluated USING ACUPUNCTURE COMBINED WITH
with the PVS score. The factors that contribute to come around from
PVS were analyzed with logistic analysis. Results: Among sixty REHABILITATION THERAPY EARLY ON THE
patients with PVS, twenty-three patients came to consciousness ACUTE STROKE PATIENTS
completely, twelve patients were excellence and ten patients were Gao Chong1, LI Li1, Huang Liping2
improved. The factors of domestic treatment, movement posture and
rehabilitation intervention time were included in logistic regression
1
TianJin DaGang Oil Field General Hospital and 2Dept.of Health
equation. Conclusion: The PVS perhaps come to consciousness if & Exercise Science, Tianjin University of Sport (China)
they are treated with comprehensive rehabilitation approaches and Purpose: To investigate the ability of ADL of acute stroke patients
Who have good domestic treatment, early awaked rehabilitation by using acupuncture combined with rehabilitation therapy early.
and no abnormal movement posture have more opportunity to Materials and Methods: 100 patients of acute stroke were randomly
come around. divided into rehabilitation group and control group, 50 patients each
group; The patients in control group were given routine treatment
of neurology and the patients in rehabilitation group were given
0501PP7
acupuncture combined with rehabilitation therapy early except for
HEMIPLEGIC UPPER LIMB REHABILITATION BY the routine treatment of neurology . The device of acupuncture:
THERAPEUTIC ELECTRONIC INSTRUMENTAL Mainly depending on the acupuncture of Hand-Foot-Yangming
MUSIC PERFORMANCE Meridian and decorated with Xingnao Kaiqiao, tongjing huo luo.
Acupoints: the main points Bai hui, ipsilateral feng chi, jian Yu,
Fumihito Kassai, Hideyasu Watanabe, Masazumi Mizuma Qu chi, Wai guan, He gu,Huan tiao, Yang Ling-chuen, Zusanli, Jue

gu, Tai chong and so on . Acupoints depending on the disease: the hypoxic encephalopathy related spastic gait was impressed. Due
patients with facial paralysis were taken Si bai, Di cang, Jia che; to progressive tremor over left hand and then right hand, thyroid
the patients with the strong tongue were taken Lian quan, Tong li; function was examined but with negative finding. Cervical spine
the patients with the pain in the shoulder were taken within Jian nei magnetic resonance imaging was arranged in March 2009 with no
ling, Jian wai ling ,Jian zhen,Jian zhong yu, Jian wai yu. Methods: specific finding. However, in April 2009, an episode of generalized
Requires the feel of acupuncture, according the syndrome and tonic-clonic seizure occurred. He was then admitted in the hospital
asthenia and sthenia to impose reinforcing or reducing techniques, and brain magnetic resonance imaging, electroencephalography
and most strong stimulation mainly stay-pin 20–30 min, a day one were arranged. Results showed no specific findings at that time.
time, 10 days for a course of treatment, a total of three treatments. Upper limbs nerve conduction study and electromyography were
The methods of rehabilitation treatment, mainly adopting the Bobath performed with normal findings. Other serum examinations, in-
approach with the comprehensive rehabilitation therapy. Scoring cluding creatine phosphokinase, magnesium, vitamin B12, folic
with NIHSS and BI index system before and after the treatment acid, and phosphate were within normal range. He was discharged
for 4 weeks. Results: The improvement on ADL and neurological in May 2009 under the diagnosis of suspected delayed hypoxic
impairment were significant (p < 0.01). Conclusion: The using of encephalopathy. However, progressive limb weakness starting
early acupuncture combined with rehabilitation therapy can promote from left upper limb to right upper limb, and finally both lower
the restore of neurological function in patients with stroke and limbs was noted. Upper limb nerve conduction study and electro-
improve their quality of life. myography were repeated again in September 2009 and revealed
diffuse anterior horn lesion. Riluzole was given thereafter. How-
ever, weakness of four limbs progressed rapidly and he became
0501PP9 bedridden with total dependent ADL function one month later.
REHABILITATION PROGRAMS FOR A GIRL Manual muscle test by Medical Research Council scale disclosed
WITH ANTI-NMDA RECEPTOR ENCEPHALITIS: A grade 1 over left upper limb, grade 2 over right upper limb, and
grade 3 over both lower limbs. Four limbs muscle atrophy with
CASE REPORT fasciculation was noted. Deep tendon reflex increased over four
Min-Yuan Yu, Jen-Wen Hung1, Ying-Chao Chang2 limbs. Lower limbs nerve conduction study was performed in
1
Rehabilitation Dept, Kaohsiung Chang Gung Memorial Hospital October 2009 with no specific finding. Abdominal muscle wast-
(Taiwan), 2Pediatric Dept, Kaohsiung Chang Gung Memorial ing was also observed. Speech function was evaluated and spastic
dysarthria with tongue atrophy was noted. Neither sensory impair-
Hospital (Taiwan)
ment nor sphincter dysfunction was found. Results: After a series
Introduction: Anti-N-methyl-D-aspartate receptor (NMDAR) en- of history taking, clinical examination, image and laboratory
cephalitis is a new category of treatment-responsive encephalitis examination, sporadic juvenile amyotrophic lateral sclerosis was
associated with “anti- NMDAR antibodies”. The clinical presenta- diagnosed definitely by Revised El Escorial criteria. Conclusion:
tion of psychosis like symptoms, seizures, abnormal movements, and Sporadic rapid progressive juvenile amyotrophic lateral sclerosis
autonomic disturbances is a highly characteristic of NMDA-receptor in patients of cerebral palsy is rarely reported. Early diagnosis may
antibodies in both of female and male patients. Case Report: This be difficult due to the misleading underlying disease of hypoxic
report describes a 16-year-old girl with anti-NMDAR encephalitis encephalopathy. This case reminds physicians to consider it as a
who had psychosis symptoms (such as emotional disturbances, differential diagnosis for patients with cerebral palsy presenting
aggressive behavior and disorientation), cognitive impairment, with combined upper and lower motor neuron signs. The relation-
short attention span and memory problems. She was brought to ship of hypoxic encephalopathy with amyotrophic lateral sclerosis
our rehabilitation department and rehabilitation programs were is still unclear in literature. We believe this is the first reported
arranged. The occupational therapist designed specialized activity case of sporadic rapid progressive juvenile amyotrophic lateral
programs for her, including computer cognition therapy, attention sclerosis post cerebral palsy.
concentration training, memory training, visual perception training,
visuomotor organization training, thinking operations training and
0501PP11
art therapy. The duration of the training program was 14 weeks. (3
times/week, 30~60 mins/time). Discussion: The great improvement THE EFFECT OF INJECTION OF BOTULINUM
presented in Loewenstein Occupational Therapy Cognitive Assess- TOXIN A ON TIBIALIS POSTERIOR IN THE
ment. (LOTCA) The girl had great improvement in not only cogni- TREATMENT OF SPASTIC EQUINOVARUS FOOT
tion but also behavior. After 31 therapeutic sessions, she returned
to school successfully. AFTER STROKE
Jen-Wen Hung1,2, Ming-Sue Tasi1, Wei-Ning Chang3,4
1
Department of Rehabilitation, Chang Gung Memorial Hospital-
0501PP10
Kaohsiung Medical Center, 2Chang Gung University College of
A CASE OF SPORADIC RAPID PROGRESSIVE Medicine, 3Department of Orthopedics, Kaohsiung Veterans Gen-
JUVENILE AMYOTROPHIC LATERAL SCLEROSIS eral Hospital and 4Department of Orthopaedics, School of Medicine,
POST CEREBRAL PALSY National Yang-Ming University (Taiwan)
Tung-Liang Lin1, Yu-Chun Lee1, Chin-Teng Chun1 Purpose: Using the computerized gait analysis tool to investigate
1
Department of Physical Medicine and Rehabilitation, Taichung the outcome of Botulinum toxin A (BoNT-A) injection on tibialis
Veterans General Hospital (Taiwan) posterior for equinovarus foot in patients with hemiplegic stroke.
Materials and Methods: A prospective study was conducted at
Purpose: Sporadic rapid progressive juvenile amyotrophic lateral an out-patient rehabilitation clinic and a gait laboratory. Twelve
sclerosis is a rare disease. To our knowledge, this may be the first chronic hemiplegic stroke patients with equinovarus foot were
report of sporadic rapid progressive juvenile amyotrophic lateral recruited. They were all independent ambulators with or without
sclerosis post cerebral palsy. Materials and Methods: We report a walking aids. Patients were injected with 100 units of BoNT-A
20-year-old male patient suffering from cerebral palsy after birth. (BOTOX, Allergan, Inc.) to the affected tibialis posterior muscle
He has no family history of hereditary disease. He could jump, (TP). Full gait evaluation was performed before and 1 month after
run and besides of minimal spastic gait, his motor function was the injection. The gait evaluation uniformly included a videotape
acceptable for daily life. Although with mild mental retardation, he analysis, a physical therapy evaluation, kinematic, kinetic, dy-
had independent Activity Daily Living (ADL) function and worked namic electromyography, plantar pressure studies and a question-
part-time at a cookie store. However, since January 2009, several naire. The kinematics study was done with a six-camera Motion
episodes of falling down were noted. He visited the hospital and Analysis System (Motion Analysis Inc., Santa Rosa, CA, USA)

with a sampling rate of 60 Hz. Kinetic data was obtained with was better than the latter and had a shorter course of treatment
four AMTI OR6-7 force plates (Advanced Mechanical Technology to severe patients. So our observation showed the advantage of
Inc., Watertown, MA, USA). The plantar pressure were evaluated therapeutic effects.
with the Foot scan 3D Pressure System (RSscan International,
Belgium). The percentage of medial impulse (PMI) was calcu-
lated using the duPont foot model (Chang WN, Gait and Posture 0501PP13
2004). The following parameters were obtained and analyzed. ASSESSING FACTORS THAT ASSOCIATE WITH
Temporal-spatial data: Self-selected walking speed, cadence, THE OCCURRENCE OF DEPRESSION AMONG
step length, stride length, and step width. Kinematic data: The
peak flexion/extension angle and total range of flexion-extension POST-STROKE ADULTS IN TAIWAN
motion of the hip/knee/ankle joints in stance/swing phases, along Laure Kuei-Tsu Kao
with the foot progression angle. Kinetic data: Peak ankle plantar Department of Adapted Physical Education, National Taiwan Sport
flexion and supination/pronation moment, the peak and summa- University (Taiwan)
tion of ankle power generation. Plantar pressure: The percentage
of medial impulse (PMI) was calculated with the duPont foot Purpose: This study investigated the point prevalence of post-stroke
model. (Chang WN, Gait and Posture 2004) Subjective improve- depression (PSD) from the aspects of patients’ demographic charac-
ment after BoNT-A injection was obtained from a questionnaire. teristics and health conditions. It also examined factors predictive
Statistic analysis: A series of paired t tests was done to compare depression from the perspectives of patients and their caregivers.
the temporal-spatial, kinetic and plantar pressure data between the Materials and Methods: A total of 90 post-stroke patients including
pre- and post-injection conditions. In order to identify the good 47 males and 43 females, admitted in two rehabilitation centers were
responders of BoNT-A injection, the patients were categorized invited for this study. A Post-Stroke Depression Inventory (PSDI)
into antagonist-active and antagonist-inactive groups according consisted of 31 yes/no questions were used to assess symptoms of
the dynamic EMG amplitude of the tibialis anterior muscle. The depression. Ratings of depression were obtained from patients’ self
Mann-Whitney U test was used to test the subjective improvement reports, and from reports of the caregivers in the cases of aphasia
rate between two groups. Results: The results showed significant following stroke. Patients’ conditions were evaluated by age, gender,
improvement in walking speed (p = 0.007), step length of unaf- education level, physical functioning (Barthel Index) and living
fected side (p = 0.046), the sum of hip flexion range and peak hip arrangement (home care vs. institutional care). Data from a one-to-
flexion of unaffected side (p = 0.017, 0.046). The peak and sum of one semi-constructed interview and onsite observations were also
plantaflexion moment of affected ankle also improved (p = 0.025, collected for result interpretation. Quantitative data was analyzed
and 0.041). The antagonist-active group has a higher rate of sub- using chi-square, multivariate analysis of variance (MANOVA), cor-
jective improvement (p = 0.018). Conclusion: BoNT-A injection relation coefficients and multiple regressions. Results: Comparisons
on TP for equinovarus foot deformity in patients with stroke is of the PSD prevalence suggested patients of institutional care were
effective in improving some but not all gait parameters. Based on significantly more depressed than that of the home care with the
the fact that the tibialis anterior-active group has a higher improve- rates of 76.7% and 41.7%, respectively; both of the self-rated and
ment rate, the indications of BoNT-A treatment for equinovarus caregiver-rated responses indicated higher PSD among institutional
foot in hemiplegic patients should include an active antagonist of patients. The correlation coefficient of Pearson Product was 0.82
the target muscle. between the PSD ratings of patients and caregivers. Results from
the multiple regression analysis of the self-rating scores indicated
the occurrence of PSD was best predicted by patients’ scores of
0501PP12 Barthel Index, the onset age of the stroke and the patients’ education
CLINICAL OBSERVATIONS OF TREATMENTS OF level with accumulated R2 = 0.3272; whereas two important PSD
POST-STROKE DEGLUTITION DYSFUNCTION predictors rated by the caregivers were scores of Barthel Index and
the onset age of the stroke with accumulated R2 = 0.3118. Conclu-
WITH ACUPUNCTURE AND ELECTRIC sion: Comparisons of the PSD prevalence suggested patients of
STIMULATION institutional care were significantly more depressed than that of the
Zhen Huang, Yu Min home care with the rates of 76.7% and 41.7%, respectively; both
of the self-rated and caregiver-rated responses indicated higher
Panyu Cental Hospital (China)
PSD among institutional patients. The correlation coefficient of
Purpose: To compare therapeutic effects of acupuncture and Pearson Product was 0.82 between the PSD ratings of patients and
electric stimulation on post-stroke deglutition dysfunction on the caregivers. Results from the multiple regression analysis of the self-
basis of rehabilitation training. Materials and Methods: 97 patients rating scores indicated the occurrence of PSD was best predicted
with post-stroke deglutition dysfunction were recruited and divided by patients’ scores of Barthel Index, the onset age of the stroke and
into acupuncture group (A, n = 32), electric stimulation group(ES, the patients’ education level with accumulated R2 = 0.3272; whereas
n = 35) and control group(C, n = 30) randomly. On the basis of con- two important PSD predictors rated by the caregivers were scores
ventional rehabilitation training, A group added with acupuncture of Barthel Index and the onset age of the stroke with accumulated
while ES group received Vitalstim’ electric stimulation once per R2 = 0.3118.
day for 2 course of treatment (12-day as one treatment course). C
group received only conventional treatment. At the end point of
0501PP14
the observation, deglutition function was evaluated with water-
drinking test, stethocatharsis scoring and fluoroscopic examination PHYSICAL EXERCISE INDUCES EXPRESSION
of swallowing function. Results: After 2-course of treatments, OF CD31 AND FACILITATES NEURAL FUNCTION
deglutition function from three groups all improved significantly RECOVERY IN RATS WITH FOCAL CEREBRAL
(p < 0.01). By comparison with C group, both A group and ES
group displayed statistic significance (p < 0.01). By intervention, INFARCTION
the total effective rate of A group was 96.88%, with ES group Haiqing Zheng, Xiquan Hu, Jie Fang, Tiebin Yan
94.29% and C group 66.67%. There was significant difference Department of Rehabilitation Medicine, The Third Affiliated Hos-
on the total effective rate among three groups (p < 0.01), while no pital, Sun Yat-sen University (China)
difference between the former two groups (p > 0.01). Conclusion:
The therapeutic effect of acupuncture and ES combination with Purpose: To examine that the physical exercise might play activating
rehabilitation treatment was better than that of simple rehabilita- role in angiogenesis as well as improving the neural function. Ma-
tion training. As to deglutition dysfunction, the therapeutic effects terials and Methods: An infarction model was induced by ligating
of acupuncture and ES were almost equivalent, while the former the left middle cerebral artery occlusion (MCAO) in total sixty-six

adult Sprague-Dawley rats,which were further randomly divided suggest that the hydrotherapy could be used as a training method for
into three groups: the physical exercise group (n = 30), which were patients with discoordination.
given running wheel exercise everyday after MCAO, the control
group (n = 30) and sham-operated group (n = 6), which were fed
in standard cages with no any special training exercise. Then the 0501PP16
rats were scarified on 3rd, 7th, 14th day and the neurological severity CNS DIFFUSE LARGE B CELL LYMPHOMA
scores (NSS) was examined for evaluating the neural function, as PRESENTING INITIALLY WITH ACUTE
well as the neogenetic microvessels around the peri-infarction re-
gion were studied with the specific marker CD31. Results: Though INFARCTION OF MIDBRAIN AND THALAMUS: A
neogenetic microvessels in the peri-infarction region were observed CASE REPORT
in both control group and physical exercise group, which showed Cheng-Yuan Lin, Hui-Wen Chen, Cheng-Min Chiu
the highest signal on the 7th day after ischemic, the number of
CD31 positive cells in significantly increased in physical exercise Far Eastern Memorial Hospital (Taiwan)
group in comparison with those in control group, on the 7th and Primary central nervous system lymphoma (PCNSL) can mimic
14th day after ischemic (p < 0.01). Furthermore, the neurological diverse neurological diseases. A 40-years-old male,who denied any
severity scores in the physical exercise group showed more quick other systemic disease except schizophrenia under regular medica-
declination as compared to those in control group from 7th day after tion for 10 years, experienced acute onset of dizziness and left side
ischemic. Conclusion: our study implicating that physical exercise limbs weakness and was sent to a area hospital for help.Computed
could play an important role in angiogenesis as well as promoting tomography was performed but the diagnosis was unclear.He was
neural function revcovery after cerebral infarction in rats, but the transfered to our hospital for further evaluation and MRI of brian
mechanisms need to be further investigated. was then performed and revealed acute infarct in the right midbrain
and right thalamus with mild hemorrhagic transformation. He was
admitted for further evalaution and rehabilitaion therapy. A series
0501PP15
of young stroke data work up was done and no signficant contribu-
THE EFFECT OF THE HYDROTHERAPY ON tory factor was identified. He was then discharged under stable
UPPER-LIMB DISCOODINATION condition one months later. Two months later ,he was re-admitted
for further rehabilitaion therapy due to persistent left side limbs
Sachiko Osada, Shin Yamada, Tetsuya Iwamoto, Hoshi weakness with ADL impairment. During hospitalization,sudden
Murai, Tomoko Watanabe, Hiroshi Fuseya, Hirofumi onset of headache and vomiitng without progressive neurological
Terabayashi, Akio Kimura deficit were impresed. MRI with contrast of brain was performed
Keio University Tsukigase Rehabilition Center (Japan) due to the persistent symptomes and signs and revealed two rapidly
grown intra-axial brain tumor in the right caudate nucles and the
Objective: The purpose of this study is to investigate the effect of the right posterior basal ganglia with well-enhancement post contrast
hydrotherapy on upper-limb discoordination. To assess the useful- administartion and moderate perifocal or vasogenic edema appear-
ness and applicability of the hydrotherapy for patients with motor ing in the right frontal lobe and the right striatocapsular region.
dysfunction, muscle activity and joint movement were evaluated Metastatic lesion was not suspected after a series of examination.
during repetitive elbow flexion and extension in water. Subjects and The patient then received stereotaxic biopsy of the tumor and diffuse
Methods: Subjects were 2 patients with upper-limb discoordination large B-cell lymphoma was confirmed.
due to stroke. Patient 1 was a 76-year-old male with pontine hemor-
rhage who suffered from left ipsilateral limb ataxia, and patient 2
was a 75-year-old male with ischemic stroke who presented with left 0501PP17
hemiparesis. Both of the patients had no remarkable communication
problems and written informed consent was obtained. The subjects EXTRA- AND INTRAMUSCULAR NERVE
were required to move their affected hands back and forth between DISTRIBUTION PATTERNS OF THE MUSCLES OF
their episternums and a target according to rhythm of an electronic VENTRAL FOREARM
metronome (45, 60, 75 beats/min). The target was placed at the level
of subjects’ episternums, and distance to the target was set the same as Dong-wook Rha1, Dong Jin Kim1, Hee-Jin Kim2, Sung-
their reach length. Surface EMG signals were recorded from the biceps Yoon Won2
brachii and triceps brachii with water-proof sealed electrodes and 1
Department and Research Institute of Rehabilitation Medicine,
the elbow joint angle with an electric goniometer. These procedures Yonsei University College of Medicine and 2Division of Anatomy
were performed on the ground and in water conditions sequentially. & Developmental Biology, Dept. of Oral Biology, Oral Science
Data were stored in a computer and processed offline. After full-wave Research Center (Republic of Korea)
rectification, the EMG signals were smoothed by moving averages. In
the next step, cross-correlation coefficient (CC) between the recorded Purpose: The aim of this study was to clarify the detailed intramus-
waves and computer simulated sinusoidal waves, which had the same cular nerve branching patterns innervating the pronator teres (PT),
frequency as the tempo of the metronome, was calculated. Statistical flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU), thereby
analyses were conducted by using the MATLAB 6.1 (The Mathworks, providing critical information on determining the most effective
Inc.). Results: There were a high correlation between joint angles points for Botulinum toxin injection. For this purpose, we used
and the simulated waves on dry ground (CC > 0.9). Correlation was Modified Sihler’s staining to overcome the limitation of manual
the lowest at 75 beats/min in water (patient 1 CC = 0.33, patient 2 dissection and to reveal the exact distribution of the intramuscular
CC = 0.89). The faster upper-limb moved the lower CC become in branches. Materials and Methods: To investigate nerve entry points
underwater condition. Discussion and Conclusion: Movement of and intramuscular nerve arborization patterns, 17 Korean and 6
the upper-limb was disturbed under the influence of water resist- French cadavers (9 males, 14 females; mean 70 years, range: 56–87
ance, whereas no positive effect was observed nevertheless of water years) were dissected and subjected to whole-mount nerve staining
buoyancy which had seemed to support body weight. Because water with Sihler’s method which shows the exact nerve distribution pat-
resistance is proportional to square of velocity, it must be difficult to terns without manual dissection. The location of nerve entry point
perform faster and accurate limb movement in water. On the other and arborized portion were expressed as a percentage of distance
hand, the EMG activities kept consistent rhythm at every velocity. from interepicondylar line to interstyloid line. Results: For PT, it
One of the causes of this was that feedback control strategy could was supplied by 2 separated branches in 17 cases (1 proximal and
not catch up with dynamic water resistance and turbulent flow. To 1 distal), and it was supplied by a single branch in 6 cases. Com-
achieve smooth and coordinated limb movement, reinforcement of mon nerve entry points were located at about 12.6% and 25.7%.
anticipatory feedforward control should be needed. These findings The arborized portion of the intramuscular branch was located at

about 19.5%. For FCR, the nerve supply to the flexor carpi radialis study (VFSS) were included. The patterns of aspiration were dif-
came from a single branch in all cases. Common nerve entry point ferentiated as pre-swallowing (n = 5) and during-swallowing pattern
and the arborized portion of the intramuscular branch were located (n = 23), by the order between swallowing and aspiration event. In
at about 28.0% and 32.1%. For FCU, ulnar nerve always gave off aspiration that occurs during swallowing, anterior group (n = 10)
two branches (dorsal and ventral) and common nerve entry points and posterior group (n = 13) were identified in terms of the route
were located at about 22.9% and 31.2%. But the arborized por- of aspiration. Two-dimentional motion analysis on the hyoid bone,
tions of the intramuscular branch were diffusely located through vocal cord and epiglottic movements was performed. temporal
the muscle. Conclusion: Using whole-mount nerve staining with and spatial variables and clinical results, such as clinical scores
Sihler’s method, the area with high density of neuromuscular and residue, were compared among aspiration patterns. Results:
junctions was found to be at about 20% for PT, and about 30% for In during-swallowing aspiration, initiation of the epiglottic rotation
FCR. These results might be helpful for maximizing the efficiency was significantly delayed than that of vocal cords and hyoid bone
and minimizing the side effect of Botulinum toxin injections into in posterior group as compared with valleculae group (p < 0.05) and
forearm muscles. the horizontal displacement of hyoid bone is increased in piriform
sinus group (p < 0.05). there are no difference in angle of epiglottic
closure. Between pre-swallowing and during-swallowing aspiration,
0501PP18 there were no significant differences in spatial characteristics, while
A CASE OF POLYARTERITIS NODOSA earlier aspiration time than onsets of hyoid, vocal cords, epiglottic
PRESENTING INITIALLY AS INTRACEREBRAL movement were significant in pre-swallowing group (p < 0.01).
Conclusion: These results suggest that the starting order of vo-
HEMORRHAGE IN YOUNG ADULT: A CASE cal cords and hyoid bone movement is different between pre- and
REPORT during-swallowing aspiration. But there are no significant differ-
Chien-Chung Lin1, Wen-Yih Hsieh1, Hsin-Shui Chen1, ences in clinical outcomes and spatial characteristics between pre-
Ruei-Kai Ho2, Tzung-Chang Tsai3, Da-Wei Chen4 and during-swallowing aspiration. Increased hyoid movement and
delayed epiglottic closure can show the mechanism of posterior type
1
Department of Physical Medicine and Rehabilitation, China Medi- aspiration, overflowed residue of piriform sinus, but there are no dif-
cal University Beigang Hospital and 2Department of Cardiology, ferences in clinical ontcomes between during-aspiration groups.
China Medical University Beigang Hospital, 3Department of Neurol-
ogy, China Medical University Beigang Hospital and 4Department
of Gastroenterology, China Medical University Beigang Hospital 0501PP21
(Taiwan) QUANTITATIVE BIOMECHANICAL EVALUATION
A 40-year-old man was transported by ambulance from his home to FOR MOTOR CONTROL OF UPPER LIMB IN
the emergency department because of a sudden change in mental status STROKE AFTER USING KINESIO-TAPING
and left hemiplegia. Computed tomographic scanning of the brain
revealed an intracerebral hemorrhage. The patient received rehabilita- Yu-Chia Tsai1, Shu-Min Chen1, Jin-Wen Lei1, Bing-
tion and was discharged in a stable condition with left hemiplegia. He Cheng Kung2
presented symptoms of progressive little verbal output followed by 1
Dept. of Physical Medicine and Rehabilitation, National Cheng
emergency admission to the neurology service eight months after his Kung University Hospital and 2Dept. of Mechanical Engineering,
first intracranial hemorrhage. Computed tomographic scanning and National Cheng Kung University (Taiwan)
magnetic resonance imaging (MRI) of the brain showed a cerebral
infarction. A diagnostic procedure was performed and a diagnosis of Purpose: Arm and hand functions are crucial for many activities in
polyarteritis nodosa (PAN) was made. daily living. Loss of function in an affected upper limb after stroke
is common. Various methods including kinesio-taping have been
used to improve the function of upper limb function in the adult with
0501PP19 hemiplegia. Some studies have showed that Kinesio-taping improves
ROLE OF TRANSCRANIAL MAGNETIC the function of upper limb, but no quantitative assessments on the ef-
fects were used. We applied the shoulder-elbow rehabilitation robot to
STIMULATION IN TREATMENT OF CEREBRAL
assess the effect of motor control of the upper limb quantitatively after
INFARCTION using Kinesio-taping. Materials and Methods: A 48-year-old male
Chun-Jing You1 had left putaminal hemorrhage with right hemiplegia for two years.
1
Tongji Hospital (China) He had received comprehensive rehabilitation. He could walk with a
regular cane independently at the time of this study. Brunnstrom stage
Purpose: To investigate role of transcranial magnetic stimulation of the affected upper limb was III, modified Ashworth scale was 1+
in treatment of cerebral infarction. Materials and Methods: Role and Fugl-Meyer scale was 24. He had flexor spasticity in the elbow
of transcranial magnetic stimulation in treatment of cerebral infarc- with poor finger flexion movement during catching objects which
tion. Results: Role of transcranial magnetic stimulation in treatment disturbed the activities of daily living. He received kinesio-taping
of cerebral infarction. Conclusion: Role of transcranial magnetic for the right upper limb, 24 hours each time, three times a week, for
stimulation in treatment of cerebral infarction. a period of one month. Then the upper limb function was assessed
objectively with quantitatively biomechanical indices including EMG
index and Intergration of Absolute Deviation of Torque (IADT).
0501PP20 These two indices were built by a shoulder-elbow rehabilitation
KINEMATIC ANALYSIS OF ASPIRATION robot. The changes in Brunnstrom stage, modified Ashworth scale
PATTERNS DURING SWALLOWING IN STROKE and Fugl-Meyer scale were also compared before and after taping.
Results: There were no differences in Brunnstrom stage and modified
PATIENTS Ashworth scale between the pre-treatment and after treatment data.
Ja-ho Leigh, Han Gil Seo, Byung-mo Oh, Tai Ryoon Han However, Fugl-Meyer scale increased from 24 to 26 after taping.
Seoul National University College of Medicine (Republic of Korea) In the aspect of biomechanical indices, both EMG index and IADT
decreased after taping which indicated an improvement in motor
Purpose: The purpose of this study is to classify aspiration patterns control. In addition, the patient reported improvement in the func-
kinematically, quantitatively and to find out the coorelations between tion of the affected upper limb subjectively during the application
aspiration patterns and clinical results. Materials and Methods: of Kinesio-taping. Conclusion: The Kinesio-taping could improve
A total of 28 subacute stroke patients with subglottic aspiration upper limb function both subjectively and objectively. Further clinical
on 2cc or 5cc of fluid at the initial videofluoroscopic swallowing studies are needed in the future.

0501PP22 was conducted for four hours and six hours respectively following
EFFECT OF FUNCTIONAL ELECTRICAL MCAO. T2 weighted-imaging (T2WI) and 1H magnetic resonance
spectroscopy (1H MRS) were performed, to study the changes of
STIMULATION ON THE EARLY NEURONAL the imaging and the neuronal metabolites N-acetyl aspartate (NAA),
PLASTICITY IN THE PENUMBRA OF RATS WITH creatine/phosphocreatine (Cr/PCr) and choline (Cho) following
PERMANENT FOCAL CEREBRAL ISCHEMIA cerebral ischemia. The changes of blood flow speed were measured
by laser Doppler flowmetry. The surface vascular density in right
Dongmei Jin1, Zhiqiang Zhuang1, Tiebin Yan1, Yun hemisphere were calculated. Results: The hyperintense signals and
Xiang1, Xiuyuang Zheng1, Yuan Peng2, Yannan Fang3, volume in the right cerebrum in group C were decreased compared
Raymond Ky Tong4 to that of the group B, the T2 values were decreased, and the level
1
Department of Rehabilitation Medicine, Sun Yat-sen Memorial of NAA increased, the ratio of Cr/NAA and Cho/NAA decreased.
Hospital, Sun Yat-sen University and 2Department of Rehabilitation The blood flow speed in group C were improved. The length of brain
Medicine, First People’s Hospital in Guangzhou City, 3Department surface vessels in group C increased. Conclusion: The Angelica
of Neurology, First Affiliated Hospital, Sun Yat-sen University and sinensis injection enhanced the blood circulation in the ischemic
4
Department of Health Technology and Informatics, The Hong Kong brain, improved the neuronal metabolisms.
Polytechnic University (China)
Purpose: This study investigated the neural mechanisms of functional 0501PP24
electrical stimulation (FES) on motor behaviors, synaptic ultrastruc- THE EFFECTIVENESS OF SURFACE ELECTRIC
tures and protein expression of synaptophysin in the penumbra of
rats with cerebral infarction. Materials and Methods: Following STIMULATION ON THE TREATMENT OF
surgery of middle cerebral artery occlusion (MCAO), SD rats were DYSPHAGIA IN STROKE PATIENTS
randomly allocated to FES, placebo or sham-operated group. Rats Chi-Fen Chang, Lu Lu, Yin-Ting Tseng, Ai-Ju Wu
in FES group and placebo group received electrical stimulation and
Department of Physical and Rehabilitation Medicine, National
placebo stimulation respectively for 3, 7 or 14 days (10 min/day),
while the ones in sham-operated group received the similar surgery Taiwan University Hospital (Taiwan)
without MCAO occlusion and had no particular treatment. Functional Purpose: To investigate the effectiveness of surface electric stimu-
evaluations were assessed at baseline and each time point described lation therapy in stroke patients with dysphagia. Materials and
above. Synaptic ultrastructures in the penumbra were observed under Methods: Stroke patients referred for swallowing therapy during
transmission electron microscope and protein expression levels of 2008 were recruited with the inclusion criteria of dysphagia with
synaptophysin in the penumbra were also measured by Western blot. nasogastic tube feeding as the main nutritional supply, fair mental-
Results: When compared with the rats in placebo groups, rats in FES ity and cooperation, informed consent, and no significant medical
group exhibited a significantly improved functional performance in problems. 36 subjects were included in this study initially and
prehensile traction test at the time point of 7d and 14 d (p < 0.05), were assigned into 2 groups randomly but 4 dropped out before
although the performance scores were still lower than that of rats reaching the treatment goal due to unrelated reasons. A total of 32
in sham-operated groups at the corresponding time points. With subjects finished the study. 20 subjects in the experimental group
prolonged treatment, the regressive ultrastructures of synapses in received simultaneous surface electric stimulation and traditional
the penumbra of the infracted hemisphere of the rats in FES groups swallowing therapies. The 12 subjects in control group received
improved more markedly than that of placebo groups. When compared traditional swallowing therapy only. There was no significant differ-
with the protein expression levels of synaptophysin in the penumbra of ence in dysphagia severity or oromotor function between these two
placebo group, the ones in FES group were up-regulated significantly groups. Each patient received 30 min of therapy twice a week till
at the time point of 3 days, 7 days and 14 days (p < 0.05). Conclusion: they could eat per oral safely or till 30 treatment sessions. Outcome
Results from this study indicated that FES applied at the early stage were analyzed by the changes in dysphagia severity scale, oral and
of cerebral infarction could facilitate the functional recovery of the pharyngeal motor function scale, oral and pharyngeal swallowing
paralyzed limbs and activate the neuronal plasticity in the penumbra function scale, and rate of successful oral feeding. Results: There
of the rats with cerebral ischemia. were significant improvement (p < 0.05) in all outcome measures
in both groups of patients. However, no significant difference was
0501PP23 noted in any outcome measures between these two groups. Further
analysis by correlating the pretreatment severity with the treatment
THE EFFECTS OF ANGELICA SINENSIS outcome also showed no group differences. Conclusion: Our study
INJECTION ON THE NEURONAL METABOLITES results did not support additional treatment effect of superficial elec-
AND BLOOD FLOW SPEED WITHIN tric stimulation on stroke dysphagic patients. However, since most of
the subjects were in acute stage, further studies using chronic cases
REPERFUSION FOLLOWING THE ISCHEMIC
are necessary before exclusion of its treatment effectiveness.
CEREBRAL INJURY IN RATS
Wei-jing Liao1, Wan-tong Yang1, Li-yun Li2, Mai-li Liu2, 0501PP25
Yun-huang Yang2
1
Department of Rehabilitation Medicine, Zhongnan Hospital, THE EFFECTS OF EXERCISE ACCORDING TO
Wuhan University, 2Wuhan Institute of Physics and Mathematics, THE APPLICATION TIME AND INTENSITY ON
Chinese Academy of Sciences (China) COGNITIVE FUNCTION IN TRAUMATIC BRAIN
INJURED RATS
Purpose: To investigate the effects of Angelica sinensis injection on
the neuronal metabolites and blood flow speed within reperfusion Sam-Gyu Lee1, Seung-Hoon Yang1, Jae-Young Han1, In-
in the ischemic cerebral injury in rats. Materials and Methods: Sung Choi1, Gye-Yeop Kim2, Kyoung-Yoon Kim2
Sixty-nine male Sprague Dawley rats with an average body weight 1
Department of Physical and Rehabilitation Medicine, Research
of 160 ± 10g (mean ± SD) were used, and were randomly divided into Institute of Medical Sciences, Chonnam National University Medical
three groups: group A rats (n = 4) underwent sham operation, group School & Hospital and 2Department of Physical Therapy, Dongshin
B (n = 30) underwent an operation of ischemic brain injury, group C University (Republic of Korea)
rats (n = 35) underwent the same operation and received the treat-
ment of Angelica sinensis injection (5 g/kg weight, i.p). The right Purpose: Exercise and physical activity can improve cognitive
middle cerebral artery occlusion (MCAO) of both group B and group function by the growth and genesis of nerve cells in the hippocam-
C rats was induced by 5/0 nylon suture for 2 hours. The reperfusion pus. However, there are debates on the proper time and intensity

of exercise for the maximal therapeutic effects in traumatic brain Purpose: To investigate the etiological diagnosis of dysphagia
injured rats. The aim of this study was to investigate the effects of by using the digital gastrointestinal machine for patients with
exercise according to the application time and intensity on cognitive dysphagia underwent dynamic pharyngoesophagraphy. Materials
function in traumatic brain injured rats Materials and methods: and Methods: 5 cases of healthy volunteers and 18 cases of pa-
One hundred male Sprague-Dawley rats, weighing 250 ± 50 g, aged tients with dysphagia underwent dynamic pharyngoesophagraphy
8–10 weeks old were used. Before the induction of brain injury, all during April 2007 to September 2008 in Zhongnan Hospital.
rats were acclimated to treadmill training, Rota-Rod training, and 18 cases of patients: 13 males and 5 females, 42–85 years old,
swimming for 1 week. Traumatic brain injury was induced by weight median age: 65 years old. 3 patients with traumatic brain injury,
drop method. All rats were randomly divided into 4 groups: early 9 patients with stroke after treatment, 4 patients with esophageal
high intensity exercise group (group A, n = 25); early low intensity cancer after radiotheraphy, 2 patients of carcinoma in the upper
exercise group (group B, n = 25); delayed high intensity exercise esophagus. Philips OD digital gastrointestinal machine, photo
group (group C, n = 25); delayed low intensity exercise group images 25 frames per second, checking and recording of digital
(group D, n = 25). High intensity exercise (20 min of treadmill, images at the same time, the images can be saved as dynamic
20 min of Rota-Rod, four times of swimming for 3 min each) and AVI format and JPG format. Results: Dysphagia is divided into
low intensity exercise (10 min of treadmill, 10 min of Rota-Rod, two stages, oral phase and pharyngeal phase, the patient may
two times of swimming for 3 min each) were performed from 2nd appear an anomaly or the coexistence of a variety of abnormali-
and 8th day after brain injury once a day, for 3 weeks according to ties. Abnormal Stage I: 2 cases with the cricipharyngeus muscle
the groups. Morris water maze test for the evaluation of cognitive abnormal opening, 3 cases with abnormal lips closing, 5 cases
function and immunohistochemistry for BDNF in the CA1 region with swallowing launch delaying, 4 cases with the mouth remain-
of the hippocampus were performed before and at 1st, 7th, 14th, 21st ing, 5 cases with ineffective swallowing, 3 cases with abnormal
day after brain injury. Results: 1) On Morris water maze test, there tongue movement, 6 cases with repetitive swallowing, 9 cases
were no significant differences in all groups before and at 1st day with the epiglottis valley stranded, 13 cases with pyriform sinus
after the induction of brain injury (p > 0.05). Escape latency was stranded, 3 cases with the nose penetrating; Abnormal Stage II:
significantly delayed in group B compared to the other groups at 14 cases with the penetration before swallowing or aspiration,
21st day after brain injury (p < 0.05). Escape latency was delayed 8 cases with reducing pharyngeal peristalsis, 8 cases with the
in group A with time. However, it was shortened in group B, C, and penetration during swallowing or aspiration, 5 cases with glottal
D with time. That of group B was shortest among them. 2) There insufficiency, 4 cases with penetration after swallowing or aspi-
was no immunoreactivity in all groups at 1st day after brain injury. ration. Conclusion: Applying dynamic pharyngoesophagraphy
There was no immunoreactivity in group A at 7th and 14th day. Im- could diagnose specific location of dysphagia and improve the
munoreactivity had been observed in group B, C, and D at 7th, 14th, accuracy of further treatment.
and 21st day. Group B and C showed increased immunoreactivity
with time. Group B showed the most significant immunoreactivity
among them. Conclusion: We think that early low intensity exercise 0501PP28
may be the most effective exercise protocol for the recovery of
cognitive function in traumatic brain injured rats. QUESTIONNAIRE ASSESSMENT OF
SATISFACTION OF PLASTIC ANKLE-FOOT
0501PP26 ORTHOSES IN STROKE PATIENTS
EFFECT OF ALL-TRANS RETINOIC Min-Cheol Joo, Hyo-In Park, Se-Eung Noh

ACID ON THE EXPRESSION OF MATRIX Department of Rehabilitation Medicine (Korea)
METALLOPROTEINASES 9 AFTER Purpose: Plastic Ankle-Foot Orhoses (AFOs) are widely used
INTERCEREBRAL HEMORRHAGE IN RATS orthoses in the rehabilitation of the patients with stroke. This
study was performed to investigate the status and the satisfac-
Guangyu Shen, Jie Ji, Kefu Cai, Su Liu tion of using orthoses in social activities, and complaints about
Affiliated Hospital of Nantong University (China) orthoses as well. Materials and Methods: The questionnaires were
given to 27 patients with stroke whom orthoses were applied to
Purpose: To investigate the effect of all-trans retinoic acid (ATRA) over one month. Details about the appliance included its comfort,
in intercerebral hemorrhage (ICH) and observe its role on brain fit, cosmetic acceptability, and frequency of wear. Results: The
edema. Materials and methods: First, rat models of cerebral hemor- level of patient satisfaction with the plastic AFOs was 64%. The
rhage were made, and then these rats were devided into two groups: satisfaction at color was the highest among these by 68%, the
experimental group and control group. Rats in experimental group satisfaction at weight was the lowest by 56%. The purpose of us-
were given ATRA. The expression of matrix metalloproteinases ing orthoses in each item of Gait supporting, Spasticity control,
-9 (MMP-9) was detected by immunohistochemistry. Results: and Instability supporting accounted for 70%, 15%, and 15% of
The expression of MMP-9 in experimental group was lower than the total, respectively. As to the time when orthoses are used, the
that of control group.There has been the significant difference in items of Never, Necessary Condition, Indoor, Outdoor, and Always
the two groups (p < 0.05). Conclusion: ATRA could reduce the accounted for 33%, 33%, 4%, 4%, and 15%, respectively. The
expression of MMP-9 in experimental group and further reduce patients who did not wear AFOs during the investigation reached
the brain edema. to 13 people, 48% of the whole. The causes of disuse in order of
frequency were like Pain, Discomfort, Heavy weight, and Unim-
0501PP27 proved Gait Pattern. Many of the patients who were dissatisfied
had more than one criticism. The main criticisms were as follows:
A PRELIMINARY STUDY ON THE APPLICATION High price, The delicacy of manufacturing process, Explanation of
OF DYNAMIC PHARYNGOESOPHAGRAPHY IN the purpose of wearing, After Service, Proper prescription based
DYSPHAGIA on functional roles, Periodical examination, etc. Conclusion: This
survey shows an unacceptably high level of patient dissatisfaction
Zhiyan Lu with AFOs. Physiatrists should pay more attention to physical
Medical Imaging Division, Zhongnan Hospital, Wuhan University examination before AFOs prescription and follow-up survey of
(China) patients with stroke.

0501PP29 in the control group (p < 0.05). Conclusion: Electromyography

THE COMPARISON OF THE THERAPEUTIC biofeedback training can improve upper limbs motor function of
hemiplegic patients.
EFFECTS OF NEUROMUSCULAR ELECTRICAL
STIMULATION COMBINED WITH SWALLOWING
REHABILITATION THERAPY FOR RECENT AND 0501PP31
PERSISTENT DYSPHAGIA IN STROKE THE THERAPEUTIC EFFECT OF
Chau-Peng Leong, Tsung-Hsun Yang, Yi-Jung Hsin, MONOCHROMATIC INFRARED PHOTO ENERGY
Yiu-Chung Lau, Yu-Chi Huang (MIRE) ON MYOFASCIAL PAIN SYNDROME IN
Chang Gung Memorial Hospital-Kaohsiung Medical Center THE UPPER TRAPEZIUS MUSCLE
(Taiwan) Kang-Ming Huang1, Shu-Min Chen1, Jo-Tong Chen1,
Purpose: The purpose of this study is to compare the effectiveness of Wei-Jang Yen1, Ta-Shen Kuan1, Chang-Zern Hong2
neuromuscular electrical stimulation (NMES) combined with swal- 1
lowing rehabilitation program (SRP) between recent and persistent Cheng Kung University and 2Department of Physical Therapy,
dysphagia in stroke patients. Materials and Methods: Forty patients Hungkuang University (Taiwan)
with post-stroke dysphagia were analyzed in this retrospective study.
All of them had treated with traditional SRP at least for one month, Purpose: Myofascial pain syndrome (MPS) is characterized by
but failure to remove their feeding tubes. Twenty-two of them with the existence of myofascial trigger point (MTrP). Current animal
post-stroke dysphagia lesser than 6 months were enrolled in the recent and human studies have attributed the pathogenesis of myofascial
dysphagia group (RD group). Eighteen of them with dysphagia more trigger point (MTrP) to the “energy crisis” hypothesis (local hy-
than 6 months were enrolled in the persistent dysphagia group (PD poxia). Many therapeutic strategies for MTrP have been reported,
group). All patients received both clinical swallowing evaluation including myofascial release, physical modalities, myofascial
and videofluoroscopic swallowing study (VFSS) before treatment. trigger point injection…etc. Monochromatic infrared photo
All of the subjects received 60 min NMES combined with SRP as energy (MIRE) is one kind of photon therapy (890 nm of wave
one session of therapy, 2 to 3 sessions each week. The end point of length). Its effects in the restoration of sensation and reduction of
swallowing treatments was removing the feeding tube, reaching the pain for patients with diabetic peripheral neuropathy have been
functional oral intake scale (FOIS) level 7, or no more swallowing demonstrated. The vasodilatation effect of MIRE might play a
improvement in five consecutive sessions. The outcome measures major role in its therapeutic effectiveness. Our recent study has
were the change of FOIS, patient numbers of successfully removing shown that MIRE could significantly inhibit the irritability of an
the feeding tube, and sessions of the swallowing therapy. Results: MTrP in rabbit skeletal muscle. The objective of this study is to
There were no significant differences in the age, sex, stroke charac- determine whether the therapeutic effect of MIRE is beneficial
teristics and severity of dysphagia between the RD and PD groups. In for an MTrP in human upper trapezius muscle. Materials and
both of the RD and PD groups, we found significant improvements in Methods: We have recruited 6 patients (one male, 5 females, mean
FOIS scores after therapy. The average change in FOIS scores of the age: 39.8 years old) with MTrPs in their upper trapezius muscles.
RD and PD groups were 4.32 ± 2.14 and 3.67 ± 1.60, respectively, but The interventional protocol consisted of a daily 40 min treatment
this scores did not show statistically significant differences in either of MIRE, three times per week for 2 weeks. Pain measurements
groups. At the end of treatment, the average numbers of sessions in the including verbal rating scale (VRS), visual analog scale (VAS),
RD and PD groups were 15.91 ± 9.81 and 26.11 ± 15.92, respectively. pressure pain threshold (PPT), neck disability index (NDI) were
The treatment sessions of the RD group were significantly lesser evaluated before the intervention of MIRE (M0), immediately after
than that of the PD group. Eighteen (81.8%) patients in RD group the 2-week intervention (M1), and one week after completion of
and 13 (72.2%) patients in PD group regained swallowing ability the intervention (M2). Results: After 2 weeks of MIRE interven-
and successfully removing their feeding tube after treatment. No tion, the mean value of VRS was decreased from 2.3 (M0) to 1.5
complication was observed in both groups. Conclusion: The NMES (M1), and then 1.5 (M2); the mean value of VAS was decreased
combined with SRP is an effective treatment strategy for both recent from 4.6 (M0) to 2.9 (M1), and then increased to 3.3 (M2); the
and persistent dysphagia caused by stroke. To supply this therapy for mean value of PPT was increased from 2.2 (M0) to 2.4 (M1), and
recent dysphagia is more cost effectiveness than persistent dysphagia then 2.4 (M2); the mean value of NDI was improved from 18%
because lesser treatment sessions are needed. (M0) to 8% (M1), and to 6% (M2). Conclusion: Our preliminary
results revealed that the therapeutic effect of MIRE might be a
useful option for the treatment of an MTrP. Further studies are
0501PP30 needed for a definite conclusion.
THE EFFECT OF IMPROVING UPPER LIMBS
MOTOR FUNCTION OF HEMIPLEGIC PATIENTS 0501PP32
BY ELECTROMYOGRAPHY BIOFEEDBACK
PHYSICAL THERAPY COMBINED WITH
TRAINING
CERVICAL SYMPATHETIC NEVER BLOCK IN THE
Hong-wei Zhai, Wei Chen, Zun-Ke Gong, Jiang-Bo Hu, TREATMENT OF ACUTE FACIAL NEURITIS
Jing-jie Zhou
Chinese Association Of Rehabilitation Medicine (China) Hongguang Duan, Liqiang Yang, Meihua Hu, Hong
Geng, Yuna Guo
Purpose: To study the effect of improving upper limbs motor The Department of Rehabilitation Medicine, Xuanwu Hospital
function of hemiplegic patients by electromyography biofeedback Capital Medical University (China)
training. Materials and Methods: 60 hemiplegic patients were
randomly divided into control group (n = 30) and study group Purpose: To compare the effects of physical therapy and the com-
(n = 30).The latter received electromyography biofeedback train- bined use of physical therapy and cervical sympathetic never block
ing, 6 times a week for 60 days, in addition to regular medication. in treatment of acute facial neuritis. Materials and Methods: The
All patients were evaluated with wrist joint active AROM, upper patients with acute facial neuritis were divided into two groups.
limbs FMA and the largest EMG signal in the wrist extensor befoer The patients in group A (n = 52) were treated by ultrashortwave
and after the treatmen. Results: The AROM, FMA and EMG in and polarized light, while those in group B (n = 50) were treated
each group had a significant difference (p < 0.01) after the treat- by ultrashortwave and polarized light combined with cervical
men, The improvement in the study group was greater than that sympathetic never block. Results: The effect was better in group

B than in group A, with a significant difference (p < 0.05) , and no visable to test the Vitamin D level and to consider supplementation
complication occurred in both the groups. Conclusion: The com- accordingly for the treatment of chronic low back pain.
bined use of the physical therapy and cervical sympathetic never
block is better than the only use of ultrashortwave and polarized
light in the treatment of acute facial neuritis. 0501PP35
THE ASSOCIATION BETWEEN PERCEIVED PAIN,
0501PP33 PSYCHOLOGICAL DISTRESS, AUTONOMIC
STATUS, DISABILITY AND SLEEP AMONG THE
PREVALENCE OF LOW BACK PAIN AND
CHINESE PATIENTS WITH CHRONIC NECK
ASSOCIATED FACTORS AMONG ADULTS IN
SHOULDER PAIN
TAIWAN: A POPULATION-BASED STUDY
Su-Hsien Lin1, Shih-Ching Chen1, Sung-Hui Tseng1,
Yi-Chun Chou1, Chun-Chuan Shih2, Jaung-Geng Lin2, Chien-Hung Lai1, Allen Chia-Lin Hsu1, Jiunn-Horng
Chien-Chang Liao2 Kang1,2
1
Department of Physical Medicine and Rehabilitation, China Medi- 1
Department of Physical Medicine and Rehabilitation, Taipei Medi-
cal University Hospital and 2 College of Public Health and College cal University Hospital and 2Institute of Biomedical Engineering,
of Chinese Medicine, China Medical University (Taiwan) National Taiwan University (Taiwan)
Purpose: Low back pain is a common symptom interfering with activi- Purpose: The chronic neck-shoulder pain is relative common problem.
ties of daily living and a leading cause of disability. The purpose of this The impact of chronic neck-shoulder pain could be mulit-dimensional.
study is to investigate the prevalence, characteristics, and associated Complex interaction between psychological and physiological factors
factors of low back pain (LBP) among adults in Taiwan. Materials and could be involved in pathomechanism of chronic neck-shoulder pain.
Methods: This study analyzed the data from the 2002 National Health The goal of the study is to analyze the perceived pain, psychological
Interview Survey conducted by Department of Health, Taiwan. It was distress, autonomic status, disability and sleep among the Chinese
a face-to-face questionnaire survey among people aged 15 years and patients with chronic neck shoulder pain. Materials and Methods:
older. People who complained of sometimes or frequent LBP within Patients who chronic neck-shoulder pain for more than three months
the past three months were considered as case group. Adolescents aged were included in this study. We excluded the patients who had
15–19 years were excluded from this study. Results: Among 24435 known systemic rheumatologic diseases, malignancy, previous neck
eligible study participants aged 20 years and older, 25.7% of them trauma or surgery and co-existing cervical radiculopathy. Totally
had LBP within the past three months. The prevalence of LBP was Forty-three patients (37 female/6 male) were included in this study.
18.8% among people aged 20–29 years increased to 36.4% among Average VAS for pain was recorded for each patient. Chinese Health
people aged 80 years and older (p < 0.0001). Female (odds ratio Questionnaire-12 (CHQ-12), Pittsburgh Sleep Quality Index (PSQI),
[OR] = 1.67, 95% CI = 1.433–1.95), low education (OR = 1.38, 95% Neck Disability Index (NDI) were also recorded for measure patents’
CI = 1.23–1.55) and blue collar (OR = 1.16, 95% CI = 1.07–1.26) were psychological stress, sleep quality, and disability respectively. Pres-
factors associated with LBP in the multivariate logistic regression. sure pain thresholds were recorded with a pressure algometry at
Compared with people had no osteoporosis, people had osteoporosis bilateral neck paraspinal muscles, trapezius and rhomboid for each
were more likely to have LBP (OR = 2.55, 95% CI = 2.33–2.78) or patient. 5-min EKG were recorded under quiet supine position for
frequent LBP (OR = 4.15, 95% CI = 3.66–4.70). The ORs of frequent each subject and short term HRV were further analyzed with lead
LBP in association with osteoporosis in men and women were 5.77 II in both frequency and time domains. Pearson’s and Spearman’s
(95% CI = 4.66–7.15) and 3.49 (95% CI = 2.99–4.07), respectively. correlation test were conducted for analyze the correlation between
Conclusion: This study found a high prevalence of low back pain perceived pain and psychological distress, sleep quality, disability,
within past three months among adults in Taiwan. Low back pain was and HRV parameters. Significant level was set as p < 0.05. Results:
associated with osteoporosis and the association seemed stronger in The mean VAS, PSQI, CHQ-12 and NDI were 5.5 ± 2.0, 12.0 ± 4.2,
men than in women. 5.2 ± 3.1 and 17.0 ± 8.0, respectively. We found VAS for pain was
significantly positive correlated with pain duration (r = 0.31, p = 0.04).
In addition, VAS for pain was negative correlated with RMSSD and
HF power in HRV analysis (r = –0.273, p = 0.05; r = –0.31, p = 0.004,
0501PP34
respectively). However, VAS for pain was not significantly correlated
EFFECTS OF VITAMIN D IN THE TREATMENT OF to psychological distress and sleep quality. Interestingly, we found
LOW BACK the NDI was significantly positively correlated with CHQ-12 and
PSQI (r = 0.50, p = 0.001; r = 0.37, p = 0.02, respectively). Conclu-
Chunbo Cai sion: We found the perceived pain was associated with significantly
Kaiser Permanente Medical Center, San Francisco (United decreased HRV and increased sympathetic component among the
States) patients with chronic neck–shoulder pain which could reflect with
common pathophysiological effects of pain in autonomic status. In
Purpose: To evaluate the role of Vitamin D in the treatment of low addition, we found the level of disability among these patients was
back pain. Materials and Methods: This is a descriptive cohort study positively correlated with psychological status and sleep quality. Our
with 98 cases collected from 2008 to 2009. The patients came to the data support the impact of chronic neck–shoulder pain is tremendous
spine clinic for chronic low back pain with the reported visual analog and complex. Our data can help to develop further clinical strategy
score (VAS) at 5–9/10. Their blood Vitamin D level was tested to to improve the care of these patients.
be below the normal limit. The age of the patients was from 20 to
80 year-old. There were 34 (35%) males and 64 (65%) females. All
have failed physical therapy and commonly used pain medications. 0501PP36
They were advised to take Vitamin D supplement for 8 to 12 weeks. RESTORATION OF CERVICAL LORDOSIS AND
Eight patients were lost in follow up at 8th to 12th week. Results: In
the 90 cases, 61 patients (68%) reported at least 50% improvement REDUCCTION OF FORWARD HEAD POSFURE
of the pain, among which 19 (21 %) patients reported at least 90% FOR THE TREATMENT OF NECK PAIN IN
improvement; 29 patients (32%) reported less than 50% improvement YOURY ADULTS USISY SEATED EXTENDED
of the pain, among which 15 patients (17%) patients reported no relief. COMPRESSED CERVICAL 2-WAY TRACTION
Conclusion: Vitamin D does play a role in low back pain. Although it
warrants more in-depth study to determine whether Vitamin D should Sunto Yen
be screened in the patients who have chronic low back pain, it is ad- Healthone Rehabilitation Clinic (Taiwan)

Purpose: To study whether a seated, extended and compressed ratio (LF/HF). Results: A significantly increased RR, HF, TP, and
cervical 2-way traction would cause tension in the antrior ligament, Var were found in LBP patients after physical agent modalities.
anterior disc and muscle structure, and thereby restore cervical lor- Besides, the scores of VAS and ODI significantly decreased on
dosis, reduce forward head posture in the treatment of young adult comparing with the pre-treatment status. There was a significant
patients with neck pain. Materials and Methods: This is a nonrand- negative correlation between post-treatment ODI and pre-treatment
omized.prospective.clinical control trial. Thirty preselected patients LF, HF, TP, and Var, respectively. Conclusion: The study demon-
after diagnostic screening for tolerance to cervical extenion with strates enhanced cardiac vagal activities and decreased pain as well
compression were treated for the 2 months of care using hot pack as disability in LBP patients after physical agent modalities. There
and a new type of cervical extension-compression traction (verticl might be a potential link between parasympathetic function and
weight applied to the subjects’ forehead in the sitting position with improvement of disability in LBP patients with modality therapy.
a transverse load at the areas of cervical kyphosis ); Measurements The clinical implication of autonomic function in predicting the
are as follows; 1) Visual Analogue Scale (VAS) 2) Neck Disability efficacy of physiotherapy warrants further investigation.
Index. 3) Lateral Cervical Radiographs analyzed with the posterior
tangent method for changes in alignment measurements of pretreat-
ment and posttreatment of each patent were compared. Results are 0501PP38
compared to a control group of 30 subjects receiving no treatment SCIATICA CAUSED BY A INTRASPINAL JUXTA-
and matched for age, sex, weight, height, and pain. Results: Control FACET SYNOVIAL CYST: A CASE REPORT
subjects reported no changes in VAS pain ratings, neck disability
index; and had no statistical significant change in cervical alignment Tai-Yi Wu1, Yu-Ting Hsieh1, Jen-Li Pan1, Chien-Huang
on comparative lateral cervical radiographs. (difference in all angle Kuo1, Shu-Hua Lin1, Chung-Sheng Ho1, Hsing-Hong
mean values < 1.0) For the traction group, VAS ratings were 5.8 Chen2, Chein-Wei Chang3
pretreatment and 0.9 posttreatment; neck disability index were 26.5 1
Department of Physical Medicine and Rehabilitation, Poh-Ai
pretreatment and 7.8 posttreatment. Comparative lateral cervical Hospital, 2Department of Neurosurgery, Poh-Ai Hospital and
radiographs showed statistically significant improvements includ- 3
Departments of Physical Medicine and Rehabilitation, National
ing anterior head weight bearing (mean improvement of 15mm),
cobb angle at C2–C7 (mean improvement of -12), and the angle of Taiwan University Hospital (Taiwan)
intersection of the poseriontcngent, at C2-C7(mean improvement of Purpose: Report a case of left sciatica due to a intraspinal juxta-
16.5). Conclusion: A seated extended compressed cervical 2-way facet synovial cyst. Materials and Methods: Detailed history was
traction can decreased neck pain and improved cervical lordosis taken and clinical physical examination was done. A 50-year-old
in 30 visits over 8 weeks, as indicated by increases in segmental female patient, who suffered from painful numbness over her left
and global cervical alignment. Anterior head weight-bearing was leg for 4 months despite of conservative treatments was evaluated
reduced by 15 mm; Cobb angles averaged an increase of 12; and the by electrophysiological study, plain film and magnetic resonance
angle of intersection of posterior tangents on C2 and C7 averaged image (MRI). A juxta-facet synovial cyst between the left lumbar
16.5 of improvement. fourth and fifth spine levels associated with the left fifth lumbar
radiculopathy was diagnosed and approved from the specimen of
a excisional surgery. Results: Weakness of left extensor hallucis
0501PP37 longus muscle and painful numbness over her left fifth lumbar
PHYSICAL AGENT MODALITIES ENHANCES dermatome were noted. MRI showed a facet joint synovial cyst
CARDIAC VAGAL ACTIVITIES IN LOW BACK between her left fourth and fifth lumbar spinal segments, with an
PAIN PATIENTS obliteration of lateral recess and compression on the fifth spinal
nerve root. Under the diagnosis of synovial cyst causing fifth lum-
Clement SH Yang1,6, Terry B.J. Kuo2,7, Cheryl CH Yang2,7, bar radiculopathy, hemilaminectomy with excision of the synovial
Kun-Ruey Shieh3, Pesus Chou4,8, Chieh-Yu Liu5 cyst was performed. Synovial cyst was confirmed by histological
1
Department of Physical Medicine and Rehabilitation, Buddhist Tzu examination. After operation, her neurological functions get much
Chi General Hospital, 2Sleep Research Center, National Yang-Ming improvement. Conclusion: Juxta-facet synovial cyst is a relatively
University, 3Institute of Physiological and Anatomical Medicine, Tzu uncommon cause of sciatica in lumbar spine. Most juxta-facet cysts
Chi University, 4Community Medicine Research Center, National are observed between the fourth and fifth lumbar spinal levels,
and commonly occur in patients older than 65 years old. MRI is
Yang-Ming University, 5Department of Nursing, National Taipei
the imaging modality of first choice for the diagnosis. Treatment
College of Nursing, 6College of Medicine, Tzu Chi University, regimen such as physical therapy, epidural injection, oral steroid
7
Institute of Brain Science, National Yang-Ming University and medication, and non-steroidal anti-inflammatory drugs are usually
8
Department & Institute of Public Health, National Yang-Ming given in patients without neurological deficit. Surgical intervention
University (Taiwan) with excision of the synovial cyst has been recognized as a highly
Purpose: To investigate the potential differences in pain, disability effective treatment for pain relief.
and autonomic function of low back pain (LBP) patients before and
after physical agent modalities. Materials and Methods: Twenty- 0501PP39
nine LBP patients (14 men and 15 women) who never had or had no
physiotherapy for over 6 months were enrolled (mean age 38.7 years, THE IRRITABILITY OF THE MYOFASCIAL
standard error of the mean 2.1). The same prescription of physical TRIGGER SPOT IN GASTRONEMIUS MUSCLE
agent modalities including hot pack, interferential current therapy, FROM RABBITS WITH HYPERTHYROIDISM
and lumbar traction were applied on all the study participants. A
battery of measures including assessment of their pain, disability Wei-Chi Hsieh1, Kai-Hua Chen1, Hung-Chih Hsu1,2,
and autonomic function by means of heart rate variability (HRV) Chang-Zern Hong3
were carried out before and after physical agent modalities. Pain was 1
measured using a visual analog scale (VAS) with a score of 0 (no Memorial Hospital, 2Graduate Institute of Clinical Medical Science,
pain) to 100 (unbearable pain), and disability was measured using Chang Gung University, College of medicine and 3Department of
the Oswestry Disability Index (ODI). Frequency-domain analysis Physical Therapy, Hung Kuang University (Taiwan)
of the stationary R-R intervals (RR) was performed to calculate
the mean of the RR, variance of the RR (Var), total power (TP), Purpose: A animal model to investigate the influence of thyroid
high-frequency power (HF, 0.15–0.40 Hz), low-frequency power hormone on the prevalence of endplate noise (EPN) recorded
(LF, 0.04–0.15 Hz), LF in normalized units (LF%), and the LF/HF from the myofascial trigger spot (MTrS) in skeletal muscle from

hyperthyroidism rabbit; a blinded controlled study. Materials and either in the same group of patient or using other techniques such
Methods: Twenty New Zealand male white rabbits were divided as self-stretching.
randomly into hyperthyroidism and control group. The rabbits with
hyperthyroidism are following the induction of hyperthyroid state by
intramuscular administration of L-thyroxine for 7 days. The control 0501PP41
group rabbit were also intramuscular injected with the same volume THE EFFECTIVENESS OF EXTRACORPORAL
of normal saline one week. Before and after full course injection, SHOCK WAVE THERAPY ON TENDINITIS OF THE
TSH, free T4, T3 and TSH level in serum were checked. The preva-
lence of endplate noise (EPN) from MTrS in bilateral gastronemius SHOULDER
muscle were also recorded at the same time by EMG study. Results: Wang Yan
The serum level data of T3, T4, free T4 and TSH in control group Wuhan University (China)
was not significant before and after 0.45% saline injected (p > 0.05);
and so did in the prevalence (p > 0.05). In Hyperthyroidism group, Purpose: The Effectiveness of Extracorporal Shock Wave Therapy
post seven days L-thyroxine injected, T3, T4, FreeT4 ,TSH level on Tendinitis of the Shoulder Materials and Methods: We treated
and EPN prevalence are significant (p < 0.05) compare with pre- 30 patients in Extracorporeal shock wave therapy (ESWT) and
injected by thyroxine. The regression analysis between T3, T4, control group each to have the medium frequency electical therapy
free T4 or TSH with EPN prevalence are significant (R square: (MFET). Results: 12 weeks after ESWT the patients treated have
T3:0.52 T4: 0.42 free T4: 0.42 TSH: 0.26; sig: 0.00). Conclusion: a significant better outcome as the shame group by scoring the
In hyperthyroidism condition, the irritability of MTrS in rabbit’s Constant-Murley-Score (p < 0.001). Conclusion: The shock wave
skeletal muscle increase. The serum levels of T3, T4, free T4 and therapy is the best evidence based treatment lesions of the shoulder
TSH have positive correlation with EPN prevalence. Furthermore and must be indicated before operative
T3 has stronger effect on EPN prevalence than others.
0501PP42
0501PP40
LOW BACK PAIN FROM MULTIPLE MYELOMA: A
EFFECTS OF PROPRIOCEPTIVE
CASE REPORT
NEUROMUSCULAR FACILITATION (PNF)
STRETCHING ON MYOFASCIAL TRIGGER POINT Chao-Chih Lee
OF UPPER TRAPEZIUS MUSCLE IN FEMALE Chen Hsin General Hospital, Rehabilitation Department (Tai-
wan)
UNDERGRADUATE STUDENTS
Low back pain is a common musculoskeletal disorder affecting 80% of
Saowanee Luangaram, Suwalee Namwongsa
people at some point in their life time. It can be either acute, subacute,
Naresuan University (Thailand) or chronic in duration. Most often, the symptoms of low back pain
Purpose: Myofascial trigger point (MTrPs) in the upper trapezius show significant improvement within a few weeks with conservative
muscle is claimed to be a common source of neck pain. Patients treatment. However, there are some causes of low back pain which
often report regional and persistent pain that usually result in a require different approach and management. A case of 57 y/o female
decreased cervical range of motion (CROM). Stretching exercise patient suffered from sudden onset of low back pain since four months
has been recommended as an easy treatment of MTrPs. Previous ago, she received conservative treatment and seemed no improvement.
researches suggest some proprioceptive neuromuscular facilitation Due to pain persisted, she then visited emergency department for help,
(PNF) stretching techniques produce greater increase in range of T8 compression fracture with retrolisthesis of L4/5 were diagnosed,
motion and reduce pain than static or ballistic stretching. However, and surgery was then performed. However, the pain progressed after
the most effective PNF technique was still unclear. Therefore, the series of treatment; she was hospitalized for further evaluation. During
purpose of this double blind control trial was to determine the ef- hospitalization, a series of survey were arranged. Whole body bone
fectiveness of three types of PNF stretching in women with MTrP scan showed increased uptake of numerous segments of T-spine, and
in upper trapezius muscle. Materials and Methods: Eighty-nine no positive finding of tumor makers. Serum protein electrophoresis
females (18-25 years old), were recruited from the undergradu- gives positive finding of the presence of M band, IgA, and kappa light
ate students of Naresuan University. Volunteers were randomly chain. Bone marrow biopsy was then arranged and showed hypercel-
allocated to 3 groups; Hold-relax group (HR, n = 30), Agonist- lularity and increased portion of immature plasma cell, which fulfilling
contract-relax group (ACR, n = 30) and Contract-relax-antagonist- the diagnostic criteria of multiple myeloma, thus we have found the
contract group (CRAC, n = 29). Passive stretching in all groups was cause and explanation of low back pain, and further anti-cancer therapy
done by the same physical therapist and hold 15 seconds for 10 were suggested. This case suggests that there are variable causes of
times and alternate with 5 seconds rest. The outcome parameters, low back pain. If the pain condition was not improved after conserva-
pressure pain threshold (PPT) on the MTrP and CROM (flexion, tive or surgical management, it is necessary to explore other etiology
lateral flexion and rotation), were measured before and 0, 5, 15 with more detailed survey as in this case, for example, a malignant
and 30 min after treatment. Data were analysed by ANOVA and condition, even it is uncommon.
repeated measures ANOVA with significance level of 0.05. This
study was reviewed and approved by the Institute Ethics Com- 0501PP43
mittee, Naresuan University. Results: The general characteristics,
baseline PPT and CROM of all groups were not significantly THE EFFECT OF REPETITIVE TRANSCRANIAL
different and were all within the normal range. In addition, PPT MAGNETIC STIMULATION (RTMS) ON NNOS AND
and CROM of all groups show significantly increase (p < 0.05) GFAP IN RATS WITH CHRONIC NEUROPATHIC
after stretching complete. Moreover, PPT levels were improved
17.39%, 12.23% and 8.80% in HR, ACR, and CRAC, respectively. PAIN
However, CROM in all groups increased linearly with time but Tiecheng Guo, Jingfei Xu
showed no statistical significance between groups (p > 0.05). No Tongji Hospital, Tongji Medical College, Huazhong University of
adverse effects from all subjects were reported after stretching Science and Technology (China)
procedure. Conclusion: Based on the result, we conclude that all
techniques in this study help improve PPT and CROM in women Purpose: Repetitive transcranial magnetic stimulation (rTMS) has
with MTrP in upper trapezius muscle. In addition, from PPT level, been applied for treatment of chronic neuropathic pain. However,
the HR technique tends to show more efficiency than others. So, the mechanism has not been elucidated. In this study, we evaluate
the further studies should focus on the effect of HR technique the effects of different frequencies of rTMS on chronic neuropathic

pain and observe change of neuronal nitric oxide synthase (nNOS) OSTEOARTHRITIS – A PROSPECTIVE STUDY
in the dorsal root ganglion (DRG) and glial fibrillary acidic protein WITH 6 MONTHS FOLLOW-UP
(GFAP), a specific activation marker of astrocytes in the lumbar
spinal cord. Materials and Methods: A chronic neuropathic pain Shu-Fen Sun1,2, Chiao-Wen Hwang1, Jue-Long Wang1,
model was adopted and made by chronic constriction nerve injury Chien-Wei Hsu3, Kam-Fai Wong4, Yi-Jiun Chou5, Hsien-
(CCI). A total of 28 male Sprague-Dawley rats were divided into a Pin Sun6
control group and an rTMS group which in turn were divided into 1
Department of Physical Medicine and Rehabilitation, Kaohsiung
a sham-rTMS group, 1 Hz rTMS group, 20 Hz rTMS group, with 7 Veterans General Hospital, 2National Yang-Ming University School
animals in each group. Three days after the CCI operation, rTMS was of Medicine, 3Department of Internal Medicine, Kaohsiung Veter-
applied to primary motor cortex (M1) contralateral to the site of pain ans General Hospital, 4Institute of Statistics, National University
for 10 consecutive days. Behavioral observation, mechanical allodyia of Kaohsiung, 5Department of Orthopedic Surgery, Kaohsiung
and thermal hyperalgesia tests were examined before surgery, 3 days Veterans General Hospital and 6Department of General Surgery,
postsurgery and after 10 days of rTMS. The expression of nNOS in
Cheng Ching Hospital (Taiwan)
DRG and GFAP in lumbar spinal cord were examined, respectively,
by using immunohistochemistry technique. Results: The withdrawal Purpose: Ankle osteoarthritis can cause substantial pain, functional
thresholds of the hind paw to mechanical stimulation and the latencies limitations and often it affect a person’s balance and walk. Viscosup-
of foot withdrawal to noxious heat in rats underwent CCI operation plementation with 3 to 5 intraarticular injections at weekly intervals
were lower than those in the control group (p < 0.05) 3 days post- is a well-established treatment option in knee OA and is included in
surgery. After rTMS, mechanical allodyia and thermal hyperalgesia the treatment guidelines, evidence for efficacy and safety of its use
were relieved only in 20 Hz rTMS group but not in 1 Hz rTMS group in ankle OA is limited. Previous studies reported that five weekly hy-
(p < 0.05). Compared with control group, the expression of nNOS was aluronate injections were safe and effective for the treatment of ankle
significantly increased in ipsilateral L4–L6 DRG in sham-rTMS group osteoarthritis. The effect of three weekly injections has rarely been
and 1 Hz rTMS group (p < 0.05) and the nNOS staining was mainly investigated. The purpose of this study was to evaluate the efficacy and
found in the small and medium neurons. A recovery of nNOS expres- safety of three weekly injections of sodium hyaluronate (Hyalgan) in
sion was observed in the 20 Hz rTMS group but not the 1Hz rTMS patients with unilateral ankle osteoarthritis. Materials and Methods:
group (p < 0.05), and the expression of GFAP in the ipsilateral L4-L6 As a prospective observer-blind study done in a university-affiliated
lumbar spinal dorsal horn showed similar change. Conclusion: can tertiary care medical center, 50 patients with unilateral ankle pain for
Relief of mechanical allodyia and thermal hyperalgesia after 20Hz at least 6 months and radiographically classified as Kellgren-Lawrence
rTMS to contralateral M1 was accompanied with down-regulation of grade 2 or 3 ankle osteoarthritis were recruited. Patients received three
over-expression of nNOS in the corresponding segmental ipsilateral weekly intraarticular injections of Hyalgan into symptomatic ankles.
DRG and GFAP in ipsilateral lumbar spinal dorsal horn. It is suggested The primary outcome was the change in the Ankle Osteoarthritis Scale
that high frequency rTMS can relief neuropathic pain through down- (AOS) score at 6 months after the third injection. Several secondary
regulating the over-expression of nNOS in the DRG and inhibiting the outcome measures including American Orthopedic Foot and Ankle
proliferation and activation of astrocytes spinal dorsal horn. Society ankle/hindfoot score, four clinical balance tests, analgesics
consumption and patients’ global satisfaction were assessed. Results:
Forty-six participants completed the study. Significantly greater re-
0501PP44 duction in AOS scores was noted at 1, 3 and 6 months after the third
THE IMMEDIATE EFFECTS OF REMOTE DRY injection (p < 0.001 for each following visit compared with baseline).
NEEDLING ON PATIENTS WITH MYOFASCIAL The mean American Orthopedic Foot and Ankle Society ankle/hind-
foot score improved from 60.5 points at baseline to 73.5, 75.5 and
PAIN SYNDROME
76.7 points at 1-month, 3-month and 6-month follow-up, respectively
Wen-Ming Chang1, Hung-Chih Hsu1, Chu-Hsu Lin1, Kai- (p < 0.001). Acetaminophen consumption dropped significantly follow-
Hua Chen1, Wei-Chi Hsieh1, Alice MK Wong2 ing treatment (p < 0.001). Patients demonstrated significant improve-
1
Department of Physical Medicine and Rehabilitation, Chang Gung ments in four clinical balance tests at each follow-up visit compared
Medical Fundation, Chiayi Branch and 2Department of Physical with baseline (p < 0.001 for each test). The patients’ satisfaction rate
Medicine and Rehabilitation, Chang Gung Medical Fundation, was high with no serious adverse events. Conclusion: This study
suggests that three weekly injections of sodium hyaluronate are well
Linkou Branch (Taiwan)
tolerated, can provide pain relief and improve function and balance
Purpose: To evaluate the immediate effects of remote dry needling on in patients with unilateral ankle osteoarthritis. The results require
the myofascial trigger point in the upper trapezius muscle. Materials confirmation in larger, well-controlled trials.
and Methods: Twenty-five patients with active myofascial trigger
points in upper trapezius muscles were recruited in this study and re-
ceived dry needling on the distal acupoint (Hoku; LI4 ). We measured 0501PP46
the visual analog scale, pressure pain threshold, and range of motion
of the neck before and immediately after the treatment. Results: The A DOUBLE-BLIND RANDOMIZED PLACEBO
immediate effect on the intensity of visual analog scale was signifi- CONTROLLED PARALLEL GROUP STUDY
cantly decreased, but the pressure pain threshold was significantly DEMONSTRATES ANALGESIC EFFECTS OF
increased (p < 0.001). Also, there were significant improvement of SHEANUT OIL EXTRACT [BSP-201] IN EXERCISE
range of motion of the cervical spine, including neck extension, side
bending and rotation (p < 0.05). Conclusion: The positive immediate INDUCED MUSCLE TENDERNESS
effects of remote dry needling were demonstrated based on the pain Lars Arendt-Nielsen1, Allan Rosetzsky2, Morten Weidner2
intensity, pressure pain threshold and range of motion of the neck. 1
Center for Sensory-Motor Interaction, Laboratory for Experimental
Dry needling on the distal acupoint may provide a new approach to PainResearch, Aalborg University and 2Copenhagen Science Park
treat the active proximal myofascial trigger point. Symbion (Denmark)
Purpose: Oral sheanut oil extract [BSP-201] is an active bio-complex
0501PP45 obtained from a fraction of sheanut oil with approximately 50 to 70
EFFICACY OF THREE WEEKLY INTRAARTICULAR percent unsaponifiables that reduced dose-dependently interleukin-6
production from the rat pristine-induced peritonitis exudates cells. The
INJECTIONS OF HYALURONATE ON PAIN, primary objective of this placebo-controlled study was to investigate
PHYSICAL FUNCTION AND BALANCE IN the effects of BSP-201 on development of post-exercise muscle tender-
PATIENTS WITH UNILATERAL ANKLE ness. Materials and Methods: Three grams of BSP-201 or placebo

was given orally daily in 4 × 750 mg soft gel capsules for 22 days Methods: The skin impedance obtained from the electrode applied to
to 20 healthy men aged, 26 ± 0.61 years [mean ± standard deviation] the hand was measured, and it made comparative study of the value
in a double-blind, randomized control study. Subjects carried out an before and after the pain treatment. The patients with the chronic
intensive eccentric exercise of the first dorsal interosseous muscle of pain and the low back pain were done the hyperthermia of hot pack
the left hand on a standardized hand exerciser on the day 14. Muscle and the xylocaine intramuscular injection, and visual analogue scale
tenderness was tested on days 0, 14 [before exercise], 14 [immediately was compared additionally before and after treatment as sight scale.
after exercise], 15 [one day after exercise], 16 [two days after exercise Results: For the patients with the chronic pain and the low back pain,
with maximal tenderness], and 22 [eight days after exercise] by pres- the difference was admitted in the individual value that was able to
sure algometry. Results: Muscle tenderness on days 0 and 14 [before be put in the resting state, and the change was seen in response to the
exercise] was not different in the two groups. Muscle tenderness was state of their posture. Impedance decreased with the exacerbation
significantly reduced [24.3 ± 4.8 mm] in the group that consumed of the pain, and it has increased with the improvement of the pain
BSP-201 as compared to the placebo group [47.4 ± 6.5 mm] at day 14 sensation. The larger the improvement of the pain sensation was the
[immediately after, p < 0.01] and at day 16 [p < 0.04] after the exercise. smaller increases of impedance when the low back pain was improved
None of the participants reported any adverse effects. Conclusion: This by the effect of the hyperthermia. There was no change in impedance
current study showed that sheanut oil extract reduces muscle tenderness in case of the patients by the intramuscular injection of physiological
most likely via reduction of pro-inflammatory cytokine IL-6. salt solution though their sight scales were improved. Conclusion: The
pain is a subjective phenomenon, and it is changeable. The objective
evaluation is difficult because there are extremely a lot of troubles
0501PP47 that cause the pain. The improvement of the pain and the change in
THE SHORT-TERM EFFECT OF A HOME the skin impedance were in the correlation. It was suggested that a
EXERCISE PROGRAM AND SELF-MASSAGE FOR quantitative evaluation of the pain sensation was possible though it
was thought the change of the pain took place through the autonomic
SUBJECTS WITH MYOFASCIAL PAIN SYNDROME nerve system. The possibility of quantitatively appreciation of the pain
Tzyy-Jiuan Wang1, Mei-Wun Tsai1, Yuan-Chi Chan1,2, by the change of the skin impedance value was suggested. We hope to
Mei-Mang Chu2 examine the change in the pain sensation exactly in the future and to
1
Department of Physical Therapy and Assistive Technology, examine the assessment that can do by 24 h measurements.
National Yang-Ming University, 2Department of Rehabilitation,
Tri-Service General Hospital (Taiwan) 0501PP49
Purpose: The purpose of this study is to investigate a short-term effect THE TREATMET EFFECTS IN MYOFASCIAL
of a home exercise and self-massage program for subjects with MPS. TRIGGER SPOTS BY SONOPHORESIS WITH
Materials and Methods: This study was a randomized controlled trial. XYLOCAINE
The patients were randomly assigned into either the self massage plus
stretch exercise (MS) or the modality (MO) group. The MO group Wei-Chi Hsieh1,2, Chang-Zern Hong3
received six sessions of physical therapy including Silver Spike Point 1
(SSP) and hot pack. The MS group received the same treatment as Memorial Hospital, 2College of Medicine, Chang Gung University
the MD group plus a self massage and stretch exercise instruction by and 3Department of Physical Therapy, Hung Kuang University
a physical therapist. The intervention lasted for 2 weeks. Outcome (Taiwan)
measures including Patient Specific Functional Scale (PSFS), pressure
pain threshold (PPT) on trigger points and heart rate variability (HRV). Purpose: A blind controlled study for well knowing the treatment ef-
were recorded at the beginning and after 2 weeks of intervention. fects of sonophoresis with 2% xylocaine in human’s myofascial trigger
Repeated measures ANOVA were used to compare the between group points by animal model which the irritability of myofascial trigger
differences of the treatment effects. Results: The self massage and spot (MTrS) determined by recording the prevalence of endplate noise
stretch exercise group demonstrated significantly more improvement (EPN) in gastronemius muscle of rabbits. Materials and Methods:
on reducing resting pain (p = 0.000), pain during regular activities Ten rabbits, we randomize bilateral gastronemius muscle into experi-
(p = 0.000), maximal pain intensity (p = 0.000) and PPT (p = 0.000). ment and control side.In controlled side, the MTrS in gastronemius
Significantly more functional improvement was also observed in the was applied with pure jelly by sonophoresis (1 KJ/cm2, continuous
self massage and stretch exercise group than the modality only group. mode, duration 5 min) and the experiment side with 2% xylocaine
With regards to the HRV indices, the self massage and stretch exercise by the same setting of sonophoresis. Six treatments were applied to
group demonstrated significantly more increases in LF% (p = 0.008), each rabbtis . The treatment effect included immediate and cumula-
HF% (p = 0.001), and decrease in LF/HF (p = 0.002) than the modal- tive were assessed by the prevalence of EPN with electromyographic
ity group. Conclusion: A 2-week self-massage and stretch exercise (EMG) recordings after the first and last treatments Results: In control
combine with SSP and hot pack is more effective than SSP with hot group, the prevalence of EPN in first or last treatment compare with
pack alone in pain relief and functional improvement for subjects in the before one , the values are significant (p = 0.00); but between first
MPS. The effects can be partially explained by the increases of the and last treatment has no significant different. In experiment group,
parasympathetic activity. significant different (p = 0.00) by comparing prevalence of EPN in
first or last treatment with the before. Last treatment has no significant
different than first treatment. Compare between groups, first and last
0501PP48 treatment effects on EPN both have no significant result (p > 0.05)
EFFECTIVENESS OF PAIN MEASUREMENT BY Conclusion: Sonophoresis with 2% xylocanine did not inhibit the
irritability of an MTrS in rabbit skeletal muscle.
ELECTRIC PHENOMENON
Kenji Kagechika1, Minori Nakata1, Misao Tsubokawa1, 0501PP50
Hirotaka Kawasaki1, Masao Yamaguchi1, Akio Kobe2,
Yasutaka Takagi3 EFFECTS OF INTRA-ARTICULAR BOTULINUM
1
Department of Rehabilitation Medicine, Kanazawa Medical Uni- TOXIN INJECTIONS ON LOWER-LIMBS
versity hospital, 2Department of Medical Rehabilitation Services, BIOMECHANICS AND FUNCTIONAL ABILITIES IN
Kanazawa Medical University Hospital and 3Department of Ortho- PATIENTS WITH KNEE OSTEOARTHRITIS
pedic Surgery, Tonami General Hospital (Japan) Lin-Fen Hsieh1, Shih-Hui Wu1, Sai-Wei Yang2, Ching-
Purpose: To examine whether it is possible to evaluate of the pain by Chieh Chou2
the measurement of the change in the skin impedance. Materials and 1

Wu Ho-Su Memorial Hospital and 2Institute of Biomechanical 0501PP52

Engineer, National Yang-Ming University (Taiwan) SELECTIVE INNERVATION OF SACRAL
Purpose: Intra-articular botulinum toxin (IA-BOTOX) injection ANTERIOR ROOTLETS TO MICTURITION AND
is a new therapeutic option for pain management, especially for ERECTION FUNCTION IN RATS
patients with refractory joint pain; however the biomechanical
effects of IA-BOTOX injection is still unknown. This is the first Wen-Ting Wang, Mou-Wang Zhou, Hong-Shi Huang,
study to evaluate the early effects of IA-BOTOX injection on Ya-Ping Chen, Yan-Yan Yang, Fan-Shuo Zeng
lower-limb biomechanics and functional abilities in patients with Department of Rehabilitation Medcine, Peking University Third
knee OA. Materials and Methods: Nineteen subjects (4 male Hospital (China)
and 15 female) with knee OA and 20 normal controls (6 male
and 14 female) participated in this study. Each patient with knee Purpose: To investigate the selective innervation of sacral anterior
OA received IA-BOTOX injection (100 units in 2 ml) in the af- rootlets to micturition and erection function in SD rats. Materials
fected knee. The assessments for patients with knee OA included and Methods: 40 male SD rats of clean grades, aged of 6 weeks,
demographic data, WOMAC index, Lequesne index, plain films were selected. 10 rats were conducted retrograde nerve tract trac-
of knee joints, clinical examinations, and gait evaluation. All ing study; 30 rats were chosen to do electro-physiology research:
of the assessments were performed before and 1 week after the the L6–S1 spinal cord segment anterior rootlets of anesthetic rats
IA-BOTOX injection. Normal controls were assessed with only were electrostimulated respectively, the intravesical pressure,
demographic data and gait evaluation once. Results: The severity urethral perfusion pressure and intracarvernerous pressure were
of knee OA ranged between II and IV (grade III: 68.4%). After recorded simultaneously, and innervation effectiveness was ana-
IA-BOTOX injection, knee pain was reduced 40%, Lequesne lyzed. Results: CB-HRP labeled neurons were observed mainly
index (13.11 to 9.94) and WOMAC index (37.21 to 25.88) were in the L6–S1 spinal cord. When some anterior rootlets of L6–S1
also improved. On level walking, increased peak ground reaction were electrostimulated, the intravesical pressure was increased
force and cadence (91 to 101 steps/min) were observed. The on- gradually, but the urethral perfusion pressure and the intracavern-
set time of vastus medialis (VM) firing was improved(-88.36 to ous pressure curve changed slightly; when other rootlets of the
–114.93 ms), the EMG intensities of VM increased 27 to 121% at same anterior root were stimulated, the urethral perfusion pressure
all intervals, and the shock absorption ability of the knee muscles could reach the peak maximally; while others were stimulated, the
was also improved after the injection. However, the co-contraction intracavernours pressure was increased quickly, but there were
pattern of knee muscles was not changed. No adverse effects were no great changes on intravesical pressure and urethral perfusion
found after the injection. Conclusion: IA-BOTOX injections are pressure. There were some other rootlets which could lead 2 or 3
suitable for knee OA patients with refractory pain, and for patients pressures mentioned above changed simultaneously. Conclusion:
who are not suitable for medications or joint replacement. We The innervation of L6–S1 anterior rootlets to rats’ bladder detrusor,
believed that pain relief contributed to the improvement in lower- external urethral sphincter and penis cavernours are significantly
limb biomechanics and restoration of functional abilities in early distinct, different rootlets can be distinguished by microanatomy
phase. Further long-term follow-up of the effects and side effects and electrostimulation.
of IA-BOTOX injections is indicated.
0501PP54
0501PP51
A CASE OF NONTRAUMATIC SPINAL CORD
INTRA BACLOFEN THERAPY OF SPASTIC INJURY - HISTORICAL ASPECT OF POTT’S
PARALYSIS AFTER SPINAL CORD INJURY PARAPLEGIA
CLINICAL ANALYSIS ON PATIENTS
Kimihiko Nakata
Xiaoying Shang1, Kenji Kagechika2, Yasutaka Takagi3 EN Clinic (Japan)
1
Rehabilitation Hospital of Heilongjiang (China), 2Kanazawa Medi-
cal University Hospital and 3Tonami General Hospital (Japan) Purpose: To clarify the natural history of tuberculous spondylitis or
Pott’s paraplegia. Materials and Methods: A famous Japanese Haiku
Purpose: Observation and analysis of intra vote with baclofen and Tanka poet Masaoka Shiki, who was born in 1867 and died at the
therapy in severe spinal cord injury patients with spasticity and age of 34 in 1902, continued writing articles of newspapers until 2
spasm of the effect of ADL. Object: July 2006 to March 2009, Japan days before his death. He made a precise description of his physical
Tonami Municipal Comprehensive Byoin received intra vote ba- deterioration of Pott’s disease at these articles in ‘Bokuju-itteki’ or
clofen therapy in 15 patients with the target. Among them, 14 males ‘Byosho-rokushaku’ and in his diary ‘Gyoga-manroku’. The clinical
and 1 female; mean age of 61.3 years (20-86 years). Baclofen pump course of this historical case treated without anti-tuberculosis drugs
implantation in 12 cases; reservation operation, 2 cases; patients do is reported here. Results: When the patient was 20, he began cough-
not agree with surgery for one case. According to the disease can ing up blood due to pulmonary tuberculosis. At the age of 28 he felt
be divided into: 12 cases of cervical spine injury; thoracic injury severe low back pain and diagnosed as spinal caries. He underwent
in 1 case; spastic paralysis of lower limbs in 2 cases. Materials drainage operation for gravitation abscess and its wound remained
and Methods: In this study, Ashworth Evaluation and Kenny-style open. After the age of 32, he became bed-ridden, suffering from
self-health management evaluation method before and after ITB paraplegia, neuropathic pain and faecal incontinence, which were
therapy for spasticity of the changes in clinical observation and probably due to the injured spinal cord. Intolerable pain during dress-
evaluation. Results: Ashworth score before administration of the ing change and suicide attempt were written by himself in the diary.
average 3.08±0.73; after administration of 1.35±0.71, a significant Flexion contracture of the left knee, anal fistula, gingivitis were
improvement. Efficiency is 93.3%.Significant improvement in pointed out. But only oral morphine was administered to alleviate
spasticity, while QOL improved, with cases also reduced. However, pain, which probably caused constipation. Approximately 7 fistulae
two cases of catheter loss, seizures again after surgery to improve in the back were discharging and he was afflicted by the diarrhoea
again. Discussion: ITB therapy can improve the central spasmolytic caused by tuberculous colitis at the terminal stage. In autumn 1902
spastic invalid, because the body buried in the baclofen pump, so he was considered to have died of cachexia and respiratory failure
the long-term maintenance of efficacy. However, issues such as resulting from systemic tuberculosis. One of the last poems is ‘a
catheter loss ITB therapy should be an important part of postopera- quart of phlegm – even gourd water couldn’t mop it up (translator:
tive management. J. Beichman)’. Conclusion: Pott’s paraplegia laid the case at the

sickbed for 6 years, but he was clear conscious and described his A injection or saline injection were applied, observe the change in
physical and mental status in clinical detail, which would show us electron microscopy, functional score and spasticity and compare
the natural history of of Pott’s paraplegia. with the normal control group 1 week and 3 weeks after injection,.
In the observed 1 week after injection and 3 weeks of electron
microscopy, functional assessment and spastic changes at the same
0501PP56 time, the formation of 1 week of cramps and 3 weeks after the injec-
tion of botulinum toxin type A groups of the electron microscope,
SELECTIVE INNERVATION OF SACRAL DORSAL function and spasticity score for comparison. Results: 1) compare
ROOTLETS TO MICTURITION AND ERECTION before and after injections: after the formation of spastic model,
FUNCTION IN SD RATS electron microscope results indicate that: sarcomere was shortened
significantly, muscle wire was in disorder, H-zone shortened, the
Mou-Wang Zhou, Wen-Ting Wang, Hong-Shi Huang, number of mitochondria glycogen reduced. After the injection of
Gen-Ying Zhu botulinum toxin type A significant change in sarcomere length,
Department of Rehabilitation Medicine, Peking University Third myofilament disarray, Z-line drift, H band broadens, and markedly
Hospital (China) increased mitochondrial swelling, glycogen is also increased in
the number. 3 weeks after injection, sarcomere length is longer
Purpose: To investigate the selective innervation of sacral dorsal than 1 week after injection. Function score: BBB ratings are part
rootlets to micturition and erection function in SD rats. Materials of the improvement, Ashworth score also significantly reduced.
and Methods: 40 male SD rats of clean grade aged of 6 weeks 2) spasticity formed after 1 week and 3 weeks compared: electron
were selected. 10 rats were conducted retrograde nerve tract microscopy results showed that: cramps 3 weeks than 1 week shorter
tracing study and microsurgical anatomy research; 30 rats were sarcomere, Z-line drift is more obvious, H-zone with a significantly
chosen to do electro-physiology research: The L6–S1 spinal cord reduced compared with 1 week. In the post-injection of botulinum
segment dorsal rootlets of anesthetic rats were electrostimulated toxin type A has a variable-length sarcomere, mitochondria swelling
respectively, the bladder pressure, the urethral perfusion pressure and the Z-line drift, but the sarcomere length of the 3 weeks group
and the intracavernous pressure were recorded simultaneously, and compared with the injection of more 1-week group before the op-
innervation effectiveness was analyzed. Results: CB-HRP labeled posite. Function score: the improvement of function after injection
neuronsobserved in the L6S1 spinal cord. The dorsal root could be of both, BBB ratings are part of the increase, Ashworth score also
divided into several rootlets. When some dorsal rootlets of L6–S1 significantly lower function scores slightly better three weeks than
spinal cord segment were electrostimulated, the intracavernous 1 week. Conclusion: 1) A-type botulinum toxin can significantly
pressure reached the peak rapidly, while the bladder pressure and reduce the level of muscle spasm; 2) in the morphology the reduction
the urethral perfusion pressure curve changed a little. When other of the muscle spasm degree of the 3 weeks after injection is better
rootlets were stimulated, the bladder pressure increased rapidly, than 1 week after injection; 3) part of muscles function improvement
but at the same time and the urethral perfusion pressure and the has been achieved after injection of botulinum toxin type A; 4) the
intracavernous pressure didn’t change too much. When some other reduction of the spasm is much higher in the 3rd weeks group than
rootlets were stimulated, the urethral perfusion pressure could that of the 1st week group.
reach maximally, but there were no great changes on the bladder
pressure and the intracavernous pressure. There were some other
rootlets which could induce 2 or 3 pressures mentioned above to 0501PP58
change simultaneously. Conclusion: There are different rootlets
in the L6–S1 dorsal root which conduct bladder detrusor, external EXPERIENCE OF INTRATHECAL BACLOFEN (ITB)
urethral sphincter and penis cavernous. The different rootlets can THERAPY TO SEVERE SPASTICITY
be distinguished by microanatomy and electrostimulation.
Yasutaka Takagi1, Hiroshi Yamada1, Yoshimitsu
Kanazawa1, Wataru Nasu1, Hiroyuki Tanaka1, Shingo
0501PP57 Shimozaki1, Kenji Kagechika2
AFTER BOTULINUM A TOXIN INJECTION THE
1
Tonami General Hospital and 2Kanazawa Medical University
CHANGE OF MUSCLE TISSUE OF SPASTIC RAT (Japan)
WITH SPINAL CORD INJURY IN MORPHOLOGY Purpose: To determine the outcome of intrathecal baclofen (ITB)
AND FUNCTION therapy in patients with severe spasticity. Materials and Methods:
The baclofen of 50 μg was administered to 18 patients who had
Yu Fu, Lijuan Ao, Yongmei Li, Wenli Wang severe spasticity due to 16 spinal cord injury, 1 cerebral infarction,
Department of Rehabilitation, the Second Affiliated Hospital of 1 hereditary spastic paraplegia in lumbar puncture as a schooling
Kunming College (China) injection, and the pump burial operation were performed to 13
patients. The change of the spasticity was evaluated by the Ash-
Purpose: To establish a stable spasm model of spinal cord injury, worth score points. Results: The improvement of the spasticity was
intramuscular injection of botulinum toxin type A was applied in remarkably admitted in all cases, and the pain from the spasticity
order to observe their morphology, spasticity and function score disappeared. The pain was reduced by adjusting the amount of the
changes before and after injection. Spasms were observed at dif- medicine without the exacerbation of the spasticity and it became
ferent times of the formation of botulinum toxin type A, after their former walking ability though it became difficult to walk temporar-
morphology, spasticity and function score changes. To identify the ily by reducing the apsasticity in the cases who could walk before.
effect of botulinum toxin type A to the morphology of the spasm Moreover, there was a case to whom the substantial contents of
muscle, and compare the change in the morphology of spasm rehabilitation was able to be done by improving the spasticity, too.
muscle after the botulinum toxin type A was injected at different Two catheter-related complications were found. Additional opera-
stage of spasm. To make it clear given after spasm after botulinum tions of the exchange of the catheter were needed. The improvement
toxin type A change in their morphology, and further formed at of the spasticity was recovered of additional operations. Conclusion:
different times to give a clear spasm botulinum toxin A. What is The spasticity of the pain who doesn’t obtain the improvement by
different from its morphology. Materials and Methods: Establish the taking treatment is improved enough, and the reduction of the
the model of spinal cord injury with adult SD rat, the were divided pain is seen, and the ITB therapeutic effect is expected that the
into 1-week group, 3-week group, saline group and normal control improvement of patient and family’s QOL can be attemped from
group according to the time of spasm formed. Botulinum toxin type the experience of these series.

0501PP59 statistically significant difference in the chances of motor improve-

SPINAL CORD INJURY CAUSED BY LONG-TERM ment between groups with and without spinal cord atrophy (odds
ratio = 66.0, 95% CI [3.472-1254.567], p-value = 0.002). Decrease
NECK EXTENSION IN A PATIENT WITH C-SPINE in CSA of the atrophied segment was 35.1 ± 13.2% from the initial
HERNIATED INTERVERTEBRAL DISK – A CASE one. Conclusion: Pediatric patients with transverse myelitis who
REPORT had developed spinal cord atrophy on follow-up MRIs had poor
motor recovery than those who had not. The appearance of spinal
Yi-Ling Chen, Yung-Tsan Wu, Shin-Tsu Chang, Shang- cord atrophy on MRI could be an indicator of poor prognosis in
Lin Chiang pediatric transverse myelitis.
Department of Physical Medicine and Rehabilitation, Tri-Service
0501PP61
Purpose: Discuss the pathogenetic relation between long-term neck
extension and anterior cord syndrome. Materials and Methods: INTRADURAL SPINAL ARACHNOID CYSTS
Case report. Results: A 39-year-old previously healthy male had ASSOCIATED WITH SPINAL CORD INFARCTION:
habit of nap with neck extension for 30 min every day. One day, he A CASE REPORT
suffered from acute four-limb weakness predominant in the bilateral
legs and distal part of right hand, urinary retention, and impaired Chun-Ching Chang1,2, Li-Wei Chou1,3,4
sensory of temperature and pain below the cervical region after a 1
Department of Physical Medicine and Rehabilitation, China Medi-
nap. T2-weighted image on MRI showed an area of hyperintensity cal University Hospital, 2Graduate Institute of Integrated Medicine,
over the anterior two-third region of cord and disc herniation at the China Medical University, 3School of Chinese Medicine, College of
C6/C7 vertebral level. Laboratory investigation showed no evidence Chinese Medicine, China Medical University and 4Department of
of infections, autoimmune, inflammatory, or neoplastic causes. We Physical Therapy, China Medical University (Taiwan)
hypothesized that he developed anterior spinal cord syndrome which
caused by disc herniation. Treatments with steroid for 8 days and Purpose: We report a case of spinal arachnoid cyst related to spi-
surgical intervention on the 11th day were given. The recovery of nal cord infarction. This 43-year-old female with end-stage renal
neurological function was fast and progressively good along with disease suffered from progressive left abdominal distension and
rehabilitation programs. Conclusion: The common cause of ante- pain accompanied with acute onset of bilateral lower limb weak-
rior cord syndrome was hyperflexion injuries with impingement of ness and numbness during her regular renal dialysis. High-grade
bone or herniated disc tissue directly on the anterior spinal cord and fever was also noted. Materials and Methods: Intenstinal obstruc-
the outcome is usually poor. However, this is a rare case showing tion was considered and abdominal-pelvic computed tomography
long-term neck extension induce anterior cord syndrome. Besides, (CT) revealed a left tubulo-ovarian abscess with compression of
early steroid use and surgical decompression resulted in better sigmoid colon. After treatment with drainage of the abscess and
neurological outcomes of anterior cord syndrome. antibiotics use, her abdominal symptoms and fever got resolved
but weakness of bilateral lower limbs with numbness still existed
with exacerbation into nearly paraplegia. Magnetic resonance im-
0501PP60 aging (MRI) of the thoracic spine showed linear hyperintensity in
the center of T1 to T5 spinal cord on T2-weighted image. Spinal
SPINAL CORD ATROPHY AND MOTOR cord infarction with paraplegia was considered and rehabilitation
RECOVERY FOLLOWING TRANSVERSE program was arranged. At a three-month later MRI follow-up, a
MYELITIS IN PEDIATRIC PATIENTS longitudinal subdural arachnoid cyst at T5 to T7 level with anterior
compression of the spinal cord was discovered, but there was no
Moon Suk Bang, Jung Yoon Kim, Sang Jun Kim worsening of her neurologic symptoms. Unfortunately, one month
Department of Rehabilitation Medicine, Seoul National University later worsening of her neurologic symptoms was noted including
College of Medicine (Korea) pain sensation, trunk weakness and autonomic dysfunction with
orthostatic hypotension. Results: Surgical intervention with T5 to
Purpose: To investigate relationship between spinal cord atrophy
T7 laminectomy for decompression and removal of the arachnoid
and motor recovery following transverse myelitis in pediatric pa-
cyst was performed. Her recovery was excellent and she could walk
tients Materials and Methods: A Retrospective case-control study
without walking assist for a short distance at eight months after the
was performed in one tertiary children’s hospital in Seoul, Korea.
operation. Conclusion: This case reminded us that the formation
Subjects were children who were diagnosed as transverse myelitis
of spinal arachnoid cyst could be related to spinal cord infarction,
from January 1995 to January 2009 and undertook initial and follow-
and provided a good example for further understanding about the
up MRIs. Medical records and spine MRI scans were reviewed to
mechanism of spinal arachnoid cyst formation.
find out whether clinical improvements in motor weakness had
occurred and spinal cord atrophies had developed on follow-up
MRIs. Spinal cord atrophy was defined as an abnormal thinning 0501PP62
of the spinal cord in the sagittal plane in two segments or more
beyond the limits of vertebral injury and reduction in spinal cord TREATMENT FOR PATIENTS WITH SPINAL
area ≥50% in more than two consecutive transverse planes. It was CORD INJURY BY TRANSPLANTATION OF
confirmed by radiologists. Atrophic changes were also measured in AUTOLOGOUS BONE MARROW STEM CELLS IN
cross-sectional areas using an image processing program, Marosis
5 CASES
M-view 5.4 (Marotech Inc., Seoul, Korea). Improved motor power
was defined as elevation of one or more grades in Medical Research Gongwei Jia, Lehua Yu
Council grades. The chi-square test was used and the odds ratio The Second Affitiated Hospital of Chongqing Medical University
was calculated. A probability of p < 0.05 was taken as statistically (China)
significant. All statistical analysis was done using SPSS 17.0 for
windows. Results: Nineteen patients were selected (8 males and 11 Purpose: To discuses the possiblity of treatment for patients with
females, onset age 5.6 ± 3.8 years). Initial MRI was taken 5.2 ± 8.9 spinal cord injury by transplantation of autologous bone marrow
days after the onset. Interval between initial and follow-up MRIs stem cells in human. Materials and Methods: Bone marrow was
was 56.2 ± 113.4 days. Seven patients had developed spinal cord harvested (about 200 ml) from patient’s ilia. To get the bone mar-
atrophies and 12 patients had not. Of the 7 patients with spinal row stem cells(BMSC),bone marrow was processed by Marrow &
cord atrophy, 6 showed no motor recovery. Among 12 patients Cord Blood Stem Cells Isolating Reagents produced by Ningxia
without atrophy, 11 had motor improvement except one. There was Zhonglianda Biotech Co., Ltd. The final preparation of BMSC were

infused into subarachnoid space.At different time(1st week,4th week, der and bowel were noted, and the boy received several courses of
8th week) after transplantation, ASIA were detected, and improve of chemotherapy. The rehabilitation program for balance control and
symptom were investigated. Results: The patient’s ability to control upper limbs strengthening were prescribed. During hospitalization
urine improve greatly who has urination disorder and the score of in November 2009, there was minimal neurological improvement
the ASIA has no improvement at 1st week after transplantation of including temperature sensation, trace muscle power in trunk flexor,
bone marrow stem cells. And at 8th week, the motor score improve at but his neurological status still remained T4 paraplegia. Follow-up
least 14, the pin prick score improve 4-10, and the light touch score AFP was within normal ranges. The cervicothoracic spine MRI
improve 4–6 only. Conclusion: ASIA were significantly improve showed no recurrent tumor.
after bone marrow stem cells transplantion, especially on the ability
of motor, the treatment of bone marrow stem cells transplantation
is safe and effective. 0501PP65
LONG-TRM SURVIVAL OF SPINAL CORD
0501PP63 INJURIES ADMITTED TO THE REHABILITATION
WARD OF A MEDICAL CENTER
THE EFFECTS OF FUNCTIONAL ELECTRICAL
STIMULATION WITH CYCLING TRAINING Yu-Ren Chen1, Huey-Wen Liang1, Yen-Ho Wang1, Fu-
FOR LOWER LIMB IN SPINAL CORD INJURY Chang Hu2
PATIENTS
1
Departement of Physical Medicine and Rehabilitation, College
of Medicine, National Taiwan University and 2National Center
Ninghua Wang, Xin Wang, Bin Xie, Rongli Wang of Excellence for Clinical Trial and Research, National Taiwan
Department of Physical Medicine and Rehabilitation (China) University Hospital (Taiwan)
Purpose: To review the effects of functional electrical stimula- Purpose: To follow up the mortality and calculate the standard
tion cycling training in the spinal cord injury patients, and there mortality ratio for traumatic spinal cord injuries (SCI) who was
provide the evidence base for the clinical application. Materials admitted for in-patient rehabilitation in a medical center. Materials
and Methods: We did the literature search from medical databases, and Methods: 183 patients (150 men and 33 women) with acute
like OVID and MD consult core service for recent 10 years, the 38 spine cord injuries and admitted to a rehabilitation ward from 1989
of all articles were chosen for our target reference. These target to 1997 were included in the current study. The date and cause of
articles were met the inclusion criteria on the base of the Cochrane death was obtained by linking to the mortality database till 2007
Collaboration Method to minimize the bias. Results: The article provided by Bureau of Vital Statistics of Department of Health,
showed that functional electrical stimulation with cycling training Taiwan. Standardized mortality ratios (SMRs) were calculated
in the spinal cord injury patients could reduce the spams muscle and compared with the mortality of general population in the
tone, improve weakness muscle strength, and knee extensor power Taipei County. Results: Forty-two cases (23.0%) were deceased
output with higher cycling speed. The results also showed that bone at the end of follow up, with an average follow-up period to be
mineral intensity was increased after training with 1 hr per time, 12.7 years. The leading cause of death recorded by the database
3–4 times each week for 12 months. The positive physiological was malignancy. SCI patients in the cohort had a significantly
effects such as cardiopulmonary function and cardiovascular func- increased mortality compared to the general population. SMR was
tion were also demonstrated. Conclusion: The functional electrical significantly higher for women than for men (65.0 vs. 40.8), and
stimulation with cycling training has become a useful method for higher in patients with complete tetraplegia compared to patients
improvement of functional ability and quality of life of patients who with paraplegia (64.7 vs. 44.8). Those cases injured in a young
suffered from spinal cord injury. age also had a high mortality, with the highest SMR among those
injured under 20 years old (SMR: 388.9) and between 30 to 39
years old (SMR: 96.5). Conclusion: Although long-term survival
0501PP64 of SCI is improving in recent decades, the life expectancy of
YOLK SAC TUMOR IN THE SPINAL CORD – A the cohort in this study was still lower than that of the general
CASE REPORT population, especially among the young population, complete
tetraplegia and females. Whether the high mortality for this group
Sun Mio1, Shan-Ju Lin2, Yen-Ho Wang1 of patients was related to the post-injury care or not warranted
1
Department of Physical Medicine and Rehabilitation, National further investigation.
Taiwan University Hospital and 2Department of Physical Medicine
and Rehabilitation, National Taiwan University Hospital YunLin
Brand (Taiwan) 0501PP66
CHARACTERISTICS OF SPINAL CORD INJURY
Yolk sac tumor, so called endodermal sinus tumor, is the rarest germ
cell tumor. The germ cell tumor generally arises in the gonads, and PATIENTS IN AN ACUTE HOSPITAL
the incidence of primary central nervous system (CNS) has been Julia Patrick Engkasan, Tze Yang Chung
reported to be 2.8% in Japan. The CNS lesion is often within intrac- University of Malaya (Malaysia)
ranial area, rarely primarily in spinal cord. Here we presented a case
of primary yolk sac tumor in thoracic spinal cord. This 9-year-old Purpose: To describe the profile of spinal cord patients managed
boy was admitted with the complaint of progressive bilateral lower by a Spinal Rehabilitation Unit of an acute hospital Materials and
limbs weakness in one week in July 2009. The physical examina- Methods: All patients managed who were wholly and partially
tion revealed muscle power grading 3 of 5 over bilateral lower by the Spinal Rehabilitation Unit during a 3 months period were
extremities without evidence of sphincter dysfunction. The magnetic included in the study. Demographics data of both in-patients and
resonance imaging (MRI) of thoracolumbar spine showed multiple out-patients were collected and analyzed. Results: There are more
T-spine intradural extra- and intra-medullary tumors with cord com- males (70.2%) than females in the study. The mean age is 43.2
pression. His alpha-fetaprotein (AFP) was measured as up to 984.46 years. Non traumatic spinal cord dysfunction constitutes 40.7%
ng/ml. Only partial resection could be performed due to unclear of the etiology. For traumatic spinal cord injury, half (51.0%)
margin between the tumors and the spinal cord. The histological were due to transport related accident, followed by fall (35.4%).
examination showed yolk sac tumor. And no suspicious primary Approximately half (52.0%) has vetebral injury but only a small
tumor was noted in the brain, abdominal, and pelvic computerized percentage (14.0%) has associated injuries such as traumatic brain
tomography (CT). Postoperatively, paraplegia with neurogenic blad- injury, abdominal or chest injury needing surgery and major limb

trauma needing amputation. There are more paraplegia (62.0%) 0501PP69

compared to tetraplegia (35.1%) and 59.0% have incomplete lesions. INJURY-INDUCED MIGRATION OF WHITE
Using the American Spinal Injury Association (ASIA) guidelines,
34.5% have ASIA Impairment Scale (AIS) A, 31.0% have AIS D MATTER ASTROCYTES IS INFLUENCED BY
followed by 16.4% with AIS C and 11.7% with AIS B. The main MAGNETIC STIMULATION
place of discharge was to private residence (85.4%). Conclusion: Zheng-Yu Fang, Xiao-lin Huang, Zhe Li, Jiang Xu, Yi-
Educating the public about transport safety and fall precautions play
a role in prevention of spinal cord injury. Zhao Wang, Jie Huang
Tongji Medical College, Huazhong University of Science and
Technology (China)
0501PP67
Purpose: To investigate the effects and underlying mechanism of
INTRADURAL SCHWANNOMA PRESENTED magnetic stimulation on injury-induced migration of white matter
AS RADICULOPATHY IN PATIENT WITH astrocytes. Materials and Methods: 24 adult healthy SD rats were
ANKYLOSING SPONDYLITIS – CASE REPORT selected to inject 0.5 ml of 1% ethidium bromide (EB) in PBS into
the dorsal spinal cord funiculus on the left side at the T10–11 level
Wei-Hao Sung, Fong-Cheng Lin, Mu-Jung Kao, Ching- to make located spinal cord injury models. Then they were randomly
Yang Lin divided into four groups (A, B , C and D). Groups A, B, C and D
Department of Rehabilitation Medicine, Taipei City Hospital were exposed to 1 Hz pulsed magnetic stimulation underwent 5-min
(Taiwan) sessions on 14 consecutive days at the following levels: 0T(Group
A); 1.9×40% T (Group B); 1.9×80% T (Group C); 1.9×100% T
Schwannoma is a common spinal cord tumor. The most initial (Group D). On the day 14 after stimulation, the rats were killed and
presentation is pain, which may be confused with degenerative the expression of glial fibrillary acidic protein (GFAP), microtubule
spinal disease. Moreover, it seems to be more difficult in patients associated protein-2 (MAP-2), extracellular signal-regulated kinase1/
complicated by ankylosing spondylitis. A 50-year-old male patient 2 (ERK1/2) and the volume of holes were detected with immunohis-
was presented with right mid-back pain in root distribution. He was tochemistry. Quantitative analysis of the expression of GFAP, MAP-2
first treated as subacute radiculopathy from degenerative disease and ERK1/2 were performed with the image analysis system. Results:
or esthesitis resulted from ankylosing spondylitis. Due to failure With the increase of magnetic stimulation intensity, the volume of hole
treatment with anti-inflammatory agents and physical modalities, decreased at day 14 (p < 0.05). In lesion areas, the expression of GFAP
magnetic resonance image was arranged and showed a mass at T8 and ERK1/2 could be seen, while that of MAP-2 did not change before
level with high signal intensity on T2-weighted image, with low and after magnetic stimulation. Significant difference was revealed
signal intensity on T1-weighted image. Resection of tumor was in the expression of GFAP, ERK1/2 among the four groups. It was
performed and symptoms were relieved after excision. It is impor- significantly higher in the magnetic stimulation groups than that in
tant to differentiate schwannoma from other disease with similar the control group (p < 0.05). After magnetic stimulation, astrocytes
presentation, especially in patient with ankylosing spondylitis. The migrated into the hole. U0126, a potent and selective MEK1/2 in-
better outcome relied on the earlier diagnosis. hibitor, inhibited up-regulation of pERK1/2 which was stimulated by
magnetic stimulation. Conclusion: Our results showed that magnetic
stimulation increases the migratory capacity of reactive white matter
0501PP68 astrocytes in the injured center nervous system, which may be associ-
BARRIERS TO EXERCISE IN SPINAL CORD ated with activation of MEK1,2/ERK mitogenic pathway.
INJURED PARAPLEGICS
Tze Yang Chung, Nazirah Hasnan, Julia Patrick Engkasan 0501PP70
University of Malaya (Malaysia) RESPIRATORY MANAGEMENT STATUS OF
Purpose: To determine the levels of involvement of spinal cord PATIENTS WITH ACUTE TRAUMATIC CERVICAL
injured paraplegics in exercise, their associated demographic factors, SPINAL CORD INJURY WHO ADMITTED TO AN
and their perceived barriers to exercise. Materials and Methods: ACUTE CARE HOSPITAL WITH EMERGENCY
Fifty four subjects, with the diagnosis of acquired Spinal Cord Injury
CARE CANTER
(SCI) at level T2 and below for at least 1 year, wheelchair dependent
and who were attending the spinal rehabilitation clinic in a tertiary Kozo Hanayama, Takashi Kasahara, Mitsuhiko Kodama,
hospital during the study period, were asked to complete a self Yuji Koyama, Yoshihisa Masakado
reported questionnaire. The questionnaire consists of demographic Tokai University (Japan)
characteristics, injury details, pre and post injury exercise status
and a pre-generated list of common barriers to exercise. Results: Purpose: To know respiratory management status and prognosis
The mean age of the subjects (n = 54) is 36 years. Male to female in patients with acute traumatic cervical spinal cord injury (SCI)
ratio was 7:3. More than half of them were involved in some form who admitted to an acute care hospital with emergency care center
of exercise (69%). Only 11 (20%) exercised at least 5 times a week not specialized for SCI. Materials and Methods: We reviewed the
for at least 30 min duration while another 10 (27%) exercised at medical records of the patients with acute traumatic cervical SCI who
least 3 times a week for the same duration. The only significant as- admitted to our hospital between October 2003 and March 2009 and
sociation amongst them was income levels of RM1000 and below discharged until September 2009. The patients who admitted within
(p = 0.005). Their pre injury exercise status was not associated with 24 hours from injury and remained ASIA impairment scale (ASIA-IS)
current status of exercise. Two most common exercises performed A, B or C through the hospital stay were included. The patients who
were propelling their wheelchairs (30%) and sports (24%). The top were complicated with severe brain injury and/or had preexisting
five perceived barriers are ‘lack of equipment and facilities’ (57%), neurological disorder were excluded. We examined demographic data,
‘weather is too hot’ (33%), ‘too lazy’ (24%), ‘no transportation’ length of stay (LOS), ASIA-IS, neurological injury level, associated
(22%) and ‘exercise causes pain’ (22%). Those who had more injuries, co-morbidities, complications, ventilator use, tracheostomy
negative perceptions were less likely to exercise. Conclusion: The surgery, use of noninvasive positive pressure ventilation (NPPV), use
prevalence of exercise is this study is surprisingly high compared of mechanically assisted coughing (MAC) and respiratory manage-
to the general population. Other than the usual environmental and ment status at discharge from our hospital. Results: Sixty-four patients
motivational factors, warm weather is an important barrier to ex- (9 females, aged 58.2 on average (19–89 years old)) met the criteria.
ercise in a tropical country. Twenty-seven patients were classified into ASIA-IS A, 6 into B and

31 into C, respectively. The injury level of 15 ASIS-IS A patients June 2009. The patients with traumatic brain injury, previous renal
and 1 ASIS-IS B was C4 and above. Three ASIA-IS A patients died or bladder diseases, and peripheral polyneuropathy were excluded.
during hospitalization. Their direct causes of death were not respira- Urodynamic study (Urolab Janus-V, Life-Tech Inc., Texas, USA) was
tory complications. Among 61 patients excluded these patients, LOS performed in all patients. Voiding senses were checked and ice and
was 11–625 days (median 56 days). All of them were transferred warm water tests were performed. Maximum cystometric capacity,
to rehabilitation hospitals or long-term care hosipitals. Twenty-six compliance of detrusor muscle, reflex of detrusor muscle, maximal
cases (43%) were intubated and managed with ventilators, 19 were detrusor pressure, and urethral pressure profile were analyzed. We
traceostomized (73% of intubated cases) and 3 patients discharged used the anatomical classification of neurogenic bladder by Wyndale,
on ventilator. Sixteen cases were weaned and discharged with tra- which were the part above the 10th thoracic cord, that between the
cheostomy. LOS of the patients with ASIA-IS A, B and C was 98, 59 10th thoracic cord and the 2nd lumbar cord, and that below the 2nd
and 44 days on average, respectively. LOS of the patients with and lumbar cord. Results: 1) According to the anatomical classification of
without tracheostomy was 111 and 50 days on average, respectively. neurogenic bladder, neurological level of injury was above T10 in 78
Nocturnal NPPV was applied for 2 patients and MAC for 8. MAC patients, between T1–L2 in 20 patients, and below L2 in 11 patients.
was used one or two sessions daily with +40 cm H2O for insufflation 2) The lower the level of injury was, the higher the compliance of
and –40 cm H2O for exsufflation through the tube in 4 patients and detrusor muscle was and the lower its reflex was, however, it was not
with face mask in 4 patients. All of 4 patients through the tube were statistically significant (p > 0.05). There was no significant correla-
finally undergone tracheostomy. All of 4 patients used MAC with tion between the level of injury and the activity of detrusor muscle
face mask did not get intubated even if the patient’s cough peak flow (p = 0.142). 3) In the patients whose level of injury were above T10,
(CPF) was as low as 60 L/min. Conclusion: Acute traumatic cervical no significant differences were observed in the tonicity, reflex and
SCI patients who admitted to an acute care hospital with emergency activity of detrusor muscle according to the completeness (p > 0.05).
care center had high rate of intubation, especially ASIA-IS A and 4) There was a significant correlation between the reflex of detrusor
B. Most intubated patients were weaned but many discharged with muscle in the urodynamic study and the infusion volume in the ice
tracheostomy. There was still little use of NPPV and MAC, but the water test (r = 0.346, p = 0.045), however, no significant correlation
introduction of a comprehensive system seemed to be necessary to between the maximum cystometric capacity and the infusion volume
improve respiratory status of acute cervical SCI. in the warm water test (r = 0.291, p = 0.095). 5) In the patients whose
level of injury were above T10, no significant difference was observed
in the tonicity, activity and reflex of detrusor muscle according to
0501PP71 the existence of voiding sensation. Conclusion: Urodynamic study
THE EFFECTS OF COMPREHENSIVE findings according to the anatomical classification of neurogenic
bladder are not consistent in spinal cord injury patients.Therefore,it
REHABILITATION THERAPY ON MUSCLE
would be necessary to apply a patient-specific individualized bladder
SPASTICITY IN PATIENT WITH SPINAL CORD management program in spinal cord injury patients.
INJURY – ONE CASE REPORT
Xiang-dong Xu 0501PP73
Department of Rehabilitation Medicine, Zhongnan Hospital, Wuhan EFFECT OF RECIPROCATING GAIT
University (China)
ORTHOSIS(RGO) IN THE TREATMENT OF LOWER
Purpose: To observe the effects of comprehensive rehabilitation therapy EXTREMITY IN PATIENTS WITH THORACIC
on muscle spasticity in patient with spinal cord injury. Materials and SPINAL CORD INJURY
Methods: One patient with thoracic spinal cord injury complicated
with muscle spasticity were treated with exercise therary, heat pad and Qin Yang, Ya-tao Ouyang, Dan Tang, Yan-ling Zhao,
automatic compression system, etc. The modified Ashworth Scale was Yuan-bao Li
used to evaluate the change of spasticity of the patient. Results: The Fraternity Rehablitation Hospital (China)
score of modified Ashworth Scale was improved after the comprehen-
sive rehabilitation therapy in comparing with the pretreatment state. Purpose: To explore the effect of reciprocating gait orthosis (RGO) on
Conclusion: The comprehensive rehabilitation therapy is effective for muscle spasticity and activity function of the affected lower extremity
improving muscle spasticity in patient with after spinal cord injury. in patients with thoracic spinal cord injury Materials and Methods:
By 15 cases of thoracic (T1–T12) spinal cord injury patients with low-
er limb muscle spasm assembly Reciprocating gait orthosis (RGO),
0501PP72 respectively, give them the compensatory and residual strength train-
ing, balance training, balance of walking training within Parallel rod,
URODYNAMIC FINDINGS IN SPINAL CORD walking training by walkers and elbows Shui indoor or outdoor before
INJURY PATIENTS and after assembly. Then use Modified Ashworth Spasticity Scale
In-Gyu Kim, Hyung-Suk Sun, Jae-Young Han, In-Sung (MAS), 6 min walking distance test and Barthel index to evaluate the
Choi, Sam-Gyu Lee treatment efficacy. Results: The patient’s walking ability and ADL
ability improved significantly compared with before (p < 0.01),their
Department of Physical and Rehabilitation Medicine, Research lower limb muscle cramps are also ease differently (p < 0.05); They
Institute of Medical Sciences, Chonnam National University Medical achieve functional walking essentially. Conclusion: The selection of
School & Hospital (Republic of Korea) Reciprocating gait orthosis can significantly improve the walking and
Purpose: Neurogenic bladder is a very common complication in ADL ability of patients with thoracic spinal cord injury, also, there is
spinal cord injury patients. Urodynamic study is the gold standard for a certain effect on improving their lower limb muscle spasm.
the evaluation of the function of bladder and urethral sphincter and
recommended to be conducted on a regular basis to evaluate changes 0501PP74
in bladder function after spinal cord injury. The aim of this study was
EFFECT OF RECIPROCATING GAIT ORTHOSIS
to investigate the characteristics of urodynamic findings in spinal
cord injury patients. Materials and Methods: We retrospectively (RGO) IN THE TREATMENT OF LOWER
reviewed the medical records of the urodynamic study in 109 spinal EXTREMITY IN PATIENTS WITH THORACIC
cord injury patients (86 males, 23 females; age 43.0 ± 12.7 years; SPINAL CORD INJURY
duration 18.1 ± 15.9 months; complete injury 51 patients, incomplete
injury 58 patients; cervical 43 patients, thoracic 51 patients, lumbar Qin Yang, Ya-Tao Ouyang, Dan Tang, Yan-ling Zhao,
5 patients, cauda equina 10 patients) admitted to the rehabilitation Yuan-Bao Li
unit of Chonnam National University Hospital from January 2004 to Hunan Fraternity Rehablitation Hospital (China)

Objective: To explore the effect of reciprocating gait orthosis (RGO) antibiotics successfully. However, urinary retention persisted and
on muscle spasticity and activity function of the affected lower ex- failed to remove the indrawlled catheter. An urologist was con-
tremity in patients with thoracic spinal cord injury. Materials and sulted, and ordered urodynamic study with a tentative diagnosis
Methods: By 15 cases of thoracic (T1–T12) spinal cord injury patients of neurogenic bladder. The urodynamic study showed detrussor
with lower limb muscle spasm assembly Reciprocating gait ortho- hyporeflexia with decreased sensation, detrussor-sphinter dys-
sis (RGO), respectively, give them the compensatory and residual synergia (DSD), marked post-voiding residual without evidence
strength training, balance training, balance of walking training within of outlet obstruction. Plain film of lumbosacral spine revealed
Parallel rod, walking training by walkers and elbows Shui indoor or minimal L5/S1 spondylolisthesis. He was referred from the Urol-
outdoor before and after assembly. Then use Modified Ashworth Spas- ogy Department for intermittent catheterization program (ICP)
ticity Scale (MAS), 6 minutes walking distance test and Barthel index because of persistent urinary retention although been treated with
to evaluate the treatment efficacy. Results: The patient’s walking bethanecol and tamsulocin. The neurological examination showed
ability and ADL ability improved significantly compared with before clear consciousness with mild impaired memory, no obvious mo-
(p<0.01),their lower limb muscle cramps are also ease differently tor weakness in four limbs, impaired light touch sensation below
(p<0.05); They achieve functional walking essentially. Conclusion: bilateral inguinal areas, impaired proprioception at bilateral big
The selection of Reciprocating gait orthosis can significantly improve toes, and hypereflexia in right upper and bilateral lower extremi-
the walking and ADL ability of patients with thoracic spinal cord ties. He was admitted to PM&R ward under the impression of
injury, also, there is a certain effect on improving their lower limb thoracic spinal cord infarct with neurogenic bladder. T spine MRI,
muscle spasm. Key words: Reciprocating gait orthosis; spinal cord intermittent catheterization program, standing balance training, and
injury; lower limb; muscle cramps; motor function. ambulation training were arranged. The MRI showed recent spinal
cord infarction in posterior aspect of T3 to T8 level (mostly in T6
level) and no obvious thecal sac compression at the lumbosacral
0501PP75 level. Seven weeks after starting the ICP, he had a balance bladder.
STANOZOLOL IN OSTEOPOROSIS MANAGEMENT He was ambulatory independently later and discharge. Follow-up
AFTER SPINAL CORD INJURY: A CASE REPORT urodynamic study showed detrussor hyperreflexia with DSD and
small capacity, which were compatible with spastic type neurogenic
Michael Acuff bladder. During the 2-year follow-up in the clinic, his endurance
Physical Medicine and Rehabilitation, University of Missouri and gait pattern gradually normalized, only one episode of UTI
Columbia (United States) developed, and with normal renal sonographies.
Purpose: A case report of a 66 year old female with L2 complete
paraplegia, 49 years post-injury, severe osteoporosis, treated with 0501PP77
the anabolic steroid Stanozolol. Materials and Methods: The pa-
tient underwent DEXA scan for osteoporosis monitoring: T-scores A RANDOMISED CLINICAL TRIAL TO
were 1.6–5.4, and –5.6 at the lumbar spine, femoral neck, and hip, INVESTIGATE THE EFFECTS OF ORAL INTAKE
respectively. She initiated off-label treatment with Stanozolol, an OF WATER IN PATIENTS WITH DYSPHAGIA
anabolic steroid, 2 mg twice daily, compounded by a local pharmacy.
The patient continued her prevlous standard osteoporosis treatment, Martha J.P. Karagianni1,2, Leonie K. Chivers3, Tom C.
including a bisphosphonate and calcium with Vitamin D supple- Karagiannis4,5
mentation. She also received 1 month treatment with Ergocalciferol
1
Manager Allied and Community Health, West Wimmera Health
50,000 units weekly for Vitamin D deficiency. Results: Following Service, 2Founding Director, Darebin Aged Care Health Service),
four months of treatment, T-scores improved to 2.1, –3.6, and –3.6 3
Speech Pathologist, Latrobe Regional Hospital (Australia), 4Senior
at the lumbar spine, femoral neck, and hip, respectively. Liver Research Officer, Trescowthick Research Laboratories, Peter Mac-
function tests remained in normal range. The patient complained of Callum Cancer Centre and 5Department of Pathology, the University
hirsutism and acne, and following the repeat DEXA scan, Stanozolol of Melbourne (Australia)
dose was reduced. Conclusion: Stanozolol was used successfully
for the treatment of osteoporosis in one spinal cord injury patient. Purpose: We designed a relatively large-scale, randomised-control
Future studies should evaluate the efficacy and side effect incidence prospective study, to investigate the following:
of Stanozolol for osteoporosis management in a larger spinal cord • the effects of water aspiration in dysphagic patients prescribed
injury population. thickened fluids;
• the hydration levels in dysphagic patients on thickened fluids only
compared to dysphagic patients on thickened fluids and water;
0501PP76 • the quality of life and satisfaction levels of dysphagic patients on
SPINAL CORD INFARCTION PRESENTING WITH thickened fluids only compared to dysphagic patients on thickened
fluids and water. Materials and Methods: A total of 100 patients
URINARY RETENTION were randomly assigned either to the control group (thickened
Lin-Yi Wang, Bin-Chi Chang fluids only) or to the study group (thickened fluids and free access
Chang Gung Medical Foundation, Kaohsiung Branch (Taiwan) to water). Patients were examined for chest status, temperature
changes and hydration levels. Furthermore, quality of life surveys
Spinal cord infarct is an uncommon disease, and frequently pre- were administered at the end of the monitoring and intervention
senting with motor weakness. It is rare that urinary retention as or control phases depending on the group in which patients were
the first presentation of a spinal cord infarct. To our knowledge, assigned. Results: Our findings suggest a significant increase in
there were only 3 cases reported. We report a case diagnosed as T6 aspiration pneumonia in patients allowed access to water compared
spinal cord infarct presenting as urinary retention after a surgery to the control group. However, further analysis of our observations
of aortic aneurysm. A 56 year-old man visited PM&R clinic with indicates that only a subset of patients, namely, those with no or
a chief complaint of urinary retention for 3 months. The patient very low mobility developed aspiration pneumonia. Further, our
received a repair surgery for type B aortic aneurysm, and compli- findings indicate an increase in total fluid intake in patients allowed
cated with right hemiparesis 5 weeks after the operation. Brain free access to water, and patients in the study group noted signifi-
MRI was done under the impression of stroke by a neurologist, cant improvements in quality of life. Overall, our findings reaffirm
and revealed bilateral multiple embolic cerebral infarctions. The the difficulties associated with the management of patients with
weakness related to the stroke recovered well gradually, and he dysphagia. Conclusion: On the basis of our findings we recom-
could ambulate with mild support. After the stroke, several episodes mend that, only sub-acute patients with relatively good mobility, be
of urinary tract infection (UTI) developed and were treated with considered for placement on free water protocols. In addition, we

recommend that these patients be closely monitored for 24-36 hours of Education and 2Department of Physical Medicine and Rehabilita-
post implementation for adverse effects. Further research should tion, National Taiwan University Hospital (Taiwan)
be aimed at clarifying the risk factors for aspiration pneumonia in
sub-acute patients with dysphagia. Purpose: To investigate the effect of aphasia on health related qual-
ity of life (HRQOL) after controlling the factor of motor disability
by comparing the HRQOL among chronic stroke patients of minimal
0501PP78 motor disability with aphasia and those without aphasia. Materials
and Methods: 26 stroke patients with aphasia were recruited in this
INDIVIDUAL SPINAL DORSAL RAMUS
study. The inclusion criteria were more than 6 months post onset, fair
DYSFUNCTION CAUSING LOWER BACK PAIN auditory comprehension (scored 5/10 or above in the comprehension
(SPINAL DORSAL RAMUS SYNDROME) subtest of Western Aphasia Battery) and minimal motor disability
(Bathel index 90 or above). 23 chronic stroke patients with minimal
Linqiu Zhou1, Carson Schneck2, Zhenhai Shao3
motor disability but no aphasia were recruited as the control group.
1
Jefferson Medical College, 2Temple University School of Medicine There were no significant difference between the two groups in
(United States), 3Nanfang Medical University (China) terms of their motor stages, daily activities functions, demographic
Purpose: To review the relationship between the spinal dorsal ramus variables, and stroke-related health variables. All subjects were
and low back pain, including the anatomy, clinical findings, patho- interviewed with the Chinese version of The Stroke and Aphasia
genesis and treatment of low back pain Materials and Methods: The Quality of Life Scale-39 (SAQOL-C) for assessment of their HR-
literature on spinal dorsal ramus and low back pain was reviewed QOL. T test and ANOVA were used for group comparison. Results:
along with a summary of the author’s extensive experience. Results: Comparing to stroke patients without aphasia, the aphasic patients
Each spinal dorsal ramus arises from the spinal nerve and then divides reported significantly lower overall HRQOL on the SAQOL-C total
into at least medial and lateral branches. The medial branch supplies score (3.56 vs. 4.03, t = 3.126), and the communication subscale
the tissues from the midline to the facetjoint line and innervates two (3.03 vs. 4.71, t = 8.332), but there was no significant difference on
to three adjacent facet joints and their related soft tissues. The lateral the physical (4.16 vs. 4.32, t = 1.081), psychosocial (3.04 vs. 3.23,
branch innervates the tissues lateral to the facet joint line. Clinically, t = 0.807), and energy (3.36 vs. 3.75, t = 1.808) subscales between
an individual dorsal ramus dysfunction secondary to segmental nerve the two groups. Conclusion: We conclude that the presence of
distortion or compression can cause low back pain. The patients with aphasia could have adverse effect on chronic stroke patients’ health
spinal dorsal mamus syndrome can present unilateral or bilateral low related quality of life.
back pain. In the acute phase, patient usually complains of unilateral
low back pain with radiation to the ipsilateral iliac and buttock. Some
patients may present ipsilateral paraspinal muscle spasms. In the 0501PP80
chronic phase, low back pain can be bilateral and paraspinal muscle AUTOGRAFTING SATELLITE CELLS REPAIRS
spasm may be absent. The pain never radiates below the knees. During
THE DAMAGED MUSCLE INDUCED BY CHRONIC
the physical examination, the patient usually points the pain at lower
back or lateral iliac crest. When palpating patient’s spinous processes, COMPARTMENT SYNDROME IN RABBIT
there is a step-off and deep tenderness at the intraspinous processes. Yuehong Bai, Qingtian Li, Yiming Xu, Hong Yu, Manlin
At the same level, there is also a deep tenderness at the conjunction of Cao
the lateral facet joint and proximal transverse processes ipsilaterally
with pain radiating to the distal complaining site (referral pain area). The Sixth People’s Hospital Affiliated to Shanghai Jiaotong Uni-
The level of step-off intraspinous processes and deep tenderness of the versity (China)
lateral facet are usually at two to three segments of vertebrae above Purpose: Chronic compartment syndrome (CCS) is one cause of
the referral pain area depending on involvement of the median and/or muscle pain in humans, interfering with tissue circulation and
lateral branches. Based on clinical presentation and anatomy, the in- causing skeletal muscles damage. This paper is to investigate
volved dorsal ramus can be localized. The diagnosis can be confirmed the regenerative effect of satellite cells used by autografts on
by relief of low back pain and muscle spasm by a single injection damaged muscle Materials and Methods: 24 adult rabbits were
to the involved spinal dorsal ramus. Etiologically, any factor which randomized 3 groups: experimental group, non-graft group and
stimulates the spinal dorsal ramus can cause low back pain. A mild control group. The CCS model was established in experimental
low back injury such as twisting low back or awkward positioning group and non-graft group. Transplantation was done in experi-
during sitting, standing , weight lifting or acute compression fracture mental group and control group. Satellite cells from a half of soleus
causing vertebra deformity, which irritates or strains the spinal dorsal muscles in experimental group and control group were isolated
ramus, can cause acute low back pain. Facet join hypertrophy, lumbar and then expanded in vitro. The specific protein was identified by
scoliosis and other chronic conditions usually cause chronic low back immunochemistry before engraftment. DAPI-tag satellite cells
pain. The authors’ studies found that L1 and L2 are the most common were transplanted back to the remaining half of soleus muscles.
sites of dorsal rami involvement because of more mobile and free The number of satellite cells with DAPI-tag was counted by Fluo-
rotation at the thoracolumbar junction. Treatment includes injection rescence after grafts. The histological changes were compared at
to the involved spinal dorsal ramus and percutaneous neurotomy with the time of the last compression and at the end of the 28th day
radiofrequency or cryolesion for intractable patients. Conclusion: grafting respectively. Results: 28 days later after grafting the
Irritation of the individual spinal dorsal ramus is a potential source of same number of the satellite cells, the satellite cells from the
low back pain (spinal dorsal ramus syndrome). The precisely local- compressed soleus muscle increased significantly than before in
izing the origination of low back pain is challenging. Based on the experimental group (p = 0.013), whereas those in control group
anatomy and clinical presentation, the involved spinal dorsal ramus remained the same (p = 0.076). In HE staining, a large cluster of
can be localized and treated. myofibers and interstitial fibers necrosised in compressed muscle
for both the experimental group and non-graft group, while the
skeletal muscle fibers and interstitial fibers were integrity in control
0501PP79
group. After graft, the engraft muscle showed a great repair but
EFFECT OF APHASIA ON THE HEALTH-RELATED the non-engraft muscle exhibited dominant fibrosis. Conclusion:
QUALITY OF LIFE IN PATIENTS OF CHRONIC The satellite cell can be activated to repair partly the damaged
STROKE WITH MINIMAL MOTOR DISABILITY muscle induced by CCS once the elevated compartment pressure
is in relief. Autografting satellite cells by means of a small amount
Chang Lochia1, Lu Lu2 of expansion in vitro could improve the regenerative efficiency to
1
Graduate Program of Speech Therapy, Taipei Municipal University repair a large cluster of damaged myofibers induced by CCS.

0501PP81 1
Department of Physical Therapy and Assistive Technology, Na-
THE DEVELOPMENTS OF SELF CARE AND tional Yang Ming University and 2Department of Orthopedics,
Taipei Veterans General Hospital (Taiwan)
DOMESTIC LIFE ASSESSMENT SCALES IN
ELIGIBILITY OF PERSON WITH DISABILITIES IN Purpose: To investigate the normal neurodynamic response of
TAIWAN: AN APPLICATION OF ICF MODEL the femoral slump test in healthy population that might assist in
evaluating minor femoral nerve injury in the future. Materials and
Ting-Fang Wu, Shu-Hua Shih Methods: Fourteen asymptomatic subjects (10 males, 4 females)
National Taiwan Normal University (Taiwan) were included in this study so far. Individuals were excluded if they
had history of lower limb pathology or injury, pain in the tested knee
Background and Purpose: The International Classification of (Right side), or scoliosis. The examiner performed the femoral slump
Functioning, Disability and Health (ICF) endorsed by World Health test by pushing the thigh towards extension with full knee flexion
Organization (WHO) in 2001 have been accepted as a global model position. The level of passive thigh extension represented the nerve
in describing an individual’s health and functions. The health and tension and was measured by recording the extension range of motion
rehabilitation professions use ICF pervasively as a universal language (ROM) of the hip joint at the onset of pain over the anterior thigh.
in clinical practice, research and policies. The Right Protection Act Two trunk positions, slump and neutral were used in order to provide
for Person with Disability which was revised in 2007 has adopted different nerve tension. Cervical extension was then performed as
ICF as a framework to determinate the eligibility of persons with the structural differential method in order to determine whether it
disabilities in Taiwan. However, the difficulties encountered when would alter the pain. Visual analog score (VAS 0-100) was used for
administrating ICF framework to clinical assessment due to the lack pain measurement at the onset of pain and goniometer was used to
of an operational definitions about the qualifiers. In order to provide measure the hip ROM (ICC(3,3) = 0.94~0.96; SEM = 1.1°~1.6°).
a standardized process for eligibility of persons with disabilities, the Besides, flexibility of the hip flexors and knee extensors were also
Disability Eligibility Assessment Scale was developed in Taiwan measured. One-way repeated measure ANOVA was used to compare
recently. The aims of this study are to develop the assessment scales the differences in hip ROM between different trunk and neck posi-
of the ‘Self-care’ chapter (d5) and ‘Domestic life’ chapter (d6) of tions (TSNF = Trunk slump + neck flexion; TSNE = Trunk slump +
the Disability Eligibility Assessment Scale. Methods: A panel of neck extension; TNNF = Trunk neutral + neck flexion; TNNE = Trunk
experts from occupational therapy, physical therapy, clinical psy- neutral + neck extension). Pair t test was used to compare the VAS
chology social work, and the delegates of persons with disabilities score between different neck positions and Pearson correlation model
were found to establish the consensus about the items of the self was used to evaluate the relationship between the muscle flexibility
care and domestic life assessment scales. There are 3 phases in the and the femoral slump test. The significant level was set at 0.05.
development of the self care and domestic life assessment scales: 1) We suppose thirty asymptomatic subjects will be included on April
Preparatory phase (phase 1): Through extensive literature review, in 2010. Results: We found that the hip ROM in neck extension
the preliminary items which are essential for persons with disabilities were significantly larger than in neck flexion in two trunk positions
to participate in self-care and domestic life were selected. 2) Phase (p < 0.001), and were also significantly larger in trunk neutral than in
2: Each preliminary evaluation item was discussed one by one by trunk slump in two neck positions (p < 0.001). (TSNF: –14.5° ± 6.5°;
experts in consensus meeting to formulate the final set of the items TSNE: –11.3° ± 5.9°; TNNF: –8.9° ± 8.2°; TNNE: -6.5° ± 8.2°)
in the scales. 3) Phase 3: The qualifiers which describe the limita- Moreover, we found that the VAS score were significantly reduced
tions in participate in self care and domestic life in each item were when neck extension was performed as structure differential method
formulated. 4) Phase 4: The reliability and validity of assessment after the pain was produced in both trunk positions. (Trunk slump/
scales of self-care and domestic life of the Disability Eligibility As- Neck flexion: 39.9 ± 20.9, Neck extension: 31.6 ± 21.9, p < 0.001;
sessment Scale will be done in 2010. Results: Through the above Trunk neutral/Neck flexion: 45.8 ± 21.5, Neck extension: 39.7 ± 23.7,
phases, 7 second level categories of chapter 5 and 4 categories of p < 0.001). Low correlations were found between muscle flexibility
chapter 6 were included in the assessment process of eligibility of and the level of hip extension ROM in different positions. (Thomas
disability. Those items are d510, d520, d530, d540, d550, d560, d570, test: r = –0.19~–0.28, p > 0.05; Ely’s test: r = –0.16~0.4, p > 0.05)
d620, d630, d640 and d650. The qualifiers of 0, 1, 2, 3 and 4 will Conclusion: By changing the trunk and neck into different posi-
represent the no, mild, moderate, severe, and complete problems in tions, decreasing the nerve tension could increase the level of hip
participating daily activities. To sufficiently distinguish the qualifiers extension ROM and decrease the pain intensity. These responses
of 0, 1, 2, 3 and 4, each second level category item was analyzed to should be taken into account during the clinical assessment. In ad-
several tasks. Each task was assigned a disability score. An individual dition, low correlations between muscle flexibility and the level of
unable to perform the task independently will earn the disability score hip extension ROM further supported the changes in neurodynamic
of the specific task. Sum of the total disability scores of an item will responses mainly came from neural tissues.
convert to the qualifier which describes the difficulties or problems
encountered when performing this item. Using participation and
activities components of ICF provide a comprehensive sketch about 0501PP83
a person with disability rather than traditional diagnostic model. TO DEVELOP AN ICF CORE SET FOR DISABILITY
Conclusion: The Disability Eligibility Assessment Scale using ICF
framework is being designed with the goal of providing the standard EVALUATION ON SUBJECTS WITH STROKE IN
procedure in assigning the eligibility of persons with disabilities TAIWAN
in Taiwan. The evaluation items and qualifiers of d5 and d6 were Kwang-Hwa Chang1, Shih-Ching Chen2, Tsan-Hon Liou3,
formulated. The clinical pilot study of using Disability Eligibility
Hung-Yi Chiou4, Kuo-Lung Lee5, Wen-Ta Chiu6
Assessment Scale in 500 persons with disabilities will be done in
2010. In addition, the reliability and validity of Disability Eligibility
1
Department of Rehabilitation, Taipei Medical University-Wan Fang
Assessment Scale will also be investigated in the nearly future. We Medical Center,) 2Department of Rehabilitation, Taipei Medical
hope using ICF framework in eligibility of disabilities will lead to University Hospital, 3Department of Rehabilitation, Taipei Medi-
further interventions and accommodations to enhance participations cal University-Shuang Ho Hospital, 4College of Public Health and
of persons with disabilities. Nutrition, Taipei Medical University, 5Social Worker Office, Taipei
Medical University-Shuang Ho Hospital and 6Institute of Injury
Prevention & Control, Taipei Medical University (Taiwan)
0501PP82
FEMORAL SLUMP TEST: THE NORMAL NEURO Purpose: This study aimed to develop an International Classifi-
cation of Functioning, Disability and Health (ICF) core set for
DYNAMIC RESPONSE IN HEALTHY POPULATION disability evaluation on subjects with cerebral stroke (stroke).
Weng-Hang Lai1, Yi-Fen Shih1, Pei-Ling Lin1, Hsiao-Li Ma2 Materials and Methods: Using Delphi method, we conducted

a multi-center study between October 15, and December 15, 0501PP85

2009. According to the previous publication, a total of 144 ICF THE TEST-RETEST RELIABILITY AND PRACTICE
second-level categories comprised the questionnaire which was
relevant to stroke. The questionnaire included 47 categories from EFFECT OF THE SYMBOL DIGIT MODALITIES
the component body functions, five from body structures, 59 from TEST IN PATIENTS WITH STROKE
activities and participation, as well as 33 from environmental Chia-Lin Koh1, Hui-Chun Chen1, I-Ping Hsueh1,2, Ching-
factors. Twenty-five experienced experts and opinion leaders,
including physicians, therapists, psychologists, and social work- Lin Hsieh1,2
ers, attended the consensus process. Using Likert’s 5-point scale,
1
School of Occupational Therapy, National Taiwan University and
the participants weighted the impact of each category on daily life
2
performance after stroke. Then, the core set for disability evalua- Taiwan University Hospital (Taiwan)
tion was the collection of those categories with mean scale of 4.5
Purpose: The Symbol Digit Modalities Test (SDMT) is a widely
or more. Results: The core set for disability evaluation for stroke
used measure of switching attention in health elderly and people
contained 19 categories. They represented 13% of the total relevant
with neurological impairments. This paper-pencil test requires
categories for stroke. Of them, five categories (b110 consciousness
participants to match a particular number (1–9) with a paired
functions, b114 orientation functions, b117 intellectual functions,
geometric figure within 90 min. Larger amount of correct answers
b730 muscle power functions, and b770 gait pattern functions)
represents better switching attention of an individual. The test-retest
were from the component body functions, one (s110 structure
reproducibility of the SDMT is largely unknown in patients with
of brain) from body structures, 12 (d310 communicating with –
stroke limiting its utility. The purpose of this study was to examine
receiving – spoken messages, d330 speaking, d420 transferring
the test-retest reliability and practice effect of the SDMT in people
oneself, d440 fine hand use, d445 hand and arm use, d450 walking,
with stroke. Materials and Methods: We recruited 32 outpatients
d510 washing oneself, d520 caring for body parts, d530 toileting,
with stroke from three rehabilitation units in northern Taiwan
d540 dressing, d550 eating, and d560 drinking) from activities and
between November 2007 and May 2008. The inclusion criteria for
participation, as well as one (e410 individual attitudes of immedi-
participants were 1) ≥18 years old; 2) diagnosed as either ischemic
ate family members) from environmental factors. Cronbach’s α was
or hemorrhage stroke; 3) onset for more than 3 months when first
0.987. Conclusion: International Classification of Functioning,
evaluated; 4) medically stable without any other major diseases
Disability and Health will be implemented in Taiwan for dis-
that influence cognitive functions; 5) able to follow commands to
ability evaluation on social welfare service system in 2012. Since
perform the tests with one of their better hand; and 6) able to provide
stroke is one of the most common causes of disability in Taiwan.
informed consent. Initially, all eligible participants were confirmed
It is important to develop a specific disability evaluation core set
not having spatial inattention or cognitive impairment which may
for stroke subject. From this study, the component activities and
encounter their performance, using the Behavioural Inattention
participation play an important role of disability evaluation on
Test and the Mini-Mental Status Examination, respectively. All
subjects with stroke.
participants were repeatedly measured using the SDMT in a 1-week
interval. All test sessions were administered by a same examiner.
0501PP84 Results: The mean age of the patients was 60.3 years. Male (84.4%)
and ischemic stroke (62.5%) represented the majority of the sample.
DYNAMIC 3 DIMENSIONAL MODEL OF The result showed that the SDMT demonstrated sufficient test-retest
ANTERIOR CANAL BENIGN PAROXYSMAL reliability (ICC = 0.88) in a 1-week interval. However, a medium
POSITIONAL VERTIGO practice effect (Cohen’s d = 0.56) of the SDMT were found. The
90% confidence interval of the practice-effect corrected reliable
Xin-Xian Lee1, Pei-Chen Sun2 change index (RCIp) was [–6.3, 12.3]. Conclusion: Our results
1
Department of Physical Medicine and Rehabilitation of Cender showed that the SDMT is a reliable measurement to repeatedly
Hospital and 2Dacun Junior High School (Taiwan) evaluate stroke patients’ ability of switching attention. However,
clinicians and researchers have to take account the existing practice
Purpose: To establish an useful dynamic 3 dimensional (3D) effect for interpreting the test results. Only a patient who obtains a
model of anterior canal-benign paroxysmal positional vertigo difference of score in a week beyond the RCIp interval [–6.3, 12.3],
(AC-BPPV) for diagnosis and treatment. Materials and Methods: he or she can be considered having a significant improvement or
We use four sets of software including “Maya”, “Poser”, “Pho- regression during the two test sessions. Considering that clinicians
toshop” and “Director” to establish the 3D model of AC-BPPV. may repeatedly administer the SDMT at more than one week apart,
The labyrinth model was constructed by Maya, the human model therefore having a smaller practice effect, the upper end of RCIp
by Poser, and the eye model by photoshop. Director was used to provided above could be viewed as a high standard for a patient to
combine all parts together and simulate the clinical presentation achieve significant improvement.
of AC-BPPV. The nystagmus was determined by the Edward III
law. Results: AC-BPPV results from the otoliths depositing within
anterior semicircular canal. During simulation, the otoliths within 0501PP86
right anterior semicircular canal move toward the ampula during NEW DIAGRAMS EXPLAINING ICF CONCEPTS
left Dix-Hallpike maneuver. This action causes tilting of the cu-
pula which induces transient nystagmus and vertigo the same as AND REHABILITATION MEDICINE
the left posterior canal-BPPV. We introduce a new examination YoonKyoo Kang, GueHwan Ann
(hyper-extended head hanging position) to differentiate AC-BPPV Korea University Anam Hospital (Republic of Korea)
from PC-BPPV. In the left hyper-extended head hanging posi-
tion, persistent nystagmus occurred because the otoliths attach Purpose: It is not easy to understand the concept of the ICF for
to the cupula. In the right hyper-extended head hanging position, different cultural background with non-English speaking people,
the otoliths move from the anterior canal to the posterior canal. especially the relationship between the components of health and
After the conversion from right AC-BPPV to right PC-PPPV, the umbrella terms-functioning and disability. The purpose of this
otoliths are ready to be moved back to the utricle by the Epley’s study to develop diagrams to help understand of concepts of ICF.
maneuver. Conclusion: The dynamic 3D model of AC-BPPV Materials and Methods: We imagined the 3 individual frames of
reveals that ipsilateral AC-BPPV is similar to contralateral PC- the diagram, circle (global), bridge (connection or communication)
BPPV during Dix-Hallpike maneuver. The hyper-extended head and umbrella and brought basic concepts from the bio-psycho-social
hanging position help us to differentiate AC-BPPV from PC-BPPV model and definitions of components of health. Main concepts were
and convert AC-BPPV to PC-BPPV which can be easily treated translated into the drawings and others used words themselves and
by Epley’s maneuver. arranged within the diagrams. Results: We made 3 diagrams named

‘ICF Wheels’ with concentric circles, ‘ICF-Bridge over Disability’, Medical University Hospital, Department of Physical Therapy,
and simply ‘3 Umbrellas’-Functioning, Disability, and HEALTH. Graduate Institute of Rehabilitation Science, China Medical Uni-
Also authors tried to imbed those diagrams to self-learning materials versity and 4Institute of Occupational Safety and Health Council
made by German WHO-FIC Collaborating Centre, ICF Research of Labor Affairs, Executive Yuan (Taiwan)
Branch to provide users with basic knowledge of the ICF and its
uses. Conclusion: It will help to learn the concepts of bio-medico- Purpose: Sleepiness-at-the-wheel was well identified as a major
psycho-social meanings of ICF using these diagrams and to apply cause for highway accidents and sleep-disordered-breathing (SDB)
into various working fields. has been reported as an associate factor to cause accidents. Any
reliable SDB home-based screen indicator should be valuable in
public security. The aim of our study is investigating systemically
0501PP87 reliabilities of individual indicator and various combinations on
STUDY ON HOW TO OBJECTIVELY ASSESS professional drivers. Materials, Methods and Results: All 151
THE MEDICAL SERVICE QUALITY OF participants were long haul bus drivers with duty period more
than 12 hours a day and duty shifting by two-hour-later day after
REHABILITATION
day. Each bus-driver had received overnight polysomnographic
Ya-Wen Hsu, Ching-ying Lin, Chi-Lun Rau, Chin-Wen study (PSG) and following alternative devices’ measurements
Wu, Chien-Fang Huang, Tsan-Hon Liou simultaneously post anthropometrics taking and questionnaires’
Department of Physical Medicine & Rehabilitation, Taipei Medical filling-out. Based on either recording-time or actigraphy-related
University-Shuang Ho Hospital (Taiwan) corrected sleep time, the oxygen-desaturation indices by 3 and 4 %;
and pulse-rising indices by 7 and 8 % from baseline detected with
Purpose: To review the methods of evaluation quality of service and pulse oximetry; and apnea-hypopnea indices measured with Ap-
establish subjective and practical monitoring mechanism for rehabili- neaLink all correlated significantly (all p < 0.0001, r = 0.87–0.92;
tation. Materials and Methods: There were nine experts participated 0.61–0.89; and 0.70–0.70, respectively) and have high agreement
in this research, including president and opinion leaders of Taiwan (94.5–96.6; 93.8–97.2; 91.1-91.3%, respectively) with apnea-
Rehabilitation Association, chief of department of rehabilitation of hypopnea indices with PSG (AHIpsg). They are quite reliable
medical centers, and professors of hospital management in national in SDB screening, according to under-curve-areas (0.93–0.95 or
universities. Using Delphi methods, service quality indexes of re- 0.94–0.95; 0.76–0.76 or 0.74–0.75; and 0.79–0.79 or 0.81–0.82,
habilitation medicine were reviewed after the first expert meeting. respectively) of the receiver-operator-characteristic curve analysis
The questionnaire was divided into three categories: importance, for selected points on 5 or 15 events/hr of AHIpsg threshold. By
appropriateness, and accuracy. Analytic hierarchy process was used contrast, no validities of SDB screening were found in multi-
for this research and experts filled up the questionnaires by giving variables apnea prediction questionnaire, Epworth sleepiness scale,
scores from one to five. The higher the score was, the more the experts night-sleep heart rate variability, wake-up systolic blood pressure
valued the item. Experts completed the questionnaires after the expert and anthropometric variables. Conclusion: The parameters from
meeting. The same questionnaire was filled up again after the second pulse oximetry and ApneaLink alone or adding actigraphy sleep-
expert meeting and the results were analyzed. Results: Nine experts time-correction are home-based indicators in screening SDB
returned questionnaires twice with 100% return rate. Primarily service professional drivers’ SDB.
quality items are 18 in structure perspective, 20 in process perspective
and 19 in outcome perspective. Only those items that were scored
greater than four in the second run of questionnaires are listed as fol- 0501PP89
lowed: Structure perspective: “The percentage of visiting staffs” was IMPLEMENTING THE DISABILITY EVALUATION
scored greater than four in the service quality of index at importance, SYSTEM IN TAIWAN BASED ON INTERNATIONAL
appropriateness, and accuracy while “associated certification rate of
CLASSIFICATION OF HEALTH FUNCTIONING,
therapists” were marked at importance and appropriateness. “Fully
equipped therapy rooms, and professional training equipments in DISABILITY AND HEALTH (ICF)
therapy rooms” was only marked at importance. Process perspec- Tsan-Hon Liou1, Shih-Ching Chen2, Hung-Yi Chiou3,
tive: “Complications resulting from treatment, including burns and Chia-Chin Lin4, Kuo-Lung Lee5, Wen-Ta Chiu6
fractures” were scored greater than four in the service quality of index
at Importance, and appropriateness. s “The percentage of complicated
1
Department of Rehabilitation, Taipei Medical University – Shuang
treatment, including head injury and stroke” were scored greater than Ho Hospital, 2Department of Rehabilitation, Taipei Medical Uni-
four in the service quality of index at importance, appropriateness, versity Hospital, 3College of Public Health and Nutrition, Taipei
accuracy in all treatments while “the percentage of injury resulted Medical University, 4School of Nursing, Taipei Medical University,
from falling”, “body function improving rate of patients before and
5
Social Worker Office, Taipei Medical University – Shuang Ho
after treatments”, and “percentage of readmission within 14 days” Hospital and 6Institute of Injury Prevention & Control, Taipei
were scored greater than four at importance and appropriateness. Medical University (Taiwan)
Conclusion: “The percentage of readmission within 14 days”, “the
functional improving rate of patients after treatment”, “associated Purpose: The purpose of this study is to report on how to imple-
certification rate of therapists”, and “percentage of complicated ment disability evaluation system in Taiwan based on International
treatment” were recognized as better indexes. Further studies to Classification of Health Functioning, Disability and Health (ICF).
evaluate the effect of these items on quality of medical service of Materials and Methods: A national decision-making process
rehabilitation will be necessary through analysis of data bank of was applied. Members of Taiwan ICF Team includes physicians,
national health insurance. nurses, physical therapists, occupational therapists, social workers,
psychologists, special education teachers, vocational assessment
workers, public health scholars, and representatives of welfare
0501PP88 groups for people with disability. There were total of 199 profes-
sional members (124 members for body function/body structure,
EVALUATION OF HOME-BASED SCREEN and 75 members for participation/environment) participated in 16
INDICATORS IN SLEEP DISORDERED groups (8 groups for body function/body structure, and 8 groups
BREATHING OF PROFESSIONAL DRIVERS for participation and environment). In each group, there was one
member to be the leader to lead the discussion by focus group
Pei-Pi Shih1, Hua Ting1,2, Shu-Yun Chang2, Ai-Hui session and voting to reach agreements. These groups need to
Chung2, Shin-Da Lee2,3, Tung-Sheng Shih2,4 develop evaluation methods and standards and formulate related
1
Department of Physical Medicine and Rehabilitation, Chung-Shan training courses for disability evaluation professionals. And each
Medical University Hospital, Center of Sleep Medicine, Chung-Shan group further discussed and drafted related regulations. Results:

Starting from 2008, the project has completed several parts of the Purpose: To explore how jiont dysfunction affects quadriceps mus-
standards, tools, and practice manuals for ICF. For the purpose cles function in patients with unilateral knee injury. Materials and
of clinical practice, we only use second-level categories of ICF Methods: Twenty three unilateral knee injured patients with jiont
codes for disability evaluation. Professionals in each group reach dysfuntion were assesed for isometric EMG activity of vastus lateralis
agreement that functional evaluations are developed based on cur- (VL), vastus medialis obliques (VM0) and rectus femoris (RF)of both
rent available tools, such as WAIS-III and Berg balance scale. In thighs during three 5-s maximal isometric voluntary contractions at
addition, environmental factors are only distinguished as positive a knee joint angle of 30° (0°: full knee extension), and torque were
(facilitator) and negative (barrier) to note the result of disability recorded at same time. Results: The average amplitude (AEMG,
evaluation. Conclusion: Because World Health Organization mean power spectrum (MPF) values of VL, VMO and RF muscles
(WHO) ICF is a general description of function and not a specific in affected knees are significantly lower during maximal isometric
tool for evaluating disability, the content of ICF covers wider range voluntory contraction at knee 30° flexion than those in unaffected
than that of disability evaluation. Many items are not applicable knees, and torque of affected knees is lower than unaffected knees.
for evaluating disability. In this new disability evaluation system In health side, the AEMG, MPF and MF value of VL are higher than
based on ICF, physicians, therapists, social workers and special VMO and RF, the AEMG, MPF value of RF are higher than VMO ; In
education teachers form an evaluation team to provide function affected side, the AEMG, MPF value of RF are higher than VMO and
and disability assessment. In order to prevent time wasting during VL, The AEMG, MPF value of VL are higher than VMO. Conclusion:
evaluation, a number of core sets will be developed. Although there sEMG can provide quantitative measurements of muscle function,
are several core sets developed in WHO, these core sets are mainly the isometric strength and neuromuscular avtivation lever are lower
for diseases and may be not applicable to disability evaluation in in affected limb , RF may be affected less more than VL and VMO in
Taiwan system. Therefore more applicable core sets, especially knee injured patients with knee dysfunction.therapeuic intervention
for disability determination, are of vital importance. Currently, should focus on improving quadriceps neural muscles function.
the project adopted or modified current measure protocols and
tools to match ICF system. However, the protocols and tools need
to be tested and observed for longer period of time. And how to 0501PP92
correlate the application in Taiwan with ICF qualifiers need to be THE APPLICATION OF SURFACE
further observed and analyzed. ELECTROMYOGRAPHY IN LOW BACK PAIN
Jing-Song Mu, Chao-Min Ni
0501PP90 Department of Rehabilitation Medicine, Affiliated Provincial Hos-
THE ROLE OF MEDICAL SOCIAL WORKER IN pital of Anhui Medical University (China)
NEW DISABILITY CERTIFICATION BASED ON ICF Low back pain is closed with low back muscles fatigue and reduced
ability to contract. Therefore, functional assessment of back muscles
Ti-Li Kao1, Kuo-Lung Lee2, Yi-Shan Lin2 has great value with diagnosis of the lower back pain and assessment
1
Department of Social Work, Tunghai University and 2Social Work of rehabilitation outcome. Early clinical and rehabilitation medicine
Department of Shuang Ho Hospital (Taiwan) to the evaluation of low back muscle has been limited for polyphonic
Purpose: Taiwan’s “People with Disabilities Rights Protection subjectivity and uncertainty. Surface electromyography is concerned
Act” had originally enacted in 1980 (it was called “Physically and by rehabilitation medicine and sports medicine researchers because
Mentally Disabled Citizens’ Protection Act” at that time). In the past, of its specific reliability, sensitivity, non-invasive real-time and
the Act was amended 8 times. In addition to name-change of the multi-target measurement of the benefits, the paper reviewed the
Act, several new categories of disability had included and welfare application on the surface electromyography in low back pain.
of the disabled had adjusted. It includes categories of disability
from “The International Classification of Functioning, Disability 0501PP93
and Health” (ICF) in 2007. In accordance with the Act, new assess-
ment mechanism will comprise the ICF principle and needs to be ANALYSIS OF SURFACE ELECTROMYOGRAPHY
implemented in 2012. In the past 3 decades, most of the medical IN SWALLOWING AND DYSPHAGIA
social workers only responsible for administrative procedures of Jing-Song Mu, Chao-Min Ni
disability assessment. There are even some medical social workers
Department of Rehabilitation Medicine, Affiliated Provincial Hos-
had never involved in any part of disability assessment. However,
in new assessment mechanism imposed by the ICF principle, in pital of Anhui Medical University (China)
addition to the doctor evaluates the body functions and structures, Swallowing is controlled by cerebral cortex and subcortical central,
the PT, OT, ST, Psychologists and Social Workers all will join the and participated by more of the nerves and muscles as a complex
assessment team to evaluate the activity, participation, and environ- process of reflection. To some extent’ Surface Electromyography
ment factors regarding disability condition.The purpose of this study (sEMG) could reflect real time neuromuscular function of swal-
is to explore the role of medical social workers in the new disability lowing and swallowing disorders, and can be used for detection of
certification system based on ICF. No studies have ever tried to swallowing disorders and assessment of dysphagia rehabilitation
discuss this issue. Materials and Methods: This study involved outcome. At the same time, because of its non-invasive, dynamic
questionnaires filled by participants, who are medical social workers and multi-target measurement, more and more attention is paid
from hospitals. Surveys were conducted in 4 ICF trial hospitals and by scholars. Key words: surface electromyography, swallowing,
4 non ICF trial hospitals as a comparison of applying ICF system dysphagia, rehabilitation assessment.
in Taiwan. Results: Ongoing. Conclusion: Ongoing.
0501PP94
0501PP91 APPLICATION OF SURFACE
SURFACE ELECTROMYOGRAPHY OF ELECTROMYOGRAPHY IN FUNCTIONAL
QUADRICEPS FEMORIS IN KNEE INJURED ASSESSMENT OF PATIENTS WITN LUMBAR DISC
PATIENTS WITH JOINT DYSFUNCTION HERNIATION
Jing-song Mu, Chao-Min Ni, Yun Miao, Qing Xia Jing-Song Mu, Chao-Min Ni, Qing Xia
The Department of Rehabilitation Medicine of The Affiliated Anhui Department of Rehabilitation Medicine, Affiliated Provincial Hos-
Provincial Hospital of Anhui Medicine University (China) pital of Anhui Medical University (China)

Objective: To investigate the application of surface electromyog- many evidence that low-frequency transcranial magnetic stimula-
raphy (sEMG) in patients with Lumbar Disc Herniation. Methods: tion for depression is safe. As its application in the treatment of
44 patients with chronic Lumbar Disc Herniation were classified the depression, its safety performance will be considered as one
into mild pain group (A group) and moderate to severe pain group of the major issues.
(B group), ME6000-T8-type surface EMG machine were used to
collecte sEMG of two groups of patients, and calculate ratios of
AEMG and MFs. Results: AEMG of ipsilateral erector spinae 0501PP97
and gastrocnemius with two groups than the healthy side were SOLVING JOBS PROBLEM FOR PEOPLE WITH
significantly reduced (p < 0.05); absolute value of MFs in the af- DISABILITY IN DEVELOPING COUNTRY
fected side were significantly elevated (p < 0.05). Both sides of
AEMG in lumbar paraspinal muscles and gastrocnemius, MFs of THROUGH CBR APPROACH, PSIKI EXPERIENCE
health side in gastrocnemius was no significant difference between 2008
A group and B group (p > 0.05); absolute value of MFs in affected Ferial Hadipoetro Idris
lumbar paraspinal muscles and gastrocnemius with B group are
significantly boosted in comparison with A group (p < 0.05); ratio of Department of Medical Rehabilitation RSCM Hospital / Faculty of
AEMG with B group subjects was observably increased (p < 0.05); Medicine (Indonesia)
MFs of lumbar paraspinal muscles and gastrocnemius were no Back ground: The most difficult aspect in rehabilitation of People
significantly difference between A group and B group (p > 0.05). with Disability (PWD) is job placement, especially in developing
Conclusion: Surface EMG can be used as a non-invasive tool in country, where are many People without Disability also jobless.
detecting neuromuscular functional status of lumbar and lower Goals: 1. to identify PWD who need a jobs. 2. to solve jobs place-
limb in patients with Lumbar Disc Herniation; isometric loading ment problems for PWD. Methods: Design cross sectional for goal
tests of gastrocnemius on maximal inflective ankle can be used as 1, followed by intervention pre- post for goal 2. Materials: form 1
evaluation of neuromuscular functional status of crura in patients and 2 WHO CBR manuals adapted by Ferial HI, CBR manuals for
with lumbar disc herniation; there are dissimilar sEMG imbalance family member number 30, small funding. Process: June–August
in lumbar paraspinal muscle and gastrocnemius while subjective 08 home visits in Urban CBR area by CBR caders to identify PWD
pain levels of patients are different. who need jobs use form 1 and 2. Followed by empowered family
member and People with disability used CBR manuals for family
0501PP95 member number 30, small funding as needed. Results: 20 PWD who
need a job were identified, from August 08 to December 08 only 3
CLINICAL APPLICATIONS OF SURFACE PWD success having a jobs, as cleaning worker in mosque, sales
ELECTROMYOGRAPHY IN STROKE in small vendor and private laundry. Others still on going process.
REHABILITATION ASSESSMENT Conclusion: CBR could be solve job problem for PWD even taken
time in empowering PWD and the family with the support from
Jing-Song Mu, Chao-Min Ni CBR caders and others.
Department of rehabilitation medicine, Provincial Hospital, Anhui
Medical Univesity (China)
0501PP98
Surface: Electromyography (sEMG) is a non-invasive technique
to measure electrical muscle activity, which could be used for OXYGEN UPTAKE RESPONSE TO CYCLE
rehabilitation assessment and therapy. The paper reviews records ERGOMETRY AS RELATED TO SEVERITY
in the past few years who has made use of sEMG to study stroke OF HEMIPARESIS IN POST-ACUTE STROKE
rehabilitation assessment, commonly used sEMG index and its SURVIVORS
meaning, related results of study and so on.
June-Kai Chen1, Tien-Wen Chen1, Ming-Cheng Weng1,
Chia-Hsin Chen1,2, Mao-Hsiung Huang1,2
0501PP96 1
REPETITIVE TRANSCRANIAL MAGNETIC Medical University Hospital and 2Department of Physical Medicine
STIMULATION BASIC PRINCIPLE AND and Rehabilitation, Faculty of Medicine, College of Medicine,
APPLICATION PROGRESS IN DEPRESSION Kaohsiung (Taiwan)
Jin Chen, Chao-Min Ni Purpose: To quantify the potential impact of neuromuscular im-
The Department of Rehabilitation Medicine, Anhui Provincial pairments on oxygen uptake response in post-acute stroke patients.
Hospital (China) Materials and Methods: 64 participants (mean age 59.2 ± 10.7, mean
BMI 24.3 ± 3.2) with a poststroke interval of 8.63.8 days underwent
Transcranial magnetic stimulation is a biological stimulation. It can symptom-limited cardiopulmonary exercise testing. Severity of
change action potentials of nerve cells in the cortex. It does this hemiparetic lower limb was assessed by Brunnstrom recovery stages
though induction current produced by time-varying magnetic field for lower limb. Oxygen uptake (VO2) was measured by open-circuit
effect on the cerebral cortex, thereby affecting on brain electrical spirometry during standard upright ergometer cycling. Results:
activity and metabolism. Repetitive transcranial magnetic stimula- Mean resting, unloaded, and peak VO2 (VO2resting, VO2unloaded,
tion refers to repeated transcranial magnetic stimulation in specific and VO2peak) were 3.9, 7.7, and 12.7ml•kg-1•min–1, respectively.
cortex. The occurrence of depression may be related to reduction of Mean work efficiency (ΔVO2/ΔWR) was 8.4 ± 2.5. After adjustment
varying degrees of 5-HT and regional cerebral blood flow. Excit- for age, sex, stroke type, hemiparetic side, modified Ashworth
ing/inhibitory amino acids imbalances can lead to depression. It is Scale, time poststroke, comorbilities and medicines use, compared
usually thought that dorsol-ateral prefrontal cortex have relations with participants with the four Brunnstrom recovery stages for
to emotions.Theoretically, improving the dorsal-lateral prefrontal lower limb (III, IV, and V to VI), the VO2peak decreased 35.8%,
function area can alleviate patients mood disorders. Repetitive 28.4%, and 19.1%, respectively. Severity of hemiparetic lower limb
transcranial magnetic stimulation show preliminary efficacy in explained 76% of the variance in VO2peak after adjustment for
treating depression, but there are still many issues to be solved. age, sex, stroke type, hemiparetic side, modified Ashworth Scale,
To further explore repetitive transcranial magnetic stimulation time poststroke, and 79% after additionally adjusted for comorbili-
mechanism and its biological effects and its molecular changes are ties and medicines use. Although there was a trend of increasing
necessary. It makes further perfecting the treatment of depression ΔVO2/ΔWR with increasing Brunnstrom recovery stages for lower
and provides the theory basis for clinical application. There are limb, the difference was not statistically significant. Conclusion:

This study provides evidence that VO2peak decreases much more significant correlation was found between ratings of communication
than 10% difference in severity of hemiparetic lower limb, and needs and performance in the aphasic patients (r = 0.653) but not in
muscular work output increase lesser. It would be to take severity the proxies (r = 0.073). Finally, the agreement on communication
of hemiparetic lower limb into consideration to accurately evaluate needs decreased with increasing caregiver burden and the agree-
aerobic capacity poststroke. ment on communication performance decreased with increasing
severity of stroke. Conclusion: Our results showed that aphasic
patients differed in ratings of functional communication needs and
0501PP99 performance from proxies, but the differences were relatively small
AN INVESTIGATION OF SURGEONS’ MENTAL in statistical magnitude.
HEALTH UNDER OCCUPATIONAL STRESS AND
THEIR COPING STRATEGIES FOR MENTAL 0501PP101
REHABILITATION DEVELOPMENT AND VALIDATION OF THE
Jianping Li1, Jianan Li2, Chunxiao Wan3 CHINESE VERSION OF THE STROKE AND
1
Third People’s Hospital of Wuxi, 2Nanjing Medical University and APHASIA QUALITY OF LIFE SCALE-39
3
Wuxi No. 2 People’s Hospital (China)
Hsiu-Fen Ko11, Lu Lu2, Ching-Lin Hsieh3, Hilari
Purpose: This study investigated 162 surgeons’ mental health Katerina4, Rei-Jane Huang
under occupational stress and the effects of their different coping 1
Graduate Program of Speech Therapy, Taipei Municipal University
strategies on mental rehabilitation. Materials and methods: The of Education, 2Department of Physical Medicine and Rehabilita-
Symptom Checklist-90 (SCL-90) and Coping Strategies Scale (CSS) tion, National Taiwan University Hospital, 3School of Occupational
were used to investigate mental health and coping strategies of 162 Therapy, College of Medicine, National Taiwan University (Taiwan)
surgeons came from different hospitals in a medium-sized city of and 4Department of Language and Communication Science, City
Chinese developed region. Participations including 126 males and University (United Kingdom)
36 females were anonymous, voluntary, and random .Their mean
age was 37.4 ± 9.6 years. Results: According to the standard score of Purpose: To adapt the Stroke and Aphasia Quality of Life Scale-39
Symptom Checklist-90 (SCL-90), 54 of the participations (33.3%) (SAQOL-39) into Chinese version for the measurement of health-
had varying degrees of mental health problems such as interpersonal related quality of life in aphasic patients in Taiwan, and to test its
sensitive, anxiety, et al. At the mean while ,these participations’ reliability and validity. Materials and Methods: The SAQOL-39
coping strategies were immature type or mingle type according to was first adapted into the Chinese version (SAQOL-C) following the
the standard score of Coping Strategies Scale(CSS).The total level Mapi approach of linguistic validation, including the processes of
and each element of SCL-90 were positive correlation with that conceptual definition, forward and backward translation, expert re-
of the Coping Strategies Scale (CSS) (p < 0.01). Conclusion: The view, and pilot testing with a sample of 6 aphasic subjects. 34 stroke
majority of surgeons’ pressures origins from their work, so the oc- patients with chronic aphasia (onset > 6 months) and fair comprehen-
cupational stresses of surgeons are more severe than those of social sion (scored 6 or above in the auditory or reading comprehension
people. Surgeons should take more positive coping strategies for subtest of the Concise Chinese Aphasia Test) were then recruited
self-rehabilitation of mental health. and interviewed with the Chinese version of WHOQOL-BREF, the
SAQOL-C and a questionnaire about its acceptability. 21 subjects
were interviewed with the SAQOL-C again 1–2 weeks later. Results:
0501PP100 Most subjects reported this measure to be easily comprehensible,
THE AGREEMENT BETWEEN SELF REPORT appropriate in content, and could be finished quickly. The Cron-
AND PROXY REPORT OF THE FUNCTIONAL bach’s a for global scale was 0.93 and 0.73 to 0.92 for subscales,
suggesting good internal consistency. There were acceptable test-
COMMUNICATION NEEDS AND PERFORMANCE retest reliability for the global scale (ICC = 0.81) and most subscales
IN APHASIC PATIENTS (ICC = 0.70~0.82) except for the energy domain (ICC = 0.49). There
Chiung-Wen Fan1, Lu Lu2 were acceptable correlations between individual items and the total
scale (r = 0.355 to 0.732) and good correlations between subscales
1
Department of Speech and Hearing Disorders and Sciences, Na- and global scale (r = 0.68 to 0.84), suggesting acceptable construct
tional College of Nursing and 2Department of Physical Medicine and validity. The four subscales showed good convergent validity with
Rehabilitation, National Taiwan University Hospital (Taiwan) the WHOQOL domains. There was also good discriminant validity
Purpose: To investigate the agreement between self report and except the psychosocial subscale. Good criterion-related validity
proxy report of the functional communication needs and perform- was noted when comparing the scores of SAQOL-C and the total
ance in aphasic patients, and to investigate its association factors. scores of the Taiwan version of WHOQOL-BREF and its sum-
Materials and Methods: A 35 item functional communication scale mary subscale (Spearman’s rho = 0.511 and 0.505). Conclusion:
was designed and validated for the assessment. 41 stroke aphasic Our results showed that the SAQOL-C is a psychometrically valid
patients with fair comprehension (scored 7 or above in the auditory measure that can be used to assess the health-related quality of life
or reading comprehension subtest of the Concise Chinese Aphasia for most aphasic patients in Taiwan.
Test) and their significant others were recruited and interviewed with
the functional communication scale. Possible association factors
0501PP102
including the severity of aphasia, severity of stroke, and care giver
burden were assessed by the severity scale of Boston Diagnostic EFFECTS OF PULSE MAGNETIC FIELD ON
Aphasia Examination, the Bathel Index, and the Caregiver Burdens BRAIN INJURY AND INSULIN-LIKE GROWTH
Scale, respectively. Results: The proxies tended to rate the patients FACTOR-1 EXPRESSION IN RATS WITH
as having a higher communication needs and lower communication
performance than the patients themselves, but the differences were CEREBRAL ISCHEMIA
mostly non-significant (p≥0.05) or relatively small in statistical Tye Wei, Jina-Zhong Fan, Hong-Ying Wu, Chuan Li
magnitude (d < 0.5 ). The proportions of close agreement between the Southern Medical University (China
patients and their proxies ranged from 85.14%~92.07% in functional
communication needs and 73.84~89.13% in functional communica- Purpose: To study the effects of pulse magnetic field on brain injury
tion performance. The agreements were highest in items on basic and insulin-like growth factor-1 (IGF-1) expression in rats with
communication and lowest in social communication. Moreover, cerebral ischemia. Materials and Methods: 48 SD rats were divided

into 3 groups: sham-operation group, model group and magnetic man presented with a 1-month history of progressive dysphagia
group. 16 rats in every group.The rats in model group and magnetic to liquids associated with 10 kg weight loss. His past medical
group were established focal cerebral ischemia reperfusion model history included chronic sinusitis and chronic serous otitis media.
by the thread occlusion method. Then the rats of magnetic group Physical examination revealed right ptosis and bilateral shoulder
were treated by pulse magnetic apparatus ( 0–105 Gs, 50 Hz) im- girdle weakness. Myasthenia gravis was diagnosed by decremental
mediately after reperfusion 2 h (20 min/time, 1 time/day, everyday response to repetitive nerve stimulation on NCV and associated with
till the rats were decapitated). The neurological function assessment positive anti-acetylcholine receptor antibody tests. The swallowing
was applied for every rat after reperfusion 2 h, 1 day, 3 days, 7 days. evaluation by speech-language pathologist showed difficulty in
After reperfusion 7 days, the changes of pathology, IGF-1, infarct deglutition and incoordination of swallow reflex trigger. During
size in brain tissue of the rats were observed. Results: Compared videofluoroscopic study, poor oral holding and tongue movements,
with the model group, the neurologic deficit scores when 7 days after absence of swallow reflex, incomplete glottic closure and reduction
reperfusion were significantly less in magnetic group (0.31±0.48) in pharyngeal movements were noted. With repeated swallowing,
(p=0.023, p<0.05). The injury degree of neuron greatly reduced and residues in bilateral pyriformis sinuses increased in volume, espe-
the infarction area also markedly decreased in the magnetic group cially in the right side. However, the residues decreased in volume
(p=0.000, p<0.05). At the same time, the number of IGF-1 positive when the head rotated to the left side. Because the patient’s medical
neuron increased significantly in the magnetic group compared with condition exacerbated, he was admitted to intensive care unit due to
model group (p=0.000, p<0.05). Conclusion: Magnetic field can respiratory failure. Dysphagia with aspiration, along with respiratory
reduce the brain injury in rats with cerebral ischemia, this effects involvement, could be a significant cause of morbidity and mortality
might be associated with IGF-1 expression. in myasthenia gravis. Swallowing therapy would play an important
role in management of those cases. In this patient, compensated neck
rotation to the left side, thermal stimulation and energy conservation
0501PP103 are useful. Nevertheless, active exercises to maximize the strength
COMPARISON OF ULTRASONOGRAPHIC of swallowing muscles are usually limited by fatigue. Phamacologic
treatment with pyridostigmine, prednisone or plasma exchange will
CHARACTERISTICS AND PARAMETERS OF THE also improve the symptoms of dysphagia.
LATERAL COLLATERAL LIGAMENT OF THE
KNEE IN POSITIONS OF KNEE EXTENSION AND
0501PP105
CROSS-LEG POSTURE
ANALYSIS OF THE CLINICAL ASSESSMENT OF
Min-Hsin Lai, Shin-Tsu Chang, Liang-Cheng Chen,
UNILATERAL NEGLECT AFTER STROKE
Ming-Fu Hsieh, Kao-Chih Hsu, Tsung-Ying Li
Department of Physical Medicine and Rehabilitation, Tri-Service Weiqun Song, Qian Xu, Jie Hu
General Hospital, School of Medicine (Taiwan) Department of Rehabilitation, Xuanwu Hospital, Capital Medical
University (China)
Purpose: The purpose was to compare imaging quality of the lateral
collateral ligaments (LCL) of the knee in knee extension position Purpose: The purpose of this study is to investigate unilateral ne-
with cross-leg posture, by evaluating morphologic changes and glect patients, performance in line bisection and line cancellation
grey-scale histogram of the ligaments by means of ultrasonography tasks. Materials and Methods: We retrospectively analyzed the
(US). Materials and Methods: This was a cross-sectional study unilateral neglect patients, performance in line bisection and line
with a total of 64 healthy subjects. Ultrasound examination with a cancellation tasks before and after rehabilitation treatment. Results:
5–12 MHz linear transducer was used to assess LCL. Each subject Before treatment, statistical analyses revealed the patients, perform-
was randomly assigned to first step either the knee extension posi- ance in line cancellation and line bisection did not differ from each
tion or the cross-leg position, and 10 min later to undergo the other other (p = 0.902). After treatment, statistical analyses revealed a
position. Ultrasonographic measurements obtained included the significant difference between the two tasks (p = 0.007). With line
widths and grey-scale histograms of the LCL when the subjects bisection only, we detected 29/30 (97%) patients with neglect; with
lay with two knee positions. The angle α between the LCL and line cancellation only, we detected 22/30 (73%) patients with ne-
horizontal line was also measured. Results: Data of 64 subjects glect. Conclusion: As the performance of unilateral neglect patients
(22 men, 42 women; mean, 24.3 ± 4.0 years; height, 166.9 ± 8.6 cm; improved, patients have revealed difference between the perform-
weight, 58.8 ± 10.6 kg) were analyzed. The widths of the LCL and ance in line bisection and in line cancellation. One test alone would
the angle α were significantly decreased in cross-leg position when miss more subjects with neglect. That is to say, combination of the
compared with those of knee extension position, and conversely two tests was more sensitive than any single test alone.
the grey-scale histogram of the LCL were significantly increased
in cross-leg posture (all p < 0.05). Conclusion: Cross-leg position
is an effective way in stretching of the LCL when compared with 0501PP106
knee extension position. A better sonographic image quality of the COMPARISON OF SURFACE
LCL can be obtained in the cross-leg position. ELECTROMYOGRAPHY CHARACTERISTICS
DURING DYNAMIC MOVEMENT BETWEEN
0501PP104 PERSONS WITH LOW BACK PAIN AND HEALTHY
CONTROLS
MYASTHENIA GRAVIS WITH DYSPHAGIA: A
CASE REPORT Bin Xie, Rongli Wang, Chun Luo, Ninghua Wang
Peking University First Hospital (China)
Hui-Chun Juan , I-Hsien Wu , Shu-Chen Lo , Pei-Chi
1 1 1
Hsiao2, Jung-Tai Liu2 Purpose: To investigate surface electromyography differences in the

1
Department of Physical Medicine and Rehabilitation, Chi-Mei back, hip and lower limb muscles during dynamic movement between
Medical Center and 2Department of Physical Medicine and Reha- patients with non-specific low back pain (nsLBP) and healthy control
bilitation, Chi-Mei Medical Center Liouying (Taiwan) subjects Materials and Methods: 10 nsLBP patients and 10 healthy
controls were involved in this investigation. All participants were
Fatigable muscle weakness is one of the characteristics of required to perform active extension/flexion cyclic movements of the
myasthenia gravis. Weakness of the oropharyngeal muscles leads right hip at a rate of 40 repetitions/min. Simultaneously, surface elec-
to dysarthria and dysphagia, which occurs in approximately 6–24 tromyography (EMG) was applied to erector spinae (ES), multifidus
% of patients with myasthenia gravis. We report a 57-year-old (MF), gluteus maximus (GM), hamstring (HS) and abdominal external

oblique (EO) muscles bilaterally to assess the muscle recruitment Imaging Science, Chang Gung University (Taiwan) and 3Program
pattern and muscle activity in two populations during the dynamic of Neuroscience and Education, Department of Biobehavioral Sci-
cyclic motion. Results: Healthy control subjects reached peak EMG ences, Columbia University (United States)
value earlier than nsLBP subjects, but decreased quickly afterwards.
A higher level of muscle activation during the relaxation phase of the Purpose: To understand the brain mechanism of different Chinese
cyclic motion was demonstrated in all the studied muscles in nsLBP writing tasks for further writing disorder diagnosis. Materials and
subjects compared to healthy subjects, particularly for multifidus. Methods: Eight healthy college females (mean age = 21.19 years,
Conclusion: Surface EMG is a practical and sensitive tool to detect all right-handed, well-learned phonetic symbols) were given three
muscle function alterations during dynamic functional movement in Chinese writing conditions (coping, dictation, and phonogram-
LBP subjects. LBP subjects have different muscle activation patterns to-writing) and one control condition (scribbling). Stimuli of the
compared with healthy controls. Rehabilitation for LBP should stress four conditions were displayed randomly, while we used fMRI
muscle activation training or muscle reeducation of both back muscles for detecting brain activation. Subjects were asked to write down
and hip muscles, especially the multifidus. corresponded Chinese characters within 10 seconds. All twelve
Chinese characters were below ten strokes, and one phonogram cor-
responds to one character. The trial would show visual or auditory
0501PP107 stimulus (1.3 seconds), “+” picture (8.7 seconds), and blank picture
INFLUENCE OF RESPIRATION ON LATERAL (1.3 seconds) in order. A total of three runs, 72 trials per condition
were administered to one participant. Results: For the comparison
ABDOMINAL MUSCLES’ THICKNESS WITH with scribbling condition, significant activations were found only
ULTRASOUND SCANNING IN HEALTHY in phonogram-to-writing condition, including right medial frontal
SUBJECTS gyrus (BA 6/32), left middle frontal/precentral/postcentral gyrus
(BA 3/4/6), right cingulate gyrus (BA 24/31/32), left posterior
Yoshitaka Otani1, Keisuke Itotani1, Noriaki Maeda1, cingulate (BA 18/30/31), and left claustrum (p < 0.001). Those
Michi Ikada2, Megumi Hatanaka2, Junichi Kato3 areas were involved in verbal working memory, decision making,
1
Division of Physical Therapy, Hyogo Rehabilitation Center at Ni- discrimination, detecting letter features, and distributed attention.
shi-Harima, 2Department of Clinical Laboratory, Hyogo Rehabilita- The contrast between three conditions shows that the phonogram-
tion Center at Nishi-Harima and 3Department of Internal Medicine, to-writing condition elicited greater activation than dictation
Hyogo Rehabilitation Center at Nishi-Harima (Japan) condition, including right caudate body and putamen for language
comprehension and retrieval of implicit knowledge (p < 0.001);
Purpose: Recent studies have investigated the lateral abdominal the dictation condition elicited greater activation than copying
muscles in humans by means of ultrasound assessment. The ab- condition, including left middle/superior/inferior frontal gyrus (BA
dominal muscles have important functions not only as flexors and 10/46), left precuneus (BA 31), right anterior cingulate (BA 33), left
rotators of the trunk, but also as respiratory assistant muscles. The cingulate gyrus/sub-gyral (BA 31), left insula/claustrum (BA 13)/
purpose in this study was to examine the changes of thickness and caudate head, and right caudate body (p < 0.001). Plenty of activa-
the reliability of the lateral abdominal muscles during respiratory tions were found in comparing phonogram-to-writing with copying
maneuvers. Materials and Methods: Participants were 9 healthy condition, showing more areas in temporal and occipital lobe for
male volunteers (26.4±2.7 years old). The ultrasound B-mode scan- more complex visual comprehension and phonological procedure.
ning (HD11XE with 3–12 MHZ linear probe, Philips Co. Ltd, Japan) Both phonogram-to-writing and dictation condition shows activated
was performed with the subject lying supine position and the probe regions in left middle/superior frontal gyrus (BA 10), left inferior
was placed transversely border midway between the costal border frontal gyrus (BA 46), left insula/claustrum (BA 13), left caudate
and abdominal muscles. The muscle thickness of external oblique head, and right caudate body (p < 0.001). Functions of inferior
(EO), internal oblique (IO), transverses abdominal (TA), and also frontal gyrus, superior frontal gyrus, and precuneus considered for
the total of the muscle thickness (lateral abdominal muscle: LAB) writing were dictation itself, recollection of the representation of
were measured under two conditions; resting expiration (Rex) and the graphemes, and memory and visuospatial mental operations,
maximum expiratory effort (MEE). Thickness measurements under respectively. Conclusion: The differences between three conditions
these conditions were obtained by 3 times, respectively. Percent suggest that, in a cognitive point of view, the phonogram-to-writing
thickness change was calculated as thickness MME – thickness condition is the most complex task, which needs more phoneme-
Rex/thickness Rex×100. Interclass correlation coefficients (ICC1.1) to-grapheme process than other two conditions, and the copying
were used to estimate reliability. Statistical analysis was used by condition is the simplest one. Further study needs to investigate
Wilcoxon matched-pairs signed-rank test and a p-value less than the phonogram-to-character process.
0.05 was taken to be significant. Results: Percent thickness change
during MME were significantly increased to compared with that
during Rex (IO, TA and LAB, respectively: p = 0.01), although 0501PP109
only the EO thickness was significantly decreased (EO: p = 0.03). QUANTITATIVE ASSESSMENT OF HYOID BONE
Intraexaminer reliability estimates (ICC) ranged from 0.72 to 0.94
in EO, 0.63 to 0.85 in IO, 0.53 to 0.71 in TA and 0.77 to 0.85 in MOVEMENT AND PHARYNGEAL STASIS IN
LAB respectively. Conclusion: We conclude that the thickness of DYSPHAGIC STROKE
lateral abdominal muscles was influenced with voluntary respiration, Pei-Hung Lin1, Yan-Hao Chen2, Yeun-Chung Chang3,
and the assessments of that by means of ultrasound scanning are
adequately reliable. This information may be useful for informing Wen-Shiang Chen2, Tyng-Guey Wang2
exercise prescription.
1
National Taipei College of Nursing, 2Department of Physical
Medicine and Rehabilitation, National Taiwan University Hospital
and 3Department of Medical Imaging, National Taiwan University
0501PP108 Hospital (Taiwan)
CORTICAL ACTIVATION DURING WRITING Purpose: To objectively evaluate hyoid bone movement and the
TRADITIONAL CHINESE CHARACTERS IN amount of pharyngeal stasis in dysphagic stroke objects. Materials
FEMALES: A FUNCTIONAL MRI STUDY and Methods: Videofluoroscopic study (VFSS) was performed in
11 normal and 11 supra-tentorial dysphagic stroke subjects with
Hsin-Yu Chen1, Ling-Fu Meng1, Chiu-Ping Lu1, Pei-Shan 5-ml thin, thick, and paste bariums. All stroke subjects were rated
Wei2, Ho-Ling Liu2, Yi-Wen Li3 level 4 to 5 by Dysphagia Outcome and Severity Scale (DOSS). The
1
Dept. of Occupational Therapy and Institute of Clinical Behavioral hyoid bone movement, including forward and upward displacement,
Science, Chang Gung University, 2Institute of Medical Physics and duration, velocity, and amount of pharyngeal stasis were calculated

by self-designed program with Matlab®. Results: The hyoid bone 0501PP112

movement with three bariums showed no difference in normal and JUVENILE MUSCULAR AMYOTROPHY OF DISTAL
dysphagic stroke subjects. The pharyngeal stasis with paste barium
was significantly greater in dysphagic stroke subjects than that of UPPER LIMBS (HIRAYAMA DISEASE) – A CASE
normal subjects (p < 0.05). Conclusion: The pharyngeal stasis in REPORT AND REVIEW OF THE LITERATURE
dysphagic stroke subjects significantly increased; nevertheless, the Tzu-Ying Sung1, Chiao-Wen Hwang1, Jue-Long Wang1,
hyoid bone movement seemed normal.
Shu-Fen Sun1,2, Po-Chin Wang3
1
0501PP110 Veterans General Hospital, 2Department of Medicine, School of
Medicine, National Yang-Ming University and 3Department of
DYSPHAGIA CAUSED BY CERVICAL
Radiology, Kaohsiung Veterans General Hospital (Taiwan)
OSTEOPHYTE – A CASE REPORT
Juvenile muscular amyotrophy of distal upper limbs (Hirayama
Chih-Ming Lin, Ke-Vin Chang, Tyng-Guey Wang disease) is a rare disease predominantly affecting the anterior horn
Department of Physical Medicine and Rehabilitation, National cells of the cervical cord in young men. It is a kind of cervical
Taiwan University Hospital (Taiwan) myelopathy characterized by insidious onset of unilateral distal
Purpose: To present a case with swallowing difficulties caused by dominant upper limbs muscle weakness and atrophy due to anterior
ventral cervical osteophytes and assess video fluoroscopic examina- cervical cord compression. It is difficult to differentiate this disease
tion results including hyoid bone movement. Materials and Meth- from other diseases with similar symptoms such as motor neuron
ods: We present a 76-year-old man complaining of insidious-onset disease. Cervical magnetic resonance (MR) study in flexed position
swallowing difficulties for 2 years. Voluminous ventral cervical is helpful to confirm the diagnosis. We reported a 21-year-old man
osteophytes extending from C3 to C6 and narrowing the pharyn- who complained of slowly progressed muscle atrophy and weak-
goesophageal segement by external compression were diagnosed ness of right hand and forearm after right shoulder stretching injury
radiologically. To evaluate the mechanism, the Video fluoroscopic three years ago. Electrodiagnostic study revealed acute and chronic
swallowing study was performed and results were analyzed. Results: denervative change in the right side atrophied muscles. Routine
The Video fluroscopic swallowing study revealed epiglottic closure cervical MR images showed high signal intensity over anterior horn
failure attributable to bridging osteophytes, prominent vallecula cell of lower cervical cord. With the suspicion of Hirayama disease,
stasis, silent aspiration and impaired bolus passage due to mechani- flexion MR was performed and the striking and pathognomonic
cal obstruction. Reduced hyoid bone movement (measurement: 1.72 picture of anterior shifting of cervical posterior dura at the lower
cm) was also found during swallowing. Conclusion: Large ventral cervical spinal canal was noted. He received neck collar therapy
cervical osteophytes could cause dysphagia. In our case, reduced and vitamin B12 supplement. No further progression of symptoms
hyoid bone movement, impaired epiglottic closure and bridging was noted at the 3 months follow-up study. Though Hirayama
ventral osteophytes aggravated aspiration condition. disease is spontaneous arrest, early diagnosis is necessary because
early cervical collar application by preventing neck flexion has
been shown to stop disease progression. Surgical managements are
0501PP111 preserved to late stage. In cases of early onset of distal upper limb
THE INCIDENCE AND AWARENESS OF FATIGUE weakness with cold paresis and contractile fasciculation, the finding
of asymmetric lower cervical cord atrophy on routine cervical MR
IN AN ASIAN POPULATION OF DISABLED ADULTS study raise the suspicion of Hirayama disease. A flexion MR study
– A PILOT STUDY should be performed to confirm the diagnosis.
San San Tay, Sheldon Lee, Sherry Hy Young
Changi General Hospital (Singapore) 0501PP113
Purpose: This study aims to determine the incidence of fatigue in WITHIN-SESSION ACQUISITION OF
a sample population of multi-ethnic Asian disabled adults and their ANTICIPATORY POSTURAL ADJUSTMENTS
level of awareness of this issue. Materials and Methods: Twenty- DURING FORWARD REACHING TASK
one adults with the diagnosis of stroke, traumatic brain injury or
spinal cord injury attending a physical medicine and rehabilitation Wen-Yu Liu1, Yang-Hua Lin1, Hen-Yu Lien1, Lin-Ya
clinic who consented and were able to complete the Brief Fatigue Hsu1, Yi-Ju Tsa1, Chia-Fang Liao1, Fuk-Tan Tang2,3
Inventory in either English, Chinese, Malay or Tamil were recruited. 1
Graduate Institute of Rehabilitation Science, Chang Gung Univer-
This questionaire was administered at the end of the clinic visit. sity, 2Department of Physical Medicine & Rehabilitation, Chang
The medical records were reviewed and the following data were Gung Memorial Hospital and 3Chang Gung University, College of
obtained: diagnosis, chronicity of illness, current functional status, Medicine (Taiwan)
motor FIM, presence of depression and sleep disorders. The medical
records were also reviewed if the patient had complaint of fatigue or Purpose: To describe the within-session acquisition of APAs in
had similar complaints prior to administration of the questionnaire. healthy adults during standing forward reaching training. Materials
Laboratory data were reviewed for anaemia or endocrinopathies. and Methods: Repeated-measures design was used in this study.
Results: Chinese patients consisted 66.7% of all patients. Malays Within one day, ten healthy subjects practiced the forward reaching
and Indians made up 23.8% and 9.5% of the sample population to a moving target for a total of sixty trials (ten trials, six blocks).
respectively. Their ages range from 21 to 85 and the mean age APAs were defined by electromyography and center of pressure
was 52.6 ± 20.1. 66.7% of patients had mild fatigue and 33.3% measurements. Repeated measure ANOVA was used to compare the
had moderate fatigue. None had complaint of fatigue during the changes of APA among the six blocks. Results: All subjects showed
clinic visit. Most were unaware of but amenable to interventions basic APA patterns in the beginning, such as posterior shift of COP
to treat fatigue. The chronicity of their illness range from 2 to 108 and the activation of tibialis anterior prior to the initiation of reach
months and the average was 10 months. 66.7% of the patients were movement. With practice, the onset latencies of posterior shift of
independent or had modified independence. The rest required assist- COP between block 2 and 6 (p < 0.05) and ispilateral tibialis anterior
ance but were not dependent. Conclusion: Fatigue is common in between block 1 and 3 (p = 0.01) were significantly shorten. Conclu-
the disabled adult population. The symptoms of fatigue may need sion: The results suggested the within-session acquisition of APA
to be screened using a tool due to the lack of awareness in Asians. could be observed after 50 trials of practice in healthy adults during
Further research on this issue with greater numbers and education functional reaching in standing. Further study will need to verify the
of this population may be beneficial. optimal number of practice trials in the different populations.

0501PP114 the lateral distance (LD) between the lateral border of the acromion
THE FINDINGS OF NORMAL SUBJECTS AND and the greater tuberosity and the anterior distance (AD) between
the anterior border of the acromion and the lesser tuberosity in the
STROKE PATIENTS WITHOUT SPASTICITY affected and unaffected shoulders. The ultrasonograhic findings of
USING A NEW HAND-DRIVEN AND PORTABLE rotator cuff tendon abnormalities were described as normal, a tendi-
SPASTICITY-MEASURING SYSTEM nopathy, a partial-thickness tear, and a full-thickness tear. Results:
The motor status of proximal hemiplegic arm of all the participants
Jeong Hwan Seo1, Soo Yon Son1, Keo Sik Kim2, Chul Gyu is Brunnstrom stage II. The mean duration of stroke was 42.29±9.26
Song2 days. The ultrasonographic findings of hemiplegic shoulder included
1
Chonbuk National University Medical School and 2Chonbuk partial-thickness tear in one patient, tendinopathy in four patients.
National University, Division of Electronics and Information En- The AD and LD of the affected shoulder (AD: 3.12 ± 0.51 cm; LD:
gineering (Republic of Korea) 2.87 ± 0.27 cm) were greater than those of the contralateral shoulder
(AD: 2.40 ± 0.47 cm; LD: 2.12 ± 0.33 cm). Conclusion: The ultra-
Purpose: To see the normal findings in newly developed hand-driven sonography is a convenient diagnostic tool to measure the degree of
portable spasticity-measuring system, we evaluated normal healthy shoulder subluxation directly in patients with post-stroke hemiplegia
controls and stroke patients without spasticity. By considering these without exposure to ionizing radiation.
normal findings, we can analyze the data of spasticity more reason-
ably. Materials and Methods: Spasticity was evaluated in 10 normal
persons without CNS lesion and 10 stroke patients without spastic- 0501PP116
ity, modified Ashworth scale (MAS) 0. Our device was designed
for measuring the joint angle, angular velocity, electromyographic OPTIMAL TIMING OF MEDICAL INTERVENTION
(EMG) signals, and force (torque). One set of 10 passive flexion/ FOR OSTEOPOROSIS
extension movements of elbow was completed at 60, 90, 120, 150 Fong-Cheng Lin1, Wei-Jung Chang2, Ching-Yang Lin3,
and 180 degrees per second(deg/s). Electromyographic data and
Mu-Jung Kao4
torque were collected from the biceps and triceps muscle. Results:
In all subjects, we measured the EMG activities, joint angles, angular
1
Department of Physical Medicine and Rehabilitation, Taipei City
velocities, and torque by using the new portable spasticity measuring Hospital, Renai Branch, 2School of Health Care Administration,
system. The maximal EMG amplitude varied from 71 μV to 926μV Taipei Medical University, 3Department of Physical Medicine and
in biceps muscle and from 48 μV to to 374 μV in triceps muscle. Rehabilitation, Taipei City Hospital, Renai Branch and 4Depart-
The maximal flexion torque was 17 Nm and the maximal extension ment of Physical Medicine and Rehabilitation, Taipei City Hospital,
torque was 9 Nm. The EMG acitivities and torque were increased Yangming (Taiwan)
with increment of angular velocity. The portable spascity-measuring
system had good inter-rater and intra-rater reliability. Conclu- Purpose: In developed countries, the morbidity of fractures caused by
sion: Newly developed portable system for measuring spasticity osteoporosis has surpassed that of heart disease and stroke; moreover,
is designed to test spasticity more precisely and objectively. The the disability caused by fractures is no less than by cerebral infarction.
inter-rater and intra-rater reliability was good. By considering these Therefore, it is worthwhile to determine the magnitude of the social
normal findings and the good reliability of this system, we suppose cost of osteoporosis. The purpose of this study was to analyze bone
that this system can be used to measure the spasticity more precisely mineral density data in the hope of finding the appropriate timing
and easily in clinical settings. for intervention with medications, so as to reduce the probability of
corresponding fractures. Materials and Methods: BMD T-score data
measured by DXA was collected from female patients greater than 65
0501PP115 years of age who were admitted to the hospital or visited the OPD for
femoral neck, intertrochanteric, or vertebral fractures between January
ULTRASONOGRAPHIC FINDINGS IN 2005 and October 2007 in order to determine the difference in T-scores
HEMIPLEGIC SHOULDER IN PATIENTS WITH as compared with a control group (non-fracture OPD patients). Re-
STROKE sults: T-scores had a negative correlation with age. T-scores decreased
with age and the T-scores of fracture patients were significantly lower
Ting-I Hang, Pei-Yu Yang, Nai-Hsin Meng, Shu-Wei than non-fracture patients at the same age. Furthermore, the correla-
Dee, Chia-Chen Lin tion coefficient of age and T-score in the control group was not as
Department of Physical Medicine and Rehabilitation, China Medi- significant as in the study group, which suggests that the problem of
cal University Hospital (Taiwan) BMD decreasing with age could be relieved by interventions which
served as controllable factors. However, if the decrease in BMD
Purpose: Shoulder pain is a common complication in hemiplegic could not be reduced in a timely manner, the probability of fractures
patient after stroke. The well-known causes of the shoulder pain would increase. Of the patients in the study group, 75.6% had a T-
include shoulder subluxation, shoulder-hand syndrome, adhesive score < –2.5 as compared with 14.9% in the control group. The odds
capsulitis and rotator cuff lesion. The exact mechanism of develop- ratio for fractures was 5.06. If the comparison standard was changed
ment of shoulder pain is not clear, thus the most effective treatment to a T-score of < -3.5, 58.5% of patients in the study group would
remained uncertain. Radiography with/without contrast has been have been included as compared with 1.1% in the control group; the
used to obtain a quantitative measurement of shoulder subluxation corresponding odds ratio for fracture would be 50.9. Conclusion:
and investigation of rotator cuff tear in post-stroke patients. How- After summarizing the study results and considering the problem of
ever, the characters of low cost, convenience, and lack of risk make effective usage of medical resources, it is recommended that a T-score
dynamic ultrasonography an excellent imaging tool for evaluating the of –3.5 is the minimum limit for drug treatment.
shoulder of hemiplegic patient recently. The purpose of this study is to
evaluate the hemiplegic shoulder by ultrasonography. Materials and
methods: Seven patients with post-stroke hemiplegia (all Brunnstrom 0501PP117
stage II in proximal part of affected upper limb) were recruited from
the rehabilitation clinic in a teaching hospital. Basic data including CONTROL IN MOTOR UNITS ON GLUTEUS
duration of stroke, Brunnstrom stage, spasticity (Modified Ashworth MEDIUS MUSCLES DURING MAXIMAL WALKING
scale) of the hemiplegic side were collected. Ultrasonography was SPEED IN NORMAL PERSONS
performed using an ultrasonographic equipment with a 7–12 MHz
linear array transducer (LOGIQTM5 PRO, GE medical system) Akio Kobe1, Kazuhiko Kuriiwa1, Junko Kiyoi1, Tosiyuki
by a physiatrist. The distance of acrominal-humeral distance was Muratani1, Mayumi Oda1, Kenji Kagechika2, Ayumi
measured by the method described by Gi-Young et al. We measured Kaneuji3

1
Department of Medical Rehabilitation Services, Kanazawa Medi- in Taiwan have been developed through a national decision-making
cal University Hospital, 2Department of Rehabilitation Medicine, process carried out by members of Taiwan ICF Team includes phy-
Kanazawa Medical University and 3Department of Orthopedic sicians, nurses, physical therapists, occupational therapists, social
Surgery, Kanazawa Medical University (Japan) workers, psychologists, special education teachers, vocational
assessment workers, public health scholars, and representatives
Purpose: The purpose of this study was to investigate difference of of welfare groups for people with disability. There were a total of
control in motor units on gluteus medius muscle (GM) using surface 199 professional members (124 members for body function/body
EMG between normal and maximal walking speeds. Materials and structure, and 75 members for participation/environment) partici-
Methods: The participants consisted of 9 healthy women volunteers pated in 16 groups (8 groups for body function/body structure,
with informed consent. Using a foot-switch, the mid stance phase and 8 groups for participation and environment). In each group,
was selected and sEMG signal of GM during mid stance phase was there was one member to be the leader to lead the discussion by
analyzed with non-linear system called “MemCalc”. Parameters focus group session and voting to reach agreements. These groups
included: 1) EMG median frequency (MF); 2) integrated EMG need to develop evaluation methods and standards and formulate
normalized maximal voluntary contraction and compared between related training courses for disability evaluation professionals.
the normal and maximal walking speeds. Results: The mean EMG And each group further discussed and drafted related regulations.
activity of GM during the mid stance phase in maximal walking There were 6 items, 2 items, 7 items and 3 items, respectively, of
speed was greater than that during the same stance phase in nor- body function, structure, demand and environment in Taiwan ICF
mal walking speed, but there was no significant difference. On the used in the pilot study to evaluate disability of stroke patients.
other hand, the mean MF, in frequency range of 20 to 1000 Hz, of The disability of stroke patients evaluated by Taiwan ICF were
GM during the mid stance phase in maximal walking speed was also compared with that of same patients using Barthel index and
significantly lower than that during the same stance phase in nor- modified ranking scale (mRS) to elucidate the usefulness of Taiwan
mal walking speed (p < 0.05). Conclusion: It was suggested that ICF on disability of stroke patients. Results: Stroke patients with
the control in motor units on GM during the mid stance phase of mRS 2-4 and did not have recurrent stroke would be recruited as
maximal walking speed in normal persons was selectively achieved study subjects. Compared with the item specific score of body
by recruitment of smaller motor units distributed over slow twitch function at 6th month after stroke onset, the memory function in
fibers compared to normal walking speed. one year have been improved. However, the items of brain and
nervous systems did not show significant improvement during 6
month to one year. The same results were also observed for items
0501PP118 of activity and environment. The comparison between evaluation
EFFICACY OF INTRA-ARTICULAR HYALURONAN of stroke disability based on ICF, Barthel index and mRS will be
INJECTION IN KNEE OSTEOARTHRITIS provided in the conference. Conclusion: This is a pilot study on
evaluation stroke disability using newly development Taiwan ICF.
Ling-Li Liu We found that it provide more comprehensive scope including
Department of Rehabilitation Medicine, Zhongnan Hospital, Wuhan interaction between stroke patients and their living environment
University (China) on stroke disability than Barthel index and mRS. We also provide a
preliminary data to show it is very important to develop a country
Purpose: To evaluate the effect of intra-articular hyaluronan injec- specific version of ICF on disability of chronic diseases.
tion in treatment of knee osteoarthritis. Materials and Methods:
Twenty cases of knee osteoarthritis in outpatient were treated with
intra-articular hyaluronan injection between March to August in 0501PP120
2009. Knee radiographs were reviewed and graded on the basis
Kellgren and Lawrene classification system. Preinjection and HEAD, TRUNK, HIP AND SHOULDER MOVEMENT
postinjection evaluation were conducted by the score change of DURING SITTING FORWARD REACHING TO
pain relief, physical examination and knee function. Results: All THREE DIFFERENT DISTANCES
the cases were available for follow-up and responded to a detailed
patient questionnaire. The satisfactory rate was 90% in the patients Te-Hsiang Lo1, Yi-Fen Shih1,2
with radiographic I and II grade. Conclusion: It is recommended 1
Department of Physical Therapy and Assistive Technology, Na-
that intra-articular hyaluronan injection be used in the patients with tional Yang-Ming University and 2Department of Education and
radiographic evidence of mild disease. Research, Taipei City Hospital (Taiwan)
Purpose: To investigate and compare the movement pattern of
0501PP119 head, trunk, hip and shoulder segments during sitting forward
reach task at three testing distances: 100%, 115% and 130% arm’s
A PILOT STUDY ON IMPLEMENTING length. Materials and Methods: From September 2009 to Decem-
THE DISABILITY EVALUATION FOR ber 2009, the testing involved a total of ten healthy subjects who
STROKE PATIENTS IN TAIWAN BASED ON were free from spinal pain and other musculoskeletal problems. In
INTERNATIONAL CLASSIFICATION OF HEALTH order to collect joint motions of the head, trunk, hip and shoulder
FUNCTIONING, DISABILITY AND HEALTH (ICF) in the sagittal plane, an electromagnetic tracking device was used.
Participants were instructed to reach forward to touch the target
Hung-Yi Chiou1, Yu-Ling Li1, Fang-I Hsieh1,2, Chyi-Huey placed at eye-level under three different horizontal distances (100,
Bai1,3 115 and 130% arm’s length) with gaze fixed on the target.The
1
School of Public Health, Taipei Medical University, 2Dr. Chi-Chin speed of movement was guided by a metronome and each testing
Huang Stroke Research Center, Taipei Medical University and 3Cen- was performed in two seconds. Onset of joint motion was the mo-
tral Laboratory, Shin Kong WHS Memorial Hospital (Taiwan) ment when the joint angle exceeded two standard deviations of
its baseline. The onset of hand movement and the end of reaching
Purpose: The specific aim of the study is to elucidate the useful- movement were defined respectively as the time at which contact
ness of disability evaluation of stroke patients using International with hand switch was broken and target switch was touched. Onset
Classification of Health Functioning, Disability and Health (ICF) latency was defined as the difference between joint movement
in Taiwan. Materials and Methods: A total of 30 stroke patients onset and hand movement onset. Intraclass correlation coefficients
were recruited through Taiwan Stroke Registry and were then (ICC(3,3)) were calculated to describe the measurement repeatability
evaluated their disability between the 6th month and one year of the testing variables and Pearson correlation coefficients were
after the onset of stroke based on International Classification of used to examine the relationship between movement of the head,
Health Functioning, Disability and Health (ICF). The ICF system trunk, hip and shoulder joints. Results: During forward reach, head

and trunk extended while shoulder and hip flexed; the greatest 0501PP122
values of amplitude of joint angle occurred at the 130% test (head THE IMMEDIATE CHANGE OF CENTER OF
extension angle = 13.92°, trunk extension angle = 9.74°, hip flexion
angle = 21.00°, and shoulder flexion angle = 96.79°). The reliability GRAVITY AFTER DUAL TASK BALANCE
of head, trunk, hip and shoulder movement angle was good to TRAINING IN ACUTE ISCHEMIC STROKE
excellent for the 115% test (ICC(3,3) = 0.84–0.98) and the 130% PATIENTS
test (ICC(3,3) = 0.88–0.99). The measurement of movement range
was less repeatable for the 100% test (ICC(3,3) = –0.58 to 0.96). The Min-Kyung Lee, Hyun-Sik Yun, Jae-Young Han, In-Sung
ICC value for the measurement of head movement onset latency Choi, Sam-Gyu Lee
was the best for the 130% distance (ICC(3,3) = 0.74) while trunk, Department of Physical and Rehabilitation Medicine, Research
hip and shoulder joint onset latency had a range of moderate to Institute of Medical Sciences, Chonnam National University Medical
good reliability in all three testing distances (ICC(3,3) = 0.59–0.98). School & Hospital (Republic of Korea)
In both 115% and 130% testing distances, movement of trunk and
head were negatively correlated (r = –0.86 and r = –0.77), and there Purpose: Hemiplegic stroke often affects balance-demanding ac-
was a positive relationship between trunk extension and hip flexion tivities, and that limits independence in activities of daily living.
movement at the 130% testing distance (r = 0.72). More than half The balance function can be improved by dual task balance train-
of the participants started the forward reach movement with their ing, which maintains balance training performing cognitive task
head segment at both 100% reach distance (57%) and 115% reach simultaneously. There are no reports on the immediate effect of
distance (72%). At 130% reach distance, 14% and 43% subjects dual task balance training in unilateral hemiplegic stroke patients.
initiated their movement with head and trunk segments respec- The aim of this study was to investigate the immediate change of
tively. Conclusion: During sitting forward reach, head and trunk center of gravity after dual task balance training in acute ischemic
moved into extension while hip and shoulder flexed; increased stroke patients. Materials and Methods: Eight acute ischemic
trunk extension angle was associated with increased hip flexion stroke patients (2 male, 6 female; age 66.5 ± 8.3 years; duration of
angle and decreased head extension angle. The testing distance of disease 8.7 ± 3.3 days), who can stand alone for more than 60 ± 30
130% arm’s length resulted in the best consistency for kinematic seconds without assistance, were recruited. Their mini-mental status
measurement and joint onset latency. examination scores were 22 points or more. The patients with visual
or vestibular impairment, peripheral polyneuropathy, lumbosacral
radiculopathy, musculoskeletal deformity, aphasia, and cognitive im-
0501PP121 pairment were excluded. Single task balance training was performed
THE EFFECT OF PHONOPHORESIS ON PATIENTS on the balance board. Dual task balance training was performed on
the balance board counting loudly backwards from 50. Single or
WITH ANTERIOR CRUCIATE LIGAMENT dual task balance training was performed for 15 min, once a day,
INJURIES OF THE KNEE alternating two types of balance training for 4 days. Berg balance
I. Mircea, Simona Daciana Birsan scale and functional standing balance scale were checked before
and after every single or dual task balance training. Plantar pressure
Oradea University School of Medicine (Romania) distribution ratio, deviation of center of gravity, and distribution of
Purpose: Knee pain is one of the most common medical problem. center of plantar pressure were measured on standing position by
The knee joint must also be supported by soft tissues - muscles, using Gaitview (alFOOTs®, Seoul, Republic of Korea). Results: 1)
tendons, and ligaments – which are also subject to injury, overuse, The changes of Berg balance scale and functional standing balance
and under use. Degenerative conditions and other diseases in the scale were not significantly different in both types of balance train-
body may also contribute to knee problems, or generate pain that ing, respectively (p = 0.81, 0.77). 2) The changes of plantar pressure
travels along nerves to the knee. Non-pharmacological methods distribution ratio, percentage of deviation of center of gravity, and
including a variety of physical agents are the cornerstone of distribution of center of pressure were not significantly different in
the management of the shoulder pain. Phonophoresis is the use both types of balance training, respectively (p = 0.65, 0.30, 0.53).
ultrasound to enhance the delivery of topically applied drugs. Conclusion: The immediate effect of dual task balance training was
The aim of the study was to what parameters of ultrasound will not significant in acute ischemic stroke patients. Further randomized
most efficiently facilitate topical drugs diffusion,and what dura- controlled trials including long-term follow-up would be needed.
tion ultrasound should be used to maxime absorbtion of drugs in
patients with knee pain. Materials and Methods: Fifty patients
with knee pain (duration > 2 months ) of both sexes ( 30 males 0501PP123
and 20 femals) aged 51.03 + 9.25 years,addmited for stationary DETERMINANTS OF THE STROKE-SPECIFIC
medical rehabilitation in a rehabilitation center,were functional
evaluation was realized with ADL ( Activities of Daily Living) HEALTH-RELATED QUALITY OF LIFE (HRQOL)
,range of motion (ROM) for knee joints,the pain and the evalu- Yin-Jung Wang, Chia-Yeh Chou
ation of pain free effect of therapy were analysed with the scale Department of Occupational Therapy, College of Medicine, Fu- Jen
VAS. One group :ultrasound was performed with continous mobile Catholic University (Taiwan)
technique,at the intensity of 0,75 W/cm2. for 12 min per session
used cream with Capsaicin 7,5 % ,and the second group : ultra- Purpose: The health-related quality of life is expected to be im-
sound with continous mobile techniques at the intensity of 0.5 proved for the outpatients of stroke survivors. This therapeutic
W/cm2 for 6 min per session with ketoprofen cream. Apart from goal can be achieved by the suggestions from the determinants
descriptive statistics,Student’s test was used to assess difference identification of the HRQOL. This study was aimed to Identify the
between the two groups and between baseline and post-therapeutic determinants of the health-related quality of life (HRQOL) for the
data.The level of significance was set at p < 0.05. Results: Study stroke patients. Materials and Methods: This was a prospective,
results showed favorable effects of both group used ultrasound cross-sectional, and a still on-going project conducted at the hospi-
but the group who used capsaicin cream have a good difference. tals in Taiwan from September 2008 to November 2009. Participants
The chronic pain is generally associated with physical, psycho- with diagnosis of stroke were recruited. They were also outpatients
logical as well as social dysfunctions.Although physical agents whose cognitive comprehension allowed them to be able to listen
have many avantages over interventions. Conclusion: In our study or to read in Chinese language. The Stroke-Specific Quality of
of knee pain patients ,sonophoresis decreased the level of pain Life (SS-QOL) is a disease-specific HRQOL instrument and was
and improved the shoulder range of motion, additional studies used as the main outcome measure in this study. The SS-QOL was
are needed to establish the place of these treatment modalities in completed by self-rating or being interviewed by the researchers.
patients with knee pain. In addition, the Barthel Index (BI), Mini-Mental State Examination

(MMSE), National Institutes of Health Stroke Scale (NIHSS) were of Environmental and Occupational Medicine, National Taiwan
also administered for the identification of the determinants. The University Hospital (Taiwan)
Spearman rank correlation coefficient (ρ) was used to investigate
whether there were significant correlations between the scores of Purpose: To evaluate the responsiveness and estimate the mini-
SSQOL, and those of BI, MMSE, and NIHSS. The multiple regres- mal important difference (MID) on Roland and Morris Disability
sion would also be computed to search determinants from the BI, Questionnaire (RMDQ) for the patients with low back pain (LBP).
MMSE, or NIHSS on the SS-QOL. The SPSS software was used for Materials and Methods: Patients with low back pain were con-
statistical analysis. Results and Conclusion: The determinants of secutively recruited from several clinics of physical medicine
the NIHSS, MMSE, and BI on the SS-QOL would be identified. The and rehabilitation. All patients received an initial evaluation
determinants identified were relevant to either physical recovery, consisting of a medical history and physical examination. Every
cognitive function, or the performance of daily activities. These patient completed the RMDQ and rate their pain intensity by a
determinants identified would provide valuable suggestions for Visual Analog Scale. The disability days was defined as restricted
the clinical practitioners and researchers regarding the areas of the activity days or work absence days during the previous 4 weeks
health care for improving the HRQOL of the stroke outpatients. because of back pain. Follow-up questionnaire was obtained from
each patient 8 weeks later. The changes of clinical status were
also recorded by the patients using a 5-point Likert Scale as an
0501PP124 external criterion. Responsiveness was analyzed by calculating
the effect size (ES) and the standardized response mean (SRM).
PREDICTING ELDERLY FRAILTY BY Two methods were employed to estimate the MID in this study:
FUNCTIONAL PERFORMANCE TESTS (1) Receiver operating characteristic curve was created for cut-
Pay-Shin Lin1, Meng-Tieh Chen1, Tzu-Wen Chen1, Alice point analysis between improved and non-improved group; (2)
Multiple Linear Regression analysis was used to examine how
M.K. Wong1, Jong-Shyan Wang1, Hsiang-Wei Tang1,
the MID linked to one disability day for RMDQ. Results: There
Shin-Cheng Su1, Huey-Shinn Cheng2 were 100 patients recruited consecutively. The mean disability
1
Graduate Institute of Rehabilitation Science, Chang Gung Uni- days during the previous 4 weeks was around 4.1days. 84% of
versity and 2Internal Medicine, Chang Gung Memorial Hospital, the participants reported improvement of LBP after the 8-week
LinKou Branch (Taiwan) follow-up and 11% participants remained in stable condition. Only
5% of the participants reported deterioration. Comparison between
Background: Frailty was a fairly common biological syndrome in the results obtained from the initial and follow-up questionnaire
the elderly. It caused vulnerability to adverse outcomes, such as showed statistically significant improvements in pain intensity and
falling, institutionalization, or death. Sarcopenia may be the possible disability scale. The ES and SRM of RMDQ was 0.31 and 0.33
mechanism of frailty, which may result in decline in muscle strength respectively. The area under the curve for the Roland and Morris
and, thus, physical function. In the current study, the author would Disability Questionnaire was 0.56 (0.39, 0.73). The cut-point of the
like to know if frailty could be simply predicted by functional tests RMDQ corresponded to a change of 1.5 points. After adjustment
battery. Methods: In this cross-sectional study, we recruited 484 for the effect of age and gender on the changes of disability days
community-dwelling elderly aged over 65 years old. After a consent by multiple linear regression analysis, the coefficient of RMDQ
form, each participant went through a interview with a questionnaire, was 0.44. In other words, an RMDQ score increment of 2.3 would
and 6 functional tests (grip strength (GS), knee extension (KE), 6 reduce one disability day, which could be considered as the ap-
minute walking test (6MWT), 30 sec sit-to-stand (30STS), timed up proximate magnitudes of MID for this instrument. Conclusion:
and go (TUG) and functional reach (FR)). All the subjects were clas- In our case, the responsiveness of Roland and Morris Disability
sified into normal, prefrail, and frail groups according to modified Questionnaire was only mild to moderate high. However, the es-
Dr. Fried et al’s classification. One-way ANOVA was used to test timation of the minimal important difference showed that Roland
the differences of the results of functional tests in the three groups. and Morris Disability Questionnaire could reflect meaningful
Multiple linear regression analysis was used to construct a predictive clinical changes among the patients with low back pain.
model of functional performance tests to frailty score for the elderly
Results: The ANOVA showed that different levels of frailty elderly
were significantly different in functional tests in GS (F = 22.66),
6MWT (F = 24.09), 30STS (F = 19.12), TUG (F = 43.41) and FR 0501PP126
(F = 15.70) for male, and in GS (F = 24.33), KE (F = 12.92), 6MWT IATROGENIC BRACHIAL PLEXOPATHY : A CASE
(F = 17.6), 30STS (F = 30.96), TUG (F = 68.79) and FR (F = 12.82) REPORT
for female. In regression model for male, GS (β = –0.039) and TUG
(β = 0.108) were the significant predictors and both explained 40.3% Shu-Fen Chiu1,2, Lee-Kiat Ban1, Yi-Ying Lu2
of the variance of the frailty score. In female, 30STS(β = –0.029), 1
Department of Physical Medicine and Rehabiltation, Department
GS (β = -0.036), TUG (β = 0.071) explained 36.6% of the variance of of Surgery (Taiwan), 2Department of Radiology (Taiwan)
the frailty score jointly. All p < 0.05. Conclusions: Different levels
of frailty elderly have significantly different functional test results. Purpose: The case report describes a lady with iatrogenic brachial
Among them, GS, TUG and 30 STS can predict the frailty score plexopathy after modified radical mastectomy. The purpose is to
jointly in both gender. They may serve as a screening battery. demonstrate the predicting correlations in progression and different di-
agnostic tools. Iatrogenic neuropathy is used for describing the marked
motor–sensory impairment after surgery. The outcome and recovery
0501PP125 course varies among different surgical exploration, anatomic localiza-
THE RESPNSIVENESS AND MINIMAL IMPORTANT tion or injury mechanism. Rare iatrogenic neuropathy was reported
after modified radical mastectomy (MRM). A 53-year-old female
DIFFERENCE ON THE ROLAND AND MORRIS underwent a right MRM and dissection of the axillary lymph node.
DISABILITY QUESTIONNAIRE FOR THE The patient suffered from predominant right shoulder weakness on
PATIENTS WITH LOW BACK PAIN the next day. The muscle strength of right shoulder flexor and biceps
were trace and poor minus, respectively. The patient complained mild
Yi-Shiung Horng1,2, Ming-Chuan Lin1, Valeria Chiu1, paresthesia of right upper limb. Consequently, localized tenderness on
Chung-Wei Huang1, Yi-Wei Chang1, Jung-Der Wang3,4 the skin flap and supraclavicular area was palpated. Using magnetic
1
Department of Physical Medicine and Rehabilitation, Buddhist resonance image study, the possible presence of root avulsion or right
Tzu Chi General Hospital, Taipei Branch, 2Department of Medi- brachial plexus lesion and localization (mechanism) was clarified.
cine, Tzu Chi University, 3Institute of Occupation Medicine and Beside, the initial post-injury electromyography revealed absence
Industrial Hygiene, National Taiwan University and 4Department of MUAP with voluntary control. A second needle EMG shows co-

exist PSW / fibrillation and polyphasic waves 5 weeks after surgery. 0501PP129
Complete recovery of shoulder elevation was months. Conclusion: GAIE ANALYSISIN THE HEMIPLEGIC WALKING
The “ time and location “ principle should be documented by serial
NCV and electromyography for extent of iatrogenic neuropathy. The WITH DIFFERENT ANGLE AFO
MRI study is helpful to differentiating the etiology of weakness and Giuangxu Xu, Qingming Qu, Jianan Li
enclose the mechanism of brachial plexopathy. Nanjing Medical University (China)
Purpose: To explore the best angles of static ankle-foot orthosis
0501PP127 (AFO) to hemiplegic patients through gait analysis. Materials and
REAL-TIME PREDICTION OF THE VARIABILITY Methods: Ten patients using three different angles static AFO (dorsi-
flexion 5o, plantarflexion 5o, functioning 0o) and barefoot walking on
OF COP BY ACCELEROMETRY
the platform of gait analysis system, gait parameters were collected
Shih-Wei Chen1, Te-Son Kuo1,3,4, Shih-Ching Chen2 and calculated. Results: Comparing with barefoot, AFO with dorsi-
1
Department of Electrical Engineering, National Taiwan Uni- flexion 5o can significantly increase in stride length, step length and
versity, 2Department of Physical Medicine and Rehabilitation, velocity (p < 0.05). The dorsiflexion 5o AFO can significantly reduce
Taipei Medical University and Hospital, 3Institute of Biomedical the double support time than 0??AFO (p < 0.05). There is no signifi-
Engineering, National Taiwan University and 4Graduate Institute cantly difference in gait symmetry. Conclusion: The dorsiflexition 5o
of Biomedical Electronics and Bioinformatics, National Taiwan AFO can improve step length, stride length, and velocity, and reduce
double support time. Though the symmetry comparisons between
University (Taiwan)
four groups have not significantly differences, dorsiflexion 5o AFO
Purpose: Force plate system is known as an effective assistive has more tendency to normal gait symmetry.
apparatus for standing balance training and weight transferring
training for hemiplegic patients. However, traditional force plate 0501PP130
is too bulky and costly to be popular and used at home. In this
study, we propose an alternative scheme of measuring the vari- DEVELOPMENT OF A SYSTEM TO DETECT AND
ability of center of pressure (COP) by using a practical and low ANALYSE THE LOCUS OF HUMAN MOVEMENTS
cost method: accelerometry. Materials and Methods: 7 normal IN THE SAGITTAL PLANE
subjects were recruited in this study. One tri-axes accelerometer
was attached on the L5 of the subject. Another tri-axes accelerom- Guangqing Li
eter was attached on the back of the right knee of the subject. The The Department of rehabilitation Medicine, Xuanwu Hospital
variability of COP was measured simultaneously by the force plate Capital Medical University (China)
and accelerometry. Results: Each subject was asked to perform 6
anterior-posterior COP excursion trials and 6 medial-lateral COP Purpose: To develop a low cost system to detect and analyse the
excursion trials. The average percent error between the real-time locus of human movements. Materials and Methods: By taking im-
anterior-posterior COP excursions predicted by accelerometry ages of human movements and identifying the maker points sticking
and the one measured by the force plate is 11.8 ± 9.1 %, and the to the positions waiting for analysis utilized color image processing
average percent error between the real-time medial-lateral COP techniques, the locus of human movements is obtained. Then we
excursions predicted by accelerometry and the one measured by can research the human movements by analyzing and comparing
the force plate is 6.2 ± 5.3%. The performance of predicting the the stick -figure, the phase graph of the displacement or angle, etc.,
anterior-posterior COP excursions is moderate because the subjects getting from the locus. Results: The system developed for the pur-
sometimes made humpbacked stances when performing anterior- pose mentioned above has the advantages of convenient operation
posterior COP excursion. Conclusion: Our preliminary results and small floor area. It also can be used with the three-dimensional
demonstrated the applicability of using accelerometry to predict force plate synchronically. Conclusion: The analysis software is
the variability of COP. The accelemetry can be a popular and integrated all of the commonly methods used in gait analysis and
low cost (compared with the force plate) alternative of the force the detecting report can be obtained rapidly and conveniently.
plate for household use; because its portability and ease-of-use, it
can also be applied to feedback-controlled lower limb functional 0501PP131
electrical stimulation (FES) to help hemiplegic patients recover
the ability of standing stably in their daily activities. THE APPLICATIONS OF SINGLE SWITCH
CONTROL DEVICES FOR COMPUTER USERS
WITH SEVERE MOTOR DISABILITY
0501PP128
Jui-Kun Chang
EFFECT OF EARLY PELVIC STRENGTHEN Rehabilitation Dept., Kaohsiung Chang Gung Memorial Hospital
TRAINING ON BALANCE AND WALKING ABILITY (Taiwan)
OF PATIENTS WITH HEMIPLEGIA
Purpose: Identifying client’s motor ability for consistent and reliable
Yan Li, Xudong Gu, Yunhai Yao, Hua Wu, Zhiliang Yu, control is essential part of a single switch assessment. The quadri-
Hui Li, Wei Wang, Xiongwei Zhang plegia cases of muscular dystrophy & ALS (Amyotrophic lateral
The No.2 Hospital (China) sclerosis) demonstrated well-control in computer task with single
switch input devices. Materials and Methods: Four components of
Purpose: To investigate the effect of early pelvic strengthen train- a single switch control evaluation: 1) Evaluate proper seating of the
ing on balance and walking ability of patients with hemiplegia. client and positioning of the devices. 2) Identify an anatomical site
Materials and Methods: 53 cases patients with hemiplegia were under the client’s voluntary control. 3) Identify and assemble the ar-
randomly divided into treatment group (n = 27) and control group ray of switch/control options that work with the identified anatomical
(n = 26). Both of the two groups were received routine rehabilitative site. 4) Conduct comparative evaluations of the switch/control options
training, and besides, patients in the treatment group were received through actual use with the identified anatomical site. Results: Fol-
early pelvic strengthen training, twice a day .Scale before and after lowing the evaluation findings, the client’s needs hierarchy of input
treatments by the Fugl-Meyer scale, the BBS, and the FAC. Results: device selection and use was proposed. There are several kinds of
Fugl -Meyer scale, the BBS and the FAC all were better than before switches were applied with auto-scanning software. The sensor switch
(p < 0.05). Conclusion: Early pelvic strengthen training can improve & winking switch controlled by single smallest muscular movement
balance and walking ability. were more efficient & successful according to our clients’ perform-

ances. Conclusion: The essential components of a single switch cially for facilitating intermittent pressure relieve. However, pressure
evaluation were identified. Using this detailed information should redistribution of static seat cushion design is only momentarily due to
lead to optimal switch placement and switch use. compression and distortion of its material. Although dynamic cush-
ion systems have better efficacy for pressure redistribution, they are
expensive and are intended for powered wheelchairs. Therefore, the
0501PP132 purpose of current study was to develop a newly-designed dynamic
cushion system, and to investigate its effect on the pressure distribution
PUDENDAL AFFERENT STIMULATION of human buttock as well as the efficacy for pressure sore prevention.
AUGMENTS BLADDER EMPTYING IN URINARY Materials and Methods: This newly-designed dynamic cushion system
RETENTION RATS consisted of an upper base, a lower base, a universal joint and four
spring elements. The upper base and lower base were assembled by
Chih-Wei Peng1, Shih-Ching Chen1, Chien-Hung Lai1, the ball joint and socket which were located at the center of the base
Wen-Jia Fan2, Warren M Grill3 respectively. Four spring elements were set at the corners of upper
1
Dept. of PM&R, Taipei Medical University and Hospital, 2Institute and lower bases for damping function. The principle of this design
of Physiology, National Yang-Ming University (Taiwan) and 3Depart- is to transfer the center of pressure (COP) trajectory through upper
ment of Biomedical Engineering, Duke University (United States) limb movement and the damping function of the cushion. Twenty
male and ten female paraplegic patients with injury levels below the
Purpose: Chronic urinary retention can lead to reflux, upper urinary thoracic spine were recruited in this study as the experimental group.
tract damage, urinary tract infection, and overflow incontinence, and Novel Pliance-X system was used to perform the measurement of
traditional treatments are inadequate. Currently, sacral nerve root buttock pressure distribution. All subjects were asked to sit on this
neuromodulation has been applied in patients with urinary reten- dynamic cushion system with two different spring (6.37, 10.37 N/
tion who initially failed standard treatment. While effective in some mm) and rigid element respectively. Maximum mean pressure, peak
patients, many patients do not respond to sacral nerve neuromodula- pressure, pressure-time integral and pressure-time process were
tion. Thus, there is a need for a more effective prosthesis to restore analyzed by the analytical software of Novel multimask. Statistical
the bladder voiding function. Our recent studies demonstrated that analysis was performed by independent-samples t test and analysis
unilateral electrical stimulation (UES) of the pudendal sensory nerve of variance repeated measurement. Results: In our SCI patients, the
improves bladder emptying efficiency in an animal model of urinary reduction of maximum mean pressure beneath the ischial tuberosity
retention, established by acute transection of the pudendal sensory was 13.22% and 13.77% when sitting on our newly dynamic cushion
nerves in rat. In the present study, we sought to determine whether system of high and low stiffness as compared to the rigid support
bilateral electrical stimulation (BES) of the pudendal sensory further seat cushion. As compared to rigid cushion support, the decrease in
enhanced bladder emptying efficiency, as compared to UES. Materials peak pressure beneath the ischial tuberosity was 11.48% and 28.01%
and Methods: Female Sprague-Dawley rats (n = 6) were anesthetized with high and low stiffness cushion support respectively. Pressure-
with urethane (1.2 g/kg, s.c.). All rats underwent bilateral transection time integral beneath the ischial tuberosity was reduced 12.82% and
of the pudendal sensory nerves (BST), and the proximal ends of the 14.58% with high and low stiffness as compared to the rigid cushion
transected sensory nerves were mounted in bipolar cuff electrodes for support. Since peak pressure distribution was altered, the average
electrical stimulation. Continuous transvesical infusion cystometro- differences between maximum and minimum pressures were 20.55
gram (CMG) measurements were conducted to quantify the effect kPa, 17.39 kPa and 14.36 kPa when sitting on the rigid, high stiffness
of UES and BES on voiding. Results: Contraction duration (CD), and low stiffness cushion systems respectively. Conclusion: Based
inter-contraction interval (ICI), bladder contraction area, and void- on the experimental results, our newly designed dynamic cushion
ing efficiency (VE) were significantly reduced following BST. The system with spring elements is able to decrease the peak pressure in
average CDs and ICIs were prolonged by both UES and BES across the cushion-buttock interface instantaneously. This system can also
all tested amplitudes and frequencies, and no significant differences relieve the effect of cumulative loading effectively. As a result, this
were found between the effects of UES and BES. Further, both blad- dynamic cushion system with low spring stiffness can reduce not only
der contraction area and voiding efficiency (VE) were significantly the skin pressure but also the cumulative pressure loading beneath the
increased by UES and BES across all tested stimulation parameters. ischial tuberosities. Therefore, this device may be used to decrease
Although BES consistently generated a 4–5% larger increase in VE the occurrence of buttock pressure ulcer formation in patients with
than UES, this improvement did not reach statistical significance. paraplegic spinal cord injuries.
Conclusion: Disruption of sensory feedback carried by the pudendal
sensory nerves dramatically reduced voiding efficiency and created an
effective animal model of urinary retention. Artificial replacement of 0501PP135
sensory activity by either unilateral or bilateral electrical stimulation
prolonged the duration of voiding bladder contractions and enhanced EFFECT OF DIFFERENT INSOLE MATERIAL
bladder emptying efficiency. Therefore, either unilateral or bilateral COMBINATIONS ON THE PLANTAR PRESSURE OF
electrical activation of pudendal nerve afferents may be a new direc- NORMAL FOOT
tion for the design of alternative neuroprostheses for patients with
urinary retention as well as other voiding dysfunctions. Chien-Hsuan Lee1, Weng-Pin Chen1, Fuk-Tan Tang2,
Shih-Cherng Lin2,3
1
Department of Mechanical Engineering, 2Department of Physi-
0501PP134 cal Medicine and Rehabilitation and 3Department of Biomedical
THE EFFECT OF NEWLY-DESIGNED DYNAMIC Engineering (Taiwan)
CUSHION SYSTEM ON BUTTOCKS PRESSURE Purpose: Custom-made foot orthoses are frequently prescribed in rou-
DISTRIBUTION IN PARAPLEGIC PATIENTS tine clinical practice to prevent or treat plantar ulcers by reducing the
peak plantar pressure. However, there was no evidence showing that
Shih-Cherng Lin1,3, Fuk-Tan Tang1, Ngok-Kiu Chu1, Pei- stiffness or hardness was suitable to be the indicator for insole material
Hsuan Wu1, Kuan-Jung Chen1, Pai-Chu Chen1, Weng- selection. Therefore, the purpose of this study was to investigate the
Pin Chen2, Feng-Long Cai3 effect of total contact insole with different material combinations on
1
Department of Physical Medicine and Rehabilitation, 2Depart- plantar pressure distribution, and to find out either stiffness or hard-
ment of Mechanical Engineering and 3Department of Biomedical ness was to be a good indicator for material selection. Materials and
Engineering (Taiwan) Methods: Thirteen commercial orthotic materials were collected to
determine their stiffness and hardness by material testing machine and
Purpose: Various wheelchair cushion system designs have been durometer. Four different materials were selected from above men-
developed to provide pressure relieve during prolonged sitting, espe- tion to manufacture the total contact insole according to the value of

stiffness and hardness, respectively. One subject received a precision ticity result in an altered gait pattern during walking. This study
optical imaging device scanning to obtain the contours of right and left introduces a neuromuscular electrical stimulation in enhancing
feet, and then the geometric parameters were imported into the CAD/ functional ankle dorsiflexion based on sensor-driven electrical
CAM system to mill out the bottom layer of total contact insole. After stimulation for the augmentation of walking. Materials and
that, a softer thin material which was used to be the upper layer was Methods: In our trial, ineffective ankle dorsiflexion during swing
plastered with the bottom layer. Finally, a total of twelve combined (drop foot) and failure to achieve heel strike at initial contact are
insoles were completed for plantar pressure measurement. Novel common problems that disturb gait pattern after stroke. All 25
EMED-X system and Novel Pedar-X system were used to measure the subjiects are selected to the follow conditions: 1) first episode of
plantar pressure in barefoot and in-shoe conditions respectively. Novel unilateral stroke with hemiparesis during the previous 6 months,
multimask program was used to calculate the peak pressure (PP) and 2) a score between 1 and 3 inclusive on the Brunnstrom stages for
pressure-time integral (PTI) beneath forefoot, midfoot and forefoot. the lower extremity, 3) ability to understand and follow simple
The mean and standard deviation of PP and PTI were calculated to verbal instructions, 4) ambulatory before stroke, 5) no medical
compare the influence of different material combination insoles on contraindication to walking or to electric stimulation, and 6)
plantar pressure. Results: The results showed that subject with total ability to stand with or without assistance and to take at least 1
contact insole can reduce peak plantar pressure around 30~50% in or more steps with or without assistance. We used an assessor-
the forefoot and rearfoot regions. The minimal reduction 32.189% blinded, randomized, controlled design in this study. 22 patients
was occurred in the forefoot when subject wearing insole which was were assigned to the control group (conventional rehabilitation
consisted of the bottom layer (EFM) and upper layer (Light Weight program) and the remaining 23 were assigned to the NMES group
Cork) with higher hardness. The maximum reduction 51.594% was (conventional rehabilitation program plus NMES). All 45 subjects
arisen in the rearfoot when subject wearing insole which was consisted participated in a conventional stroke rehabilitation program, 5 days
of the bottom layer (Firm Micro Puff) and upper layer (Plastazote Firm) a week, 2 to 5 hours a day, for 3 weeks. The conventional program
with lower hardness.In the forefoot region, the PP was raised with the is patient-specific and consists of neurodevelopmental facilitation
hardness increased of upper layer material under the same bottom techniques, physiotherapy, occupational therapy, gait therapy, and
layer material. In terms of stiffness, there was no obvious trend can speech therapy (if needed). The NMES group also received 20 min
be found out. In the rearfoot region, upper layer insole with the lowest of NMES to the peroneal nerve of the paretic limb two times a
hardness and stiffness could result in lower PP. Besides, the results day, 5 days a week for 3 weeks. Transcutaneous NMES was given
of PTI were similar to PP in all insole combinations. Conclusion: with the cefar Step II, on and off through a heel swith. It woks by
According to the results of current study, insole material with higher two skin electrodes positioned activating the peroneal nerve to the
hardness could probably lead to higher plantar pressure, especially in muscles that bend the foot upwords (dorsiflexors) with electrical
the forefoot region. More experimental data will collect to prove the impulses during the swing phase of gait .The stimulation was
conclusions of this study in the future. activated by the heel switch whenever the heel lost contact with
the ground, and it was deactivated when the heel regained contact
with the ground. The strength, frequency and delay time can be
0501PP136 adjusted according the condition of the patient. The Fugl-Meyer
MOUTH OPENING EXERCISE IN PATIENTS WIHT (FM) test for the lower extremities, Berg Balance Scale (BBS) for
SEVERE TRISMUS stability, Barthel Index (BI), mean walking velocity (vmean) over
a 6-m distance, and Physiological Cost Index (PCI) were assessed
Shinya Yura, Kenji Kagechika, Yasutaka Takagi at the entry point and at the end of the treatment. Results: Before
Tonami General Hospital (Japan) treatment, there were no significant differences between the two
groups for age, time post-stroke, stroke severity, and the baseline
Purpose: In patients with severe trismus, physiotherapy using a of measurements. After 3 weeks of treatment, In the two groups,
mouth opening exerciser is performed. We devise a new exercise we determined significant differences in the mean values of all
which controls pain and gives a clear idea of interincisal mouth outcomes between the entry and end points of treatment (p < 0.01),
opening distances during active exercise. Ptients and Technique: We and we also found significant differences in the changes of FM,
introduced a mouth-opening exerciser (HU-OII) for mouth opening BBS, BI, vmean and PCI which occurred during the 3 weeks of
exercises in patients with severe trismus. It is made of a 5-mm thick treatment between the NMES and CON groups (p < 0.05). Con-
acrylic resin plate and is wedge-shaped with a cut tip. The exerciser clusion: Three weeks of NMES to the affected lower extremity
has 3-mm long stairs so that patients can notice improvement in of subjects with early stroke improved their function recovery.
mouth opening during exercise. Every stair has an extremely gentle NMES is an effective ways to improve ankle dorsiflexion gait in
slope so that it permits gradual mouth opening without severe pain. individuals after stroke.
The patients underwent 100 times of enforced opening using the
exerciser without help, with one opening per second, 100 seconds
total. This exercise was done twice a day, once in the morning and 0501PP138
once at night. Results: In patients with coronoid process hyperplasia, EFFECTS OF A FUNCTIONAL ELECTRICAL
30 days after surgery, the maximum mouth opening had increased to
40 mm. Conclusion: HU-OII is easy, very effective for postopera- STIMULATION ASSISTED LEG-CYCLING ON
tive mouth opening exercises. IMPROVING POSTURE CONTROL OF PATIENTS
AFTER STROKE
0501PP137 Chun-Yu Yeh1, Hsin-Chang Lo2
1
School of Physical Therapy, Chung Shan Medical University and
EFFECTIVENESS OF NEUROMUSCULAR 2
Assistive Technology Laboratory, Department of Product Design,
ELECTRICAL STIMULATION ON ANKLE Ming Chuan University (Taiwan)
DORSIFLEXION RECOVERY AND GAIT THERAPY
IN PARETIC LEG AFTER STROKE Purpose: The purpose of this study was to determine whether a
bout of functional electrical stimulation (FES)-cycling can influ-
Jubao Du, Weiqun Song, Yu Pan, Lin Zhu, Zhen Chen, ence the postural control of the patients after stroke. Materials and
Yabming Zhang, Dahua Zhang, Yuanbin Yang Methods: Twelve stroke patients (10 male, 2 female; range from
Rehabilitation department of Xuanwu Hospital of the Capital Medi- 38–64 years) with hypertonia in the paretic leg, modified Ashworth
cal University (China) scale (MAS) grade ≥3, were recruited in this study. They were
randomly assigned to the FES-cycling group (FES-CG) perform-
Purpose: Many people are left with a walking deficit after stroke. ing cycling training with the assistance of electrical stimulation
Ankle dorsiflexi motor weakness, poor motor control, and spas- and the cycling group (CG) performing cycling training without

electrical stimulation. The duration of the training program was 0501PP140

20 min. The target cadence of the cycling was set at 45 rpm. Pos- THE EFFECTS OF TWO DIFFERENT
tural control parameters included reaction time (RT), maximum
excursion (MXE), directional control (DCL), movement velocity FREQUENCIES OF WHOLE BODY VIBRATION
(MVL) and endpoint excursion (EPE) were compared before and ON BALANCING ABILITY AND FLEXIBILITY IN
immediately after training program. The Wilcoxon signed-rank test NURSES
was used for comparing the pre- and post-test data in each group.
The change ratios in postural control parameters were compared Chung Liang Lai1, Shiuan Yu Tseng1, Yi Yuan Peng1, Si
between the FES-CG and the CG using the Mann-Whitney U Xuan Zhu2, Chin Yen Tseng3, Chun Hou Wang4
test. Results: The result of RT revealed no significant difference 1
Health of Department, Tai-Chung Hospital Rehabilitation, 2Geron-
in both groups. However, the MXE (p < 0.05), DCL (p < 0.05) in technology and Service Management Institute, Nan Kai University
forward direction were found significant intervention effects in of Technology, 3School of Physical Therapy, Chun Shan Medical
FES-CG group. It indicated the subject can arrive more far dis- University and 4 Physical Therapy and Assistive Technology, Na-
tance and the accuracy of the movement was also promoted. The tional Yang-Ming University (Taiwan)
MVL (p < 0.05), EPE (p < 0.05) in forward direction also revealed
significant differences in CG group. It revealed the movement Purpose: The musculoskeletal disorders among nursing staff in
velocity was faster and the moving distance was longer than pre- Taiwan were very common, especially at neck, shoulder and back
training. These results proved one bout of cycling training with location. A good flexibility can prevent the variety of work-related
or without FES can improve the postural control of the subjects muscle and soft tissue injuries. In addition, good balance can help the
after stroke. The change of RT revealed no significant difference body to engage a variety of dynamic and static motor performance,
between the FES-CG and the CG. The forward change in MXE making the body more coordinated in all aspects of performance
and DCL revealed significant differences (p <0 .05, respectively) and being not easily to happen work accidents due to poor balance.
between the FES-CG and the CG. The results revealed the addi- Whole body vibration (WBV) training is a novel exercise intervention,
tional effect of the FES. The mechanism could be that the muscle which is applied in athletic and general populations with the aim of
tone of soleus in the FES-CG group after training was lower than improving flexibility and balancing ability. The present study sought
that of the CG. The soleus muscle could less restrict the movement to discover the response to different frequencies of whole body vibra-
of the ankle joint and then the forward direction changes were tion in sedentary nurses. Materials and Methods: Eighty sedentary
larger in the FES-CG group. Besides, there were no significant nurses were random assigned to Horizontal WBV with 5 min a day
differences in RT could be the insufficient training duration for and 3 days a week for 2 months (LV-1000, X-trend, Taiwan). The
those two groups. Conclusion: Although there was only one bout training session used a vibrating plate producing sinusoidal oscillation
of cycling training, the postural control was improved in both at 20 Hz (low frequency) or 40 Hz (high frequency) with constant
FES-CG and CG. With the assistance of electrical stimulation, amplitude (40 nurses at 20Hz vibrationt training and other 40 nurses
subjects had more progress in the ability of posture control. FES- in 40Hz vibration training ). Balance ability test which used Balance
cycling training would be a positive additional physical therapy system (Biodex, USA) included limits of stability (LOS) test and
method and can improve the balance ability of such patients. A static balance test. The flexibility test used the sit and reach test. All
further long term investigation concerning the changes in muscle the parameters were administered before and after the WBV train-
strength and reaction time is necessary to conform the treatment ing. Results: WBV with low frequency stimulation was shown to
effects of FES-cycling training. significantly increase sit and reach flexibility by 17.25% (p < 0.05)and
increase balance ability LOS by 30.39% (p < 0.05). WBV stimulation
with high frequency determined a significantly decrease in flexibility
0501PP139 by 8.03% (p < 0.05). Conclusion: The result showed the influence of
different WBV frequencies upon the subject`s adaptation responses.
SPECIAL CHAIR FOR SPECIAL CHILD In particular, untrained nurses showed enhancement in balance abil-
Marietta Prananta1, Lydia Kidarsa2 ity and flexibility after low-frequency WBV stimulation. It`s was a
1
Faculty of Medicine Padjajaran University and 2 Bioteknik Design convenient and effective training way for sedentary nurses to prevent
work-related Musculoskeletal injury.
(Indonesia)
Objective: Mobilization is one of the main problem in cerebral
palsy patient. Most of the spastic quadriplegic cerebral palsy has 0501PP141
low functional ability in mobilization. We present a case of spastic MAKEUP APPLICATION TOOLS WITH LIPGLOSS
quadriplegic cerebral palsy with dislocated hip joint and we make FOR PERSONS WHO ARE BLIND OR HAVE LOW
custome made wheel chair to helpher mobilize. Case: Patient is
VISION
a 15 years old spastic quadriplegic cerebral palsy with dislocated
of the right hip joint but the mother did not allow her child to Yasuhiro Matsuda1, Tsuneshi Isomura1, Makiko
be operated. All day long the patient can only lie in bed. All the Yamasaki2, Mika Yoshimura3
activities of daily living should be help by her mother. She can 1
Faculty of Creative Engineering, Kanagawa Institute of Technol-
smile, say a view word and she like to hear or see other children ogy, 2Kingrun Co., Ltd. and 3Hamayu Co., Ltd. (Japan)
play. The examination identified spasticity asworth scale II in four
extremities, contracture in the right knee joint and ankle joint, Purpose: Persons who are blind or have low vision have difficulties
muscle strength are weak function and dislocated of the right hip of makeup application without visual information from mirror. The
with pain and limited ROM. There is also thoracal scoliosis.We purpose of present study is development of makeup application tools
make a wheel chair that is specific to the size of the patient and with lipgloss for persons who are blind or have low vision. Materials
add several pads with three point pressure system, also separator and Methods: According to the tips for makeup application, lipgloss
and table to stabilized and accommodate herwhile sitting in the can be applied with finger and clean lipgloss is suitable for a person
wheel chair. The body of the wheel chair made from steel pip, pads who has just started to apply makeup. But lipgloss stains finger and
and separator made from rebonite. It cost about US$ 350. It take the stained finger can influence their appearance. Thus, we designed
a month on making and training the patient and her mother to use the tools with lipgloss in place of lipstick with a concept of “using
the chair. Now she can mobilized and watch other children play sense of touch but not staining finger”. We had developed the tools
in front of her house. Conclusion: Properly made wheel chair can for upper lip and bottom lip (the previous tools) because of differ-
improve mobilization and quality of life for spastic quadripleqic ences of shapes of upper and bottom lips. As for the tool for upper
cerebral palsy patient. lip, we mounted a hex nut (M5, height 3.9 mm, a vertex angle was

placed in the top), which was filled with lipgloss, on a nail tip. And meanings of the grips without emotions were as follows: involun-
as for the tool for bottom lip, we mounted a cut nail tip, which was tary grip 31%; response grip to the grip by the other subject 30%;
filled with lipgloss, on another nail tip. A user sets the tool (inside response grip to the talk by the other subject 35%; voluntary grip
of the nail tip) on the finger pulp of index finger of her dominant with an emphasis 4%. The ratios of meanings of the emotional grips
hand and applies lipgloss. We evaluated the previous tools by the were as follows: involuntary grip 15%; response grip to the grip by
duration of application and error of outline. As the result, lipgloss the other subject 12%; response grip to the talk by the other subject
application using the previous tools was useful as well as lipstick 39%; voluntary grip with an emphasis 34%. The ratios of meanings
application by index finger. To improve the error of outline at the were significantly different between the grips without emotions and
angles of mouth, we replaced the hex nut of the previous tool for emotional grips (p < 0.001). Conclusion: Our results showed that
upper lip with another hex nut (M4, height 3 mm, a side was placed the subjects mainly used the tool to respond to the grip and talk by
in the top). To improve the error of outline at the center of bottom the other subject and intended to emphasize their talk when they
lip, we replaced the cut nail tip of the previous tool for bottom lip expressed emotions.
with a cylinder (external diameter 10 mm, inner diameter 8 mm,
height 4 mm). An evaluation experiment of the improved tools by
sighted persons was conducted. Subjects were four college students. 0501PP143
All subjects gave informed consent after hearing a description of NEUROMUSCULAR ELETRIC STIMULATION FOR
the study. In order to simulate blindness, the subjects wore a sleep DYSPHAGIA IN A SPINAL MUSCULAR ATROPHY
shade during the experiment. The subjects applied lipgloss using
the previous tools and improved tools. The experiment consisted PATIENT – A CASE REPORT
of three sessions. Results: The means of the error of outline using Yi-Jung Hsin, Yiu-Chung Lau
the improved tool and previous tool for upper lip were 0.65 mm Chang Gung Memorial Hospital-Kaohsiung Medical Center
(SD = 0.45) and 0.61 mm (SD = 0.41), respectively. The means of (Taiwan)
the error of outline using the improved tool and previous tool for
bottom lip were 0.45 mm (SD = 0.24) and 0.88 mm (SD = 0.43), Purpose: Spinal muscular atrophy (SMA) is an autosomal recessive
respectively. The error of outline using the improved tool for bottom disease with progressive degeneration of anterior horn cell.Clinical
lip was significantly smaller than the one using the previous tool manifestations are progressive weakness of muscles.Dysphagia
(p < 0.034). Conclusion: Our results showed that we could improve secondary to weakness of swallowing muscles and cricopharyngeal
the makeup application tool with lipgloss for bottom lip. dysfunction are frequently seen among these patients,especially at
the late stage of their disease progression. We present an experi-
ence in using neuromuscular eletric stimulation (NMES) for SMA
0501PP142 patient with dysphagia. Materials and Methods: This 14 years old
TACTUAL COMMUNICATION TOOL FOR SMA girl with normal mental, social skill and intelligible speech
had progressive dysphagia. The only daily nutrition supply was
EMPHASIZING EMOTIONAL COMMUNICATION milk drinking through a straw.She was referred to our team due to
Yasuhiro Matsuda1, Tsuneshi Isomura1, Takehiko Shimbo2 diffucult swallowing of milk and saliva. She and her families refused
1
Faculty of Creative Engineering, Kanagawa Institute of Technology nasopharyngeal tube for feeding. She had severe kyphoscoliosis with
and 2Japan Beverage Inc. (Japan) poor head and trunk control. Videofluroscopic study (VFS) with 2 ml
and 3 ml thin barium revealed poor tongue retraction force,stasis of
Purpose: Elderly persons or persons with sensory disorders have barium in valleculae, decreased laryngeal elevation, penetration and
difficulties not only of verbal communication but also of emo- cricopharyngeal dysfunction. Dysphagia with pharyn geal muscle
tional (nonverbal) communication. The purpose of present study and cricopharyngeal dysfunction was highly suspected.Therefore,we
is development of a tactual communication tool which emphasizes try NMES to strengthen the pharyngeal muscles and to increase the
emotional communication during oral conversation. Materials and laryngeal elevation.The first pair of electrodes were placed over the
Methods: Tactual communication can express various emotions hyoid bone and the second pair were placed above the hyoid notch
between familiar persons. But there is social distance between un- over the thyrohyoid muscle.She received 1 hour MMES treatment
familiar persons. Therefore, we designed the tactual communication each day, 5 sessions per week for 2 weeks. Results: After NMES
tool with a concept of “using tactual communication but keeping treatment, she regained drinking milk through a straw and swallow-
the social distance”. The tactual communication tool consists of two ing saliva normally. Conclusion: Pharyngeal muscle strengthening
soft rubber balls and a hose pipe. Each soft rubber ball (diameter 60 with NMES is a non-invasive treatment to increase muscle power
mm) was made a hole on its surface and connected by the hose pipe and coordination of swallowing. According to our experience,it is
(inner diameter 6 mm, length 1200 mm). The interfaces between the one of the effective choices for dysphagia in SMA patient.
balls and hose pipe were sealed by adhesive bond. Two users hold
the ball, respectively. When the one ball is gripped, air is pumped
out. And then, the other ball is blown up. Thus, the user can grip 0501PP144
the ball by different ways during oral conversation; the other user RESEARCH ON THE CLINICAL CHARACTERS OF
can recognize the different way of expansion of the ball. An evalu-
ation experiment by non-disabled people was conducted. Subjects UVC ERYTHEMA
were nine college students. All subjects gave informed consent Xiangli Zhou, Zongyao Wu, Hongliang Liu, Jixiang Wu,
after hearing a description of the study. In the experiment, two Qiuhan Wu, Zhonghong Hou
subjects sat face to face and hold the ball, respectively. The subjects Southweat Hospital, Third Military Medical University (Indonesia)
communicated using speech about the specific theme (e.g. favorite
foods, what you want to do, etc.) and gripped the ball freely. Each Purpose: To investigate the erythema and other skin reactions after the
session was conducted for three min. The experiment consisted of low pressure mercury quartz lamp radiated. Materials and Methods:
42 sessions (120 min). Results: The subjects gripped the ball for 114 10 subjects aged 20–22 were recruited. They were UVC radiated from
min in total (91%). Number of gripped times was 7702 times. We 1, 2, 3, 8, 16 to 32, 64, 256, 512, 1024 seconds with radiator ZYY-9.
classified the way of gripping into 9 types (e.g. gripping by finger Investigating on the skin responses were 2, 3, 6, 12, 24 hours and
pulps 24%; gripping by one finger 24%; pinching by all fingers 2–20 days after the radiation. Results: The least radiation to produce a
23%; pinching by two fingers 18%). Then we determined whether minimum erythema is 1 second. The erythema has latent period of 3,
the grips were expressed emotions. Number of the emotional grips 6, 8 hours. The longer the exposure the earlier the erythema apeared.
was 1002 grips (13%). The breakdown of expressed emotions was; The erythema UVC produced disapeared within 24 hours after 1, 2, 4
joy 44%, disgust 18%, fear 11%, desire 9%, intention 6%, sadness second radiation. It may last 15 days if the exposure is long enough.
6% and love 4%. Finally, we gave the grips meaning. The ratios of Following the erythema, pigmentation apeared within 24 hours to 5

days after UVC radiation. Pigmentation maintained for 4 days after Background: A power-assisted pushrim-activated wheelchair
2 second radiation. But most of them last more than 12–18 days (6) 8 (PAPAW) is a wheelchair activated manually with the assistance
of 10 subjects had the skin swelling after radiation. (7) desquamaton by driving motor power. Proper muscle strength of the upper limbs
appears 6–7 days after exposure in 4 subjects and 10–13 days in 6. is required to use PAPAW . However, there has been insufficient
Conclusion: The erythema produced by low presure mercury lamp information regarding to the muscle strength of upper limbs
seriously different from that by high pressure mercury quarts lamp. It required by those who need PAPAWs. Purpose: To explore the
apears and dispears quicker. The average erythema dose is 1 s instead relationship between the upper limb muscle strength and propul-
of 2 s as generally believed previously. The most important is that sion characteristics during propelling PAPAW. Methods: Thirty
erythema strenth is less related to the radiation duration.No blasting young able-bodied participants were recruited in this study. The
even though 1024 erythema doses is given. muscle strength of upper limbs was measured with manual hand-
held dynamometer. Pearson’s correlation was used to examine the
relationship between the muscle strength and propulsion variables
0501PP145 of PAPAWs. Results: The initial pushing peak force significantly
EFFICACY OF WIITM-BASED VIRTUAL REALITY showed moderate positive correlation with the extensors of the
ASSISTED REHABILITATION FOR CHRONIC upper limbs and hand grip (r = 0.412~0.694, p < 0.05). There were
negative correlation between push frequency and shoulder hori-
STROKE PATIENTS zontal abduction as well as wrist finger flexors (r = –0.591,~0.666,
Zheng-Yu Hoe1, Jue-Long Wang1, Chao-Hung Chang1, p < 0.05) during steady-state propulsion. Conclusions: The
Shu-Fen Sun1,2, Yuk-Keung Lo3 relationship between the upper limb strength and propulsion
characteristics was found in this study that the extensor groups
1
of the upper limbs were important to initiate PAPAW, and the
Veterans General Hospital, 2National Yang-Ming University School horizontal shoulder abductors with wrist and fingers flexors were
of Medicine and 3Department of Neurology, Kaohsiung Veterans associated with the pushing frequency necessary during steady
General Hospital, (Taiwan) state of PAWA propulsion. The information would be valuable as
Purpose: Cerebral vascular disease is a major cause of disability. clinicians provide adequate rehabilitation plan.
Chronic stroke patients are usually associated with cortical, motor
and coordination function impairments. These impairments may
greatly affect patients’ quality of life if left untreated. How to en- 0501PP147
hance functional recovery with cost-saving rehabilitation strategy DEVELOPMENT OF A 2-D HAPTICS INTERFACE
remains a challenging issue. Virtual reality assisted rehabilitation FOR ASSESSMENT AND TREATMENT
provides the opportunity for a safe training environment, allows IN PATIENTS WITH ANKLE SPRAIN: A
intensive practice with repetitive tasks, provides real-time auditory
and visual performance feedback and also may augment patients’ PRELIMINARY STUDY
motivation. WiiTM has all the advantages. In addition, it is much Chueh-Ho Lin1,2, Wen-Hsu Sung1, Shun-Hwa Wei1
cheaper and thus is affordable and practical to be used in clinical set- 1
National Yang-Ming University Department of Physical Therapy
tings. The aim of this study was to evaluate efficacy of WiiTM-based and Assistive Technology and 2Hung-Kuang University Department
virtual reality assisted rehabilitation for chronic stroke patients.
of Physical Therapy. (Taiwan)
Materials and Methods: We recruited patients with chronic stroke
( > 1 year) and limbs function impairment. All patients received Purpose: The purpose of this paper is to develop a two degree-
WiiTM-based virtual reality assisted rehabilitation program with 30 of-freedom haptic interface system for ankle rehabilitation, which
min/time, 3 times/week for 3 months. Patients’ cognitive function, includes the game based training and perception assessment in
motor function of both upper and lower limbs, manual dexterity, people with ankle proprioception defect, and to compare the
balance, activity of daily living (ADL) function and depression scale difference between the subjects with ankle sprain or not by this
were assessed at 2 weeks before training, the time of beginning system. Materials and Methods: The ankle rehabilitation haptic
training and 3 months after training. Results: A total of 31 patients interface system component has a supportive frame on knee and
completed this study. Significant improvements in cognitive func- ankle joint, and a platform structure with two degree of freedoms
tion, motor function of upper and lower limbs, manual dexterity was designed which allows the movements of the ankle joint
and balance ability were noted after 3 months training. However, though its full range of motion. The system can take three inputs
ADL function and depression scale showed no significant change. from the platform: two axes titling at an angle of sagittal and
Conclusion: WiiTM-based virtual reality assisted rehabilitation coronal plane, the trigger of the handle, and communicate with a
are promising treatment for chronic stroke patients. Further studies host PC through DAQ card and USB transformation. All signal
with larger sample size and longer follow-up are warranted to help processes were done by MatLab and USB transformation to allow
confirm our results and to determine whether this training program user interactions with the assessment program and video-game
can be applied to patients with other neuromuscular diseases. training increase motivation of the user. Ten normal subjects and
ten subjects had any experience of ankle sprain in the past year
were recruited and assigned to each group to provide preliminarily
0501PP146 clinical evidence of efficacy. All of these subjects were received
RELATIONSHIP BETWEEN MUSCLE STRENGTH the joint position test at four difference coupling directions. Stu-
OF THE UPPER LIMBS AND PROPULSION dent’s t-test was used to examine the differences in joint position
sense error (JPSE) value and coefficient of variance (CV) value
CHARACTERISTICS OF POWER-ASSISTED collected by system between groups. The statistically significant
PUSHRIM-ACTIVATED WHEELCHAIR level was set at 0.05. Results: The test of this system was val-
Yu-Hsiang Huang1, Yang-Hua Lin1, Alice MK Wong1,2, idly (r2 = 0.99 and 0.99) and observed change of 0.086o can be
interpreted, with 95% confidence, as genuine. We found that the
Jyh-Yuh Ke2, Chung-Hsien Kuo3, Jiung-Woei Liaw4
perception parameters obtained from the subjects in experimental
1
Department of Physical Therapy & Graduate Institute of Rehabili- group demonstrated the accuracy of active position sense(JPSE
tation Science, Chang Gung University, 2Department of Physical value) was higher than that of the joint of control group, especially
Medicine and Rehabilitation, Chung Gung Memorial Hospital, in dorsiflexion-inversion (2.4o ± 1.3o, p < 0.05). However, variance
3
Department of Electrical Engineering, National Taiwan Univer- reposition sense (CV value) was higher than that of the joint of
sity of Science and Technology and 4Department of Mechanical control group, especially in plantarflexion-eversion (17.6% ± 4.6%,
Engineering, Chang Gung University (Taiwan) p < 0.05) and dorsiflexion-inversion (17.4% ± 4.9%, p < 0.05).

Conclusion: The study has developed a novel ankle evaluation 0501PP150

and training system for people with ankle proprioception defect. COMPARISON OF TREADMILL AND FLOOR
The main advantages of this system were to use the footplate
with two degree of freedom for quantitatively assessing patient’s WALKING IN A PATIENT WITH HEMIPARESIS
perception capability at ankle joint, and to indicate that system as Takuya Yamada1, Shin Yamada1, Yurie Yamachika1,
well-established a diagnostic tool. Hirohumi Terabayashi1, Tetsuo Ota1, Akio Kimura1,
Sawako Nakajima2
0501PP148
1
Keio University Tsukigase Rehabilitation Center and 2Depertment
of Biosciences and Informatics, Keio University (Japan)
A NEW ANTERIOR ANKLE FOOT ORTHOSIS FOR
HEMIPLEGIC PATIENTS Purpose: Many researchers suggest that treadmill training is effec-
tive in improving walking ability and functional balance of patients
Xuanlin Shen, Yifei Qian, Jiguang Sun, Jianping Zhang, with stroke. However, marked instability of walking is frequently
Ting Huang observed after introduction of this training because of differences
Changshu No. 2 Hospital (China) in kinematic strategies between treadmill and floor walking. The
purpose of this study was to identify biomechanical characteris-
Purpose: To investigate the differences between a new kind of tics of treadmill walking in a hemiparetic subject. Materials and
anterior ankle foot orthosis (AFO) and traditional posterior AFO in Methods: The subject was a 57-year-old male with left hemiparesis
hemiplegic patients. Materials and Methods: A new kind of anterior after a stroke 105 days ago. He could walk independently with a
AFO (our new invention, China Invention Patent: 200910031535.4) cane and had no experience of treadmill walking.The purposes and
is made of polypropylene. Forty hemiplegic patients were divided procedures of this study were fully explained to the subject,and
into anterior AFO group and posterior AFO group randomly. Gait informed consent was obtained.Following floor walking at self-
analysis was assessed. Results: The new kind anterior AFO is lighter, selected comfortable speed, the subject walked on a treadmill. The
smaller and more comfortable than posterior AFO. Excessive ankle treadmill speed was set according to the floor walking speed. Main
plantar flexions and inversion at stance and swing phase were de- outcome measures were gait cycle parameters (cadence, step length,
creased after wearing anterior or posterior AFO, and the posterior stance and swing durations), electromyographies (EMGs) recorded
AFO improved better. The anterior AFO have a better ankle joint from the tibialis anterior, gastrocnemius, and soleus muscles and
flexibility than posterior AFO. Walking speed of anterior AFO group the angle of ankle joint in the affected leg. Results: Cadence in
was faster than posterior AFO group. Conclusion: This new kind treadmill walking was greater (93.0 steps/min vs. 47.4 steps/min)
anterior AFO is more effective than traditional posterior AFO for and step length was smaller (0.23 m vs. 0.45 m) than those in floor
hemiplegic patients. walking. Amplitude of EMGs activities in the gastrocnemius and
soleus muscles were increased at the end of swing phase through
the initial of stance phase on the treadmill. In addition, activity in
0501PP149
the tibialis anterior muscle was decreased at the initial of stance
EVENT-RELATED POTENTIAL DURING DUAL- phase, and planter flexion of the ankle joint was disappeared just
TASKING POSTURAL CONTROL: A COMPARISON after the initial contact. Conclusion: On the treadmill, over activ-
BETWEEN STROKE PATIENTS AND NORMAL ity of planter flexor and under activity of dorsiflexor muscles were
observed. These effects may deteriorate walking ability of patients
ADULTS with hemiparesis. Therefore, when we use the treadmill training for
Jen-Suh Chern1, I-Fang Tseng1, Chiu-Ping Lu1, Chia- stroke patients, we should take more care to set appropriate tread-
Ling Chen1,2 mill speed especially at the beginning of the introduction. Usage
1
Chang Gung University and 2Chang Gung Memorial Hospital, of partial body weight support or electrical stimulation would help
preventing the harmful effects of the treadmill training.
Linkyo Branch (Taiwan)
Purpose: To investigate the cerebral activation pattern associated
with postural control during dual-task performance in stroke pa- 0501PP151
tients. The study aims to: 1. understand the impact of side of stroke THE COMPENSATORY MECHANISM OF
(left vs. right hemisphere stroke) on postural control performance; WALKING WITH PARALYSIS OF QUADRICEPS
2. compare the activation pattern of the cerebral cortex between
FEMORIS MUSCLE
single-task and dual-task performance; 3. investigate the changes
of the cerebral cortex activation pattern in single-task and dual-task Shao-Qin Gu, Guang-Xu Xu, Jian-an Li, Dian-Huai
performance. Materials and Methods: Eleven left hemisphere stroke Meng, Hong-Xing Wang
subjects, 12 right hemisphere stroke subjects and ten normal, age- Department of Rehabilitation Medicine, the First Affiliated Hospital
matched subjects were recruit for study. Each subject was tesyed of Nanjing Medical University (China)
on 6 single- and/or dual-task conditions (2 postures x 3 task condi-
tion). The performance of postural tasks (center of pressure travel Purpose: To analyze the compensatory mechanism of walking when
path length), cognitive tasks (reaction time and accuracy) and event quadriceps femoris muscle is paralyzed. Materials and Methods:
related potential of the brain activation were studied. Results: The Post-poliomyelitis clients with quadriceps femoris muscle strength
results of the ERP measures showed that FCz areas and P4 areas measured grade 2 in manual muscle testing (MMT) in one leg were
were primarily responsible for the postural control and cognitive selected for the ‘test group’ in the knee-joint-control-impediment
tasks (mental rotation). Besides, in three groups demonstrate dif- pathology model in this study. The gait pattern of the paralyzed leg
ferent ERP pattern in each experimental condition. Those results was compared with the contra-lateral good leg, and also with that
showed that the cerebral cortex injury after stroke had significant of the control group (normal subjects). The compensatory mecha-
effects on postural control, especially in right hemisphere stroke. nism of the ‘test group’ with paralyzed quadriceps was studied.
Conclusion: The findings indicate that postural control is not under The total number of subjects studied were 20 having 10 in each
automatic control, but requires more brain integration to achieve group with age and sex matched. The ‘test group’ walked under
optimal performance. When the difficulty of task increased, the various conditions: (a) wearing knee-ankle-foot orthosis(KAFO),
activation of the cerebral cortex that is in charge of postural control (b) wearing ankle-foot orthosis(AFO) and (c) without orthosis. The
and mental rotation increased and the postural stability enhanced control group walked without orthosis. The time-space parameters
during dual-tasking conditions. were collected by 3D-motion analysis system.The oxygen cost was

detected by a Cosmed K4b2 portable gas analysis system in order to ric data of upper limb were collected. The robot-aided system with
evalution the walking efficient. Results: Oxygen cost: Oxygen cost five-bar-linkage manipulator was used for guiding and measuring
of ‘test group’ walking with KAFO,with AFO and without orthosis upper-limb movement in the designated planer motion. The two-link
were 0.38 ± 0.06, 0.26 ± 0.05 and 0.40 ± 0.06 ml/m/kg, respectively. and open kinematic chain was used to simulate the kinematic model
Oxygen cost of the control group was 0.17 ± 0.04 ml/m/kg.Oxygen of upper limb. During tests, the subject sat in front of the robot-aided
cost was significantly reduced when walking with AFO, compared to system with shoulder joint being aligned to the base of manipulator
walking with KAFO and without any orthosis (p < 0.01) in the trial and were asked to hold the end-effector of manipulator. The height of
group. The oxygen cost in the control group was lower compared end-effector was adjusted approximately 5–10 cm below the shoulder
to the test group walking under all three conditions (p < 0.01).Gait joint individually. To eliminate the effects of audiovisual senses,
analysis: The duration of swing phase of the affected lower limb the subjects were blindfolded and earplugs were inserted in the ear
in the test group wearing KAFO(43%) and without orthosis (42%) canal. The subjects were randomly tested under three conditions: 1)
was longer than the opposite side (37%, 38%) and the control group no bracing, 2) application of counterforce brace and 3) application
(38%) wearing no orthosis (p < 0.01). The angle of extension of knee of brace with epicondyle. Two different point-to-point movements,
joint during the mid stance in the affected lower limb of the test backward-right to forward-left and backward-left to forward-right,
group wearing AFO was greater than that of the opposite side and with approximately 25-cm in length were randomly tested. Firstly, the
similar findings when comparing with the control group (p < 0.01). subjects’ upper limb was passively moved at 10 cm/s in the predeter-
Conclusion: When the quadriceps femoris muscle is weakened, mined point-to-point movement by manipulator for three repetitions.
using AFO and slightly knee overextension can reinforcingthe knee The subjects were then asked to repeat the movement as accurately as
joint stability and improve the gait pattern . possible for three repetitions. Position data measured from the end-
effector were sampled at 200 Hz. The corresponding shoulder and
elbow joint angles were estimated through inverse kinematics. For
0501PP152 each test, the absolute position errors and the absolute differences in
A POSTER PRESENTATION ILLUSTRATING TWO joint angles between the target and reproduced movement were cal-
INTERESTING CASE REPORTS OF IMPROVING culated. Two-way ANOVA was used to analyze the effects of bracing
and movement directions on position errors and differences in joint
FUNCTIONAL AMBULATION IN AMPUTEES angles. The significance level was set to be 0.05. Results: The results
AFTER PROSTHETICS FITTING of statistical analysis have revealed the main effect of movement
K Palaniappan, Yin Tjan Soon direction on the differences in elbow joint angle (F = 9.124, p < 0.05).
The backward-right to forward-left movement showed less absolute
Tan Tock Seng Hospial (Singapore) position errors than those resulted from backward-left to forward-
Purpose: To illustrate a relatively rare case in our urbanised country right movement. It suggested that the cross-joint muscles may affect
of how a young male below knee amputee is able to participate in individual joint position senses in different coordination patterns
both rural fieldwork and community ambulation through the use of between shoulder and elbow. Among the three bracing conditions,
his below knee prostheses and a second case illustrating an elderly there were no differences in joint position sense of elbow and shoulder
gentleman with concurrent below elbow and above knee amputation joints and in the position errors of upper-limb endpoint. Conclusion:
on the same side able to do functional ambulation with the help of The contribution of the research emphasize on the applications of
prostheses. Materials and Methods: Detailed assessments includ- brace during different joint coordinate patterns. Applications of brace
ing premorbid functions, expected goals of patients and their initial caused no effects on the elbow joint position senses for the able-body
and post prostheses fitting Functional Independence Measures and subjects. The joint position senses of adjacent joints may interact with
Amputee Mobility Index were described. We highlight the problem each other due to the involvement of two-joint muscles.
solving and training involved in returning the desired functions to both
patients. Results: Both our patients showed improvement in functional
measures and were able to ambulate despite the loss of their limbs with 0501PP154
rehabilitation and aid of carefully selected prostheses. Both returned THE EFFICACY OF SPECIALIZED SEATING/
to their desired participation in society. Conclusion: Careful selection POSITIONING ON SEVERE/PROFOUND
of prostheses taking into consideration their limitations is important. CEREBRAL PALSY
The rehabilitation involved considerable problem solving and needs
to be tailored to the individual goals of amputees. Kuang-Che Liu1, Kao-Chi Chung1, Yun-Er Wang2, Jo-
Tong Chen2, Ju-Ying Chang3
1
1Institute of Biomedical Engineering, National Cheng-Kung
0501PP153
University, 2Department of Physical Medicine and Rehabilita-
EFFECTS OF BRACING ON JOINT POSITION tion, College of Medicine, National Cheng-Kung University and
SENSE OF UPPER-LIMB 3
Department of Special Education, National Ping Tung University
of Education (Taiwan)
Ju-Ying Chang1, Kao-Chi Chung2, Kuang-Che Liu2, Jo-
Tong Chen3 Purpose: Specialized seating/positioning is usually prescribed
1
Department of Special Education, National PingTung Univer- for the children with severe to profound cerebral palsy (CP) to
sity of Education, 2 Institute of Biomedical Engineering, National maintain proper sitting posture, to decrease abnormal reflexes, to
Cheng-Kung University and 3Department of Physical Medicine avoid musculoskeletal deformities, to improve pulmonary function
and Rehabilitation, College of Medicine, National Cheng-Kung and to facilitate functional movements. The research is aimed to
University (Taiwan) qualitatively and quantitatively investigate the efficacies of proper
seating/positioning for individuals with severe to profound CP.
Purpose: Proprioception, assessed by joint position sense through Materials and Methods: A Single-Case Research Design was
active and passive positioning of the limb, contributes to dynamic used to evaluate the long-term efficacy of specialized seating for
joint stability and neuromuscular control for movements. Bracing six-month follow-up. Five subjects aged from 3 to 17 years with
has been reported to contribute to proprioceptive ability. The study severe to profound cerebral palsy recruited from National Cheng
is aimed to investigate the effects of two types of brace on shoulder Kung University Hospital participated in the research. All subjects
and elbow joint position sense for the able-bodied during planer were given informed consent to the experimental procedures prior
movements. Materials and Methods: Seven able-bodies aged from to the tests. An adjustable positioning/evaluation system was
21 to 26 years (7 male) with no history of upper-limb trauma and implemented for anthropometric data measurement, systematical
neuromuscular impairments were recruited in the study. All subjects prescription of specialized wheelchair and body support devices
were given informed consent to the experiments and the anthropomet- for each subject. After intervention of the specialized wheelchair,

the subjects were allowed to sit on wheelchair at least three by using SPSS/PC package and significant level is set to be 0.05.
hours per day and were assessed biweekly through EMGs, ROM The movement deviations and the NJC at x- and y- direction
measures and Gross Motor Functional Measure Score (GMFM). were analyzed by Mann-Whitney U test between the able-bodied
Surface EMGs were used to record muscle activities from biceps and the post-strokes. Results: Results of Mann-Whitney U test
brachii, triceps, neck extensor, back extensor, lumbar extensor, showed significant differences in the movement deviation and
rectus abdominis, quadriceps and hamstrings. The EMG meas- NJC between the able-bodied and the post-stroke both at x- and
ures, sampled at 1,000 Hz, were full-wave rectified, filtered and y- direction. The stroke subjects demonstrated greater movement
integrated over a predetermined time to represent muscle activities deviations and jerk cost while performing movement. Movement
for each muscle. The linear-regression-test-for-trends were applied impairments which may be caused by abnormal muscle recruit-
for statistical analysis of changes in EMG parameters and ROM ment, weakness and altered spinal reflexes after stroke were
measures. Results: The clinical evaluated results show the inter- showed by the upper-limb endpoint kinematic profiles. However,
vention of seating/positioning through specialized wheelchair and these robot-aided parameters were not significantly related to the
body support devices leads to improved sitting posture, increased clinical scales during active reaching movement. Conclusion: The
range of motion, decreased pathological reflexes and normalized impairments in active movement performed by the post-stroke can
muscle tone for all subjects. The results of EMG measures indicate be quantitatively demonstrated by the active movement charac-
that specialized seating/positioning could significantly improve teristics of upper-limb endpoint kinematics. The NJC seems to
pathologic neuromuscular control. The results indicate that proper be the potential measures for the evaluation of upper-limb motor
sitting contributes significantly to relax the upper extremities. The performance. These robot-aided parameters may be significant
spasticity of proximal joints like hip joints and knee joints are also to biomechanics and fundamental movement sciences as well as
improved. Conclusion: The seating/positioning prescription and clinical applications to stroke rehabilitation.
follow-up evaluation provided significant information to clinical
evidence. The improvement of normalizing muscle tone, decreas-
ing pathological reflex and functional movement are agreed to 0501PP157
the literature. The results of clinical observations and EMG data WALKING ABILITY AND ENERGY EXPENDITURE
are invaluable information for further clinical research study and IN POST-STROKE PATIENTS WITH A ANKLE-
engineering technology development in special seating.
FOOT ORTHOSIS
Junichi Kato1, Yuji Azuma2, Sou Okuyama2, Noriaki
0501PP155 Maeda3, Masahito Murakami4
ROBOT-AIDED MEASUREMENT OF ENDPOINT 1
Department of Internal Medicine, Hyogo Rehabilitation Center at
KINEMATICS DURING UPPER-LIMB ACTIVE Nishi-Harima, 2Division of Physical Therapy, Hyogo Rehabilitation
MOVEMENT IN THE POST-STROKE Center Hospital, 3Division of Physical Therapy, Hyogo Rehabilita-
tion Center at Nishi-Harima and 4Department of Physical Therapy,
Ju-Ying Chang1, Jo-Tong Chen2, Kao-Chi Chung3 Kobe International University (Japan)
1
Department of Special Education, National PingTung University
of Education, 2Department of Physical Medicine and Rehabilita- Background: In stroke, around 70 to 80% of patients regain walking
tion, College of Medicine, National Cheng-Kung University and function within a few months, although residual hemiparesis often
3
Institute of Biomedical Engineering, National Cheng-Kung Uni- involves an asymmetrical gait pattern. In particular, an ankle-foot
versity (Taiwan) orthosis (AFO) is used to correct spastic drop foot or equinus foot,
which are both commonly seen in spastic stroke-related hemiparesis.
Purpose: Impaired motor control after stroke can be evaluated Physical inactivity after stroke may contribute to cardiovascular
through characterizing changes of upper-limb endpoint kinematics and metabolic deconditioning, muscle weakness, and associated
during active movement and used as objective measures for clinical declines in physical and social functioning. Objective: The purpose
application. The research is aimed to investigate upper-limb end- in this study was to compare the gait velocity and gait energy cost
point kinematics for characterizing upper-limb active movement on on floor walking with and without a plastic AFO, and to investigate
the able-bodied and post-stroke subjects. Materials and Methods: the cardiovascular and metabolic fitness variables in chronic stroke
Both able-bodied subjects (5 males and 5 females) with no history patients with hemiparesis. Material and Methods: Participants were
of neuromuscular impairments and ten individuals (7 males and 12 hemiparetic patients with a stroke at least 6 months earlier (10 male
3 females) with hemiplegic stroke were recruited in this study. and 2 female: 47 ± 8 years old). An ambulatory activity test was per-
Before conducting tests, all subjects were given informed consent formed which involved walking for a total of 6 min at a self-selected
to the experimental procedures and the anthropometric data of up- speed with or without AFO. Before walking, each subject was fitted
per limb were collected. The post-stroke subjects were evaluated with a portable gas analyzer (VE2000 System :Medical Graphics
by two clinical scales: Modified Ashworth Scale and Fugl-Meyer Co.Ltd, USA ) programmed for metabolic analysis through indirect
Sensorimotor Scale. Motor recovery status was determined by calorimetry. The rate of oxygen consumption (VO2 in mL•min-1),
Brunnstrom’s stage. The robot-aided system with five-bar-linkage minute ventilation (L•min-1), metabolic equivalent (METS), and heart
manipulator was used for measuring upper-limb movement in the rate (HR) in beats per minute (bpm) were continuously monitored
designated scenario of planer motion. During tests, the subjects sat during the 6-minute walking trial. The Physiological cost index: PCI
in front of the robot-aided system with shoulder joint being aligned (beats•m-1) was calculated by dividing the difference between the
to the base of manipulator and rested their forearms on the arm steady-state walking and resting heart. Results: Walking speed: with
supporter. The upper-limb endpoint (i.e. the hand) was attached to and without AFO 27 ± 11 vs 23 ± 11 m/min, difference 20% (p < 0.05).
the end-effector of the manipulator and a chest strap was applied Oxygen consumption: with and without AFO 11.8 ± 2.0 vs 12.0 ± 1.9
to limit torso movement. The height of end-effector was adjusted ml/kg/min. Physiological cost index (PCI): with and without AFO
approximately 5–10 cm below the shoulder joint individually. The 1.2 ± 0.5 vs 1.6 ± 0.8 beats/m (p < 0.05). Energy expenditure cost: with
subjects were asked to actively perform point-to-point movement and without AFO 0.6 ± 0.3 vs 0.4 ± 0.2 ml/kg/m (p < 0.05). Conclu-
and move the end-effector for five repetitions as smoothly as pos- sion: Use of AFO in patients with post-stroke may increase walking
sible according to the visual cue shown on the monitor. Changes velocity and decrease energy cost during walking. Conclusions:
of upper-limb coordinates were collected at 200 Hz. To assess AFO may decrease energy demands and have physiologically energy
the movement smoothness during active movement, both number efficiency in walking in stroke patients and these obtained results in
of movement units (NMU) and normalized jerk cost (NJC) were this study suggest that a stroke hemiplegia patient with motor disorder
estimated from the mean kinematic profiles. Movement deviations can improve gait ability by wearing AFO and also lower the energy
were calculated over each trial. All data were statistically analyzed consumption while waking.

Poster presentations (May 2, 2010)
0502PP1 The condition of muscle injury: myofibrosis completely: 2 cases

THE ELECTROPHYSIOLOGICAL CHANGES OF (gastrocnemius loss myoelectricity: 1, tibial anterior loss myoelectric-
ity: 1), myofibrosis heavily: 1 (extensor indicis), myocele: 1 (vastus
LOWER LIMBS IN SUBJECTS WITH SPINAL lateralis). Conclusion: Neural electrophysiologic study can evaluate
CORD INJURY objectively, exactly, exquisitely and quantifily the traumatic condition
Hong-Xing Wang, Shao-Qin Gu, Wen-Hong Chen, Xiao of nerves and muscles on the limbs of crush injury patients.
Lu, Guang-Xu Xu, Tong Wang, Jian-An Li
The First Affiliated Hospital of Nanjing Medical University 0502PP5
(China)
RESEARCH ON THE RELATIONSHIP BETWEEN
Purpose: To investigate the electrophysiological changes of peripheral OCULOMOTOR & ABDUCENS NERVE PARESIS
nerves and muscles of the lower limbs in patients with spinal cord AND VISUAL EVOKED POTENTIAL
injury. Materials and Methods: Standard sensory and motor nerve
conductions were performed in tibial nerve, peroneal nerve to ana- Yong Yin1, Yunxi Zhang2, Yingzhou Hu3, Yingyi Ouyang1,
lyze distal motor latency (DML), compound muscle action potential Xifang Zhang1, Lei Pan1, Xintian Hu3
(CMAP), sensory conduction velocity (SNCV) and amplitude (SNAP). 1
The Department of Rehabilitation, The fourth Affiliated Hospital
Concentric needle electromyography was done in the bilateral tibial an- of Kunming Medical University, 2The Department of Neurology,
terior, vastus medialis, lateral gastrocnemlus and paraspinal musles at The fourth Affiliated Hospital of Kunming Medical University and
L4–S1 level to record spontaneous activities Results: Characteristics of 3
Kunming Institute of Zoology, CAS (China)
nerve conduction: 94.7% patients had abnormal motor nerve conduc-
tion with decreased CMAP amplitude, prolonged distal motor latency Objective: Both vision and eye movement has been well studied for
and absent response. Abnormal sensory conductions were found in a long time. People get most of the information of environments
15.8% patients, including slowed SNCV, small SNAP amplitude and through visual system. Eye movement is relative simple move-
no response. Tibial nerve: Single abnormal motor conductions were ment control system, and has also been well understood. However
found in 47.4% patients and abnormal motor and sensory conductions the interaction between visual sensory and eye movement is not
coexisted in 10.5% patients. Abnormal motor conductions were seen in very clear. The purpose of this study was to determine whether the
both sides (36.8% had no responses, 5.3% had decreased CMAP ampli- movement eye could affect visual sensory by using visual evoked
tude and 21.1% had decreased amplitude with prolonged DML). The potential (VEP). Methods: The P100 component of visual evoked
characteristics of sensory conduction were unilaterally slowed SNCV potential of 10 subjects has been recorded using Keypoint 4 chan-
and decreased SNAP amplitude. Peroneal nerve: Single abnormal nels electromyography equipment. The ten subjects suffers from
motor conductions were found in 73.7% patients and abnormal motor oculomotor or abducens nerve paresis either caused by craniocer-
and sensory conduction coexist in 15.8% patients. 84.2% patients had ebralinjury, multiple sclerosis, glioma , brain stem infraction, brain
bilaterally abnormal motor conductions with no response (57.9%), aneurysm or diabetes mellitus. Results: Eight of the ten subjects
decreased CMAP amplitude (21.1%) and both (5.3%).Unilaterally show abnormal VEP. The P100 components of four of them show
abnormal conductions were seen in 10.5% patients with decreased non-crossed asymmetrical distribution, which indicates the damage
CMAP amplitude and delayed DML. The characteristics of sensory of optic nerve happens before optic chiasm. The P100 components
conduction showed slowed SNCV, decreased SNAP amplitued and no of the rest of the 8 subjects show crossed asymmetrical distribution,
response in one or both sides. Spontaneous activities (SA), including which indicates the damage happens after optic chiasm. Two of the
fibrillations and positive sharp waves, were noted at variable degrees ten subjects show normal VEP. Conclusions: The damage of eye
in all muscles examined. Conclusion: Axonal motor neuropathy and movement system could cause abnormity of visual function. But
abnormal spontaneous activities in lower extremities were the main the interaction pathway is still unclear. A possible mechanism could
electrophysiological characteristics in patients with spinal cord injury. be that eye movement disorders not only affect the input of visual
And there was no correlation between SA and the electrophysiological information, but also affect the input of eye position information,
changes of peripheral nerves. which subsequently affect the integrated function between cortex
and subcortex nucleus. Key words: Eye movement disorder; visual
sensory; visual evoked potential (VEP).
0502PP3
APPLICATION OF NEURAL 0502PP6
ELECTROPHYSIOLOGIC STUDY TO LIMBS OF THE CHANGE OF HEART RATE VARIABILITY
CRUSH INJURY PATIENTS IN UREMIC PATIENTS WITH RESPECT TO
Qingqing Li, Dan Tang, Qinglin Xian METABOLIC SYNDROME, DIABETES MELLITUS
Guangzhou Industrial Rehabilitation Hospital (China) AND HIGH -SENSITIVE C-REACTIVE PROTEIN
LEVELS
Objective: To evaluate objectivly the traumatic condition of nerves
and muscles on the limbs of 33 crush injury patients(three kinds Sui-Foon Lo1,3, Shuan-Kuang Jung2,4, Wen-Chi Chen4,
of crush injury for earthquake, machine, road accident) by utiliz- Wei-Yung Lin4, Fun-Jou Chen4, Yung-Hsiang Chen4,
ing neural electrophysiologic study. Methods: To check up needle Yung-Hsien Chang5
electromyography, motor nerve conduction velocity, sensory nerve 1
Department of Physical Medicine and Rehabilitation,China Medi-
conduction velocity, electro-neurogram, sympathetic skin response cal University Hospital, 2Section of Nephrology, Taipei City Hospi-
of the affected limbs. Results: 1) The condition of nerve injury: 74 tal, Yangming Branch, 3School of Chinese Medicine, China Medi-
peripheral nerves injury altogether in different degree(median nerve cal University, 4Graduate Institute of Integrated Medicine,China
22, ulnar nerve 21, radial nerve 14, tibial nerve 7, peroneal nerve 7, Medical University and 5Graduate Institute of Acupuncture Science,
axillary nerve 1, musculocutaneous nerve 1, femoral nerve 1), Injury China Medical University (Taiwan)
of nerve plexus: 17 places(brachial plexus 9, lumbar plexus 4, sacral
plexus 4), Injury of cervical nerve roots: 2 cases, spinal cord injury: Purpose: A decrease in heart rate variability (HRV) is known to be
2 cases (cervical cord 1, sacral cord 1), dysautonomia: 17 cases. 2) an independent predictor of mortality after myocardial infarction.

Metabolic syndrome (MetS), diabetes mellitus (DM) and high- area and/or weakness or atrophy of the ulnar-innervated muscles.
sensitivity C-reactive protein (hs-CRP) levels are known to play im- Patients also were excluded when electrodiagnostic studies or MRI
portant roles in cardiovascular morbidity and mortality. Therefore we gave evidence of a radiculopathy, plexopathy and polyneuropathy.
investigated the HRV in uremic patients with respect to MetS (Asia Electrodiagnostic studies were as following: Motor conduction
definition of the National Cholesterol Education Program’s Adult study was performed, recording from the ADM muscle. Sensory
Treatment Panel III (NCEP-ATP III) and the International Diabetes conduction study was performed, recording from the fifth finger. We
Federation (IDF)), DM and hs-CRP levels to find out their correlation used American Association of Electrodiagnosic Medicine (AAEM)
with cardiovascular risk in these patients. Materials and Methods: criteria for diagnosis as abnormal: CMAPs under 5mV, SNAPs under
A cross-sectional cohort study involving 23 patients on mainte- 8 μV, and MCV and SCV under 50 m/s. Needle electromyography
nance hemodialysis . Patients with the following conditions were studies were performed for the FDI, FDP, FCU muscles. About the
excluded: < 40 years old, > 75 years old, hemodialysis history < 3 US examination, reference values were from 31 normal volunteers
months; presence of cardiac arrhythmia, weak pulses, psychosis, (62 arms) about entire course of ulnar nerve and at 7 sites CSAs
infection or malignance. Each participant took a 20-min rest before from wrist joint to axilla with the neurophysiologic evaluation. The
the HRV evaluation with ANSWatch®. The test which last 7 min values of CSAs were over the mean ± 2SD as abnormal. Results:
was taken 30 min prior to hemodialysis session. Data in ANSWatch® Twenty-three arms have sensory signs alone, and 21 arms have
was downloaded to a notebook computer immediately following the sensory-motor signs. Fifteen arms have muscle atrophy of ulnar-
test for review and storage. The blood sample was taken in the same innervated muscles. Number of cases with a positive sonogram
day before hemodialysis. Results: Uremic patients with DM have related to clinical and electrodiagnostic findings as follows: In 23
higher fasting blood glucose (185.82 ± 105.22 vs 84.58 ± 15.92mg/ arms with just sensory sign, 7 arms showed localized lesions and
dl, p = 0.0097), lower HDL (34.00 ± 6.16 vs 42.75 ± 12.38 mmol/l, 3 arms showed non-localizing abnormalities and 13 arms showed
p = 0.045), higher triglyceride level (214.36 ± 110.33 vs 91.33 ± 44.06 normal in electrodiagnostic studies. But with additional US studies,
mmol/l, p = 0.004) and wider waist circumference (90.91 ± 10.31 vs all of 7 arms, one of 3 arms and nine of 13 arms, showed localizing
81.17 ± 7.09 cm, p = 0.015) when compared to patients without DM. abnormalities, respectively. In the group of sensory-motor signs, 6
Similar biochemical findings also found in uremic patients with arms showed localized lesions, and 12 arms showed non-localizing
NCEP-ATP III Definition MetS when compared to patients without abnormalities and 3 arms showed normal in electrodiagnostic stud-
NCEP-ATP III Definition MetS . Decrements in HRV was found in ies. However with US examinations, 5 of 6 arms, 11 of 12 arms
uremic patients with NCEP-ATP III Definition MetS (14.88 ± 7.94 and 2 of 3 arms showed localized abnormalities, respectively. Thus
vs 24.50 ± 4.76, p = 0.011) and DM (13.27 ± 7.48 vs 21.17 ± 7.48, 18 arms showed localizing abnormalities. In the group of muscle
p = 0.02) when compared to patients without these conditions. The atrophy, only 4 arms showed localizing abnormalities in electrodi-
HRV was found to decrease gradually as the number of NCEP-ATP agnostic studies, but with additional US examination, all the last
III Definition MetS components increased (24.50 ± 4.76 (1 or 2 remaining 11 arms showed localizing abnormalities. In the group of
components) vs 17.11 ± 9.45 (3 components) vs 12.38 ± 5.34 (4 or 5 just sensory sign, abnormalities of US studies were not only enlarged
components), p = 0.018). Conclusion: Uremic patients with NCEP- CSAs but normal CSAs for example ganglions, spur, dislocation,
ATP III Definition MetS and DM have similar adverse biochemical and being involved muscle. In the group of muscle atrophy, results
conditions and decrements of HRV which may increase the risk of of the electrodiagnosis studies were no-evoked sensory and motor
cardiovascular disease. The lower HRV of these patients indicating action potential, small CMAP, late MCV showed non-localizing
the impairment of autonomic nervous function in these patients. abnormalities, but in US studies we found localizied abnormalities.
In patients with NCEP-ATP III Definition MetS, the decreasing of Conclusion: With additional US examination, we could find the
HRV with increasing number of NCEP-ATP III Definition MetS lesion even in the cases who showed no localizing abnormalities
components indicates the cumulative detrimental effect on autonomic in the electrodiagnostic studies.
nervous function increases with the severity of metabolic syndrome.
Uremic patients with 4 or 5 components of NCEP-ATP III Defini-
tion MS have the lowest HRV which indicates the highest risk of 0502PP8
cardiovascular disease in this patient group. CHILDHOOD SUBACUTE INFLAMMATORY
DEMYELINATING POLYNEUROPATHY: A CASE
REPORT
0502PP7
THE RELATIONSHIP AMONG Chia-Yu Hsu, Kuan-Wen Chen, Yao-Chia Chuang, Nan-
Chang Chiu
CLINICAL, ELECTRODIAGNOSTIC AND
Mackay Memorial Hospital (Taiwan)
ULTRASONOGRAPHIC FINDINGS IN ULNAR
NEUROPATHY AROUND THE ELBOW Purpose: To report the first case of subacute inflammatory demyeli-
nating polyneuropathy in Taiwan. Materials and Methods: Subacute
Yuka Kurihara , Toshiaki Furukawa , Michi
1 1
inflammatory demyelinating polyneuropathy (SIDP) is an acquired
Tochikura1, Noboru Takanashi2, Chieko Seto2, Yui immune-mediated peripheral polyneuropathy with clinical course
Ishii2, Mayu Kato2, Yoshihisa Masakado3 between four to eight weeks. Rare childhood cases with SIDP had
1
Department of Rehabilitation Medicine, Tokai University Hachioji been described in current literature. We reported a nine-year-old
Hospital, 2Department of Central clinical laboratory, Tokai Univer- boy with subacute inflammatory demyelinating polyneuropathy in
sity Hachioji Hospital and 3Department of Rehabilitation Medicine, Taiwan. Initial symptoms were characterized by weakness, pain
Tokai University school of Medicine (Japan) and numbness of bilateral legs. No cranial nerve or autonomic
system was involved. The cerebrospinal fluid contains much more
Purpose: There are increasing reports that ultrasonography (US) protein than usual. In electrophysiological study, nerve conduction
may be a useful complement in a neurophysiology laboratory. is markedly slowed or even blocked. No abnormality was found
Enlarged nerve cross sectional area (CSA) is one of the abnormal in brain CT and MRI. The disease reached its nadir at five weeks
findings in the US examination. The aim of this study is to determine and had a good response to corticosteroids. The patient received
possible correlations among the clinical characteristics, electrodi- rehabilitation program in outpatient settings with one year clinic
agnostic and ultrasonographic findings using the values of CSAs follow-up. Three years follow-up visits were obtained from the
in ulnar neuropathy around the elbow. Materials and Methods: We medical records. Results: This was the first case report of childhood
performed electrodiagnostic and US examination in 41 patients (32 SIDP in Taiwan with complete clinical studies. All of the clinical
men and 9 women) (44 arms). In all these patients, a diagnosis for presentations, laboratory data, electrophysiologic studies and image
ulnar neuropathy was based on clinical chatacteristics: Complain tools were compatible with childhood SIDP. Benign neurological
of numbness or paresthesia or sensory disturbances in ulnar sensory recovery without relapse was correlated with electrophysiologic

evidence of demyelinating predominantly. Rehabilitation program μV) and reduced conduction velocity (left: 27.5 m/s; right: 23.7 m/s)
might improve functional outcomes of patients with childhood SIDP. of sensory nerve action potential (SNAP) in bilateral Median anti-
Conclusion: This is the first case report of children with SIDP in sensory nerve study. Prolonged distal latency, reduced amplitude
Taiwan. Electrophysiologic study is a powerful tool in determining of compound muscle action potential (CMAP) in bilateral Median
the diagnosis and prognosis of childhood SIDP. motor nerves were also found. The electrophysiological findings
were indicative of carpal tunnel syndrome, bilateral (demyelination
and axonopathy). Pathology report showed atrophy of epidermis
0502PP9 and myxoid degeneration of dermis, mild perivascular lumphocytic
CORRECTION OF DISTANCE MEASURE inflammation associated with decrease of periadnexal adipose tis-
sue of the skin tissue, which may be early change of scleroderma.
ERROR BY ULTRASONOGRAPHY IN ULNAR Serology data revealed elevated Immunoglobulin G (1780 mg/dl),
NEUROPATHY AT THE ELBOW Immunoglobulin A (519 mg/dl), and kappa light chain (1910 mg/
Joon Shik Yoon, Sei Joo Kim, Byung Kyu Park, Kyu dl). Bone marrow biopsy exposed 10% plasma cell proliferation and
Hun Sim, Jung Mo Cho, Chan Woo Byun, Sun Jae polyclonality of kappa and lambda light chains. He underwent physi-
cal modalities and Psoralen + UVA (PUVA) therapy 6 J/cm2 twice a
Won, Jin Seok Jeong week. Symptoms gradually improved after the regimen started for
Department of Physical Medicine and Rehabilitation, Korea Uni- three months. Conclusion: We presented a case of scleromyxoedema
versity College of Medicine (Republic of Korea) accompanied with carpal tunnel syndrome treated successfully with
Purpose: To examine the change of ulnar conduction velocity across rehabilitation program and photochemotherapy (PUVA).
elbow segment by distance measure correction according to ultra-
sonographic finding, in ulnar neuropathy at elbow(UNE). Materials
and Methods: Among the patients with clinical, electrodiagnostic 0502PP11
evidence of UNE, the patients with ulnar nerve subluxation or dis- IMPROVEMENT OF MEDIAN NERVE INJURY
location confirmed by ultrasonography were recuited. First, ulnar INDUCED BY INTRANEURAL STEROID
conduction velocity was checked by conventional method, then
the ulnar nerve around elbow was followed by ultrasonography, INJECTION FOR CARPAL TUNNEL SYNDROME
the distance across elbow segment was re-estimated. Additionally Gi-Young Park1, Hea-Woon Park1, Jung-Gu Kwoon1,
ultrasonographic finding of ulnar nerve was investigated. Results: In-Soon Kang1, Sung-Uk Lee1, Seoung-Kyu Kim2, Jung-
Seven subjects (2 women, mean age 53.3 years) with 9 affected Hyun Park3
arms (2 subluxation, 7 dislocation) enrolled. The change of distance
across elbow segment was 1.46 cm (from 10.2 cm to 8.7 cm), so the
1
Department of Rehabilitation Medicine, Catholic University of
over-estimated ulnar conduction velocity was corrected by 6.8 m/s Daegu School of Medicine, 2 Department of Rehabilitation Medi-
(from 48 m/s to 41.2 m/s). The mean location of maximal swelling cine, Eulji University College of Medicine and 3Department of
point was 0.12 ± 0.47 cm above medial epicondyle and its mean Rheumatology, Catholic University of Daegu School of Medicine
cross-section area was 0.187 cm. Conclusion: Ultrasonography may (Republic of Korea)
be a useful tool for increasing accuracy and reliability of electromy-
Median nerve injury induced by carpal tunnel injection with local
ography especially in the patients with UNE or UNE symptom.
steroid is rarely reported complication of carpal tunnel syndrome.
Early surgery for epineurectomy and extraction of deposited material
0502PP10 has been usually recommended as the treatment of this complication.
There has never been a report of serial ultrasonographic evaluation
GENERALIZED SCLEROMYXOEDEMA CAUSED and nerve conduction study without surgical intervention. We are
BY PLASMA CELL PROLIFERATION WITH reporting a case of a 54-year-old woman with median nerve injury
SECONDARY CARPAL TUNNEL SYNDROME – from a blind steroid injection for management of bilateral carpal
CASE REPORT tunnel syndrome. 1 ml of methylprednisolone mixed with 2% lido-
caine was injected into her bilateral carpal tunnel by rheumatologist.
Shao-Chi Lu1,2, Ming-Fu Hsieh1, Hui-I Su1, Yi-Lin During injection, she reported no pain or tingling sensation in her
Chen1, Kao-Zhi Hsu1, Wen-Chi Hou2 hand. After injection, she complained of new spontaneous shooting
1
Department of Physical Medicine and Rehabilitation, Tri-Service pains into her right thumb and lateral index finger superimposed
General Hospital, School of Medicine, National Defense Medical upon her previous pain and numbness from carpal tunnel syndrome.
Center and 2 Department of Physical Medicine and Rehabilitation, She was referred to our outpatient clinic and we serially evaluated
Hualien Armed Forces General Hospital (Taiwan) the her median nerve with ultrasonographic evaluation and nerve
conduction study results. Ultrasonography showed hyperechoic
Purpose: We report a patient with scleromyxoedema and carpal focus in the lateral side of median nerve at the proximal carpal
tunnel syndrome treated successfully with rehabilitation program tunnel on transverse and longitudinal views. Color elastography
and photochemotherapy. An objective evaluation was carried out showed a lesion with hard elastic pattern (red) involving the lateral
using nerve conduction study, serology data and histopathology. side of median nerve. These findings suggest a white steroid crystal
Materials and Methods: 68-year-old male felt itchy and harden deposition in the median nerve. Her symptoms and ultrasonographic
sensation on four limbs accompanied with bilateral hands numb- findings were agreed with topography of the median nerve. The
ness (more involved on right side) for months. The symptoms nerve conduction study was performed and it revealed low ampli-
exacerbated at night and painful sensation occurred on his bilateral tude of SNAP for right median nerve and prolonged onset latency
palm and fingers progressively. He had major depression and panic of CMAP for bilateral median nerves. We offered non operative
syndrome regularly followed up at psychiatric department. He came management with non-steroid anti-inflammatory drug and gabap-
to our outpatient department for further evaluation. On examination, entin. Following 6 months, her symptom was sufficiently improved
several erythematous, pruritic indurated patches with excoriation on and remained well. But the result of serial nerve conduction studies
four limbs were found. Both Phalen test and Tinel sign had positive did not explain her conditions clearly. However ultrasonography
findings. There were no atrophy on bilateral thenar muscles and follow-up’s showed the disappearance of hyperechoic focus in the
normal muscle power on both palmar abductor. Nerve conduction median nerve and elastography showed soft elastic pattern (green).
study was arranged and we also referred him to other department It was correlated her changed symptoms. We assumed that the ul-
for further evaluation. Results: Nerve conduction study revealed trasonography with elastography could be a good alternative tool
prolonged peak latency (left wrist to 2nd digit: 5.9 ms; right wrist to in follow-up evaluation for nerve injuries. This case showed that
2nd digit: 5.1 ms), markedly reduced amplitude (left: 4.7μV; right: 1.5 median nerve injury induced by direct injection of steroid could be

treated conservatively, and intraneurally deposited crystal could be for functional performance, 2) Child Health Questionnaire-Parent
resolved spontaneously. Form and Pediatric Quality of Life Inventory (PedsQL)-Generic
Core Scale for HRQOL. Tools used for assessing parents included
1) WHOQOL-BREF for HRQOL, 2) PedsQL-Health Satisfaction
0502PP15 Scale, PedsQL-Family Impact Module, Impact on Family Scale, and
VALIDATING THE CEREBRAL PALSY QUALITY the Hospital Anxiety and Depression Scale for family impact. Re-
OF LIFE FOR CHILDREN (CP QOL-CHILD) FOR sults: Functional performance scores in children with developmental
delay were significantly positively correlated with physical-HRQOL
USE IN CHINESE POPULATIONS scores in these children (correlation coefficient: 0.5 to 0.9). Mild
Hui-Yi Wang1, Cheng-Chang Cheng2, Jen-Wen Hung3, positive correlations were evident between functional performance
Yun-Huei Ju1, Jau-Hong Lin1, Sing-Kai Lo4 scores and child age (correlation coefficient: 0.3), and parental
HRQOL (correlation coefficient: 0.3 to 0.4) and health satisfaction
1
Department of Physical Therapy, Kaohsiung Medical University,
(correlation coefficient: 0.4). Significant negative correlations were
2
Department of Rehabilitation, Kaohsiung Medical University found between functional performance scores and family impact
affiliated Hospital, 3Department of Physical Medicine and Reha- (correlation coefficient: 0.4 to 0.5), and parental anxiety (correlation
bilitation, Chang Gung Memorial Hospital (Taiwan) and 4Faculty coefficient: 0.3 to 0.5) and depression (correlation coefficient: 0.3
of Arts and Sciences, The Hong Kong Institute of Education (Hong to 0.5). Conclusion: Better functional performance in children with
Kong) developmental delays is associated with higher HRQOL in these
Purpose: To examine the psychometric properties of the Chinese children and their parents, and higher parental health satisfaction.
version of Cerebral Palsy Quality of Life for Children (CP QOL- Lower functional performance in these children is associated in-
Child) questionnaire. Materials and Methods: This is a cross-sec- creased family impact, and parental depression and anxiety.
tional study. We performed forward (into Chinese) and backward
translation of the CP QOL-Child (originally developed by Water et al 0502PP17
in Australia) for: (i) the primary caregiver form (for parents of child
with cerebral palsy (CP) aged 4–12 years); and (ii) the child self- FUNCTIONAL PROGRESS OF DUCHENNE
report form (for children with CP aged 9–12 years). This instrument MUSCULAR DYSTROPHY WITH AGE IN KOREA
assesses seven domains of a child’s life. A convenience sample of
children with CP and their primary caregivers were recruited from Moon Suk Bang1, Sang Jun Kim1, Jong Hee Chae3,
rehabilitation departments, early intervention centers or special Soo Kyoung Park2, Joong Youp Lee2, Jung Yun Kim1, Il
education schools in Southern Taiwan. Psychometric properties Young Jung1
assessed included test-retest reliability, internal consistency, item 1
Seoul National University College of Medicine, Department of
discrimination, construct validity, and concordance between the Rehabilitation Medicine, 2Seoul National University College of
forms of questionnaire. Results: We followed common transla- Medicine, Preventive Medicine and 3Seoul National University Col-
tion procedures. The Chinese CP QOL-Child was completed by lege of Medicine, Pediatrics & Adolescent Clinical Neuroscience
145 parents and 44 children. Excellent test-retest reliability (ICC Center (Republic of Korea)
ranged from 0.74 to 0.97) and internal consistency (Cronbach’s
alpha ranged from 0.78 to 0.91) were obtained. Item discrimination Purpose: To see if the known parameter and scales would be available
analysis revealed a majority of the items have moderate to good to apply to Korean DMD patients and to Investigate if the functional
discriminating power. Confirmatory factor analysis demonstrated progression which was evaluated by the known parameter would
distinguishable domain structure as on the original English version. indeed reflect the natural course of Korean DMD patients well. Mate-
Significant associations were found between lower QOL and more rials and Methods: We reviewed the medical records of 121 children
severe motor disability. Consistent with the English version, the with DMD, who had regularly visited the pediatric rehabilitation clinic
highest correlation between primary caregiver and child forms on at Seoul National University Hospital, from 2006 to 2009. Collected
QOL was in the domain of functioning. Conclusion: Our results data were Brooke scale, Vignos scale, muscle powers checked by
indicate that the Chinese CP QOL-Child appears to be valid for use hand-held dynamometer, scoliosis angle, the passive range of motion
in Mandarin-Chinese speaking children with CP. (PROM) of ankle dorsiflexion, peak cough flow, and cardiac fractional
shortening. Results: Brooke, Vignos scales correlate well with the
functional changes of Korean DMD patients with increasing age.
0502PP16 (Brook scale (y1), age (x) y1 = 0.3334x–1.1938, R2 = 0.397, Vignos
CORRELATION BETWEEN FUNCTIONAL scale (y2) y2 = 0.7935x–3.0598, R2 = 0.508). The PROM of ankle
dorsiflexion showed a linearly declining pattern. (right ankle PROM
PERFORMANCE IN DEVELOPMENTALLY
(y1), age(x) y1 = -4.4248x+34.828, R2 = 0.3512, left ankle PROM
DELAYED CHILDREN AND CHILD AND (y2) y2 = -4.4366x+35.107, R2 = 0.3622) Muscle powers, scoliosis
PARENTAL QUALITY OF LIFE, AND FAMILY angle, peak cough flow and fractional shortening of left ventricle
IMPACT showed diversities in their degree irrespective of age. Conclusion:
The currently known parameters partially reflect the function or
Ru-Lan Hsieh1,2, Shih-Ching Chen2, Hsiao-Yuan clinical change of DMD patients. However, it is so limited that the
Huang3, Ming-I Lin4, Wen-Chung Lee3 validity of this parameter is not satisfactory and some parameters do
1
Department of Physical Medicine and Rehabilitation, Shin Kong not have any relations with the change of age. When it comes to this,
Wu Ho-Su Memorial Hospital, 2School of Medicine, College of our next work should be designing the new functional scale which
Medicine, Taipei Medical University, 3Graduate Institute of Epi- can reflect the functional progress with higher validity.
demiology, College of Public Health, National Taiwan University
and 4Department of Pediatric, Shin Kong Wu Ho-Su Memorial
Hospital (Taiwan) 0502PP18
THE ANALYSIS OF SURFACE
Purpose: To examine the relationship between functional per-
formance in developmentally delayed children and health-related ELECTROMYOGRAM IN INFANT WITH
quality of life (HRQOL) in these children and their parents, and BIRTH-RELATED BRACHIAL PLEXUS INJURY
family impact. Materials and Methods: A total of 49 children (35 THROUGH FUNCTIONAL ELECTRICAL
male and 14 female) diagnosed with developmental delay and their STIMULATION THERAPY
parents participated in this cross-sectional study. Assessment tools
for children were 1) Pediatric Outcomes Data Collection Instrument Qing Shang

The rehabilitation Center in Children hospital of Zhengzhou Medicine and 4Department of Radiology, Ajou University School
(China) of Medicine (Korea)
Purpose: To analyze the EMG activity before and after functional Purpose: Pathogenetic mechanism of congenital muscular torticollis
electrical stimulation in infant with birth-related brachial plexus (CMT) remains elusive. There have been only a couple of reports
injury,and explore the role of surface electromyogram. Materials on histopathologic findings of CMT, which were based on fine
and Methods: To assess the changes before and after functional needle aspiration cytology of CMT. No study has investigated the
electrical stimulation on 30 cases of infant with birth-related brachial correlation between histopathologic findings and neck magnetic
plexus injury in terms of clinical treatment and surface EMG. Re- resonance imaging (MRI) findings of CMT mass in sternocleido-
sults: The integrated electromyography was increased in functional mastoid muscle (SCM).The purposes of this study were to elucidate
position and voluntary contraction location of biceps brachii, radial both histopathologic findings and MRI findings and to analyze
wrist extensor muscles and ulnar carpal flexor muscle after the clini- their correlation in order to investigate pathogenic mechanism of
cal treatment. Conclusion: The electrical stimulation can improve CMT. Materials and Method: Histopathologic sections of CMT
muscle tone and muscle strength in infant with birth-related brachial mass in SCM were reviewed for 35 subjects (22 men, 13 women;
plexus injury. Surface EMG can be used as an objective evaluation age at the time of surgical release 62.51 ± 85.51 month-old; range 5
methods which can appraisal the curative effect of electrical stimula- month-old ~ 31 year-old) who underwent myectomy for CMT. Neck
tion in infant with birth-related brachial plexus injury. MRI findings were reviewed from 37 subjects whose neck MRIs
were available among 24 subjects (20 men, 17 women; age at the
time of neck MRI 59.73 ± 103.68 month-old; range 1 month-old ~
0502PP20 38 year-old). There were 16 subjects who had both neck MRI and
SURFACE ELECTROMYOGRAPHIC histopathologic sections. Results: 1) Regarding pathologic findings,
BIOFEEDBACK IN THE TREATMENT OF THE all 35 subjects showed interstitial fibrosis and/or with presence of
aberrant tendon-like, excessive dense connective tissue which was
SPASTIC CEREBRAL PALSY either well-arranged or disorganized (100%). There were 8 subjects
Shang Qing, Hui-Chun Zhang, L.V. Nan, Zheng-Yu Li (22.9%) who showed prominent fat infiltration. Abnormally coiled
The Rehabilitation Center in Children Hospital of Zhengzhou vessels and myxoid change of nerves were also noted. 2) On neck
(China) MRI, there were 34 out of 37 subjects (91.9%) who showed one or
more low signal intensities within involved SCM muscle on T1-
Purpose: To evaluate the efficacy of Surface electromyographic and T2-weighted images, which means collagen-rich tissue such as
(sEMG) biofeedback in the treatment of lower-limb spasticity in tendon or ligament. Three subjects (8.1%) showed only enlargement
children with spastic cerebral palsy. Materials and Methods: From of the SCM without low signal intensity within the SCM. These
September 2007 to October 2009, a total of 36 with spastic CP (20 findings were found at the sternal head of the SCM in 21 subjects
males, 16 females; mean age 9±1.5 y, range 5-12 y; Muscle tone of the (56.8%), clavicular head in 3 (8.1%), and both sternal and clavicular
ankle plantar flexors was Modified Ashworth Scale level I﹢II) were heads in 13 (35.1%). As subjects get older, some subjects showed
randomly divided to sEMG biofeedback and control groups. sEMG atrophied unilateral SCM which was replaced with tendon-like,
biofeedback treatments were applied six times a week for a period extensive dense connective tissue with little muscle tissue. Conclu-
of 6 weeks. In addition, the patients in both groups received an same sions: The histopathologic findings and MRI findings showed good
rehabilitation protocol expept sEMG biofeedback therapy. Modified correlation in terms of fibrosis and aberrant dense connective tissue
Ashworth Scale (MAS), range of motion (ROM) of ankle, the gross within SCM. These findings revealed that pathogenetic events for
motor function measure (GMFM) and surface EMG potentials were CMT during prenatal or perinatal period seem to end up with fibrosis
used at the beginning and at the end of treatment course respectively with/without formation of aberrant tendon-like dense connective
for the clinical assessments. Results: The results showed that there tissue within SCM during the muscle regeneration.
were statistically significant improvements in all variables in both
groups, but the improvements of MAS , ROM of ankle , GMFM
scores and sEMG potentials were significantly greater in the sEMG 0502PP22
biofeedback group at the end of the treatment (p<0.05). After treat- FACTORS ASSOCIATED WITH THE PROGRESS
ment, the integrated electromyography (iEMG) of the gastrocnemius
muscle were decreased in passive activities, but the iEMG were OF COGNITIVE, LANGUAGE AND MOTOR
significantly lower in the sEMG biofeedback group. The iEMG of DEVELOPMENT IN CHILDREN WITH
the tibial anterior muscle was increased in Self-contraction, but the DEVELOPMENTAL DELAY
iEMG in sEMG biofeedback group were significantly increased
compared with the control group (p<0.05). Conclusion: Our study Rong-Bin Hong1, Shih-Yin Yen1, Hon-Yi Shi2, Yi-Ru
demonstrates the potential benefits of sEMG biofeedback in conjunc- Chen1, Hui-Shan Yu1
tion with neurophysiologic rehabilitation technique to maximize the
1
Department of Physical Medicine and Rehabilitation, Chi Mei
lower-limb function in in children with spastic cerebral palsy. This Medical Center, Yong Kang Campus and 2Graduate Institute of
system cou1d be used for lower-limb spasticity rehabilitation training Healthcare Administration, Kaohsiung Medical University (Tai-
in in children with spastic cerebral palsy. It could be combined with wan)
other training mothds to pvomote recovery better.
Purpose: Although substantial evidence has suggested that children
with developmental delay benefit cognitively and socially from
0502PP21 receiving early intervention, studies investigating the factors that
might influence the progress of cognitive, language and motor de-
CORRELATION OF HISTOPATHOLOGIC velopment are surprisingly few. The aim of this study was to explore
FINDINGS WITH MRI FINDINGS IN CONGENITAL the predictors that influence the progress of cognitive, language and
MUSCULAR TORTICOLLIS motor development after one year in children with developmental
delay. Materials and Methods: All 231 children from January 2006
Shin-Young Yim1, Jang-Hee Kim2, Myong Chul Park3, Il to October 2008 diagnosed with global developmental delay within
Jae Lee3, Kyu-Sung Kwack4 a single developmental clinic were recruited into the study. Children
1
Ajou Torticollis Clinic, Department of Physical Medicine and with chromosome abnormality, cerebral palsy, neural abnormal-
Rehabilitation, Ajou University School of Medicine, 2Department ity, visual and hearing impairment were excluded. Generalised
of Pathology, Ajou University School of Medicine, 3Department estimating equations (GEE) approach was applied to explore the
of Plastic and Reconstructive Surgery, Ajou University School of predictors associated with cognitive, language and motor develop-

ment. The severity of cognitive developmental delay (1-average, Purpose: Torticollis is the third most common congenital muscu-
2-borderline, 3-delay) was rated in the first assessment and in the loskeletal anomaly. The well known causes of nonmuscular torticol-
three-year follow-up assessment according to the score in Mental lis in children included Klippel-Feil Syndrome, unilateral atlanto-
scale of Bayley Scales of Infant Development-II and Wechesler occipital fusion, ophthalmologic disorder (strabismus), brachial
Preschool and Primary Scale of Intelligence-Revised. The severity plexus injury, central nervous system lesion. Congenial thoracic
of language and motor delay (1-average, 2-borderline, 3-delay) was scoliosis as the cause of nonmuscular torticollis is very rare. We re-
rated based on the development quotient in Comprehensive Devel- ported a case of congenital thoracic scoliosis presented as torticollis.
opmental Inventory for Infants and Toddlers. Socio-demographic Case Report: A female infant with a history of congenital ventricular
data including age, gender, care giver, intermarriage, parental septum defect was noted to have wry neck (head tilt to left) since
educational level, delivery mode, number of children and the type birth. She received rehabilitation program including positioning,
of early intervention setting were collected from chart review Re- stretching exercise of left sternocleidomastoid (SCM) muscle at lo-
sults: Cognitive development correlated significantly with gender cal hospital but the symptom still persisted. She was brought to our
(particularly in boys), parents as care givers, maternal educational clinic due to persisted torticollis at the age of 8-month-old. Physical
level, and intermarriage (p < 0.05). Severity of language delay after examination showed head tilted to left side, turned to right side and
one year was negatively associated with maternal educational level mild facial asymmetry. There was no palpable mass over left SCM
and integrated education with special support. Severity of motor muscle. Soft tissue echo showed no hyperplasia and no fibrotic tis-
delay was positively associated with gender particularly in boys sue over left SCM muscle. Spine x ray showed kyphoscoliosis of
and vaginal birth (p < 0.05). Finally, age of developmental delay the thoracolumbar spine. Thoracic-lumbar spine CT was arranged
identification correlated with cognitive, language and motor devel- which showed scoliosis of thoracic spine due to multiple vertebral
opment (p < 0.05). Conclusion: We found age, gender, care giver, segmentation failure at T1–8 level. Congenital scoliosis is a curva-
maternal educational level, and intermarriage were correlated to ture of the spine and is resulted from malformations of the vertebra.
cognition, language and motor development, which partially sup- The malformations include failures of formation (hemivertebra),
ported the previous studies. Issues regarding factors resulting in failures of segmentation and combinations of these defects. It is
the differences were discussed. common to see other congenital malformation in congenital scoliosis
such as cardiac abnormalities (10%), genito-urinary abnormalities
(25%), and intraspinal anomalies (40%). In our case, the scoliosis
0502PP23 results from failure of segmentation of thoracic spine. She also has
PREDICTORS OF EFFECTIVENESS OF congenital heart disease. The treatment for congenital scoliosis
EARLY INTERVENTION ON CHILDREN WITH depends on the progression of scoliosis. Surgery is indicated if the
progression is aggressive. Conclusion: Congenital thoracic scoliosis
INTELLECTUAL DISABILITY is a rare cause of torticollis. Most of the muscular torticollis can
Der-Chung Lai1, Yuh-Ming Hou1, Jiun-Horng Liu1, be managed with good or excellent results. Nonmuscular cause of
Hsiu-Chen Huang1, Chung-Hsin Chiang2, Yen-Cheng torticollis should be considered if there is no evidence of muscular
Tseng3, Shu-Fen Yao4 origin torticollis or poor response to rehabilitation program.
1
Chiayi Christian Hospital, 2National Cheng Chi University, 3Chang
Jung Christian University, 4Early Intervention Reporting Referral 0502PP25
Center of the Chiayi City and County (Taiwan)
THE PROGRESS OF CHILDREN WITH
Purpose: Early intervention to children with intellectual disability ARTICULATION AND PHONOLOGICAL
(ID) has been promoted in Taiwan for years, but the data on its
effectiveness are still limited. Materials and Methods: In order DISORDERS COMBINING WITH SENSORY
to identify predictors of the effectiveness of early intervention, INTEGRATION DYSFUNCTION OR NOT
we recruited children who were treated at the Child Development Li-Chen Tung1,2, Ching-Chi Chen1, Tsen-Jieu Ji1, Ming-
Evaluation Center in a teaching hospital in Chiayi, Taiwan from
Fang Wang1, Rong-Tai Liou3, Ching-Lin Hsieh4
2001 to 2005. We included patients with ID who had two tests for
Wechsler Preschool and Primary Scale of Intelligence-Revised.
1
Department of Physical Medicine and Rehabilitation, Chi-Mei
Data on the intervention between the two tests were collected by Medical Center, 2Graduate Institute of Early Intervention, National
social workers at the Early Intervention Reporting Referral Center Taichung University, 3Department of Physical Medicine and Reha-
of the Chiayi City and County. We used the difference between bilitation, Chi-Mei Medical Center, Liou Ying Campus, 4School of
the first test score (IQ1) and the second test score (IQ2) as the Occupational Therapy, National Taiwan University (Taiwan)
indicator of the effectiveness of intervention (IQ2–IQ1). Results:
Purpose: Articulation and phonological disorders are common com-
Muscle tenderness on days 0 and 14 [before exercise] was not
munication problems in children. Sensory integration dysfunction
different in the two groups. Muscle tenderness was significantly
means that the brain can neither effectively organize sensory stimula-
reduced [24.3 ± 4.8 mm] in the group that consumed BSP-201 as
tion nor provide correct information to oneself and the environment.
compared to the placebo group [47.4 ± 6.5 mm] at day 14 [imme-
Such a dysfunction could possibly lead to language delay or incorrect
diately after, p< 0.01] and at day 16 [p<0.04] after the exercise.
pronunciation, although empirical evidences are largely lacking. In
None of the participants reported any adverse effects. Conclusion:
order to clarify the impact of sensory integration dysfunction on
The study results showed that early intervention can improve the
children language impairment, the purpose of this study was to ex-
IQ of children with ID, and the earlier the intervention the better.
amine how sensory integration dysfunction would impact the effect
In addition, the effectiveness is more prominent in children with
of speech therapy on children with articulation and phonological
a low maternal educational level.
disorders. Materials and Methods: The children were between 3.5
and 6 years old. Before receiving the therapy, the pre-school children
0502PP24 with articulation and phonological disorders were screened by the
Hearing and Developmental Screening test. Furthermore they received
CONGENITAL THORACIC SCOLIOSIS the below evaluations: the Sensory Integration Function Evaluation
PRESENTING AS TORTICOLLIS: A CASE in Preschool Children and the Clinical Articulation Function Evalu-
REPORT ation. The children only received speech therapy, including auditory
discrimination, oro-motor training, and pronunciation localization.
Tzu-Yi Chou, Pei-Yu Yang, Nai-Hsin Meng Three months after the therapy, we followed his/her articulation
Department of Physical Medicine and Rehabilitation, China Medi- function as well as his/her total number of therapies. Based on their
cal University Hospital (Taiwan) sensory integration function, we divided the children into normal

group and dysfunctional group for further analysis. Results: A total dren with CP, children with common disease and healthy children.
of 13 children (7 boys and 6 girls) participated in our study. The Quality of life was measured with the Pediatric Quality of Life
average month-age was 59.6±7.8 and 7 of them were in sensory Inventory Generic Core Scales, version. Results: There were 479
integration normal group and the other 6 in dysfunction group. Both participants in all. 113 were children with CP of mean age 3.65±2.15
groups had no signification difference between month-age, gender, years; 68 were boy. 52 were children with common disease of mean
and number of mistakes in pronunciation. Paired t test showed sig- age 3.77±1.83 years; 30 were boy. 314 were healthy children of
nificant progresses (p = 0.001) after treatment on both groups. One mean age 4.46±1.13 years; 177 were boy. Significant differences
way ANOVA showed no significant differences (p = 0.232) between in mean scores favoring two peer groups were found for physical
these two groups after treatments. The total number of treatments functioning (CP: 27.80±22.61, common disease: 89.12±11.99,
received by the dysfunction group was significant higher than those healthy: 91.42±36.58), social functioning (CP: 37.17±23.44,
of the normal group (p = 0.012). Conclusion: Our preliminary study common disease: 88.46±13.98, healthy: 84.91±16.25), and total
showed that children with articulation and phonological disorders score (CP: 76.44±15.81, common disease: 83.12±10.54, healthy:
show significant progress after speech therapy. However, we found 86.57±24.83) (p<0.01). Means scores of Emotional functioning was
no difference of treatment effect between the sensory integration significantly higher for the healthy group (83.28±80.61) compared
dysfunctional group and normal group. It might be because of small with CP children (55.88±22.0) (p<0.05). Means scores of school
sample size. In addition, the dysfunctional group requiring more times functioning was significantly lower for children with CP com-
of therapies than the normal group indicates that the sensory integra- pared with two peer groups (CP: 55.00±18.95, common disease:
tion dysfunctional children demand more intensive speech therapy. 68.39±13.65, healthy: 83.66±11.29) (p<0.01). Conclusion: Cerebral
In the future, we suggest that such a research should recruit large palsy reduces children’s quality of life in full-scale. General quality
sample size to increase statistical power. Furthermore, we suggest of life, physical functioning, social functioning and school func-
adding the sensory integration therapy into routine therapy program tioning decrease significantly. Relatively, emotional functioning is
in order to promote effect of the therapy. less effected. Results suggest clinicians should assess and actively
improve quality of life in children with CP.
0502PP26
0502PP28
COMPARISON THE DEVELOPMENTAL
PROFILES OF CHILDREN WITH PRADER-WILLI EFFECT OF ACUPUNCTURE OF ANSHENBUNAO
SYNDROME AND MENTAL RETARDATION/ AND YIQITONGLUO METHOD ON NEURONAL
MENTAL DELAY APOPTOSIS AND PROTEIN EXPRESSION OF
NERVE GROWTH FACTOR IN BRAIN TISSUES OF
Chien-Min Chen1, Chia-Ling Chen2,3, Hung-Chih Hsu1,
NEWBORN RATS WITH CEREBRAL PALSY
Yi-Wen Chuang1
1
Department of Physical Medicine and Rehabilitation, Chang Gung Zhenhuan Liu
Memorial Hospital, Chiayi, 2Department of Physical Medicine and Nanhai Affiliated Maternity & Children’s Hospital of Guangzhou
Rehabilitation, Chang Gung Memorial Hospital, Taipei. 3Depart- University of TCM CHINA (China)
ment of Physical Therapy and Graduate Institute of Early Interven-
Purpose: To study the effect of acupuncture Anshenbunao and Yi-
tion, Chang Gung University (Taiwan) qitongluo method on apoptosis of hypoxic-ischemic cerebral neural
Purpose: Prader-Willi syndrome (PWS) is a chromosome 15 genetic cells, protein expression of nerve growth factor and the function
disorder and it could result in global developmental delay in children. of limbs in newborn rats, and analyze whether the effect is related
If there is no genetic analysis, it is difficult for clinicians to distinguish with the time of acupuncture. Materials and Methods: The experi-
children with PWS from children with mental retardation (MR)/mental ment was conducted in the Laboratory of Acupuncture & Massage
delay (MD) only by obscure characteristics. The aim of our study is as well as the Clean Laboratory of Experimental Animal Center of
to distinguish them by analyzing their full spectrum of developmental Guangzhou University of Traditional Chinese Medicine from August
functions. Materials and Methods: We recruited 10 children with to October 2005. 109 young SD rats aged 7 days were selected. Rats
PWS between the ages of 1 to 6 years and 17 MR/MD children, who recovered for 2 hours after ligation of left common carotid artery
were matched for age, gender, and scores of mental assessments were and then were put into a hyaline airtight container, in which there
selected to be a comparison group. Revised-norm Chinese Children was homeothermal water of 37°C, and hypoxia gas (including 8%
Developmental Inventory (CCDI) was used to survey the develop- of O2 and 92% of N2) was infused in the container at the speed 1 L/
mental functions. Results: The average developmental quotients of all min. Animals were taken out at 2.5 hours later, and the survival rats
domains in the children with PWS were lower than those in children received behavioral assessment following 1-hour incubation. Rats
with MR/MD. The differences of gross motor (p = 0.014), situation unable to roll over, abnormal in balance or kept on turning left were
comprehension (p = 0.035), self help (p = 0.01), and general develop- taken as successful models (n = 72). The rest 24 rats were taken as the
ment (p = 0.045) domains between children with PWS and MR/MD sham-operation group: rats were only separated of the left common
were significant, while expressive language (p = 0.056) between the two carotid artery without ligation or hypoxia treatment. Rats of successful
groups was nearly significant. Conclusion: These findings suggest that modeling were randomly divided into 3 groups: hypoxic-ischemic +
children with PWS have worse development functions in gross motor, acupuncture group (group A). hypoxic-ischemic + acupunture group
situation comprehension, self help and general development than those (group B) and model group with 24 rats in each group. The acupoints
of MR/MD. The data may help us to diagnose PWS at clinics and proof Baihui, Shuaigu to Jiaosun, Neiguan, Quchi, Zusanli, Yongquan
vide us the information to arrange therapy for children with PWS. were selected. Rats in group A were acupunctured at 24 hours after
modeling, and only acupoints in four extremities were acupunctured
in the first 7 days, while acupoints in head were also acupunctured
0502PP27 from the 8th day. Rats in group B were acupunctured at both head and
THE STUDY ON QUALITY OF LIFE IN CHILDREN body on the 8th day. Rats of both groups were acupunctured rapidly
at Neiguan and Yongquan with littlee blood and without retention,
WITH CEREBRAL PALSY then head-acupoints, Quchi and Zusanli were acupunctured. Baihui,
Zhenhuan Liu Shuaigu to Jiaosun, Quchi, Zusanli were connected with G6805-II
Nanhai Affiliated Maternity & Children’s Hospital of Guangzhou electroacupunture equipment with continuous wave at the frequency
University of TCM (China) of 5–10 Hz for 10 continuous min once a day. Rats in group A were
acupunctured for 20 continuous day. Rats in group B were continu-
Purpose: To investigate quality of life in children with cerebral ously acupunctured for 13 days. Rats in the sham-operation group
palsy. Materials and Methods: Cross-sectional evaluation of chil- were interfered the same as group A. Rats in the model group only

received no treatment but grouping. The ventral surfaces of the upper Nanhai Affiliated Maternity And Children’s Hospital of Guangzhou
limbs in rats were stuck with rubber cement at 7, 14, 21 days after op- University of TCM (China)
eration, and the time of getting out of the rubber cement was recorded.
At 21days after operation, 10 rats were randomly selected from each Purpose: In order to investigate the clinic effect of head acupuncture
group to conduct the following detection: in situ end-labeling (ISEL) therapy on childhood autism. Materials and Methods:We have ob-
and immunohistochemical method were adopted to measure the served the chinical curative effect of 38 cases of childhood autism
neuronal apoptosiss in cortex of temple and hippocampus as well as treated by head acupuncture.(31 male cases;7 female cases;3-11
the expression of nerve growth factor (NGF) in hippocampus respec- of the age ) We named this cure “9-acupoint Cure ”,which head
tively, and image analyzer was used to count the number of neuronal acupuncture of Nine needles of intelligence five needles of forehead
apoptosis and number of NGF that positive in expression under light and Seushenchung acupoints. It takes 30 times, needling every other
microscope (×400). The differences were compared with Chi square day, in each course of the treatment. After 2 year’s followed up
test, and means were compared among groups with analysis of vari- visiting and observing. Results: We find that the scosr of the Cars
ance (F-q test). Results: Of 109 enrolled rats, 13 failed for failure measurement is obviously discrepancy after and before the treat-
modeling, and no one died in the sham-operation group. At 7 days ment, p < 0.0 and the electroencephalogram of most of the children
after modeling, there were 2, 5 and 3 rats died in group A, B and model is improved after the treatment. With 3 months’ treatment, 16 cases
group respectively. At 7–14 days after modeling, there were 2, 2 and have obvious effect (42.1%) 14 cases show the effect (36.8%) and
4 respectively. At 17–21 days after modeling, they were 0,0 and 2. only 8cases show no effect (21.1%). After 2 years’ followed-up
Apoptosis of neurons in hippocampus frontal lobe stained with ISEL visiting, we find that 14 children have gradually got recovered.
in group A and B were significantly decreased, and the differences Conclusion: The result shows that the head acupuncture therapy
in comparison with the model group were remarkable (p < 0.05). can obviously improve the solitary behaviour, communicative
Moreover, the number of apoptosis in group A was obviously lower obstruction, logopathy of the childhood autism, the obstruction of
than group B (p < 0.05). Protein expression of NGF in neurons of visus communication and the emotion indifference.
hippocampuss in rats: It was significantly reinforced in group A and
B, while as to number and intensity, those were obviously greater
0502PP31
and higher than sham-operation group and model group (p < 0.01),
and those were obviously greater and higher in group A than group THE RELATIONSHIP BETWEEN INTELLIGENCE
B (p < 0.01). At the 7th day after operation, the time of getting rid of DEVELOPMENT AND LEVEL OF GMFCS IN
rubber cement in group A was obviously shorter than in medel group CHILDREN WITH CEREBRAL PALSY
(p < 0.01). At the 14th day after operation, it was significantly long
in model group than 3 other groups (p < 0.05–0.01). At the 21st day Zhenhuan Liu, Ruiping Wan
after operation, the function of upper limbs in rats of group A and Nanhai Affiliated Maternity And Children’s Hospital of Guangzhou
B as well as model group were obviously ameliorated, and that of University of TCM (China)
group A approached to normal level (there was no significant differ-
ences comparing with the sham-operation group, p > 0.05), whereas Purpose: To investigate the level and structure of intelligence of
that of model group was longer than group A and sham-operation children with cerebral palsy (CP). To analyze the relationship be-
group (p < 0.01). Conclusion: Acupuncture can inhibit the apoptosis tween intelligence development with severity degree (GMFCS) and
of hypoxic-ischemic neurocytes in brain, reinforce the expression clinical type. Materials and Methods: 18 children with CP were
of NGF in brain tissues of rats with hypoxic-ischemic damage and assessed using Gesell Developmental Scale (GDS) and Gross Motor
ameliorate the function of limbs, which has certain protective effects Function Classification System (GMFCS) to test their developmental
on hypoxic-ischemic damage, and the earlier the intervention is car- quotient (DQ) and severity degree (GMFCS), and the relationship
ried out, the better the effects are. between intelligence development with severity degree (GMFCS)
and clinical type were analyzed. Results: 112 children had found
with mental retardation among 118 cases, made up 94.9 pencent.
0502PP29 Score of motor behavior was the lowest and score of language
THE CURATIVE EFFECT OF RELIEVING behavior was the highest, the DQ of chlidren of spastic type was
SPASTICITY FOR CEREBRAL PALSY TREATED higher than athetotic and mixed type, the DQ of children below
level II (GMFCS) was higher than children above level IV (GM-
BY VIBROACOUSTIC BY THERAPY FCS), the DQ of children above level V (GMFCS) was lower than
Lihong Zhang children below level III (GMFCS), all with statistical significance
Nanhai Affiliated Maternity & Children’s Hospital of Guangzhou Conclusion: Most children (94.9%) with CP have metal retardation.
University of TCM (China) Their stucture of intelligence is abnormal. Their motor behavior is
the worse and the language behavior is the best. Severity degree
Purpose: To observe the curative effect of vibroacoustic therapy by (GMFCS) and clinical type influence intelligence development. The
relieving spasticity for Cerebral Palsy. Materials and Methods: 36 demage of intelligence is the most obvious in children with CP of
cases of Cerebral Palsy were treated by vibroacoustic therapy and mixed type. More serious of gross motor function in children with
listened to the Jiao Music for 30 min, we scale the adductor angle CP, more demage to intelligence.
and popliteal fossa angle and foot dorsiflexion angle before and after
for three times, To produce as an average figure. muscular tone in
addition, including calculate the CSS. Results: No examinee has bad 0502PP32
reation. We find that the score of the Cars measurement is obviously CLINICAL OBSERVATION OF CHILDREN WITH
discrepancy before and after the vibroacoustic therapy. p < 0.05 and the CEREBRAL PALSY THERAPY BY TRADITIONAL
angles of most of the children is impoved after the treatment. Conclu-
sion: Vibroacoustic therapy can obviously relieve the spasticity for CHINESE MASSAGE
Cerebral Palsy, accordingly improve their limb functions. Zhenhuan Liu, Yong Zhao, Lihong Zhang, Nuo Li,
Wenjian Zhao
0502PP30 Nanhai Affiliated Maternity & Children’s Hospital of Guangzhou
University of TCM (China)
THE CLINICAL STUDY OF THE CURATIVE
EFFECT OF CHILDHOOD AUTISM TREATED BY Purpose: Observation of traditional chinese massage therapy to im-
HEAD ACUPUNCTURE prove the ankle’s range of motion and the score of CSS of children.
with cerebral palsy. Materials and Methods: 286 children with the
Zhenhuan Liu 2004 symposium on the development of cerebral palsy children cer-

ebral palsy diagnostic criteria were treated by acupuncture massage cine is significantly better than that of simple speech therapy in the
along meridians, strengthening spleen and invigorating qi massage, rehabilitation treatment of cerebral palsy with speech disorder.
chiropractic,foot bottom massage, segmental massage, promotive
muscle strength massage and range of motion massage. The angle
of dorsiflexion of foot were measured and the score of CSS were 0502PP35
evaluated before and after the treatment. Results: According to the THE CLINICAL APPLICATION AND EVALUATION
standardization, there were 106 cases with marked effect (37.40%),
172 cases with effective (59.16%) and 8 cases with no-effect OF INFANTILE MASSAGE OF TONIFYING BRAIN
(2.84%). There were obvious improvement of the ankle’s range of IN PREVENTION OF CEREBRAL PALSY
motion and the the score of CSS (p < 0.05) after treatment 30 days. Zhenhuan Liu2, Jianying Ding1
Conclusion: Traditional chinese massage therapy in children with 1
Guangzhou University of TCM, 2Nanhai Maternity and Children’s
cerebral palsy movement disorders will be satisfied with short-term
effect, and there is converient, inexpensive and inspection, etc, are Hospital affiliated to Guangzhou University of TCM (China)
worthy of further promotion and research. Purpose: To evaluate infantile massage of tonifying brain on brain
damage syndrome children to prevent cerebral palsy. Materials and
Methods: 43 high-risk infants with moderate-serious brain damage
0502PP33 syndrome hospitalized between 2006-2008 were chosen to study. They
ANALYSIS OF ERYTHROCYTE AGGREGATION were all age 2-6 months, and 19 cases age 2~3 months, 20 cases age
AND NAILFOLD MICROCIRCULATION IN 4~5 months, 4 cases age 6 months; 38 cases were mail, 5 cases were
CHILDREN WITH CEREBRAL PALSY femail; factors of high-risk in perinatal period include: intrauterine
fetal distress 8 cases; fetal age: < 32 weeks 4 cases, 32~34 weeks 2.
Zhenhuan Liu, Xuguang Qian 34~37 weeks 9 cases; small for date infant 3 cases; hypoxic-ischemic
Nanhai Affiliated Maternity and Children’s Hospital of Guangzhou encephlopathy 12 cases; jaundice 18 cases; intracranial hemorrhage
University of Traditional Chinese M (China) 6 cases; asphyxia 12 cases; pneumonia of newborn 3 cases; hyaline
membrane disease 2 cases; respiratory failure 6 cases; hypoglycemia
Purpose: To study the haemorheology feature of children with cer- 3 cases; septicemia 2 cases; purulent meningitis 2 cases and other
ebral palsy by erythrocyte aggregation and nailfold microcirculation. diseases such as premature rupture of membranes, scleredema ne-
Materials and Methods: Erythrocyteaggregation of 73 children with onatorum and anaemia, etc. they were treated mainly with infantile
cerebral palsy were tested by RBC observation and clinical data massage of tonifying brain, such as attacking vital points of DU
analytical system made by Beijing Lairun medical limited comany meridian, benefiting intelligence, strengthening the qi of spleen,
and Tsinghua University image and graph research institute. Nailfold chiropractics and thenar massage. Attacking vital points of DU me-
Microcirculation was also tested by microcirculation microscope of ridian: to attack the 13 points of DU meridian to harmonize the yin
type WX-6. Results: Correlation test between the extent of cerebral and yang, replenishing qi and blood and invigorate original qi, this
palsy and Erythrocyte aggregation has been certified (p < 0.05). The skill should be conducted 15~25min every time, once a day. Massage
difference of the obstacle of heightening erythrocyte aggregation of benefiting the intelligence: to massage the points in head, face,
between mild, moderate and severe groups were significant (p < 0.01). body and limbs, such as shenting, benshen, sishencong, shenmen,
The erythrocyte aggregation of moderate and severe group was higher tongli, meiguan, laogong and lianquan, in order to achieve the goal
than that of mild group (p < 0.05). But there were no significant dif- of promoting flow of qi and blood, dredging meridians, coordinating
ferences between moderate and severe group (p > 0.05). 97.22% of the function of zang and fu organs, as well as ren and du meridians
patients had obstacle of nailfold microcirculation including short and to benefit intelligence. This skill should be conducted 20~30 min
small loops, significant spasm of input branch, fewer loops, eryth- every time, once a day. Massage of strengthening the qi of spleen:
rocyte aggregation. There were no significant differences between Abdominal rubbing exercise, pushing abdominal Yin-Yang, pushing
mild,moderate and severe groups. Conclusion: Obstacle of nailfold and kneading middle pigastrium, invigorating the spleen meridian,
microcirculation and erythrocyte aggregation generally existed in the pushing stomach meridian, each skill should be conducted 100~200
children with cerebral palsy. The degree of erythrocyte aggregation times every time, once a day. Chiropractics: 20~30 min every time,
was associated with the state of the illness: severer state. once or twice a day. thenar massage: by stimulating the reflecting
areas on the footplate of brain, cerebellum, heart and kidney to balance
the function of the body, the skill include palpating, manipulation,
0502PP34 pinching, and twisting. This skill should be conducted 10~15 min,
TREATMENT OF CEREBRAL PALSY WITH once or twice a day. Assisted with herb medicated bath, five-elements
SPEECH DISORDER BY LINGUISTIC TRAINING music(heart, liver, kidney and spleen CD) listening treatment, physical
therapy, audiovisual and early education. All the methods of therapy
AND ACUPUNCTURE should be conducted 2~3 times every week, the course of treatment is
Zhenhuan Liu 20 days, and the next course begin after 20 days’ rest, 3 courses make
Cerebral Palsy of Rehabilitation Center, Nanhai Affiliated Mater- up a great course of 3 months long. The development quotient (DQ)
nity & Children’s Hospital of Guangzhou University of Traditional is tested in the beginning of the therapy, after 3 months’ therapy, and
Chinese Medicine (China) after 1.5 year by Gesell developmentdiagnosis table. The computer-
ized tomography, brain-stem auditory evoked potential, visual evoked
Purpose: To study the best way to treat the children with cerebral potential are checked before and after the therapy. Results: The DQ
palsy and speech disorder. Materials and Methods: 76 children with (SD) in the beginning, after 3 months, after 1.5 year are 35.25 ± 28.27,
cerebral palsy and speech disorder were studied by randomized con- 65.60 ± 13.50, 74.63 ± 13.53, the latter two compared with that before
trolled trial since 2000. 38 children in treatment group was treated the therapy p = 0.000, DQ of five functional areas were all significantly
by speech therapy combined with sharpening mind and inducing higher than that in the beginning. After 3 months’ and 1.5 year, 18
consciousness acupuncture. The control group were treated only by cases and 31cases gain normal development respectively, 12 cases
speech therapy and one treatment course is 3 months. Sharpening had sequela of development delay (DD), take 28.0% of all the 43
mind and inducing consciousness acupuncture was used every other children, much lower than the reported data of 80–100%, between
day and one treatment course is 30 times. Results: The clinical them, 11 cases had light and 1case had moderate DD. After therapy,
good improvement rate shows: the treatment group(27/38) 71%, of the 20 cases with abnormal vision conduct path, 7 cases recovered,
control group (13/38) 34.44%, X2 = 10.34, p < 0.01. The speech 1case improved among the 11 cases re-examined; of the 19 cases with
DQ after treatment shows: treatment group 56.36 ± 19.77, control abnormal audition conduct path, 10 cases recovered, 2 cases improved
group 46.96 ± 15.63 t = 2.524, p < 0.05. Conclusion: The method of among the 17 cases re-examined; of the 30 cases with maldevelopment
combination of the traditional Chinese medicine and the west medi- of brain, 9 cases got normal development and 18 cases improved; Of

the 2 cases with encephalomalacia, 1 case improved; Of the 2 cases body height, the normalized latency and peak amplitude of APC were
re-examined with intracranial hemorrhage, 1 case restored. Conclu- only affected by reaching distance but not by age. Conclusion: APC
sion: To treat high-risk infants with BDS with infantile massage of is affected by reaching distance, but not influenced by age. The larger
tonifying brain can promote brain development, repair the injuried the distance, the longer (occurring earlier) the latency and the bigger
nerve, enhance the development of motor and cognition, and can the amplitude of APC. Children at the age of 5–6 years may have fully
prevent the occurrence of cerebral palsy effectively. developed the APC in standing while performing a forward reach task
to the similar level as the young adults.
0502PP36
0502PP38
CLINICAL OBSERVATION ON EFFECT OF
RELIABILITY OF CLASSIFICATION OF
CLEARING THE GOVERNOR VESSEL AND
SAGITTAL GAIT PATTERN IN CHILDREN WITH
REFRESHING THE MIND NEEDLING ON HEAD
BILATERAL SPASTIC CEREBRAL PALSY
SPECI AND CT SCANNING OF CHILDREN WITH
CEREBRAL PALSY Dong Jin Kim, Ki Jung Kim, Dong-Wook Rha, Eun
Sook Park
Zhenhuan Liu Dept. and Research Institute of Rehabilitation Medicine, Yonsei
Nanhai Affiliated Maternity & Children’s Hospital of Guangzhou Univ. (Republic of Korea)
University of Traditional Chinese Medicine (China)
Purpose: Classifications of abnormal gait patterns have been sug-
Purpose: To investigate action and value of acupuncture in Cerebral gested to help clinicians understand the pathomechanism of gait
Palsy rehabilitation. Materials and Methods: 100 spasm Cerebral abnormality and plan standardized care pathways in children with
Palsy patients from 2 to 7 years old were randomly divided intotwo cerebral palsy(CP). Qualitative classifications based on clinical
groups. Acupuncture group: 50 patients were treated with head observation are commonly used because they can be done without
acupuncture and body acupuncture; Rehabilitation-training group: expensive kinematic analysis equipment. However, there have been
50 patients were treated with physical therapy of Bobath and Vojta only a few studies discussing the reliability of video observation
methods. Results: The total effective rate acupuncture and rehabili- based classification. Therefore, we investigated the reliability of
tation-training group were obvious higher than that of rehabilitation- classification of sagittal gait patterns in children with bilateral spastic
training group. After treatment the DQ value of rehabilitation-training CP. Materials and Methods: Video clips of walking and sagittal
+ acupuncture group were higher than that of rehabilitation group kinematic data obtained by computerized motion analysis system of
(p < 0.01). In acupuncture and rehabilitation-training group were 91 children with bilateral spastic CP were reviewed individually by
higher than that of rehabilitation group (p < 0.01). In acupuncture a single expert who has clinical pediatric rehabilitation experience in
and rehabilitation-training group, improvement rate of brain dys- moreover 3 years and one resident educated on the classifications of
phasia, brain atrophy in skull CT and recovery normal rate of skull gait patterns through the kinematic analysis and video observation.
SPECT were obvious higher than that of rehabilitation-training group Abnormal gait patterns were classified into four groups using the
(t = 4.731, t = 5.971, p < 0.01). Conclusion: Acupuncture can obvi- method described by Rodda et al. (true equinus/jump gait/apparent
ously increase cerebral blood flow (CBF) and improve cerebral cell equinus/crouch gait). Reproducibility of classification was analyzed
metabolism, promote partial or complete compensation of cerebral between video observation and kinematic analysis. Reliability of
function and the restoration and function of plasticity of cerebral classification between the two observers was also analyzed in terms
tissue in children with cerebral palsy. of video observation and kinematic analysis. Weighted kappa statistics
were used to summarize ‘intra-rater’ and ‘inter-rater’ repeatablility.(
by SAS 9.1.3). Results: According to analysis derived by the expert,
0502PP37 group I (true equinus) and group II (jump gait) patterns showed higher
A DEVELOPMENTAL TREND OF THE reproducibility of classification than group III (apparent equinus)
ANTICIPATORY POSTURAL CONTROL OF and group IV (crouch gait) patterns between video observation and
kinematic analysis. According to analysis derived by the resident,
FORWARD REACHING IN STANDING only group I patterns showed higher reproducibility. Group I (true
Pei-Yu Yang1, Feng-In Yao2, Hsiang-Chun Cheng3,4, equinus) and group IV (crouch gait) patterns showed higher inter-rater
Rong-Ju Cherng2,3 agreement than group II (jump gait) and group III (apparent equinus)
on kinematic analysis. Group III (apparent equinus) patterns showed
1
Department of Physical Medicine and Rehabilitation, China
lower inter-rater agreement than the other groups on analysis through
Medical University Hospital, 2Department of Physical Therapy, video observation. The classification of gait patterns by the expert
National Cheng Kung University, 3Institute of Allied Health Sci- showed substantial reproducibility between video observation and
ences, National Cheng Kung University, 4Department of Physical kinematic analysis. ( k = 0.67, p < 0.001), in contrast by the resident
Therapy, Hung Kung University (Taiwan) showed low reproducibility. (k = 0.34, p < 0.001) There also was
Purpose: The purposes of this study were to examine the effect of substantial inter-observer reliability in kinematic analysis. (k = 0.66,
target distances on anticipatory postural control (APC) and the devel- p < 0.001). However, video observation showed low inter-observer
opmental trend of the effect of target distances on APC in a forward reliability. (k = 0.37, p < 0.001). Conclusion: The gait classification
reaching task. Materials and Methods: Sixty three subjects, divided based on video observation was substantial reproducibility with
into 5 age groups (5–6, 7–8, 9–10, and 11–12 years old and young kinetic analysis in expert, but it was low agreement in resident. And
adults) participated in the study. Each subject performed a forward video observation showed low inter-observer reliability.
reach task to press a button which was placed at four distances adjusted
by arm length and the maximal forward reach distance. The data of 0502PP39
center of pressure (COP), free torque (Tz), reaction time (RT) and
muscle activity were collected simultaneously. Main effects of age VALIDITY AND RELIABILITY OF
group, reaching distance, and their interaction were tested using a TROCHANTERIC PROMINENCE ANGLE TEST
two-way ANOVA repeated measures. Results: The results showed that IN THE MEASUREMENT OF FEMORAL NECK
the latency of COP and Tz increased as reaching distance increased ANTEVERSION IN CHILDREN WITH SPASTIC
and as age decreased; the peak amplitude of COP and Tz increased
CEREBRAL PALSY
as reaching distance increased and as age increased. RT was longer
as reaching distance increased and as age decreased. No interaction Dong-wook Rha, Eun Sook Park, Dong Jin Kim, Ki
effects were noted. However, after normalization of variables with Jung Kim

Department and Research Institute of Rehabilitation Medicine, in autism children, stimulus generalization training was applied to
Yonsei University (Republic of Korea) this study. Results: The results indicated that the child acquired
the sequences of scripted verbal and motor responses quickly and
Purpose: In patients with spastic cerebral palsy (CP), the most generalized this performance across new stimuli (toys) and settings
common gait abnormality is the toe-in gait pattern, which is com- (home). In addition, the participant successfully engaged in the three
monly concurrent with increased femoral neck anteversion (FA). scenarios with researcher during generalization probes. Scripted
Trochanteric prominence angle test (TPAT) is a clinical examination motor responses for the three tasks increase from a baseline level
method commonly used for quantifying FA, but its validity and below 15 % to intervention and maintenance a stable level above
reliability have been rarely evaluated. This study was performed 80%. Scripted verbal responses for the three tasks increase from a
to evaluate the validity and the reliability of TPAT in children with baseline level of 0 % to intervention and maintenance level above
spastic CP. Materials and Methods: We recruited 44 limbs of 22 80%. Respond generalization also found during intervention and
children with bilateral spastic CP. Trochanteric prominence angle maintenance phrases. This study illustrated that video modeling
test (TRAT) is performed as following description. The patient is was an effective tool for teaching play skills to preschoolers with
laid down in a prone position and the examiner stands on the left autism. Conclusion: The study showed favor results of video mod-
side of the patient in order to measure the right hip. The left hand is eling on the effects of play skills for preschoolers with autism. The
used to palpate the greater trochanter while the right hand interally researchers excitedly found that the child displayed more symbolic
rotates the hip, with the patient’s knee flexed 90 degrees. At the reactions to the same toy and generate new playing skills through
point of maximum trochanteric prominence, representing the most video modeling introduction. The results also indicated that the
lateral position of the trochanter, the angle is subtended between the child has the behavior of taking turns and waiting because they
tibia and the true vertical. In order to determine reliability, TRAT can play with researcher and share the different roles in the scripts
is performed by observer 1 and the angle between the tibia and although their activities and language still based on the original
the true vertical is measured and recorded by observer 2 using an playing scripts. It means they have upgraded to the advanced level
angle finder. The roles are changed between the two observers, and of playing skill. In addition, the researchers found the child develop
the TRAT measurement is repeated. On a different day, TRAT was the learning property such as delayed mimic action and mimic lan-
measured for the second time by observer 1 on the same patient, guage during the experiment. Based on the result and discussion,
while observer 2 measured the trochanteric prominence angle. To it is suggested that following two directions should be focus for
determine validity, comparisons between the FA angles measured future studies: the property of learning in the influence of learning
by TPAT and computerized tomography(CT) were assessed. Intra- of playing skill; the influence of social skills and language ability
class correlation coefficient were used to evaluated ‘intra-rater’ and by increasing of playing skill.
‘inter-rater’ reliatbility of TRAT.(by SAS 9.1.3) Pearson correlation
coefficient were used to evaluated validity of the FA angles measured
by TPAT and CT imaging.(by SAS 9.1.3). Results: TPAT showed 0502PP41
very high intra-observer reliability (ICC, intraclass correlation coef-
A NEW EVALUATION METHOD OF STUDYING
ficients = 0.95) and good inter-observer reliability. (ICC = 0.72–0.76)
In terms of the concurrent validity, the correlation coefficient FIT AND UNFIT OF MOTOR FUNCTION
between the FA angles measured by TPAT and CT was 0.50-0.58. IMPROVEMENT OF CEREBRAL PALSY RATS
(p < 0.001) Conclusion: When depicting femoral anteversion by
Lan-Min Guo, Xiao-Jie Li, Li-Ping Tan
clinical examination, trochanteric prominence angle test showed
reasonably high intra- and interobserver reliability. However, valid- Children Neural Rehabilitation Laborary of Jiamusi University,
ity of trochanteric prominence angle test was moderate compared Rehabilitation Medicine College of Ji (China)
to computerized tomography measurements. Purpose: Union applicates suspension test and improved BBB
motor function assessment to Study fit and unfit of motor function
improvement of cerebral palsy rats. Materials and Methods: 1)
0502PP40
Establishment of model and grouping: 48 Wistar pregnant rats were
TEACHING PLAY SKILLS TO A CHILD WITH consecutively injected with LPS (450 µg/kg) for two days on gesta-
AUTISM : EFFECTS OF VIDEO MODELING tion 18 days. Control group pregnant rats were injected the same
dose of saline. Selected randomly control group (A) neonatal rat
Yu-Chun Liu1, Hua Feng2, Chien-Chih Liao3, Li-Wei (n = 60),and LPS group (n = 120), divided LPS group into interven-
Chou1,4,5, Hsun-Ying Chen1 tion group B1 (n = 60), and nonintervention group B2 (n = 60). The
1
Department of Physical Medicine and Rehabilitation, China intervention group was intervented early. The nonintention group
Medical University Hospital, 2Graduate Institute of Rehabilitation and the control group were raised routely. 2) Early intervention: The
Counseling, National Changhua University Education, 3Depart- 2 days rats of intervention group were early touched until 2 weeks,
ment of Psychiatry, China Medical University Hospital, 4School one week after birth were given enriched environment and two
of Chinese Medicine, College of Chinese Medicine, China Medi- weeks were given generally load swimming training up to six weeks.
cal University, 5Department of Physical Therapy, China Medical 3. Identification of cerebral palsy rats for 25-day-old: the CP rats
University (Taiwan) identified in the B1 group (B1CP) continued early interventing, the
CP rats identified in the B2 group (B2CP )continued raising routely.
Purpose: This study evaluated the effectiveness of video modeling Selected 10 rats from group A as control group (A’) rasing routely,
intervention on acquisition, maintenance and generalization of play others would be killed. The rats of 25 days in each group (A’, BICP,
skills to preschool children with autism. Materials and Methods: B2CP) were respectively carried out neurobehavior detection and
A multiple-probe across behaviors design was used to demonstrate improved BBB motor function assesments, and statistical analysis.
experimental control in this study. A 3 years and 10 months old girl 42-day-old control group rats in each group (A’,B1CP,B2CP) were
was participant in this research. The multiple-probe design was in- carried out suspension test and improved BBB motor function as-
cluded from baseline, intervention, and stimulus generalization into sessment, and statistical analysis. Results: 1) Neurological behavior
maintenance. Independent variable was video modeling of the play test of 25-day-old neonatal rats, B1 group identified seven CP rats,
skills, and dependent variables were three play skills as shopping, B2 group identified thirteen CP rats. A group did not identify CP
boarding a train and operating animal blocks. During intervention rats. 2) Comparison of the test results of the 25-day-old and 42
phrase, the child watched the video two times without experimenter- days of cerebral palsy rat in B1 group: suspension test, slopes test,
implemented reinforcement, and further prompting or correction open-field experiments, resist captured reaction p < 0.01,and others
procedures was not used during intervention. Experiment scenarios p > 0.01. Improved BBB motor function score p < 0.01; Comparison
included verbal and motor responses were videotaped using adult of the results showed no significant differences in cerebral palsy
models. In order to increase the ability of response generalization rats of B2 group and control group rats of 25-day-old and 42-day-

old. Conclusion: Using both suspension test and improved BBB in March 2008 to March 2009 (64 were diplegia, 32 hemiplegia).
motor function assessment to improve motor function of cerebral All the children who were aged between 2-5 years were diagonosed
palsy rats caused by intrauterine infection is superior to the neu- as spastic cerebral palsy,and could stand alone for at least 30s.
robehavioral detection. They were devided into 2 groups:experimental group and control
group,each of them had 48 patients. Before the feedback training
,we assessed the balance function of all the children using the
0502PP42 BPM,and there’s no difference between the 2 groups. Then we used
THE EFFECTS OF EARLY INTERVENTION ON both the Bobath therapy and the feedback training on the children
EXPRESSION OF S-100 PROTEIN AND CHANGES in experimental group. And the children in the control group took
just the Bobath therapy. Both treatments lasted for 2 months. After
OF NEUROETHOLOGY IN FILIAL RATS WITH that, we re-assessed the balance function of all the children using
BRAIN INJURY the BPM. Results: In children with diplegia two-tailed, independent
Wei Pang, Xiao-Jie Li, Lan-Min Guo t test was used before the feedback training to compare the balance
parameters (LNG, Envarea, Rectangular area, L/Earea, Gravity
Children Neural Rehabilitation Laborary of Jiamusi University, Excursion) between the experimental group and the control group ,
Rehabilitation Medicine College of Ji (China) and there’s no difference (p = 0.079). matched pair t test was used to
Purpose: To research the effects of early intervention on the expres- compare the balance parameters of the two groups before and after 2
sion of S-100 protein and changes of neuroethology in filial rats months’ feedback training, and there is difference with significance
with brain injury. Materials and Methods: Wistar rats in intrauterine (p < 0.05) in (LNG, Envarea, Rectangular area, L/Earea). But there’s
infection group received Lipopolysaccharide (LPS) intraperitoneal difference without significance (p > 0.05) in (Gravity Excursion)
injection at the 18th and 19th day after pregnant,and the rats in normal between the experimental group and control group. According to the
saline group receive the same dosage of normal saline.Take the pla- Two-tailed, independent t test,there’s difference with significance
centa for pathology detection after litter size.Take 30 filial rats from in the balance parameters(except Gravity Excursion) between the
the normal saline group randomly as B group,and take 50 filial rats experimental groups before and after feedback training (p < 0.05).
from intrauterine infection group as A group. Divided the A group into In children with hemiplegia, two matched pair t test results showed
A1 group (intervention group, n = 20) and A2 group (non-intervention that there’s difference with significance (p < 0.05) in (Gravity Excur-
group, n = 30). 1 day after born, take 10 rats from A2 group and B sion) beetween the experimental group and the control group, but
group respectively, decapitated and take their brain to detect the there’s difference without significance (p > 0.05) in other parameters.
expression of S-100 protein. 25 days after born, detect the changes Two-tailed, independent t test on the (Gravity Excursion) before and
of neuroethology in these group and thereafter decapitated, take their after feedback training showed there’s difference with significance
brain to detect the expression of S-100. Results: The placenta of rats (p < 0.05), and there is difference without significance (p > 0.05) in
in intrauterine infection group showed vascular engorgement, dropsy, other parameters. Conclusion: Both Bobath therapy and feedback
and neutrophilic granulocyte soakage. Compared with B group,the training can improve the balance function of children with spastic
expression of S-100 in A2 group was markedly increased (p < 0.01) cerebral palsy. A treatment that combines the Bobath therapy and
in 1 day-old rats. The most strong expression of S-100 appeared in feedback training together is more effective than a treatment that
A2 group,and the most weak expression appeared in the B group, uses only Bobath therapy.
the A1 group was between them. The differences between two group
showed significant. In suspension experiment, postural reflex postural
reflex, muscle tension test,involuntary movement test and open field 0502PP44
test,the scores of A2 group were lowest, after intervention,the scores THE RELATIONSHIP BETWEEN BMI (BODY
of these test in A1 group were higher than A2 group (p < 0.05),but MASS INDEX) AND THE SEVERITY OF
still lower than B group. Rats in A2 group spend more time than rats
in A2 group and B group, after intervention , amimal in A1 group DEVELOPMENT DELAY
did beter than these in A2 group (p < 0.05), but still spend more time Willy Chou, Wu Mei-Yi, Hui-Chun Juan, Mei-Zu Ko,
than rats in B group. Conclusion: Intrauterine infection could induce Chien-Nan Yeh, Hing-Man Wu, Rong-Bin Hong
brain damage of rats, and increase the expression of S-100. Early Department of Physical Medicine and Rehabilitation, Chi Mei
intervention could decrease the expression of S-100 and improve Medical Center (Taiwan)
the rehabilition of motion abnormality and dystropy of rats induced
by brain damage. Purpose: To investigate the relation between body mass index and
development delay severity. Materials and Methods: We collect the
944 data from the Conjoint Assessment Center for Children with
0502PP43 Developmental Delay of Chi Mei Medical Center. We calculated
ASSESSMENT AND FEEDBACK TRAINING WITH body mass index (BMI; kg/m2) from charted height and weight. We
THE BALANCE PERFORMANCE MONITOR IN recorded cognition, gross motor function, fine motor function, speech,
CHILDREN WITH SPASTIC CEREBRAL PALSY and social condition on the basis of clinical descriptions in clinic notes.
Cognition is initially screened with RPDQ and then further evaluated
Lihua Zhang, Yanli Hu, Xiao-Jie Li, Zhimei Jiang, Lan- according to age; if the age of the children is ≤ 4-year-old, cognition is
Min Guo, Wei Zhang, Caijun Jin further evaluated with Baley mental scale record form; if the age of the
College of Rehabilitation Medicine, Jiamusi University (China) children is > 4-year-old, cognition is further evaluated with WPPSI-R.
Speech is evaluated with two methods. First method: if the age of the
Purpose: Recently, more and more people give attention to balance children is < 3-year-old, speech is evaluated with non-formal form;
training.And beside traditional Bobath therapy,there’s a way called if the age of the children is between three to six, speech is evaluated
feedback training with the Balance Performance Monitor(BPM). with Preschool Language Scale (PLS); if the age of the children is
In children with cerebral palsy (CP) , the main method to improve between six to twelve, speech is evaluated with Child Language Scale
balance function is traditional Bobath therapy, and the former (CLS); Second method: speech is evaluated with Comprehensive
studies on feedback training with the BPM were based on a small Developmental Inventory for Infants and Toddlers (CDIIT). Gross
population and the effects of this method on children with CP are motor and fine motor are evaluated with CDIIT. Social development
not clear enough. So we assessed the balance function of a group of is evaluated with Chinese Child Development Inventory (CCDI). As-
children with CP using the BPM,and treated them using feedback sociations were analysed with Pearson’s distribution. Results: There
training for a certain period to see the effects of feedback training is no significant difference between between BMI of children with
with BPM. Materials and Methods: 96 children were selected in The development delay and cognition (p = 0.168). If BMI of children with
Rehabilitation center for child cerebral palsy, heilongjiang province development delay is higher, speech development is better (p < 0.05).

If BMI of children with development delay is higher, gross motor and 4.5–6.5 years). At baseline, there were significant negative correlations
fine motor are better (p < 0.01). If BMI of children with development between age and bilateral coordination, balance, running speed and
delay is higher, social development is better (p < 0.05). Conclusion: agility, and strength subtests. After 2-months therapy, children with
If BMI of children with development delay is higher, speech, gross DCD in experimental and control groups both had positive effects
motor, fine motor, and social development are better. on gross motor performance by Bruininks-Oseretsky Test of Motor
Proficiency Scale II. Comparing with baseline data, the post-therapy
data of experimental group got 2.6 standard score improvement and
0502PP45 control group got 1.43 standard score improvement on bilateral coor-
PRELIMINARY INVESTIGATION OF EFFECTS OF dination subtest (p = 0.44), experimental group got 2.8 standard score
improvement and control group got 0 standard score improvement on
WRIST HAND ORTHOSES TREATING CEREBRAL balance subtest (p = 0.19), experimental group got 2.53 standard score
PALSY CHILDREN WITH ADDUCTION OF THUMB improvement and control group got 1.36 standard score improvement
Xiao-Jie Li, Zhi-Hai Lu, Shi-Ling Zhang, Li-Ping Wang on running and agility subtest (p = 0.41), and experimental group got
3.33 standard score improvement and control group got 0.21 standard
Children Neural Rehabilitation Laboratory of Jiamusi University, score improvement on strength subtest (p = 0.038). Traditional pediatric
Rehabilitation Medicine College (China) rehabilitation had positive effects on bilateral coordination, running
Purpose: To observe the effects of wrist hand orthoses treating speed and agility, and strength in children with DCD. Children with
cerebral palsy children with adduction of thumb. Materials and DCD who receive both WBV plus traditional rehabilitation get better
Methods: Patients with spastic hemiplegia were divided into ex- improvement in strength performance. We also found WBV exercise
perimental group (14 cases) and control group (15 cases) and the was well tolerated and no serious adverse events were observed in any
general materials of the two group has no significant difference. of the subjects during this 2-months WBV exercise program. Conclu-
Children in the two group received routine rehabilitation training for sion: The present study showed the beneficial effect of WBV exercise
3 months. Children in experimental group wore wrist hand orthoses in addition to traditional pediatric rehabilitation therapy in improving
for 4–8h/day besides routine rehabilitation training. Evaluation the gross motor performance in the children with DCD. Low intensity
index: PROM (passive abduction angle of carpometacarpal joints and short duration WBV exercise was safe and well tolerated in the
of thumb). FMFM scores: There were 10 terms in C region, scores: children with DCD.
0, 1, 2, 3. Results: The PROM was remarkably improved (p < 0.05),
FMFM scores obviously increased (p < 0.05) in experimental groups. 0502PP47
Conclusion: Wrist hand orthoses could improve spastic hemiplegia
children’s passive abduction angle of carpometacarpal joints of FUNCTIONAL PERFORMANCE AT SCHOOL
thumb and fine motor function. This research need to enlarge sample IN CHILDREN WITH DEVELOPMENTAL
quantity and follow-up survey observe. COORDINATION DISORDER USING DIFFERENT
MOTOR TESTS
0502PP46 Yu-Wei Chen1, Mei-Hui Tseng1, Chung-Pei Fu2
TWO MONTHS EFFECTS GENERATED BY
1
School of Occupational Therapy, College of Medicine, National
Taiwan University and 2Department of Physical Medicine and Re-
WHOLE-BODY VIBRATION ON GROSS
habilitation, National Taiwan University Hospital (Taiwan)
MOTOR PERFORMANCE OF CHILDREN WITH
DEVELOPMENTAL COORDINATION DISORDER Purpose: Given the absence of gold standard for the assessment of mo-
tor skills, the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP)
Pei-Chi Hsiao1, Jung-Tai Liu1, Wan-Ju Chen1, Willy and the Movement Assessment Battery for Children (MABC) are the
Chou2, Heng-Ju Lee3 two most popular instruments used to identify children with develop-
1
Department of Physical Medicine and Rehabilitation medicine, mental coordination disorder (DCD) in clinics and in research. Some
Chi-Mei Medical Center Liouying Campus, 2Department of Physi- researchers, however, found that the two motor tests did not identify
cal Medicine and Rehabilitation, Chi-Mei Medical Center and the same children as motorically impaired so as to suggest that chil-
3
Department of Physical Education, National Taiwan Normal dren with DCD identified by the different motor tests would present
University (Taiwan) dissimilar performance. Since the impairment of DCD significantly
interferes with academic achievement or activities of daily living.
Purpose: The present study was conducted to determine the beneficial The study was, therefore, to explore possible differences in functional
effect of whole-body vibration (WBV) exercise in addition to tradi- performance at school. Materials and Methods: The sample consisted
tional pediatric rehabilitation therapy on bilateral coordination, balance, of 207 children from 8 elementary schools in Greater Taipei (male:
running speed and agility and strength of children with developmental 125, female: 82; age 7.62 ± 0.81 years). Children with developmental
coordination disorder (DCD). Materials and Methods: Thirty children disabilities and other neurological disorders were excluded. Twenty-
(21 boys and 9 girls), aged 4.5 to 6.5 years, with developmental coor- five were identified as DCD exclusively by the BOTMP whereas 42
dination disorder were randomly divided into experimental and control exclusively by the MABC. The functional performance at school was
groups (15 subjects each). The experimental group received traditional measured by 9 subscales of the physical task session in the School
rehabilitation plus whole body vertical vibration program, and the con- Function Assessment-Chinese Version (SFA-C). The association of
trol group only received traditional rehabilitation. All the participants in each subscale of the SFA-C with the status of being identified as DCD
both groups were similarly instructed to undergo pediatric rehabilitation was conducted by fitting two multivariate logistic regression models
therapy such as balance, coordination, and muscle strength training for the BOTMP and the MABC, respectively. Results: Children with
twice a week. Each time, these experimental group children received DCD identified by the BOTMP were more likely to have low scores
whole body vertical vibration stimulation for 30 seconds at a frequency on the Recreational Movement subscale of the SFA-C after adjusting
of 30Hz and amplitude of 1.2 mm for at total of six times, followed for the effects of the other covariates, such as demographic variables
by a 30-second break. WBV exercise was performed on an EN-Vibe and other subscales, in the fitted final logistic regression model (Odds
3444862 machine (Enraf-Nonius company, Holland). The period of this Ratio = 0.911 p < 0.05). Children with DCD identified by the MABC,
study was 2 months to evaluate the acute effects of WBV exercise. The on the other hand, were significantly associated with low scores on
gross motor performance at baseline and post-therapy were compared the Written Work after adjusting for the effects of the other covari-
by Bruininks-Oseretsky Test of Motor Proficiency Scale II, which ates (Odds Ratio = 0.919, p < 0.05). Conclusion: The results verified
evaluated gross motor performance including bilateral coordination the difference in the problems of functional performance at school
subtest, balance subtest, running speed and agility subtest, and strength among children identified as DCD by the two popular motor tests.
subtest. Results: The mean age of the participants was 6.3 years (range Children with DCD identified by the MABC were more vulnerable

to poor writing performance than those identified by the BOTMP, in Botley, Oxford), including walking velocity, cadence, temporal-
which the distinction between gross and fine motor items had been spatial measures of gait and joint angular motion in gait perform-
questioned. On the other hand, our result is consistent with previous ances. Statistical analysis was done by paired t test to explore the
study that poor motor proficiency measured by the BOTMP would differences between two walking conditions. Results: Compared to
affect children’s participation in extracurricular physical activities, the “preferred” condition, children with TS increased walking speed
such as those in the Recreational Movement. Thus, clinicians should (p < 0.001), cadence (p < 0.001) and step length (p < 0.001) in the “fast”
recognize the discrepant features of the two motor tests and clients’ condition. Further, all the above changes in the “fast” condition were
need for evaluating specific functional performance besides assessing related to significantly more hip flexion (p < 0.001) and knee flexion
motor problems, in order to design appropriate treatment plans. (p = 0.023) in the early stance phase, more hip flexion (p < 0.001) and
ankle dorsiflexion (p < 0.001) in the mid-swing phase, and decreased
maximal hip extension (p < 0.001) in terminal stance phase. In ad-
0502PP48 dition, they demonstrated significantly earlier to achieve maximal
THE EFFECT OF THE INTERACTIVE COMPUTER ankle dorsiflexion in the mid-stance phase (p < 0.001). Conclusion:
The results suggested that children with TS are capable to speed–up
PLAY TRAINING IN CHILDREN WITH CEREBRAL their walking velocities. According to the kinematic analyses, their
PALSY: A SYSTEMATIC REVIEW gait performances were significant different between two conditions.
Wen-Yu Liu1, Chia-Fa Liao1, Yang-Hua Lin1, Hen-Yu They demonstrated more flexion in the “fast” speed walking. Further
investigation including healthy control children is warranted.
Lien1, Alice M.K. Wong1,2, Chih-Hsiu Cheng1
1
Department of Physical Therapy & Graduate Institute of Rehabili-
tation Science, Chang Gung University and 2Department of Physical 0502PP50
Medicine and Rehabilitation, Chang Gung Memorial Hospital, OROS METHYLPHENIDATE IMPROVES THE
Taoyuan Branch (Taiwan) VISUAL-MOTOR INTERGRATION IN CHILDREN
Purpose: The purpose of this study was to review the evidence relating WITH ATTENTION DEFICIT HYPERACTIVITY
to the effect of interactive computer play (ICP) training in children DISORDER
with cerebral palsy (CP). Materials and Methods: A systematic
review was undertaken. The Pubmed, Medline, Cinahl, IEEE, and Li-Rong Lee1, Jeng-Yi Shieh2, Chi-Yung Shang3
CEPS databases were electronically searched from inception 1995
1
Department of Physical Medicine and Rehabilitation, Hsin Kong
to September 2009, using the keywords: computer game, virtual Wu Ho-Su Memorial Hospital, 2Department of Physical Medicine
reality, virtual environment, cerebral palsy and/or child. Articles that and Rehabilitation, National Taiwan University Hosptial and
met the study’s inclusion criteria were required to: (i) be published 3
Department of Psychiatry, National Taiwan University Hospital
in an English language peer reviewed journal, (ii) involve the use of (Taiwan)
ICP; and (iii) report body structures/functions and/or activity and
participation oriented outcome measures. Two assessors independ- Purpose: To examine if OROS methylphenidate (Concerta ER 18mg/
ently assessed each study’s quality using the single subject research tab) may improve the motor performance in children with attention
design (SSRD) grading system by Logan et al. Results: A total of nine deficit/hyperactivity disorder (ADHD). Materials and Methods: 23
studies were included in this review. There were three case reports children (6 to 8-year-old) were enrolled with the diagnosis of ADHD.
and six single subject research. Only one study was judged to be the They all had rehabilitation and 9 of them took OROS methylphenidate
Logan’s moderate strength and the other studies were weak. All stud- (18 to 36 mg/day) under prescription. Motor function was measured
ies were the Level V quality of evidence. No adverse effect had been with Peabody Developmental Motor Scales-II (PDMS-2) before and
reported. Despite of low level of evidence, all studies demonstrated after treatment. Results: After one year treatment, statistical analysis
generally positive effect of the ICP training. Conclusion: The ICP is of the data indicated that children with ADHD all improved gross and
a potentially tool for the rehabilitation of children with CP. While the fine motor performance in 5 subtests in PDMS-II. However, in 9 chil-
findings of this review were generally positive, the level of evidence dren having rehabilitation plus taking OROS methylphenidate, they
is too low and the research quality is too weak to permit a definitive had significant increased fine motor scores especially in the subtest
assessment of its effectiveness for children with CP. Further study in of visual-motor integration (p < 0.05). Conclusion: In a dose rang-
the form of rigorous controlled studies is warranted. ing from 18 to 36 mg per day, OROS methylphenidate may improve
the fine motor performance in children with ADHD especially in the
subtest of visual-motor integration.
0502PP49
THE EFFECT OF WALKING SPEED ON THE GAIT 0502PP51
OF CHILDREN WITH TOURETTE SYNDROME: A PILOT STUDY OF MIRROR THERAPY FOR
PRELIMINARY STUDY SPASTIC CEREBRAL PALSY
Wen-Yu Liu1, Pei-Hsuan Lin1, Huei-Shyong Wang2, Pornsawan Posawang1, Ubonwon Wathanadilok1, Arun
Fuk-Tan Tang3,4, Alice M.K. Wong3,4, Hen-Yu Lien1 Chirawatkul2
1
Department of Physical Therapy and Graduate Institute of Reha- 1
Sirindhorn National Medical Rehabilitation Centre, Ministry of
bilitation Science, Chang Gung Unive, 2Department of Pediatric Public Health and 2Konkean University (Thailand)
Neurology, Chang Gung Memorial Hospital, Children’s Hospital,
3
Department of Physical Medicine and Rehabilitation, Chang Gung Purpose: To evaluate the effects of mirror therapy on upper extremity
Memorial Hospital, Lin-Kao Branch and 4Department of Physical function of cerebral palsy. Materials and Methods: Eight children aged
Medicine and Rehabilitation, Chang Gung Memorial Hospital, between 3–8 years diagnosed as spastic cerebral palsy were studied.
Taoyuan Branch (Taiwan) They were 6 hemiplegia and 2 diplegia. The children who can follow
two steps command and have more than 50 percent of difference in
Purpose: To explore the effect of walking speed on the gait of chil- hand function tested by Modified Jebsen Taylor test were eligible to
dren with Tourette Syndrome (TS). Materials and Methods: Twelve training. Training was done by an occupational therapist as 15+15 min
children aged 7–12 years voluntarily participated in this study. All session once a day, 5days a weeks for 4 consecutive weeks. Outcome
the children were instructed to walk at the two self-selected speeds: measurements were performed by another occupational therapist at
“preferred” and “fast”. Each child completed two successful trials day 0, 1 month and 3 months after day 0 on 1) time to perform Modi-
of each walking condition. The gait parameters were collected using fied Jebsen-Taylor test of hand function 2) muscle tone by modified
six cameras with the VICON 370 system (Oxford Metrics Limited, Ashworth scale 3) hand and arm muscle power 4) hand sensation 5)

ability of hand and arm control. Results: At post training, seven cases Six children with diplegic CP and age-matched, gender-matched TD
did Modified Jebsen-Taylor test of hand function with less time than children participated in this study between March 2008 and October
the baseline. The time reduction was 26–285 seconds (average110.14 2008. In Human motion lab, they were asked to perform seated reach
seconds) or 7.14–52.97% of baseline (average 18.4%). But only three tasks with 120% arm-length distance in three reaching directions
still had improvement at three months after day 0. The muscle power (anterior, laterally, and medially). The reaching speed was modu-
and ability of hand and arm control tends to improve at post training lated by a metronome at a rate of 46 beats/min for all participants.
but still unchanged at three months after day 0. Hand sensation and Postural control performance was measured with 2 force plates
muscle tone were not change from baseline. Conclusion: Mirror (underneath chair and feet) at a sampling rate of 150 Hz. A hand
therapy technique probably improves hand function, muscle power marker was captured with a motion capture system (sampling rate:
and ability of hand and arm control in spastic cerebral palsy. 150 Hz) to define reaching events. Maximum excursion of center of
pressure (COP) in anterior-posterior (AP) and medial-lateral (ML)
directions, peak reaction force (RF) in three directions (AP, ML, and
0502PP52 vertical), and mean AP_RF and vertical RF during hand acceleration
TREATMENT EFFICACY OF PHONOLOGICAL and deceleration phases were presented during reach-out phase.
TREATMENT FOR BACKING PROCESS Descriptive statistics and two-way MANOVA were used. Significant
level < 0.05 was used. Results: Maximum COP_AP excursion was
Ming-Chun Li1, Pao-Chuan Torng2 greater in CP group than in TD and approaching significant differ-
1
Department of Rehabilitation Medicine, Taipei Veterans General ence (F = 3.79, p = 0.06). Direction effect was significant (F = 6.00,
Hospital and 2Department of Speech and Hearing Disorders and p = 0.002), but only existed in TD group. However, the interaction
Sciences, National Taipei College of Nursing (Taiwan) effect was not significant (F = 3.14, p = 0.09). Maximum COP_ML
was greater in CP group than in TD group (F = 10.56, p < 0.01). All
Purpose: To investigate the treatment efficacy of different selection children showed greater max. COP_ML when reaching laterally and
of target sounds for children with backing process, a common pho- medially. Again, no interaction effect was noted. Regarding force
nological process in Taiwan Mandarin-speaking children. Materials data, only chair peak force_ML revealed group and direction effects
and Methods: Twenty-two preschool children from Nantou, Taiwan (group: F = 5.22, p = 0.03; direction: F = 28.13, p < 0.01). Children
with backing process were recruited in the study. The children’s error with CP demonstrated higher peak force_ML compared with TD
patterns include substitution of Mandarin alveolar stops /t, th/; alveolar, children. During acceleration phase of hand reach, children with
alveolopalatal, and retroflex fricatives/s, s, s/; and alveolar, alveol- CP showed a tendency of braking force on chair and pushing force
opalatal, and retroflex affricates /ts, tsh, ts, tsh, ts, tsh/ with velar stops on feet with great variability as reaching laterally and medially. TD
and fricative /k, kh, x/. Two target sounds for treatment were selected Children showed braking force on chair with feet force oscillating
based on the complexity of the target sound in the Mandarin sound around zero as reaching laterally . During hand deceleration, children
system. The children with backing process were paired according to with CP demonstrated apparent pushing force on chair and braking
their error patterns and language abilities and randomly assigned to force on feet as reaching medially. TD children showed consistently
either a more complex target sound group (aspirated alveolopalatal pushing force on chair with feet force oscillating around zero. Re-
affricate /tsh/) or a less complex target sound group (aspirated alveo- garding weight bearing force (vertical RF), children with CP showed
lar stop /th/). A treatment protocol with a discharge criterion, 80% a tendency of using greater amplitude of chair force (mean = 84%
accuracy of target sound at sentence level over three consecutive of body weight) than TD children (mean = 75% of body weight)
sessions was developed. Treatment outcomes were discussed based during acceleration phase of hand reach (F = 3.61, p = 0.065). By
on number of treatment sessions, the percentage of PCC, occurrence contrast, children with CP tended to use less amplitude of feet force
of backing process (POBP), and the effect of generalization. Results: (mean = 17% of body weight) than TD children (mean = 25% of body
Results indicated that both groups had significant increase in PCC weight) (F = 4.00, p = 0.052). During deceleration phase, the same
and decrease in POBP in words and spontaneous speech context. In trend was found. Conclusion: Our result showed that children with
the aspect of generalization, the results showed that there were sig- CP demonstrated exaggerated, inconsistent postural control perform-
nificant treatment effect in target and untreated sounds in words and ance in terms of force modulation and COP excursion when reaching
spontaneous speech context in both groups. However, the group that in different directions. Children with CP seemly showed different
produced target sound /tsh/ required less number of sessions to reach strategies of force modulation between chair and feet compared
the discharge criterion and had better intelligibility, less occurrence with TD children. Less weight bearing by feet in children with CP
of backing process, and bigger local change in words. In addition, during reach out was preliminary noted.
children in this group acquired more fronting sounds and suppressed
more backing process during therapy sessions. Conclusion: This
study proves that articulation/ phonological treatment can make 0502PP54
overall changes in articulation/ phonological systems and selecting PARENT-CHILD INTERACTIVE READING: A
a more complex target sounds has better treatment efficacy.
COMPLETE READING CYCLE TO ENHANCE
COMMUNICATIVE PARTICIPATION FOR
0502PP53 CHILDREN WITH LANGUAGE DELAY
IMPACT OF TASK CONSTRAINTS ON POSTURAL
Yu-ting Huang, Pao-Chuan Torng
CONTROL PERFORMANCE IN CHILDREN Department of Speech and Hearing Disorders and Science, National
WITH CEREBRAL PALSY AND TYPICALLY Taipei College of Nursing (Taiwan)
DEVELOPING CHILDREN
Purpose: To study the communicative participation of children
Yun-Huei Ju1,2, Rong-Ju Cherng1,3 with language delay and parent interactive reading strategy during
1
Institute of Allied Health Sciences, College of Medicine, National parent-child reading. Materials and Methods: Six child and par-
Cheng Kung University, 2Department of Physical Therapy, College ent dyads were recruited to participate in a parent-child reading
of Health Sciences, Kaohsiung Medical University and 3Department program. Children with language delay aged from 3; 1 to 3; 10
of Physical Therapy, College of Medicine, National Cheng Kung and their main care givers were participated over a two months
University (Taiwan) time frame. Four picture books were utilized to collect data on
the communicative participation of children and parent interac-
Purpose: To examine the effects of task embedding different tive reading skill during parent-child reading. One picture book
postural demands on postural control performance in terms of was used for both pre- and post-test data collection. The other
measurement of force plates in children with cerebral palsy (CP) three were used for intervention. Parents were trained to use an
and typically developing (TD) children. Materials and Methods: interactive reading approach, the Complete Reading Cycle, to

enhance children communicative participation during parent-child young children were observed and devided into 3 functional diagnosed
reading. The Complete reading cycle includes four components: groups, including children with specific language impairment, autistic
1. Focus, 2. Query, 3. Response, 4. Feedback was instructed by disorder, and normal development. Children in delayed groups aged
Speech Language Pathologist via demonstration and discussion. from 3;4 to 6;10, and children in normal development group aged
Video and audio equipments were used to collect data during from 0;11 to 1;6. Their language development stages are controlled in
parent and children engaged in picture book interactions for 5 early and late one word stage based on the definition of Bates (1979).
to 15 min. Quantity and quality methods were used to evaluate The Communication and Symbolic Behavior Scale Developmental
the children communicative participation and parent interactive Profile (CSBS DP) (Wetherby & Prizant, 2002) is used to collect the
reading strategy. Results: Results revealed a strong enhancement communication and symbolic behavior data. There are 7 domains
in both children communicative participation and parent interac- in communicative behaviors obseved in the study, and they are: 1)
tive reading strategy using the Complete Reading Cycle in all six Communication Function; 2) Communication Means - Gestual; 3)
child parent dyads. Children with language delay were especially Communication Means - Vocal; 4) Communication Means - Verbal; 5)
increase in communicative participation for query information dur- Reciprocity; 6) Social-Affactive Signaling; and 7) Symbolic Behavior).
ing parent child reading. Conclusion: Findings support the use of The individual group performances on communicative behaviors are
parent child reading as an enhancement communication program. compared with each other. The relationships among communication
Both child and parent benefit in the growth of communication and symbolic behaviors and relevant factors are also analyzed in the
skills during this therapeutic intervention. study. Results: 1) Young children with specific language disorder had
potentially lower frequency in vocalization, and in addition they are
more limited in consonant inventory and syllable variety perform-
0502PP55 ances. 2) Young children with autism showed significant poorer
STUDY OF NARRATIVE SKILL IN CHILDREN skills in joint attention, reciprocity, gestural and vocal use. And the
symbolic behavior also showed significant poorer performances in
WITH LANGUAGE DELAY both inventory and complexity of action schemes in play comparing
Ai-Ju Wu1, Pao-Chuan Torng2 with other groups. Present results indicate 3 groups which demonstrate
1
Department of Physical, Medical and Rehabilitation, National different communication patterns. Conclusion: Findings in individual
Taiwan University Hospital and 2Department of Speech and Hear- characteristics in early communicative behaviors of children with
specific language impairment and autistic disorder are equivalent to
ing Disorder and Sciences, National Taipei College of Nursing
previous studies. Children with different diagnosis revealed different
(Taiwan) performances in certain behaviors.
Purpose: The purpose of this study is to determine the narrative
skills in children with language delay and compare them with typical 0502PP57
development children. Materials and Methods: 25 children with
language delay and 24 children with normal language development NEUROMUSCULAR RESPONSES DURING
between the age of 4:2 and 6:6 were recruited in this study. A picture WHOLE BODY VIBRATIONS OF DIFFERENT
book “I become a fire dragon” was used and the story was recorded FREQUENCIES IN CHILDREN WITH CEREBRAL
as an audio file as a stimulus for the story retelling task. The story
contained the story grammar components and were rewritten to be PALSY
shorter which consisted of 1 episodes, 51 clauses, and 15 sentences. Yung-Wen Tang1, Jia-Hao Chang2, Jau-Jia Lin3
Children recalled story they read and then answered comprehen- 1
School of Physical Therapy, 2Department of Physical Education
sion questions after retelling story. Stein and Glenn’s (1979) story and 3Department of Rehabilitation Medicine (Taiwan)
grammar were used to analyze the children’s narratives. Results:
The story retold by the language-delayed children contained fewer Purpose: The purpose of this study was to analysis the responses of
different words, shorter MLU and sentence complexity, and a lower muscle strength, flexibility, and muscle tone to different whole-body
frequency use of story grammar components than those of the control vibration (WBV) frequencies. Materials and Methods: Sixty children
group. Also, the children with normal language scored significantly with spastic cerebral palsy stood to receipt two whole body vibrations
higher than those with language delay on the narrative level meas- in random order. These subjects had a mean age of 8.56 years (SD
ured. Conclusion: the stories retold by children with language 3.14 years), height of 124.59 cm (SD 19.03), weight of 25.36 kg (SD
delay were similar to younger children, and their narrative skills 9.58).The vibration treatment lasted 60 seconds, with a 60 min rest
may increase by age. But, the finding of this investigation indicated between each treatment. The frequencies used in the experiment were
that the narrative skills in children with language delay fall behind 20, 30 Hz. A electro-goniometer was used to measure knee angle in
their peers about two years. pendulum test and the relaxation index (R2n) was analyzed to measure
spasticity. A handheld dynameter was used to measure maximum
voluntary contraction (MVC) of quadriceps. Sit-to reach test was
0502PP56 used to measure hamstring flexibility. Repeated measures ANOVA
were used to test the effect of frequency factor. Results: Both WBV
COMPARING THE EARLY COMMUNICATIVE treatment lead to increase significantly in R2n (p < 0.001), percent-
BEHAVIORS BETWEEN CHILDREN WITH age difference of MVC(MVC%) (p < 0.001), and sit-to-reach value
SPECIFIC LANGUAGE IMPAIRMENT AND (p < 0.001). Results of one-way repeated-measures ANOVA indicate
AUTISTIC DISORDER significant effects of frequency on MVC(F = 15.727, p = 0.001) and
sit-to reach value (F = 24.577, p < 0.001). MVC % value during 30 Hz
Ching-Hsien Chang1, Pao-Hsiang Chi2, Pao-Chuan vibration are greater than during 20Hz vibration. Sit-to reach value
Torng1, Chia-Ling Chen3 during 20 Hz vibration are greater than during 30Hz vibration. There
1
Department of Speech and Hearing Disorders and Science, Na- are no significant effects of frequency on R2n (F = 4.447, p = 0.052).
tional Taipei College of Nursing, 2Department of Special Educa- Conclusion: More inhibiting activation of antagonist muscles through
tion, National Taipei University of Education and 3Department of Ia-inhibitory neurons was produced at 20 Hz in decreasing resist-
Rehablitaion, Chang Gung Memorial Hospital (Taiwan) ance around the joints and increasing flexibility. The better strength
performance was found at 30 Hz, suggesting this frequency as the
Purpose: To find the individual characteristics of early communicative one eliciting the highest tonic vibration reflex response in quadriceps
behaviors in children with specific language disorder and autistic disor- muscle during whole-body vibrations. We propose that 20 Hz vibra-
der, and in addition to conclude the related influencing factors between tion is the better mode for flexibility training and 30 Hz vibration is
these groups. Materials and Methods: In this research, a total of 18 the better mode for strengthening training.

0502PP58 cooperating with the meridian-acupoint massage. Materials and

SPECTRUM OF MOTOR DEVELOPMENTAL Methods: Thirty patients were treated with patting on fengshi
point (GB31) cooperating with the meridian-acupoint massage.
DELAY Results: The cure rate and effective rate were 73. 33% and 96.67%.
Chia-Ying Chung1, Wen-Yu Liu2, Chia-Ling Chen1, Simon Conclusion: Patting on fengshi point (GB31) combined with the
Fuk-Tan Tang1, Shih-Wei Chou1, Alice M.K. Wong1 meridian-acupoint massage has a satisfactory therapeutic effect on
lateral femoral cutaneous neuritis.
1
Memorial Hospital and 2Department of Physical Therapy, Chang
Gung University (Taiwan) 0502PP62
Purpose: To evaluate the spectrum of motor developmental delay. THE EFFECTS ON HEART RATE VARIABILITY OF
Materials and Methods: A total of 149 motor developmental delay TRIGEMINAL TRANSCUTANEOUS ELECTRICAL
children were enrolled. Children referred to the clinics of Physical STIMULATION IN HEALTHY SUBJECTS
Medicine and Rehabilitation Department in Chang Gung Memorial
hospital, Taiwan was undertaken. Eligibility requirements included Jiunn-Horng Kang1,2, Fu-San Jaw1, Shih-Ching Chen2,
being younger than 7 years of age and referral for the initial evalu- Sung-Hui Tseng2, Chien-Hung Lai2, Allen Chia-Lin
ation of motor delay. All children referred to the clinic underwent Hsu2
a formal multidisciplinary developmental assessment. Results: For 1
Institute of Biomedical Engineering, National Taiwan University
149 children with functional diagnosis as motor delay, the medical and 2Department of Physical Medicine and Rehabilitation, Taipei
diagnosis encompass cerebral palsy (n = 74), developmental coor- Medical University Hospital (Taiwan)
dination disorder (n = 14 ), Down syndrome (n = 4), Beals syndrome
(n = 1), neurofibromatosis syndrome (n = 1), spinal muscular atrophy Purpose: Although the mechanism is still not well-known, cranio-
(n = 1), Waardenburg syndrome (n = 1), hereditary motor sensory facial electrical stimulation has been suggested to be benefit in
neuropathy (n = 2), brachial arch defect (n = 1), spina bifida (n = 1), managing headache, anxiety and insomnia. Heart rate variability
arthrogryposis (n = 1), mitochondria myopathy (n = 1) were included. (HRV), known to be highly correlated with autonomic status, has
Conclusion: When a child has only, or primarily motor delays, been reported to be altered in above clinical conditions. We proposed
developmental disorders that should be considered include cerebral the craniofacial stimulation could influence HRV. The objective of
palsy, developmental coordination disorder. Other medical diagnosis the study is to evaluate the change of heart rate variability after
include genetic syndromes, spina bifida, spinal muscular atrophy, trigeminal transcutaneous electrical stimulation (TENS). Materi-
peripheral neuropathy and myopathy. als and Methods: The study has been approved by lRB of local
institute. Thirty healthy participants were recruited in this study.
Each subjects received 15-min of TENS for each supra-orbital and
0502PP59 wrist area. The order of electrical stimulation for each subject was
STUDY OF COMPREHENSIVE REHABILITATION randomized selected. The frequency of TENS was set as 80 Hz
and the current was set at individual maximal non-painful level.
THERAPY ON NURITURE CONDITIONS AND The subjects received electrical stimulation with supine position
MEDICAL COSTS IN THE TREATMENT OF in a quite room. Pre-stimulation and post-stimulation 5-min EKG
PATIENTS WITH DYSPHAGIA FOLLOWING were recorded with sampling frequency as 500 Hz and HRV were
STROKE further analyzed with lead II in both frequency and time domains.
Paired t-test was performed to analyze the HRV difference between
Xiangming Ye, Niang Zhou, Yuanjiao Wang the different stimulation sites. The alpha level was set as p < 0.05.
ZheJiang Provincial Peoples Hospital (China) Results: We found significantly decreased SDNN in time domain
(–10.5 ± 21.65, p = 0.013) and decreased very low frequency (VLF)
Purpose: To explore the effect of comprehensive rehabilitation power in frequency domain (–791.03 ± 1905.92 nu., p = 0.031) in
therapy on nuriture conditions and medical costs in the treatment of subjects who received trigeminal TENS compared to wrist TENS.
patients with dysphagia following stroke. Materials and Methods: In addition, we found significantly decreased SD2 (–15.57 ± 34.90,
Eighty-seven patients with dysphagia were divided into interventional p = 0.021) in Non-linear Poincaré plot analysis when stimulation
group (IG) and control group (CG). Comprehensive rehabilitation at trigeminal territory. Conclusion: The short-term trigeminal
therapy include deglutition training, electric stimulation therapy and TENS could induce the specific change of HRV in healthy sub-
acupuncture therapy were used in IG, but were not used in CG. Nuri- jects. Decreased HRV and increased VLF power were associated
ture parameters include biochemistry index and body measurement with trigeminal TENS compared to wrist TENS. Further study is
index and medical costs were observed before and after one month suggested to explore the clinical significance and application for
in both two groups. Results: After one month, scores of deglutition our findings.
function and nuriture index were significantly higher in IG than that
in CG, but medical costs decreased significantly in IG compared with
CG. Conclusion: Comprehensive rehabilitation therapy improved 0502PP64
deglutition function and nuriture deterioration, but decreased medical EFFICACY OF TRADITIONAL THAI MASSAGE
costs in the treatment of patients with dysphagia following stroke.
ON PATIENTS WITH SCAPULOCOSTAL
SYNDROME: A PRELIMINARY STUDY
0502PP60 Vitsarut Buttagat1, Wichai Eungpinichpon1,3,4, Uraiwon
THERAPEUTIC EFFECTS OF COMBINED THE Chatchawan1, Preeda Arayawichanon2,4
PATTING ON FENGSHI POINT (GB31) WITH THE 1
School of Physical Therapy, Faculty of Associated Medical
MERIDIAN-ACUPOINT MASSAGE ON 33 CASES Sciences, Khon Kaen University, 2Department of Rehabilitation
OF LATERAL FEMORAL CUTANEOUS NEURITIS Medicine, Faculty of Medicine, Khon Kaen University, 3Research
and Training Center for Enhancing Quality of Life of Working-Age
Liansheng Li People, Khon Kaen University and 4Back Neck and Other Joint Pain
Department of rehabilitation Medicine, Xuanwu Hospital Capital Research Group (Thailand)
Medical University (China)
Background: Scapulocostal syndrome (SCS) is a common chronic
Purpose: To observe the therapeutic effects in treating lateral musculoskeletal pain syndrome which mainly affects the posterior
femoral cutaneous neuritis of patting on fengshi point (GB31) shoulder area. The effects of traditional Thai massage (TTM) on SCS

have not been found. Purpose: To preliminarily determine the efficacy necessary of special tools and facilities, nor special requirement of
of TTM on pain intensity, pressure pain threshold and muscle tension physical environment, and has been accepted by patients. Although
associated with SCS. Materials and Methods: Ten patients (7 female, the mechanisms of Gua Sha are not fully understood, the indications
aged 21–31 yrs) were randomly allocated to receive 30-min session of use is too wide in general, we still suggest that Gua Sha may
of either TTM or physical therapy (PT: ultrasound therapy and hot introduce used in rehabilitation medicine.
pack) for 9 sessions over a period of 3 weeks. Pain intensity (Visual
analog scale: VAS), pressure pain threshold and muscle tension (VAS)
were measured before and immediately after the first treatment ses- 0502PP66
sion, 1 day after the last treatment session and 2 weeks after the last THE REMOTE EFFECT OF ACUPUNCTURE OF
treatment session. Results: Results indicated that the TTM group LOWER EXTREMITIES APPLIED ON ADULTS
showed a significant improvement in the pain intensity, pressure
pain threshold and muscle tension after the first treatment session WITH LATENT MYOFASCIAL TRIGGER POINTS
and at 1day and 2 weeks after the last treatment session (p < 0.05). IN UPPER TRAPEZIUS MUSCLES: A PILOT
The PT group showed significant improvement in the pain intensity STUDY
and muscle tension only after the first treatment session (p < 0.05).
Moreover, there were significantly higher in the improvement of all of Kuan-Ming Fang1, Kai-Hua Chen1, Wei-Chi Hsieh1,
the outcome measures in the TTM group when compared with the PT Hung-Chih Hsu1,2, Chu-Hsu Lin1, Chang-Zern Hong3
group at 1day after the last treatment session (p < 0.05) except for the 1
Department of Physical Medical and Rehabilitation, Chang Gung
pain intensity (p = 0.09) and at 2 weeks after the last treatment session Memorial Hospital, Chiayi, 2Graduate Institute of Clinical Medical
(p < 0.05). Conclusion: We therefore conclude that TTM could be one Science, Chang Gung University, College of Medicine and 3Depart-
of alternative treatments for this patient population. ment Physical Therapy, Hung Kuang University (Taiwan)
Purpose: This controlled study was designed to investigate the
0502PP65 remote effect of acupuncture of the lower extremities applied on
adults with latent myofascial trigger points (MTrPs) in the upper
GUA SHA (DERMAL SCRAPE) THERAPY- trapezius muscles. Materials and Methods: Five adults with latent
A NEGLECTED EFFECTIVE ADJUNCT MTrPs in both upper trapezius muscles were randomized to receive
REHABILITATION THERAPEUTIC MODALITY acupuncture therapy or sham therapy at both Weizhong (UB-40) and
COMMONLY PRACTICED AMONG CIVILIANS Yanglingquan (GB-34) on either side. Each individual received one
treatment weekly for a total of 2 weeks. The pressure pain threshold
Shifang Zhou, Yu Jin in the upper trapezius muscles, the opposite range of motion of cervi-
Dept. of Rehabilitation Medicine, 1st Affiliated Hospital of Nanjing cal lateral bending, and the endplate noise (EPN) prevalence in the
Medical University (China) latent MTrPs of the upper trapezius muscles were assessed before
and after each treatment. Results: In the experimental side, the op-
Purpose: To introduce the Chinese traditional therapeutical modality posite range of motion of cervical lateral bending was significantly
Gua Sha as an effective adjunct rehabilitation therateutic modality improved after the second treatment (p = 0.03). The change in range
used in rehabilitation medicine. Materials and Methods: Through of motion in the experimental side was also greater than that in the
literature search covering the period of 1994–2007, a total 437 papers control side (p = 0.04). However, no statistically significant differ-
were analyzed,and supplemented by auther’s personal experience, ence was observed in other parameters after each treatment in both
and selective introduction of feasible evidence based cases. Results: sides (p > 0.05). Conclusion: Our study showed that acupuncture
1) Explanation of terminology: Introduction of what Gua Sha eans of the lower extremities improved cervical lateral bending. Thus a
in China.The practice is using an approprate tool to apply repeated remote effect of acupuncture may exist.
scraping, or using fingers to exert pulling on the skin area to be treated.
After the treatment process,the underneath of the relevant skin area
will appear with red patches or oozing of blood under the skin. These 0502PP67
post treatment marks called ‘Sha’ (means sand in Chinese) normally SCIENTIFIC TRAINING AND SPORTS MEDICINE
will be disappeared by itself in 2 to 5 days time without any residual MODEL OF “TUINA GONGFA REHABILITATION”
evidence. 2) Possible mechanism of Gua Sha: 1)Adjustment of human
body’s imbalance,the most closely related subject to Gua Sha is the Xiaodong Wang1,2, Rufeng Wang3
meridian studies. The human body has 12 meridians,8 extrachannels 1
School of Physical Education, Huazhong Normal University,
and points and all these are interlinked again all meridians, points 2
Shanghai Yueyang Affiliated Hospital, Shanghai University of Tra-
and internal organs are linked to each other and reflected at specific ditional Chinese Medicine and 3Department of Physical Education,
sites of skin respectively. So, when there is an illness, and apply South-Central University For Nationalities (China)
Gua Sha over the respective skin area, the stimulation produced will
create an adjusting process. Other than this, the blood oozed from Purpose: To analyze the basic principle of “Tuina Gongfa rehabili-
the Gua Sha activity will undergo auto hemolysis. The hemoglobin tation”, the necessity of scientific training of rehabilitation,and the
produces mild stimulating effect which in turn can initiate adjust- establishment of sports medicine model of “Tuina Gongfa reha-
ment process and provide therapeutic effect. 2) Improvement of bilitation”. Methods: Using literature analysis,logical analysis,etc.
blood circulation: Nielsen in 2007 used Laser Doppler Imaging to Results and Conclusion: the basic principle of “Tuina Gongfa reha-
study the blood flow input of standerdized skin surface areas each bilitation” is promoting the formation of compensatory mechanisms
measuring 11mmX11mm. Comparing the areas treated by Gua Sha by ways of exercise. Its role is to maintain and restore the body’s
to controls, the results had shown the Gua Sha treated areas were normal physiological function of mechanisms and development of
obviously having a much faster blood flow reaching up to 400% at compensatory function of the body.Only correct understanding of
the highest value. The control areas did not shown significant changes. the objective laws of Gongfa training,can we grasp the scientific
These results were similar to those using acetylcholine. These studies methods of Gongfa training. And then can guarantee the efficacy and
are reproducible to explain that the blood capilllaries were not dam- safety of Gongfa training, Scientific training is necessary require-
aged. 3)Several examples were presented: Here emphasis only the ment of “Tuina Gongfa rehabilitation”.the systematic application
cases of common cold, bone and joint pain, repiratory and digestive of sports medicine in the process of “Tuina Gongfa rehabilitation”
system disorders treated by Gua Sha , showed its good effects, at the can provide scientific and technological protection for Gongfa
same time, combining introduction of personal experience. Conclu- training.On the basic line of carrying out the plan of “Tuina Gongfa
sion: It obviously showed that Gua Sha has it’s theoretically basis rehabilitation”,we can establish the systematic application mode of
and therapeutical effects,and the method used is relative simple, no sports medicine in scientific Gongfa training.

0502PP68 were comparable at baseline. By hospital discharge, post operative

HOT PACK AND HOT HERBAL PACK: EFFECTS pulmonary complication developed in 8 (61.5%) patient in the
intervention group, 12 (85.7%) in the control group (p = 0.42). One
ON SIT AND REACH TEST, SKIN TEMPERATURE patient was re-intubated in the control group. The mean duration
AND PLEASURE of postoperative hospitalization stay was reduced in the interven-
Raoyrin Chanavirut, Salinee Neawla, Jindaporn tion group (6.03 ± 1.03 vs. 9.24 ± 3.29 day, p = 0.018). Conclusion:
Diaphragmatic breathing and coughing technique education before
Yimdee, Rungthip Chalermsan, Kluaymai Promdee open-heart surgery in high risk patient can shorten hospital stay and
Khon Kaen University (Thailand) decrease cost of care.
Purpose: Thai herbal compress ball is a unique natural product
of Thailand. At the original, it was designed in a ball shape with 0502PP70
a diameter of 6-7 inches. It was used to relieve muscle pain and
improve skin blood flow. However, because of its small size, it can’t CLINICAL APPLICATION OF LIGHT QUANTUM
cover as large as treatment area as of those hot pack. Therefore, BLOOD THERAPY ON THE SUDDEN DEAFNESS
this study tries to compare the physiological affect of the newly
designed hot herbal pack shape with a hot pack. The aim of this Xiao Fu
study was to evaluate the effect of hot herbal pack on flexibility Third People’s Hospital of Chongqing (China)
of lower back and thigh muscle, skin temperature and pleasure Purpose: To observe the therapeutic effect of light quantum blood
compared with hot pack. Materials and Methods: Seventy healthy therapy on the sudden deafness, and compared with the western medi-
subjects were recruited from undergraduate student of Khon Kaen cine. Materials and Methods: 126 patients were randomly divided
University, Thailand. All volunteers were randomly allocated into into light quantum blood therapy group and the drug group, with 63
two groups; hot pack (HP) and herbal pack (HBP). Pre and post cases in each group. By ultraviolet irradiation with blood therapy
data in both groups composed of sit and reach test (SRT) and skin instrument and simultaneously treated with oxygenation, blood was
temperature from three sites; lower back, left and right thigh, meas- transfused in the light quantum therapy group; while in the drug group,
ured by “Thermal imagers” (FLUKE) were recorded for analyze. vein injection with 6% low molecular dextran, ATP and coenzyme A
HP or HBP was applied to each group over lower back and thigh and oral Nimodipine Tablets, Gold Theragran was given. The changes
for 20 min. During this process, minute by minute temperature and curative effects of the whole blood viscosity, plasma viscosity,
was measured by a digital thermometer placed on buttock. In ad- hematocrit and fibrinogen before and after treatment were observed.
dition, HBP group was asked to fill up the questionnaire regarding Results: The total efficiency of light quantum blood therapy group
temperature and pleasure levels post treatment. Results: There was was 91.37% better than the drug group which was 63.36% and the
no significant difference in general characteristics of both groups. difference was statistically significant (p < 0.05). The difference of
SRT of all groups were increased (HP; 6.12 ± 5.80 to 7.65 ± 5.50 the index of whole blood viscosity, plasma viscosity, hematocrit and
cm and HBP; 6.42 ± 6.31 to 7.74 ± 6.31 cm) but did not reach the fibrinogen in light quantum blood therapy group before and after
statistical significance. Skin temperature from “Thermal imagers” the treatment was statistically significant (p < 0.05); compared with
was increased significantly (p < 0.05) when compared both within the drug group, the difference of the whole blood viscosity, plasma
and between groups at average 3.20 ± 0.93oC and 3.83 ± 1.21oC for viscosity and fibrinogen after the treatment was statistically signifi-
HP and HBP, respectively. At the 5th, 10th and 15th min, 65–80% of cant (p < 0.05); The difference of the index of whole blood viscosity,
HBP subjects rated the feeling of “Hot” and rated “Comfortable plasma viscosity, hematocrit and fibrinogen in the drug group before
warm” in 20th min. Furthermore, the smell of herbs was appreciated and after the treatment was not statistically significant (p > 0.05).
among HBP group. Conclusion: Based on this study, the increasing Conclusion: The therapy efficacy of light quantum blood therapy on
of skin temperature indicates that herb pack produces more potent the sudden deafness is significant and superior to drug therapy.
effects than hot pack and produced no advert affect. Hence, a simple
innovation that made from Thai herbs can be applied at home as a
hot pack in term of superficial heat equipment. Future study should 0502PP71
be focus on specific conditions such as myofascia pain syndrome
or muscle tightness patient. THE USE OF ACUPUNCTURE IN RELIEVING
DIZZINESS, NAUSEA AND VOMITING AFTER
CEREBELLAR STROKE – A CASE REPORT
0502PP69
Kwok Pui Leung1, L.Y. Ng2, W.L. Liu2, Leonard S.W. Li1
THE EFFECT OF PRE-OPERATIVE 1
Department of Medicine, Tung Wah Hospital and 2Chinese Medi-
REHABILITATION IN HIGH RISK OPEN HEART cine Centre, Tung Wah Hospital (Hong Kong)
SURGERY PATIENTS ON THE LENGTH OF
HOSPITAL STAY Purpose: Symptoms of dizziness, nausea and vomiting may be very
disabling after acute cerebellar stroke. Medication likes prochlo-
Willy Chou1, Wen-Chih Lin1, Chiao-Hsin Chen1, Yi-Ru rperapine is helpful but has the drawback of slowing down the central
Chen1, Cheng-Hsin Lin2 adaptation process. Acupuncture is found to be effective in relieving
1
Department of physical medicine and rehabilitation, Chi Mei chemotherapy induced and postoperative nausea and vomiting. We
Medical Center and 2Department of cardiovascular surgery, Chi sought to explore whether similar acupuncture technique is helpful
Mei Medical Center (Taiwan) in reducing these symptoms. Materials and Methods: We report on
a 66-year-old gentleman who presented with sudden collapse in mid-
Purpose: To evaluate the effect of pre-operative education of August 2009 and was found to have acute bilateral cerebellar infarcts.
diaphragmatic breathing and coughing techniques in high risk In the past, this gentleman was a known chronic hepatitis B carrier
patient scheduled for elective open heart surgery on the length of with hypertension and ischemic heart disease. He ran a very stormy
post operative hospital stay. Materials and Methods: From March acute stroke phase initially. He had obstructive hydrocephalus, which
2008 to April 2009, patients who were scheduled for elective open required ventricular shunting and respiratory failure due to aspiration
heart surgery by the same surgeon were enrolled. 27 patient who pneumonia which required tracheostomy and intensive care. He was
met the criteria for high risk was randomized into intervention transferred to our rehabilitation unit at week 5 after stroke eventually.
group (n = 13) or control group (n = 14). Intervention group received Tracheostomy was weaned off at week 9 after stroke. Patient remained
diaphragmatic breathing and coughing technique education before bed and chair-fast because of severe dizziness and nausea whenever he
surgery by the same physical therapist. All patient received the changed his positions. Acupuncture was applied on Neiguang (PC6)
usual cardiac rehabilitation after surgery Results: Both groups of both forearms. Even reinforcing-reducing needling technique was

employed to achieve soreness, numbness and distension in the local 1

Altanta VA Medical Center, 2Emory University School of Medicine
areas. Needles were retained for 30 min and manipulated once every and 3Emory Rollins School of Public Health (United States)
10 min to intensify the needling sensation. The treatment was given
once every other day, 3 times a week, for 2 weeks. Dizziness, nausea Purpose: To investigate effects on health related quality of life (HR-
& vomiting were measured by global self rating (Nil or minimal, mild, QoL) perceptions of older adults with knee osteoarthritis (OA) fol-
moderate and severe) and Visual Analogue Scale (VAS) before and af- lowing acupuncture targeted to knee pain and/or acupuncture targeted
ter treatment. Results: Patient reported remarkable improvements with to poor sleep. Materials and Methods: Design: Randomized clinical
dizziness and nausea reduced from severe grade to mild grade and VAS trial with 2x2 factorial treatment structure. Setting: Outpatient clinic
from 8 to 3. No complication was observed. Conclusion: Acupuncture at an academic university. Participants: Twenty-two adults aged 55-86
by needling the Neiguang points is potentially beneficial. Further large- (mean age = 72) with radiographically diagnosed knee OA, persistent
scale, randomized and controlled studies are warranted. knee pain more than 50% of the time by self report, and sleep distur-
bance as indicated by a global Pittsburgh Sleep Quality Index (PSQI)
score of 5+. Intervention: True or sham acupuncture for poor sleep
0502PP72 combined with true or sham acupuncture for knee pain. Measurement:
Medical Outcomes Study Short Form-36 (SF-36), pain severity rating
M-TEST (NEW TREATMENT, LIKE
(Western Ontario and McMasters University Osteoarthritis Index), and
ACUPUNCTURE, BASED ON ASSESSMENT ON global PSQI at baseline, post-intervention, and 1-month follow-up.
PHYSICAL MOVEMENT) CHANGES CERVICAL Results: Subjects who received true acupuncture for knee pain and/
ALIGNMENT AND MOVEMENT: A PILOT STUDY or for poor sleep, compared to subjects who received only sham treat-
ments, had more improvement in pain ratings (p = 0.03) and global
Yukihiro Tanimoto, Masazumi Mizuma, Nobuyuki PSQI scores (p = 0.04). True versus sham acupuncture for knee pain
Kawate, Mitsumasa Yoda, Naomi Yoshioka was associated with improved SF-36 ratings of general health (p = 0.03)
Department of Rehabilitation Medicine, Showa University School and vitality (p = 0.04). True versus sham acupuncture for poor sleep
of Medicine (Japan) was associated with improved SF-36 ratings of social functioning
(p = 0.03). Conclusion: In older adults with knee OA presenting with
Purpose: Traditional Chinese Acupuncture (TCA) has been used persistent knee pain and poor sleep, acupuncture for knee pain and/
treating motor dysfunction in East Asia for century. However, TCA or for poor sleep may improve HRQoL perceptions.
is based on experienced knowledge, and lacked reproducibility. In
Japan, TCA is widely used in complementary and alternative medicine,
but fear inserting needles into skin often makes it keep at a distance. 0502PP74
M-Test is new treatment based on TCA theory, but to confirm effec-
tive points, the assessment of physical movement is needed. There THERAPEUTIC EFFECTIVENESS OF
are 30 kinds of basic movement divided into 6 aspects. (Anterior of TRADITIONAL THAI MASSAGE ON PATIENTS
Upper extremities, Posterior of Upper extremities, Lateral-Medial of RELATED WITH EPISODIC TENSION-TYPE
Upper extremities, Anterior of Lower extremities, Posterior of Lower HEADACHE
extremities, Lateral-Medial of Lower extremities) We select merid-
ians that should be treated and meridian points from 24 basic points Chathipat Kruapanich1, Uraiwon Chatchawan1, Wichai
after assessment. Moreover, aids not to insert into skin for treatment Eungpinichpon1, Kannikar Kongbunkiat2
are used instead of the needles. The purpose of this study was to as- 1
School of Physical Therapy, Faculty of Associated Medical Sci-
sess whether M-Test effected cervical static alignment and dynamic ences, Khon Kaen University and 2Department of Attending Physi-
movement, using two dimensional operation analysis device. Materi- cian of Emergency Medicine, Faculty of Medicine, Khon Kaen
als and Methods: Four subjects with no present and past history of University (Thailand)
neck participated in this study. They moved their neck, flexion and
extension, at standing position, and Cine-Radiographic measurement Background: Episodic tension-type headache (ETTH) is the most
of lateral dynamic movement of cervical vertebrae was taken. After- common type of headache. It leads to impairment in functional,
wards, M-Test was done and we selected meridian points they could emotional and social activities. At present, There are a few and in-
move more easily. Similarly Cine-Radiographic measurement was sufficient strong methodology studies that examined the therapeutic
taken. The images obtained from two measurements were analyzed effectiveness of traditional Thai massage (TTM) on ETTH. Purpose:
with two dimensional operation analysis device (Hu-Tech Co.Ltd To evaluate the immediate effects of TTM among patients with
MMpro-2DdA). We compared the difference of lateral cervical static ETTH by comparing with non-treatment on headache pain intensity,
alignment and dynamic movement before and after M-Test. Results: pressure pain threshold and cervical range of motion. Materials and
To examine cervical flexion and extension in this study, we selected Methods: Ten patients were randomly allocated to receive 30-min
treatment points from anterior and posterior meridians. (Lung, Large for a single treatment of either TTM or control (resting). Headache
Intestine, Spleen, Stomach, Heart, Small Intestine, Kidney or Bladder). pain intensity (Visual analog scale: VAS), pressure pain threshold (kg/
In the subjects treated with anterior meridian points, cervical lordosis cm2), and cervical range of motion (degree) were measured before
was more intense compared with before M-test and the range of mo- and immediately after treatment. Results: Results indicated that the
tion toward flexion increased. In the subjects treated with posterior TTM group showed a significant improvement in the headache pain
meridian points, cervical lordosis was less compared with before M- intensity, pressure pain threshold, cervical flexion and lateral flexion
test and the range of motion toward extension increased. Conclusion: after treatment session (p < 0.05). The control group showed only
We conclude that M-test may change cervical static alignment and significant improvement in the headache pain intensity (p < 0.01).
dynamic movement, and may effect on physical function. However, all measures were not significantly different when compared
between the groups. Conclusion: It is concluded that the TTM could
be one of effective treatments for the patients with ETTH.
0502PP73
HEALTH-RELATED QUALITY OF LIFE EFFECTS
0502PP75
REPORTED BY OLDER ADULTS WITH KNEE
OSTEOARTHRITIS FOLLOWING ACUPUNCTURE EFFECT OF ELECTROACUPUNCTURE ON
TREATMENT TARGETED TO PAIN AND SLEEP: A ACUPOINTS OF DU MERIDIAN ON THE
RANDOMIZED CLINICAL TRIAL EXPRESSION OF NESTIN IN PERIINFARCT
AFTER CEREBRAL ISCHEMIA
Wei Huang1,2, Donald L. Bliwise2, Claudine V.
Carnevale3, Nancy Kutner2 Xiaolin Huang, Xiaohua Han

Department of Rehabilitation Medicine, Tongji Hospital, Tongji neuropathies, stroke, brain injury, amputations. Physical therapy
Medical College (China) interventions are provided to disabled inpatients and outpatients.
Each patient is randomly scheduled into one specific physical
Purpose: To investigate the effect of electroacupuncture (EA) on therapist. The patient shall see the the same physical therapist
acupoints of Du Meridian on the expression of Nestin in periinf- and attend each appointment for therapy.Missed appointments
arct after cerebral ischemia. Materials and Methods: Fourty-eight lost revenue and staff time. Missed appointments are costing
healthy male Wistar rats were divided into normal, model and EA rehabilitation services in our hospital 200,000 USD a year. This
group randomly. Furthermore, rats in each group were divided into study aims to determine the factors affecting no-show rates, taking
7d and 14d, 2 subgroups. Model of middle cerebral artery occlusion these parameters into consideration, appointment day of week,
(MCAO) was established, followed by 7d or 14d of EA on acupoints appointment day of month and physical therapists. Materials
of Baihui and Dazhui. The expression of Nestin in periinfarct was and Methods: In the double blind condition that neither physical
investigated in different time points and different groups by im- therapists nor patients are informed during a period in nine months,
munohistochemical technique and Western blot. Results: The result we record all no-shows of 7 physical therapists at rehabilitation
demonstrated that the expression of Nestin in EA group showed a services in our hospital. Missed appointment characteristics were
significant increase compared with model group. What’s more, much collated on 3 parameters, day of week, month of year and physical
more Nestin-immunoreactive cells were detected in EA group on therapists. Results: The data indicated the higher no-show rate for
day 7 and the expression decreased on day 14. Conclusion: These Tuesday, Thursday, higher show rate for Monday, Wednesday and
findings indicate that EA on acupoints of Du Meridian has the po- Friday. Higher no-show rate for February and higher show rate for
tential to activate Nestin in the periinfarct region of the ischemic July, August and September. The no-show rate between physical
cerebral hemisphere and facilitate neuroregeneration. therapists has statistically significant difference. The data indi-
cated F = 11.915, p = 0.00. Conclusion: Physical therapists affect
no-show rates. The hospital shall consider intervention methods
0502PP76 to reduce no-show rate, and build a reward system to encourage
QI GONG PRACTICE IN TREATING LUMBAR the physical therapist who has higher show rate.
BACK PAIN
Ana Zikic1,2, Rene Burkland1,2, Dejan Nikolic1,2 0502PP78
1
University of Traditional Chinese Medicine and 2Medical Univer- APPLICATION OF SOCIAL REPRESENTATION
sity of Belgrade (Serbia) THEORY AND ITS TECHNIQUE ON THE
Purpose: To evaluate purpose of practising Qi Gong exercises in ASSESSMENT OF TEACHING EFFECTIVENESS IN
treating lumbar back pain disorders. Materials and Methods: From REHABILITATION EDUCATION
August 2008 to September 2009 we were using acupuncture to treat
lumbar back pain of patient. We had two groups of patients. One Feng Lin, Zhongli Jiang
experimental group, and other one where besides acupuncture we Department of Rehabilitation Medicine, Nanjing Medical Univer-
apply exercises named Shi Er Lian Shou (type of medical Qi Gong). sity (China)
All patients were divided in tree groups, according to diagnose and
differentiations principles in TCM (Traditional Chinese Medicine): Purpose: Social representation theory is a theory for the social
Group I- Kidney Qi deficiency, Group II-Kidney essence deficiency, communication between members in different groups. Teach-
Group III- Qi and blood deficiency. After 6 months of practicing ing process is also a communication between teacher team and
we evaluate effects of our therapy. Results: In our group were 40 student group. The present research was designed to explore the
patients. All of them had a pain like symptom of lower back syn- application of social representation theory and its word network
drome. We divided them in two groups. In second group they were analysis technique on the assessment of teaching effectiveness in
advising to do half and hour of exercises in morning and evening. rehabilitation education. Materials and Methods: In a course of
These movements are opening meridians and collaterals, improve Rehabilitation Medicine, the present study analyzed social repre-
circulation of Qi and blood, remove stasis, stop pain, balancing sentations of the fundamental concept of “rehabilitation” before
body and mind. They are specially designed for meridians of kid- and after completion of the course. Sixty one students including
ney, urinary bladder, gall-bladder. Presence of pain before and after 28 women and 33 men participated in free evocation task for
treatments was marked from 1–5 (full-fill question-mark). There collecting cognitive elements of “rehabilitation”. The students
were significantly difference (p < 0.05) between Group I and Group executed the task before the teaching process and do it again after
II in decreasing lower back pain after therapy. From tree parts of the examination. Two evoked words networks were constructed for
Group II, in group which had Kidney –Qi deficiency syndrome were analyzing the structure of the social representation of “rehabilita-
significantly difference (p < 0.05) in decreasing pain. Conclusion: tion”. On the application of the word network analysis technique,
Our results showed that using both methods significantly increase the global properties such as densities of the two networks and
results of healing lumbar back pain. Qi Gong is kind of therapy the local parameters such as three kinds of centralities (degree
which should be used continuously in every day life, like prevent- centrality, betweenness centrality and closeness centrality) of each
ing and healing method. cognitive element in the two networks were calculated. The k-core
decomposition technique extracted central core of each network.
Changes of social representation of “rehabilitation” were detected
0502PP77 by drawing a comparison between the two networks. Results: The
densities of networks were 0.0306 in the network before the teach-
A STUDY ON CONDITIONS AND ing process and 0.0556 in the network after the examination. In
CHARACTERISTICS OF MISSED APPOINTMENT: the network before the teaching process, there was a central core
INFLUENCE FACTORS AFFECTING NO-SHOW composed of a 3-core including 12 words. In the network after
the examination, there was a central core composed of a 4-core
RATES AT REHABILITATION
including 12 words. By comparison between these two central
Yung-Nan Hsu cores, this study revealed that before the teaching process the
Chang-Hua Hospital (Taiwan) students’ social representation of rehabilitation organized itself
around the central concept of “health” and that the teaching proc-
Purpose: Rehabilitation is the medical discipline concerned with ess reorganized the social representation of rehabilitation on the
restoring and improving patients’ function and quality of life. basis of the central concept of “function”. Conclusion: The results
Physical therapists assist in the treatment of a variety of medical suggested that the social representation theory and word network
conditions such as muscle or tendon injuries, spinal cord injury, analysis technique can provide a quick, qualified and visualized

approach for the assessment of course construction and teaching matter and having motivation to learn. By way of the scaffolding
effectiveness in Rehabilitation Medicine. of tutor or peers can inspire latent energy of students. Varied PBL
approaches affected the effectiveness of learning. The research
questions of this study were identified: (1) whether different guid-
0502PP80 ing tutorial of PBL lead to distinct learning outcome? And (2) what
WHY COMMUNITY REINTEGRATION OF performance have distinction between different guiding groups?
DISABLED LARGELY FAILS IN PAKISTAN? Materials and Methods: the research used the purposive sampling,
119 participations major in occupational therapy and joined the
Farooq A. Rathore1, Tayyab Rathore2, Saeed Bin Ayaz1 “psychiatric occupational therapy modality design topics” were
1
Spinal Rehabilitation Unit, Armed Forces Institute of Rehabilita- selected. The small groups were composed of four to five students
tion Medicine and 2Medical and Regulatory Affairs, Novartis (pvt) and they were together for 16 weeks. 21 small groups were ran-
Ltd (Pakistan) domly separated into two groups. A total of 11 small-groups were
assigned to experimental group(62 students), more oral guided
Purpose: To explore and identify the factors and barriers in the by in-depth discussion, assertive, facilitative and suggestive PBL
optimal community reintegration of persons with disability (PWDs) (GPBL group) of tutor, while 10 small-groups were assigned to
in Pakistan. Materials and Methods: This presentation is based on control group (57 students), students fellow the learning schedule
our 5 year experience of managing major and minor disabilities at and tutor using general oral guided with students. Tutor didn’t
the largest Rehabilitation institute in Pakistan. For this presentation offer idea to complete the project until students get solution from
we have considered only the major disabilities like SCI, Stroke, TBI themselves (PBL group). PBL curriculum of occupational therapy
and amputations. Informal in depth interviews were conducted with modality design and PBL of Occupational therapy modality evalu-
PWDs living in the community for more than one year and their ation form were all developed by author, and validated by three
attendants/ care givers presenting at our institute. Their attitudes experienced occupational therapy instructors. In pilot study, the
and perceptions towards their disability were explored, response inter-rater reliability of evaluation form was equaled to 0.862. The
of their families was noted and social and mobility barriers were function of evaluation form was a formative assessment to check
identified. Results: The following factors acting as barriers towards learning achievement of students after PBL curriculum. There were
adequate community reintegration of these disabled in Pakistan 15 items generate under three facets of evaluation form. Each item
were identified. is worth six points. T-test and ANOVA were used in the analysis of
1. Patient related factors and issues. a) Poor motivation for independ- the data. Results: The independent sample t-test showed significant
ent living; b) Unrealistic expectations; c) Low educational status; d) difference between GPBL group and PBL group (t(117) = 7.640,
Non availability of role models; e) Lack of peer support groups p < 0.000) at significant level 0.05. The GPBL group outperformed
2. Inadequacies on the part of Health care professionals: a) Poor/ the PBL group, especially at clinical reasoning, problem solving
No counseling; b) Poor understanding of disability; c) Lack of and modality design ability. It found that when tutor interjected in
motivation towards disability management the right time, made use of assertive and suggestive guidance for
3. Social, Societal and Cultural issues: a) Barriers to mobility; b) GPBL group, the effect was more salient than using general guid-
Barriers to socialization; c) Financial constraints; d) Lack of voca- ance of PBL. Conclusion: Our results showed that: first, PBL is a
tional and avocational opportunities; e) Stigmatization of disability; student-centered learning approach, but regard students’ needs to
f) Social rejection by community provide just right guidance would make students master learning
4. Government and legislative issues: a) Improper implementation content quickly, integrate and apply knowledge. Second, the im-
of disability related laws; b) Underdeveloped infrastructure for portant elements of PBL included: problems, students and tutors.
community based rehabilitation; c) Non Governmental Organization In order to cultivate lifelong learning, there is a need for long time
(NGOs) with vested interests. participate in PBL of students and educate qualify experts in the
Conclusion: We conclude that in Pakistan, Disability remains a content of tutors; provide students with appropriate guiding are the
stigma and cultural norms are a major hindrance in the reintegration most basic to make PBL curriculum success.
of a person with disability in the society. This is compounded by the
fact that statistical data on disability is very scarce and unreliable. In
Pakistan the disabled are generally disrespected and rarely function as 0502PP82
useful members of society. There is a need to enforce the legislation DEVELOPMENT OF REHABILITATION SERVICES
regarding building design to ensure that the specifications that facilitate
IN JIANGSU PROVINCE OF CHINA
independent access by PWD, including toilet access, are implemented.
Discrimination should be addressed, by education and legislation. It Qiuye Gao1, Jianan Li1, Shaoqin Gu1, Xia Zhang2, Sijing
is a duty of medical professionals to assist the disabled in Pakistan Chen2
improves their functioning, for their sake, and that of their country. 1
Department of Rehabilitation Medicine, 1st Affiliated Hospital
of Nanjing Medical University and 2Nanjing Medical University
0502PP81 (China)
LEARNING ACHIEVEMENT OF GUIDED Purpose: To elucidate development of rehabilitation services
PROBLEM-BASED LEARNING IN at provincial level in China during past 22 yrs, Materials and
Methods: A survey through questionnaires was down from 222
OCCUPATIONAL THERAPY STUDENTS general hospitals with rehabilitation services and 19 rehabilitation
Chia-Hui Hong1,2 hospitals in Jiangsu Province, China, in October, 2009. Results:
1
Graduate Institute of Science Education, National Taiwan Normal Jiangsu Province is one of the most advanced provinces in China
University and 2Jen-Teh Junior College of Medicine, Nursing and and has population of 76 million. There was no rehabilitation
Management (Taiwan) department 22 yrs ago in Jiangsu Province except some services
for physical modalities. Since establishment of Jiangsu Asso-
Purpose: Problem-based learning (PBL) is a student-centered ap- ciation of Rehabilitation Medicine, 84.2% of general hospitals
proach, which helping students to integrate subject matter, promote developed rehabilitation departments with 1805 inpatient beds
self-directed learning. In PBL, problem-based of actual clinical in total (3.6% of total hospital beds. Specialized rehabilitation
cases make students to integrate subject matters, ease applying services included 179 physical therapy, 86 occupational service,
knowledge and lifelong learning. The study is first to involve oc- 63 speech therapy, 28 P&O, 187 traditional Chinese therapy in
cupational therapy junior college students in PBL curriculum, but rehab and 83 rehabilitation psychology. Orthopedic rehabilitation,
these students are too young to learn independently. Guided PBL neuro-rehabilitation, geriatric rehabilitation, pediatric rehabilita-
is efficiently to facilitate students to know the structure of learning tion and pain management were conducted in most of services but

only small portion of cardiopulmonary and cancer rehabilitation 16-item physician supply scale measures a single construct. Our
services. Early rehabilitation intervention is conducted in all of work supports that the scale is valid and reliable, and is worthy of
provincial hospitals but only 51% in district hospitals. Manpower that effective task. Further research should be carried out to confirm
in rehabilitation field included 148 attending doctors and 521 these results congruent to practices in clinical settings.
junior doctors, 153 PT, 139 TCM therapist, 62 OT, 33 ST and 11
P&O. Compared with advanced countries, the capacity of reha-
bilitation services and manpower is at lower level even though the 0502PP85
development is dramatic. Conclusion: The rehabilitation services EDUCATION REHABILITATION OF CHILDREN
in Jiangsu Province have been developing rapidly during past 22 WITH MENTAL RETARDATION
years with great potential.
Zhenhuan Liu
Nanhai Affiliated Maternity and Children’s Hospital of Guangzhou
0502PP83 University of Traditional Chinese Medicine (China)
EDUCATION NEEDS OF PATIENTS AND THEIR Purpose: To seek effective methods of home education for the re-
FAMILY MEMBERS IN REHABILITATION habilitation of children with mental retardation and improve the life
DEPARTMENTS quality of handicap children. Materials and Methods: 86 children
aged range from 3 to 9 years with mental retardation were treated
Juan Jin, Li Zhou, Hui Ding with home education rehabilitation. After acquired the general
Department of Rehabilitation Medicine, 1st Affiliated Hospital of information and requirements of home education rehabilitation,
Nanjing Medical University (China) training of home education rehabilitation were given to the parents in
accordance with “Portage early education course”, “early education
Purpose: We assessd the education needs of rehabilitation project of Chinese children”, “family rehabilitation training/mas-
theory for patients and their family members, carried out planned sage VCD”, “handbook of home rehabilitation for the children with
education activities for them to increase their understanding of cerebral palsy”. In order to understand the psychological develop-
rehabilitation theory skills,raise their exercise awareness so that mental feature of children with mental retardation and work out the
patients can exercise actively, health behavior be carried out individualization home education rehabilitation program, each child
and quality of their life be elevated. Materials and Methods: was regularly assessed and guided. The education rehabilitation
Forty-eight patients or family menbers in our department was program was enforced by the parents guided by the rehabilitation
enrolled.Twenty-eight of them are male with remaining twenty doctors and the intelligence development state was tested regularly.
female.The everage age is forty-nine years.Information was Results: The results showed that after systemic home education
collected by using questionnaire. Results: Sixty percent of all rehabilitation, the intelligence and adaptive behavior of children
surveys wants rehabilitation within first three days after being with mental retardation could be improved (p < 0.001). 21 children
hospitalized, with twenty-nine and thirty-one percent expect it were excellence, 55 were effective, 6 were better than before and
hold before they leave and at other times. Individual teaching is 4 were ineffective. 20 children were adopted to elementary educa-
the most favourate education form, and other forms like centered tion organization. Conclusion: Stable and practical individualized
lecture are also popular among certain groups of surveys Doc- home education rehabilitation service for the children with mental
tors and therapists, rather than nurses are the people patients or retardation can promote the healthy development of cognition,
family members want to learn rehabilitation knowledge from. speech, social adaptation.
Conclusion: Rehabilitation education, composed of rehabilita-
tion theory, skill and training methods given at different stages,
under the guidance of doctors, therapists and nurses, in the form 0502PP86
of individual teaching and centered lecture should be given to APPLICATION OF A TEACHING MODEL OF
patients and their family members. SYSTEM-BASED LEARNING AND PROBLEM-
BASED LEARNING IN REHABILITATION FOR
0502PP84 MEDICAL STUDENTS
ASSESSMENT AND COMPARISON OF CLINICAL Zhen Huang
MANPOWER BETWEEN MEDICAL CENTERS AND Peking University First Hospital (China)
REGION HOSPITALS IN TAIWAN
Purpose: To improve the comprehensive abilities of medical stu-
Willy Chou, Shu-Han Yang, Chern-Chern Sui, I-Min dents. Materials and Methods: A teaching model of system-based
Lo, Michael Lee, Chai-Wei Chan learning (SBL) and problem-based learning (PBL) has been used
Chi-Mei Medical Center (Taiwan) since 2006 instead of discipline-based learning in the past. The
course of rehabilitation has been added to neurological system
Purpose: To set up a reference norm comparison between hospitals panel and musculoskeletal system panel in year 4 of eight years’
is available for implementing the requirement of the Six Missions undergraduate education. The reforms of teaching model included
of hospital accreditation encouraging medical centers to present joined preparation of a panel course by the teachers from different
something different from others as much as possible. Materials and discipline, small group teaching, joined case discussion, clinical
Methods: We downloaded data from government website of physi- observation and case analysis in the same panel, PBL teaching and
cian supply from 79 Taiwanese medical centers and region hospitals, examination, PBL teaching in English and community-based reha-
and then adopted both exploratory factor analysis and Rasch model bilitation observation. Results: The SBL & PBL model has more
to examine unidimensionality of physician manpower characteris- advantages, such as matching the clinical thinking way, strengthen-
tics to form an appropriate scale measuring hospital performance ing the concept of whole patient management, reducing the lectures
in physician supply. Results: We found that that 1) Four kinds of and optimization the curriculum, improving the students’ skills of
physicians such as internal, surgery, Obstetrics and Gynecologym, self-learning and communication, enhancing the future doctors’
pediatrics reached 50% of total physician supply in big hospitals; understanding of the importance of rehabilitation and facilitating
2) the Ferguson discrimination delta for the study physician sup- more collaborations between departments by joined course prepara-
ply scale is 0.97; 3) over one third of Taiwanese regional hospitals tion. Conclusion: SBL & PBL model matches the requirements for
perform excellent over general medical centers. Conclusion: The future doctors much more.

0502PP87 (26.2%), and scientific (11.9%). Conclusion: The results show that
THE ACTIVITY PERFORMANCE AND the highest percentage in the “interpersonal” category reveals the good
social skills commonly possessed by the questionnaire participants.
SATISFACTION OF LABORS WITH HAND INJURY The second highest is “humanistic”. Those with the highest scores
AFTER WORK-HARDENING PROGRAM in this item possess abilities related to art, creation, expression, and
Hsiao-Wei Hsu1, Min-Yuan Yu1, Jer-Hao Chang2, Jui- intuition. The third highest is “scientific”; those with the highest scores
in this item tend to use intelligence and analytical ability to observe,
Kun Chang3 reason, assess and judge to solve problems. The major clients for an
1
OT, Rehabilitation Department, Kaohsiung Chang Gung Memorial occupational therapist are the children and the patients with physical
Hospital, 2Occupational Therapy Department, National Cheng Kung and mental problems. The interpersonal, humanistic and scientific
University and 3OT, Rehabilitation Dept, Kaohsiung Chang Gung inclinations of the participants are in line with the work content of
Memorial Hospital (Taiwan) an occupational therapist, so most of them have the potential to work
as occupational therapists. Accordingly, this study suggests that the
Purpose: Hand injuries are the most common work-related injuries Career Interest Inventory can help the students in departments of oc-
and tend to cause various disabilities in daily activity. The hand cupational therapy better understand their own career orientation so
impairment also frequently influences the individual’s quality of that they can more appropriately determine their career options.
life. The purpose of this study is to evaluate the training effect of
work hardening program on activity performance and satisfaction.
Materials and Methods: Fourteen labors with occupational hand
injury were referred to work hardening program for the purpose of 0502PP89
return-to-work. Twelve were males and two were females. Their A STUDY OF THE STUDENTS’ PHYSICAL AND
average age at the time of work hardening program was 40 years old MENTAL ADJUSTMENT IN DEPARTMENT OF
(range: 19–61 yrs). The average time from injury to receive work
hardening program was 26.72 weeks (range: 3.29–76.57 wks). The OCCUPATIONAL THERAPY: A UNIVERSITY IN
average duration of the training program was 7.64 weeks (range: SOUTHERN TAIWAN TAKEN AS EXAMPLE
4–10 weeks). All cases had full scores in The Barthel index. Statisti- Ping-Chia Li1, Chin-Hsuan Liu2, Posen Lee1
cal analysis was performed using paired-t test to examine the differ- 1
Department of Occupational Therapy, I-Shou University and
ence of Frenchay Activities Index (FAI) and Health related quality
of life (HRQL) before and after work hardening program. Results:
2
Department of Occupational Rehabilitation, Kai-Suan Hospital
The results showed that all cases had great improvement in activ- (Taiwan)
ity performance and life satisfaction. The statistically significance Purpose: Since occupational therapy is a profession providing
presented in FAI (p = 0.0006) and HRQL (p = 0.0018). Conclusion: services for people, in order to satisfactorily handle the work, it is
Work hardening program was effect in helping the labors with oc- necessary for the therapists to possess high quality communication
cupational hand injury to acquire good functional performance in ability and a mature personality that can handle stress, emotions,
daily activity and also the satisfactory quality of life. and personal relationships on their own. So far, there is no litera-
ture discussing how the students in departments of occupational
therapy become physically and mentally adjusted to the school life
0502PP88
during their learning process. Accordingly, this study probes into
AN INQUIRY INTO THE CAREER ORIENTATION the conditions of students’ adjustment in a school environment in
OF THE STUDENTS IN DEPARTMENTS OF the hope that teachers can better understand students’ adjustment
OCCUPATIONAL THERAPY: A UNIVERSITY IN problems and help them to have a smoother school life. Materials
and Methods: This study is conducted with the College Students’
SOUTHERN TAIWAN TAKEN AS EXAMPLE Adjustment Checklist (2nd Version) as the questionnaire. The sam-
Ping-Chia Li1, Chin-Hsuan Liu2, Posen Lee1 ples are the freshmen, sophomores and juniors in the department
1
Department of Occupational Therapy, I-Shou University and of occupational therapy (20.7 years old on average), in which
2
Department of Occupational Rehabilitation, Kai-Suan Hospital there are 32 freshmen, 38 sophomores, and 36 juniors, totaling
(Taiwan) 106 students, with 45 males and 61 females. All of the participants
took the questionnaire test, and based on the score ranking of each
Purpose: Occupational therapy is a profession integrating art and question, the physical and mental adjustment conditions could be
science. Occupational therapists are required to deeply understand discussed in terms of 10 categories: living problem, time manage-
the past and current conditions of the clients they handle as well as ment problem, career problem, learning problem, family problem,
future expectations, in order to ensure mutual communication and interpersonal problem, affection problem, emotion problem, spirit
a rehabilitation treatment plan that is designed to meet individual problem as well as physical problem. Higher scores mean higher
needs. However, there is no relevant literature concerning the char- degrees of problem in each item. Results: The results show that,
acteristics of the students in departments of occupational therapy. among the problems, the highest percentage falls within time man-
This study aims to probe into their career orientation as a reference agement problem (31.6%), then interpersonal problem (20.4%) and
for the teaching of occupational therapy and to provide suggestions learning problem (10.8%), signifying that what annoys the students
for students’ career options based on their aptitudes. Materials and most are time management and daily life, followed by problems of
Methods: The questionnaire used in this study is the Career Interest networking and personal relationship, and stress from schoolwork.
Inventory (CII-R for College), which is a paper pencil test and can The worry of physical problem had the lowest scores; the second and
be completed in 20~30 min. The test results can elicit six average third lowest were worries over emotion problem and spirit problem,
scores: pragmatic, scientific, humanistic, interpersonal, commercial, respectively, signifying that they had the least impact on the life of
and clerical to reveal personal interests and aptitudes. The samples the university students. Conclusion: Since the results reveal time
of this study were 106 students from the department of occupational management as the most annoying problem for the students in de-
therapy in a university in southern Taiwan, with 32 freshmen, 38 partments of occupational therapy, teachers can integrate this issue
sophomores, and 36 juniors; 45 were males and 61 were females. into the courses related to student counseling. Students’ schedules
The average age is 20.7. Results: All of the participants did the ques- after school also need proper exploration. As for the worry over
tionnaire. Based the score ranking, the career orientation could fall personal relationships, the results show the students have difficulty
within 6 categories: pragmatic, scientific, humanistic, interpersonal, networking and need to strengthen their social skills. Regarding the
commercial, and clerical, representing 6 types of aptitude. The highest worry over learning, the juniors on average had higher scores than
three percentages arranged sequentially according to the highest score did sophomores and freshmen. It may be that the juniors have more
each participant acquired, were interpersonal (54.8%), humanistic professional courses to study and face the upcoming internship in

hospitals in the senior year. Teachers can provide instructions to the independent influence on the inpatient cost. Results: The mean cost
students about solutions to these problems to help them better adjust and length of hospital stay in our study were 108365.80 New Taiwan
themselves to the school life and optimize the teaching effects. Dollars (SD = 53825.90) and 50.92 days (SD = 20.57) respectively.
On multivariate analysis the significant predictors associated with
cost were: (i) length of hospital stay (R2 = 0.739) (ii) nasogastric tube
0502PP90 intubation days( R2 = 0.161) (iii) consultation times (R2 = 0.008) (iv)
A CLUSTER ANALYSIS ON THE CARE STATUS endotracheal tube intubation days (R2 = 0.007) and (v) Foley catheter
OF THE INJURED WORKERS ACCORDING TO intubation days (R2 = 0.004) Conclusion: In our study, length of
hospital stay is still the most important determinant of stroke patient
THE TRANSFERRING PATTERNS IN KOREA cost in rehabilitation wards as previous study. However, unlike in the
Goo Joo Lee, Byung-Mo Oh, Sang Yoon Lee, Keewon other countries, 99% of total population in Taiwan was covered by the
Kim, Tai Ryoon Han National Health Insurance. As a result, stroke patients and their family
tend to stay at hospitals for better medical care and length of hospital
Department of Rehabilitation Medicine, Seoul National University
stay, therefore, is not an under-controlled factor based on medical
College of Medicine (Republic of Korea) principle. So, early removal of unnecessary catheter and prevention
Purpose: This study was performed to analyze the differences in of medical complications may be the more important factors for better
demographic characteristics, days of care, and medical cost of indus- control of increasing costs of stroke patient rehabilitation in Taiwan.
trial disaster victims according to the transferring patterns by using
cluster analysis. Materials and Methods: Data were extracted from
Electronic Data Interchange database of Korea Workers’ Compensa- 0502PP92
tion and Welfare Service. The subjects were 4,581 patients approved A STUDY ON THE USE OF TIME BY STROKE
as industrial disaster victims between Jan 1, 2006 and Dec 31, 2006 PATIENTS – A COMPARISON WITH THE RESULTS
who were suffered from the ischemic stroke, hemorrhagic stroke,
intervertebral disc disease and spinal fracture. We categorized each OF THE NATIONAL TIME-USE SURVEY
disease group into 3 to 6 subgroups according to the number of admis- Hideyasu Watanabe, Fumihito Kassai, Masazumi
sions by K-means cluster analysis, then compared the differences in Mizuma
demographic characteristics, days of care, and medical cost within
Showa University School of Medicine (Japan)
each subgroup. Finally, we divided them into early discharge group
and late discharge group, which were determined by specialist of Introduction: Although the Barthel Index, FIM, and other methods
this field, and compared the same variables. Results: Ischemic stroke have been widely employed to assess the ADL of patients in clinical
was divided 3 subgroups (I~II subgroup: early discharge group, III practice, few health care institutions assess the lifestyle of outpatients
subgroup: late discharge group), both hemorrhagic stroke (I~IV: at home. Therefore, we conducted a time-use survey involving stroke
early discharge group, V: late discharge group) and intervertebral patients attending our hospital to examine their lifestyle, and com-
disc disease (I~II: early discharge group, IV~V: late discharge group) pared the results with those of the 2005 National Time-Use Survey
were divided 5 subgroups, spinal fracture was divided 6 subgroups (NHK Broadcasting Culture Research Institute). Subjects: The sub-
(I~III: early discharge group, IV~V: late discharge group). All of the jects were twenty-seven stroke patients (twenty-one males and six
4 diseases had 1 to 3 subgroups which showed longer hospitalization females) without severe impairment of higher brain functions or de-
and more medical cost than the others (p < 0.05). Especially in the mentia attending our hospital on foot. Their mean age was 62.8 ± 10.0.
case of spinal fracture group, it showed that 3 early discharge groups Three years and five months had passed on average after the onset of
with shorter hospitalization tended to admit to lower medical institute the disorder: seventeen cerebral infarction, nine cerebral hemorrhage,
and 3 late discharge groups with longer hospitalization to higher one subarachnoid hemorrhage, nine right hemiplegia, and fourteen
medical institute (p < 0.001). Conclusion: This study was the first left hemiplegia cases, and four patients without hemiplegia. The mean
cluster analysis according to transferring patterns of industrial disaster FIM score was 110.9 ± 11.3. Methods: We distributed a survey form
victims. We found some remarkable subgroups, using K-means cluster to the patients and asked them to complete and return it by mail. They
analysis according to the number of admissions. described their activities performed during the most typical day on
the survey sheet with a time scale bar (unit: 15 min) and the names
of daily activities, as samples, printed on it. Based on their responses,
0502PP91 we calculated the time spent on each activity. Results: Based on the
DETERMINANT OF STROKE INPATIENT COST IN 2005 National Time-Use Survey, we classified their ADL into essential
CHRONIC REHABILITATION WARDS IN TAIWAN. (basic daily activities), necessary (those they are required or obliged
to perform), and optional activities. The lifestyle of stroke patients
Allen Chia-Lin Hsu1, Alice M.K. Wong2, Shih-Ching was similar to that of unemployed people. When compared to healthy
Chen1, Wei-Han Chang2, Jyh-Yuh Ke2, Shih-Wei Chou2 people in their sixties, stroke patients spent longer hours sleeping,
1
Taipei Medical University Hospital and 2Chang Gung Memorial eating, caring for themselves, and other essential daily activities, and
Hospital (Taiwan) less time to enjoy conversations and develop relationships. They did
not spend much time watching TV, reading newspapers, or enjoying
Purpose: Stroke is a disease with severe consequences which impose their hobbies. Discussion: The assessment and understanding of the
a considerable socio-economic burden on patients and society. In lifestyles of stroke patients, by comparing them to those of healthy
developed countries, stroke patients alone generate about 3–4% of the people of the same age, helped improve lifestyle-based advice for
direct costs within the health care system. The cost of rehabilitation outpatients with disorders.
and long-term care of disabled stroke survivors is expected to rise even
further because of the increasing number of the aging population and
declining stroke case-fatality rates. The aim of the paper is to evaluate 0502PP93
the factors that may influence costs of stroke patients and to estimate REHABILITATION EFFECT OF CERVICAL
the expected increasing cost. Materials and Methods: This study was SPONDYLOPATHY BY CHANGING MODE OF
conducted at a local general hospital including 249 rehabilitation beds
which is one of the main general hospitals for the urban section and LIFE
surroundings of Taipei. In 156 patients satisfied the WHO criteria for Xuya Zhou
definition of stroke, demographic and clinical data were collected. Zhongnan Hospital, Wuhan University (China)
(Including principal diagnosis, length of hospital stay, comorbid con-
ditions, infection and catheter intubation days. A multivariate linear Purpose: To observe the rehabilitation effect of cervical spondy-
regression analysis was then performed to determine factors with an lopathy by changing mode of life. Materials and Methods: A total

60 patients with cervical spondylopathy of arteria vertebralis-type Purpose: To explore status and the relationships of isokinetic strength,
and 60 patients with cervical spondylopathy of radix nervi-type fall efficacy and fall among aged adults. Materials and Methods: A
were divided into 2 groups randomly. The patients in the trial group cross-sectional research design was used. Eight communities and
were treated by changing mode of life, chirismus treatment and drug 1175 older adults aged more than 65 were selected by using random
treatment, while those in the control group were treated by chirismus and systematic sampling, respectively. Ninety six subjects aged from
treatment and drug treatment only. The therapeutic duration was 4 65 to 79 (M = 70.07) participated in this study. The Biodex system 3
weeks in both groups. The clinical effects in the two groups were was used to test knee extension and flexion strength of the dominant
observed after treatment. Results: There was statistic significance in leg which occurred at a speed of 60 degree angular velocity. Peak
effect of the patients with cervical spondylopathy after intervention torque, total work, and power recorded to represent the strength
between the two groups. Conclusion: Changing mode of life can status. The Fall Assessment Survey was used to survey the personal
promote rehabilitation for the patients with cervical spondylopathy information, falls, and fall efficacy (FE) of the participants. Results:
of arteria vertebralis-type and radix nervi-type, and it is one of the The mean scores of peak torque, total work, and power of the knee
important methods for cervical spondylopathy. extensor and flexor were reported. Strength differences were identified
between genders and exercise frequencies. No correlation between
0502PP94 peak torque, work, the power of the knee extensor and flexor and the
number of falls was identified. However, peak torque, total work, and
THE PREVALENCE ANALYSIS OF ISCHEMIC power of the knee extensor and flexor were all positively correlated
AND HEMORRHAGIC STROKE IN THE ELDERLY with each FE item (r = 0.287–0.517, p < 0.001). The strength of the
POPULATION AND CORRELATION STUDY knee extensor had a stronger impact on FE than knee flexor. The
WITH LOCAL AVERAGE TEMPERATURE: A score of FE associated with the number of fall. The strength of the
knee extensor explained 22.5% to 26.3% of the fall efficacy score
HOSPITAL-BASED CROSS-SECTIONAL STUDY IN variances. Conclusion: This project was the first study to investigate
SOUTHERN TAIWAN the isokinetic strength and fall experiences of aged adults. The knee
Hung-Chih Hsu1,2, Chia-Ling Chen1, Kai-Hua Chen1, extensor was found to have a more important role than the knee flexor
Yi-Wen Chuang3 in FE. This implied training for quadriceps strength will decrease the
fall tendency among aged adults. Recruiting more cases, eliminating
1
Department of Physical Medicine and Rehabilitation, 2Graduate the recall bias, and explore the causal effects among strength, fall and
Institute of Clinical Medical Sciences and 3Chang Gung Memorial FE were recommended in the future.
Hospital (Taiwan)
Purpose: Stroke is a commonly encountered neurologic disorder 0502PP96
in the elderly population in Taiwan, but the prevalence and extent
of severity is not clear. Previous studies suggest there might be an RISK FACTORS OF FALL-RELATED INJURIES
association between weather pattern and risk for ischemic stroke. AMONG ELDERLY PEOPLE: A NATIONWIDE
Materials and Methods: We conducted a cross-sectional study by STUDY FROM TAIWAN
reviewing the stroke patients who admitted to Chang Gung Memo-
rial Hospital for six years period (Jan 2003–Dec 2008), and patients Clement SH Yang1,4, Chung-Chao Liang1,4, Hung-Yu
over 60 were recruited for study. Comparative studies including Cheng1,5, Peilin Wu2, Chieh-Yu Liu3
type of stroke, gender, length of admission, peak prevalence age 1
Department of Physical Medicine and Rehabilitation, Buddhist
were analyzed. Local average temperatures were also calculated for Tzu Chi General Hospital, 2Institute of Rehabilitation Counseling,
correlation. Results: 6733 patients reviewed, 3583 (53.2%) were National Taiwan Normal University, 3Department of Nursing,
over sixty years. Among them, 1089 (30.4%) were hemorrhagic National Taipei College of Nursing, 4College of Medicine, Tzu Chi
and 2494 (69.6%) were ischemic. The female to male ratio is 0.77 University and 5Institute of Pharmacology and Toxicology, Tzu Chi
(477/612) in ischemic stroke and 0.81 (1123/1371) in hemorrhagic University (Taiwan)
stroke. The average length of admission is 11.51–12.22 days (95%
confidence interval) in ischemic and 11.25–13.85 days in hemor- Purpose: Fall-related injuries are believed to be the cardinal cause
rhagic stroke patients. The peak prevalence age is 76 in ischemic of disabilities and deaths among the community-dwelling elderly.
and 71 in hemorrhagic stroke patients. The regression analyses of The aim of this study was to explore the risk factors for fall and
prevalence in stroke patients over 60 and local temperature are: consequent injuries among the older adults in Taiwan. Materials and
R square 0.095 in 2003, 0.099 in 2004, 0.259 in 2005, 0.068 in Methods: The data were from the 2005 National Health Interview
2006, 0.015 in 2007, 0.003 in 2008, respectively. Conclusion: The Survey (NHIS) in Taiwan. The inclusion criteria were: (1) older
patients between 70–80 are 1.4 times more likely to have stroke adults aged 65 years and older, (2) self-reported who had history of
than those between 60–70, 2.14 times than those between 80–90. falls in 2005. The interview survey was conducted by well-trained
Above 60, the overall prevalence of ischemic stroke is about 2.3 interviewers, and information such as demographics, domestic en-
times more than hemorrhagic stroke. Men are about 1.5 times more vironment safety, chronic illness, anthropometric assessment, and
likely to have stroke than women. The peak prevalence age is older fall-related injuries history were collected. Results were expressed
in ischemic than hemorrhagic stroke. The severity hemorrhagic in terms of mean ± standard deviation for continuous data, and counts
stroke is statistic significant more than ischemic stroke, according and percentage for categorical data. The contingency table analysis
to length of admission (p < 0.05). In stroke patients over 60, there and stepwise logistic regression were adopted for investigating risk
is no significant correlation between the prevalence and local aver- factors of fall-related Injuries among the elderly. Because the 2005
age temperature. NHIS adopted unequal probability sampling design, the sampled
participants needed to be weighted by sampling weight. Therefore,
0502PP95 the resulted odds ratios were estimated by weighted logistic regres-
sion model. All statistical analysis were performed using SPSS ver-
FALL, FALL EFFICACY, AND ISOKINETICS sion 17.0 (SPSS Inc., Chicago, IL, USA), and a p-value < 0.05 was
STRENGTH IN OLDER COMMUNITY DWELLERS considered statistically significant. Results: A total of 579 old adults
of 2005 NHIS were selected. After weighted estimation by using
Shun-Ping Cheng1, I-Ju Chen2, Hsin-Pei Yin1, Cheng-
sampling weights for Taiwanese population, there were estimated
Liang Chou3 about 295,679 older adults who had history of falls in 2005. The
1
Lo-Sheng Sanatorium, Department of Health, Executive Yuan, results showed that the single elder adults had statistically significant
2
School of Nursing, National Yang-Ming University and 3Depart- higher risk of fall-related injuries than coupled ones [OR = 1.13, 95%
ment of Physical Medicine & Rehabilitation, Veteran General CI = (1.11, 1.16)], osteoporosis [OR = 1.49; 95% CI = (1.46, 1.52)],
Hospital-Taipei (Taiwan) body mass index (BMI) [OR = 1.02; 95% CI = (1.02, 1.02)], fracture

history after 50 years of age [OR = 16.94; 95% CI = (16.57–17.33)], ercise therapy, acupuncture and sports therapies, the 1st day, 2 months
daily activities on higher floors (≥ four floors) [OR = 1.39; 95% of treatment. Before and after the treatment of 3 months, 6 months,
CI = (1.35, 1.43)]. Besides, female older adults had statistically the knee is taken, routine, and observe the curative effect. Results:
significant less risk of fall-related injuries than male [OR = 0.86, the acupuncture plus exercise of greater efficiency in the exercise
95% CI = (0.84, 0.88)], handrail in the bathroom [OR = 0.76, 95% group and acupuncture group (p< 0.01), and acupuncture group and
CI = (0.74, 0.78)], small bathroom space [OR = 0.60, 95% CI = (0.56, exercise therapy has no obvious difference between groups (p > 0.05).
0.63)], exercises [OR = 0.56, 95% CI = (0.54, 0.57)], education After treatment for 3 months, 6 months to use again anti-inflammatory
[OR = 0.41 (higher vs. lower educational levels), 95% CI = (0.40, drugs, acupuncture and recurrence of the exercise therapy group
0.42)], age [OR for young-old vs. old-old = 0.82, 95% CI = (0.80, significantly lower acupuncture group and exercise therapy group
0.84)], daily activities on lower floors (≤ three floors) [OR = 0.73; (p < 0.01), acupuncture group compared with the exercise therapy
95% CI = (0.71–0.75)]. Conclusion: Previous fracture history after group, but no recurrence rate reduced significantly (p > 0.05). Acu-
50 years old was recognized as the major risk factor of fall-related in- puncture plus exercise therapy of joint gap narrowed better than the
juries for the elderly. Besides, single status, osteoporosis, high BMI, other two groups (p < 0.05). Conclusion: The acupuncture and ex-
and daily activities on higher floors were also needed to be noted. ercise therapy in elderly patients treated knee osteoarthritis synergy
Furthermore, protective factors included gender, environmental and affections are reversed the trend of radiculopathy.
modifications, exercises, education, advanced age and daily activi-
ties on lower floors. These identified factors should be accentuated
to diminish future morbidity and mortality related to fall injuries 0502PP99
among older adults, and future experimental studies were needed DO ELDERLY MEN OR WOMEN DO BETTER IN
for evaluating the influences of these identified factors. ACUTE INPATIENT REHABILITATION?
San San Tay1, C. George Kevorkian2
0502PP97 1
Division of Rehabilitation Medicine, Changi General Hospital
THE EFFECTS OF A SENSORIMOTOR TRAINING (Singapore) and 2Department of Physical Medicine and Rehabilita-
IN THE REGULATION OF POSTURAL BALANCE tion, Bayor College of Medicine (United States)
IN OLDER ADULTS. Purpose: To describe and compare the dermographics and func-
Meng-Tien Wu1, Yuan-Shuo Chan2 tional outcomes of elderly male and female patients who underwent
1
Zhi-Shan Senior Home and 2Department of Adapted Physical inpatient rehabilitation in an acute tertiary hospital in the United
Education, National Sport University (Taiwan) States. Materials and Methods: Retrospective cohort study. The in-
patient rehabilitation database was reviewed for the period between
Purpose: Aging is a period of constant change, especially the November 2005 to December 2007. There were 1182 complete
function of the neuromuscular system declines rapidly after the records, of which 741 belonged to elderly patients. The primary
6th decade. Neuromuscular deterioration with aging contributes outcome measures were FIM gain, FIM efficiency. Other outcome
to impairments in postural control and increased fall risks in older measures included the rehabilitation length of stay and discharge
adults. Looking at postural stabilization, numerous studies have destinations. Results: There were 741 patients who were 65 years
highlighted the role of vision with increasing aging. Therefore, the or older. 40.9% were male. The average age of the elderly males
aim of this study was to analyze the effects of a six-week sensori- was 76.9 ± 6.9 years and the average age of the elderly females was
motor training performed on an unstable platform. Materials and 77.3 ± 7.1 years. The average FIM gain was 16.2 ± 10.8 points in
Methods: Forty-three healthy older adults (divided into a sedentary elderly males and 18.4 ± 9.7 in elderly females. The FIM efficiency
group and a training group, mean 70.5 years) took part in a six-week was 1.63 ± 1.2 and 2.09 ± 1.3 respectively. The difference in the
training program (three times a week, involving gross and fine motor FIM gain and efficiency between the two groups was significant.
activities, coordination, auditory-motor match, visual-motor transla- 66.4% of the elderly patients were discharged home. The rate of
tion, etc). Posturomed® system was used to measure body sways discharge home in single males and females were 38.1% and 65%
before and after training. Postural control in various conditions respectively. 39.5% of widowers went home, compared to 61% in
was measured including standing naturally with eyes closed and widows. The average length of stay in the inpatient rehabilitation
open. Analysis was done using the SPSS 12.0 statistical software. unit was 11.5 ± 5.2 days in elderly men and 10 ± 4.7 days in elderly
For descriptive statistics, a paired t-test and one way ANOVA were women and this difference was significant. Conclusion: The dif-
conducted. Results: Results revealed that the sensorimotor training ference in FIM gain and rate of discharge home in elderly males
group could significantly decrease the sagittal Y and total body sway and females is significant. Females appear to do better than males.
distance on standing naturally with eyes closed, but not with eyes Making social services more available to single men or widowers
open, (p < 0.05) after six weeks of training. The control group did may help them reintegrate into the community.
not show any significant changes. Conclusion: The most important
finding from this study suggests that the tested six-week sensori-
motor training protocol significantly contributed to an increase of 0502P100
balance control ability when eyes were closed. EFFECTS OF WEIGHT-SHIFT TRAINING FOR
IMPROVING ELDERLY DYNAMIC BALANCE
0502PP98 ABILITY
THE CLINICAL EFFECT OF ACUPUNCTURE Chen-Yang Kao1, Wen-Hsu Sung1, Chueh-Ho Lin1,2,
COMBINED WITH EXERCISE THERAPY Shun-Hwa Wei1
FOR THE ELDER PATIENTS WITH KNEE 1
National Yang-Ming University Department of Physical Therapy
OSTEOARTHRITIS AND ANALYSIS OF X-RAYS and Assistive Technology and 2Hung-Kuang University Department
of Physical Therapy (Taiwan)
Xinchun Dong, Jiayan Zhao, Kaihua Zhai, Boyu Liu
The Third Hospital Xinxiang Medical Unversity (China) Purpose: Purpose of this study included 1) comparing ability of
weight-shifting and dynamic limit of stability (LOS) between elderly
Purpose: Through the analysis of X-ray changes in search of elderly and adult subjects, 2) investigating whether weight-shift training
knee osteoarthritis effective treatment methods. Materials and Meth- could increase LOS on elderly subjects, and 3) investigating whether
ods: 120 cases of elderly knee osteoarthritis patients were randomly LOS incensement could transfer into daily functions. Materials and
divided into acupuncture group (40 cases), in the exercise group (40 Methods: Study design: An experimental study, single blind, rand-
cases), acupuncture plus exercise (40) three groups, acupuncture, ex- omized controlled trial. Subjects: 15 adults aged 18~30 and 29 old

adults over 65 years fitting the inclusion criteria would be recruited Purpose: To study effectiveness of rehabilitation treatment for
and randomized into experimental group (n=15) or control group treatment knee osteoarthritis in the eldery patients. Materials and
(n=14). Intervention: Conventional balance rehabilitation program Methods: This study including 50 ambulatory patients with radio-
plus visual feedback weight-shift training, 3 times a week for 6 weeks. logically verified knee OA and a visual analogue scale (VAS) total
Training effect will be evaluated by assessing the dynamic balance pain score > 175 mm of 500 mm on the Western Ontario and McMas-
performance and clinical tests. Statistical analysis: Independent t ter Universities Osteoarthritis Index (WOMAC) pain scale despite
test was used to compare COP measurements of adults and elderly. treatment with acetaminophen or nonsteroidal anti-inflammatory
Paired t test was used to compare two groups of elderly (training drugs. Exclusion criteria included grade IV radiologic changes,
and control group) and the two measurement periods (pre-training inflammatory anthropathy, a baseline study knee tense effusion,
and post-training). The statistically significant level was set at 0.05. chondrocalcinosis, and severe varus or valgus . We divided par-
Results: Adults were found to have better dynamic balance perform- ticipants into two groups:the first group 30 patient sedentary who
ances than elderly. Elderly subject obtained significant improvement walked five or more miles weekly and effectuated electrotherapy
in LOS area, sway velocity, and maximal displacement both on (TENS) and the second group who walked less than five miles
anterior and lateral direction after 6 weeks weight shifting training. weekly and effectuated just kinetotherapy and hidrokinetotherapy.
Additionally, after 6 weeks of weight-shift training, elderly subjects Results: Analysis of the results showed the second group reduced
showed improving their daily function that included increasing 23.9% pain and improve health-related quality of life than the first group.
of Berg balance scores; decreasing 23% seconds of TUG test, and Conclusion: A kinetotherapy and hidrokinetotherapy program
increasing 24% functional reach test when comparing with previous seems to benefit patients with knee arthritis It may also delay or
test. Conclusion: To avoid fall accident occurring in older persons, prevent complication.
weight-shifting training can be implicated on them due to improv-
ing their balance function. Weight-shifting training alternated older
persons’ dynamic balance function. This alternation also can help 0502PP103
them improving certain activities of daily functions. STUDY ABOUT EFFICIENCY TREATMENT OF
ELDERY PATIENTS IN BALNEAR TREATMENT
0502PP101 FELIX SPA
BIOMECHANICAL COMPARISONS OF LOWER Simona Darciana Birsan1, I. Mircea1, M. Chiriac2
LIMB MUSCLE POWER AMONG HEALTHY 1
Ordea University of Medicine and 2University of Oradea (Ro-
ELDERLY, FALLING ELDERLY AND YOUNG mania)
ADULTS DURING PERFORMING SIT-TO-STAND Purpose: To determine the quality of life in eldery patients. Materi-
AND SQUATTING MOVEMENT als and Methods: Baile Felix Spa was certified in 1658, profiled
I-Chung Cheng1, Shun-Hwa Wei1, Chueh-Ho Lin1,2, in particular on the treatment of locomotor diseases. The climate
is gentle, continental temperate and thermal mineral waters have
Wen-Hsu Sung1 temperature between 41–49 C, being bicarbonated sulphate, cal-
1
National Yang-Ming University Department of Physical Therapy cium, sodium, silicious, oligomineral.On the point of terms of value
and Assistive Technology and 2Hung-Kuang University Department index of stress skin relaxing months are March to May and October.
of Physical Therapy (Taiwan) Ostheoarticular eldery is not synonymous with degenerativ vertebro
peripherical arthrosis.The eldery not necessarily involved in the
Purpose: The purpose of this study was to investigate the differ-
process of arthrosis but all changes are morfofunctional normaly
ence of lower limb muscle power among three groups, elder with
on the individuals throughout life. Study was conducted in front
fallen, healthy elderly and young adults, during performing STS and
of a group of 200 patients with diseases of the locomotory system.
squatting movements. Materials and Methods: Forty-two subjects
The treatment was applied varied according to the state. Lot of 125
voluntarily participated in this study. A single-axis force plate, data
patients studied had performed therapeutic cure, 50 and 25 cure
acquisition (DAQ) system and LabVIEW software were used to
prophylactic course of recovery. Results: Evaluation results were
evaluate biomechanical parameters among the tested movement.
made after clinical criteria: pain events, local functional disorders
One-way ANOVA associated with Scheffe multiple comparisons
(joint mobility, muscle troficity). Conclusion: The results were as-
were used to exam parameter differences among three tested groups.
sessed at the end of cure for those who have curative treatment and
Results: Comparing with young adults during STS movement,
recovery; the prevention belt will be appreciated in time. It noted an
elder risk fallers were found decreasing 53% (p < 0.05) of muscle
evolution of the patients better because joining harmonious natural
power in the lower extremities. Healthy elders, however, only de-
factors with physical therapy agents.
creased 25% (p < 0.05). Similar comparison but in squatting, elder
risk fallers decreased 30% (p < 0.05) of the functional strength and
69% (p < 0.05) of power in the lower extremities. However, healthy
0502PP104
elders only decreased 21% (p < 0.05) of the functional strength and
40% (p < 0.05) of power. Conclusion: Deterioration of strength and IS THE EFFECT OF POWER TRAINING
power in lower extremities might lead elder persons having high SUPERIOR TO STRENGTH TRAINING
fall incidence. Since muscle power involved quick force generation ON PHYSICAL PERFORMANCES OF THE
in order to maintain adequate leg stiffness, muscle power of lower
extremities was important for elder persons. Based on the evidence COMMUNITY-DWELLING OLDER ADULTS-A
in the present study, in order to decrease the incidence of fall accident META-ANALYSIS
among elder persons, we thought power rehabilitation of the lower Tzu-Wen Chen, Pay-Shin Pay-Shin, Wen-Yu Liu, Shou-
extremities in elder persons was extremely important.
Chuang Liu
0502PP102 versity (Taiwan)
THE STUDY OF PHYISICAL REHABILITATION Background and Purpose: Strength training (ST) is often used
OUTCOME IN THE ELDERY PATIENT WITH to aim to enhance muscle (m.) performance of the elderly. How-
KNEE OSTEOARTHRITIS DURING 2006–2008 ever, power training (PT) is advocated recently to be an important
component in older adults’ training program due to the feature of
Simona Darciana Birsan, I Mircea, F Bodog emphasizing speed of m. contraction. But, is the effect of PT supe-
Oradea University of Medicine (Romania) rior to ST on physical performance outcomes of the community-

dwelling older adults? Methods: Published studies from 1990 to 0502PP106

May 2009 were included by using electronic and manual search THE VARIATION OF MAGNETIC
according to the follow criteria 1) elderly lived in communities and
age ≥60y/o, 2) Control group received ST, 3) PT group did as fast as RESONANCE SPECTRUM OF LACTATE AND
possible in concentric phase and within 2~3sec in eccentric phase, PHOSPHOCREATINE/CREATINE AFTER
4) Outcome measurements included assessment of m. perform- CEREBRAL ISCHEMIA/REPERFUSION IN RATS
ance or functional performance, 5) Study design was randomized AT DIFFERENT TIMES.
control trial. The comprehensive Meta-analysis (V.2) software was
used to calculate the effect size (Hedges’ g), its 95% confidence Wan-Shun Wen1,2, Wei-Jing Liao1, Xiang-Ming Ye2, Wan-
interval, the Cochrans’ Q for homogeneity, sensitivity analysis, Tong Yang1, Bo Bi1, Ni Wei3, Guo-Dong Zhang1, Cheng
publication bias and to draw the forest plot. Adapting random or Jiang1
fixed effect model was according to homogeneity test results of the 1
Department of Rehabilitation Medicine, Zhongnan Hospital, Wu-
included studies. Results: A total of 13 studies were included in han University, 2Department of Rehabilitation Medicine, Zhejiang
the analysis. The results of the meta analysis showed that PT can Provincial People’s Hospital and 3Wuhan Institute of Physics and
improve older adults’ physical performance significantly than the Mathematics, Chinese Academy of Sciences (China)
ST in lower extremity m. power (Q = 111.9, Hedges’ g = 2.190, 95%
CI = 0.983~3.397, p < 0.05, fail safe n = 285), sit to stand (Q = 6.127, Purpose: To study the regulation of magnetic resonance spectrum
Hedges’ g = 0.909, 95% CI = 0.575~1.242, p < 0.05, fail safe n = 36) of Lactate (Lac) and Phosphocreatine/Creatine(PCr/Cr) after cer-
and gait speed (Hedges’ g = 0.441, 95%CI = 0.120~0.762, p = 0.007, ebral ischemia/reperfusion in rats at different times. Materials and
fail safe n = 6). Conclusions: The results support that PT program Methods: 32 male Wistar rats, weighting 160-200g, were randomly
can improve physical performance in community dwelling older divided into normal control group and operation group, operation
adults significantly more than ST programs do. group included MCAO group, sham-operation group, and simple-
infarction group, every group had eight rats. We chose proton mag-
netic resonance spectroscopy to analysis areas under the waves of
0502PP105 Lactate and Phosphocreatine/Creatine and compared the data of the
DEPRESSIVE SYMPTOM AND PHYSICAL accumulated areas under the waves. All the groups were under the
FUNCTION DECLINE IN THE COMMUNITY- constant observation of MRS. Results: Compared with normal con-
trol group and sham-operation group, the wave of Lac appeared after
DEWELLING ELDERLY ischemia in MCAO group, descended temporarily after reperfusion
Meng-Tieh Chen1, Hsu-Min Tseng2, Huey-Shinn then kept the trend of rise; the wave of Lac appeared after ischemia
Cheng3, Shin-Chang Su1, Tzu-Wen Chen1, Syu-Han in simple-infarction group, maintain the level at sometime then
Liou1, Shou-Jhuang Liou1, Pay-Shin Lin1 changed the trend of rise. The wave of PCr/Cr descended signifi-
cantly after ischemia in MCAO group, then descended significantly
1
Graduate Institute of Rehabilitation Science, Chang Gung Uni- again after reperfusion, maintain the low level; The wave of PCr/Cr
versity, 2Graduate Institute of Health Care Management, Chang descended significantly after ischemia in simple-infarction group,
Gung University and 3Chang Gung Memorial Hospital, LinKou and maintain the low level all the time. Conclusion: The variation
Medical Center (Taiwan) of magnetic resonance spectrum of Lactate and Phosphocreatine/
Background and Purpose: The purposes of the study are to inves- Creatine after cerebral ischemia/reperfusion in rats can reflect the
tigate the relationships between the depressive symptoms and the energy metabolites in head well. Whether reperfusion or not can
physical function (strength, speed, endurance, and balance) in the not change the deficiency of energy.
community-dwelling elderly in Taiwan, and to investigate the impact
of changes in the physical function on the depressive symptoms
over a 1-year-period. Methods: One hundred ninty one volunteered 0502PP107
community dwelling older adults who can walk independently EFFECTIVENESS OF FUNCTIONAL ELECTRICAL
(including walking with devices) were recruited into this study.
After signing the consent form, each subject accept face-to-face STIMULATION ON NEUROGENESIS AND BFGF,
interview and self-report for basic data. Geriatric Depressive Scale EGF EXPRESSION IN SUBGRANULAR AND
– Short Form 15 (GDS-SF15) and Mini-mental state examination SUBVENTRICULAR ZONE OF RATS WITH
(MMSE) were assessed. Physical function tests were evaluated. The STROKE
whole procedures were repeated again at follow-up in 1 year later.
Results: Prevalence of depressive symptom in the study popula- Yun Xiang1, Tie-bin Yan1, Zhi-qiang Zhuang1, Dong-mei
tion is 23.9%. At baseline, the functional performance of TUG, Jin1, Yuan Peng2, Yan-nan Fang3
Six-MWT, 30s-STS and OLS were significantly correlated with 1
Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 2the First
depressive symptoms (rho = –0.221, –0.224, –0.178, 0.222, p < 0.05, People’s Hospital of Guangzhou and 3the First Affiliated Hospital
respectively) in univariate analyses. In multivariate analysis, only of Sun Yat-sen University (China)
the association of Six-MWT and depressive symptoms remained
significant (HR = 0.994, Wald = 4.465, p < 0.05). However, with Purpose: To investigate the therapeutic effect of functional electri-
adjustment, without regular exercise and poor self-reported health cal stimulation (FES) on rats behavior and to explore impacts of
status became significantly correlated with depressive symptoms FES on endogenous neural stem cells (NSC) and basic fibroblast
(HR = 5.902, 3.855, Wald = 13.160, 9.226, p < 0.05, respectively) growth factor (bFGF), epidermal growth factor (EGF) in subgranu-
cross-sectionally. The longitudinal data showed significant differ- lar zone (SGZ) and subventricular zone (SVZ) of rats with stroke.
ence of the TUG between different depressive groups (F = 2.734, Materials and Methods: One hundred and eight rats were randomly
p = 0.045).There is an interaction between different depressive allocated into FES, placebo stimulation and sham-operated group
groups and time (F = 2.889, p = 0.037) in the Six-MWT. 30s-STS with 36 in each group. Following the surgery of middle cerebral
showed significant differences between different depressive groups artery occlusion (MCAO), rats in FES group were treated with
(F = 3.921, p = 0.010), and between pre-post tests (F = 5.237, FES device for 3d, 7d or 14d. At each assessment point, behavior
p = 0.023). Conclusion: In our study population, health and exercise evaluation was carried out and nestin positive cells in the SGZ and
status were associated with depressive symptoms better than physi- SVZ were observed while protein expression and gene transcript
cal function tests cross-sectionally. Changes of depressive symptom of bFGF and EGF were measured. Results: Rats in FES group
status were significantly associated with the lower-extremity (L/E) exhibited a significantly improved behavioral performance at 14d
function longitudinally. Remitted depression group showed signifi- when compared to placebo stimulation group (p < 0.05). Nestin
cant improvements in L/E function tests. positive cells in SGZ and SVZ of rats in FES group increased

significantly when compared to placebo stimulation group at 7d (V0) and after 2 weeks (V2) of experiment. Results: 1) At V0,
and 14d (p < 0.05) while protein and gene expressions of bFGF and there were no significant differences in BT, the latency and total
EGF were also up-regulated significantly at the same assessment score of OFT among 4 groups, the sugar consumption / weight
point (p < 0.05). Conclusion: FES could facilitate the behavioral (SC/W) in M group was higher than in E group (p < 0.01). 2) BT
recovery of paralyzed limb, promote proliferation of endogenous in each group at V2 were increased significantly than those at V0
NSCs and up-regulate bFGF, EGF expression which may be one (p < 0.01), but there were no significant differences among groups
of the mechanisms of FES to initiate the neuronal plasticity of rats or between interventional groups and C group at V2. 3) The OFT
with acute cerebral infarction. latency, which longer in M group than in C group (p < 0.05), was
shorter in E and R groups than in C group (p < 0.05) at V2, but
there was no significant difference between E and R groups. In all
0502PP108 assessments, only OFT latency in E group after intervention was
RUNNING EXERCISE EXHIBITED BENEFICIAL significantly shorter than before intervention (p < 0.05). Analysis
of variance (ANOVA) showed that only the enriched environment
EFFECT TO CHRONIC KIDNEY DISEASES have effects on the OFT latency of rats (p < 0.05). 4) The OFT
Chiung-Chi Peng1, Hsin-Ying Lu1, Ying-Ru Chen1, Tzu- total score of each group decreased significantly after intervention
Chi Lin1, Chiu-Lan Hsieh2, Robert Y. Peng3, Kuan-Chou than before intervention (p < 0.01), and the score in E group was
Chen4 significantly higher than in M group at V2 (p < 0.01). But there
were no significant differences between interventional groups and
1
China Medical University, 2National Changhua University of
control group at V2. 5) There were no significant differences in
Education, 3Hungkuang University and 4Taipei Medical University SC/W among each group at V2, but ANOVA showed that enriched
Shuang Ho Hospital (Taiwan) environment had positive effects on S /W of rats (p < 0.05). Only
Purpose: To investigate the strategy in view of rehabilitation to SC/W in E group after intervention was significantly increased
ameliorate chronic kidney diseases (CKD). Although regular exer- than before intervention (p < 0.05). Conclusion: Enriched envi-
cise (RE) has become a favorable non-pharmacological intervention ronment can increase the alertness and delighted mood in rats.
for treating the systemic metabolic syndromes, documented inter- Both enriched environment and motor skill training contribute to
vention of RE in the doxorubicin (DOX)-induced CKD model is still stable emotion in rats.
lacking. Materials and Methods: CKD in SD rats were induced by
s.c. 8.5 mg DOX/kg and divided into six groups: the control and the
0502PP110
DOX-treated groups with or without RE running at 30 m/min (for
30-min or 60-min/day, 3 days/week). Blood and urine were collected THE EFFECT OF DETRAINING ON LEUKOCYTE
for biochemical analysis, sera were ELISA tested for the oxidative AND IT’S DERIVATIONS IN ELITE MALE
stress, inflammatory cytokines, and profibrotic growth factors. After KARATE KA
a three-month span of experiment, kidneys and hearts were excised
and subjected to pathological examinations. Results: Running RE Mohammad Javad Deylam1, Mohammad Ali Gheraat2,3,
significantly decreased levels of cholesterol and triglyceride. Serum Abolfazl Deylami4
albumin decreased steadily but insignificantly. Concomitantly, im- 1
Ali Abad Katool Branch, Islamic Azad University, 2Pasteur Institute
proved creatinine clearance was seen to occur in a dose-responsive of Iran, 3Sports Medicine Research Center, Tehran Medical Sciences
manner. In contrast, the urine protein levels were totally unaffected. University and 4Chaloos Branch, Islamic Azad University (Islamic
In addition, RE running (60 min) significantly altered the oxidative Republic of Iran)
stress status. For level of SOD, the SOD/DOX-treated group had
7.56 U/ml compared to 10.63 U/ml of DOX/60 min exercise group. Purpose: Various effects of physical activity on immune system
For level of TBARS, the DOX-treated group revealed a level 9.78 and contradictory operations of diseases on training and per-
uM, comparing to the DOX/60 min exercise group, which was re- formance are debatable topics that must be searched widely. A
duced to 4.74 µM. Concomitantly the inflammatory markers were wide range of studies have investigated about variable effects of
downregulated, level of IL6 in DOX-treated group exhibited 18.50 training, but a few researches have investigated about the effects
ng/ml; while level of DOX/60 min exercise group was reduced to of detraining on immune factors. To determine an aspect of this
17.48 ng/ml. Conclusion: RE running can be a potential alternative notion, we studied about effects of detraining on leukocyte and
treatment or an adjuvant remedy for treating CKD. some of it’s derivations like lanfosit, eozonofil and notrofil in elite
male karate ka. Materials and Methods: we selected 20 elite male
karate (22.4 ± 1.3 years old) with international awards randomly
0502PP109 who were volunteered to participate in the experiment (60 days
IMPACT OF MOTOR SKILL TRAINING AND hard training). The questionnaire of disease was filled and the
personal anthropometrical information like height (Seca Instru-
ENVIROMENT ON BEHAVIOR OF RATS ment), weight (Camry Instrument) and fat percentage (Launch
Xiaojun Zhu, Tong Wang, Jin Wang, Xiaojing Ding Caliper; Jackson-Polkas three point way) was taken before and
Department of Rehabilitation, the First Affiliated Hospital of Nan- after detraining period. The first blood donation was taken im-
jing Medical University (China) mediately after the last session of training period and it repeated
after 21 days detraining. The group was denied to use any drug
Purpose: To evaluate the impact of motor skill training and en- and supplement requested to use only those common nutrition
riched environment on behavior of rats. Materials and Methods: program (they had to report those daily nutrition program). The
52 male SD rats were randomly assigned to 4 groups: (1) Motor amount of factors accounted by Cell-Counter Instrument (Beck-
skill training group: rats running in a rotating cage (5 r/min) for man Z-1). Obtained data analyzed by paired t-test. All results have
10 min/day and training on acrobatic task for 1h/d (M group, shown as mean ± SEM. In all statistical comparisons, p<0.05 was
n = 13), (2) Enriched environment group: rats being housed in en- considered as the significant difference. Results: A significant
riched environment for 2h/d (E group, n = 13), (3) Co-intervention difference was found in the amount of leukocyte concentration
group: rats with motor training plus enriched environment (R after-detraining in comparison with before-detraining period
group, n = 13), (4) Control group: rats without any intervention (p < 0.05). But regarding to the concentration of lanfosit, eozonofil
(C group, n = 13). Each group of rats were bred in common way and notrofil in after-detraining test, these differences were not
and had a two-week experiment. Body weight (BT), open field test significant compared to the last session of training. Conclusion:
(OFT) and sugar consumption test (SCT) were measured before As a reason of some increases in leukocyte, the results suggest

that a three-week detraining enhances the amount of leukocyte Animal model of HS. The right femoral artery of rats were can-
which is known as main immune factor. On the other hand, it can nulated with polyethylene tubing (PE 50), under anesthesia (ure-
be claimed that detraining may decreases the side-effects of hard thane 0.6 g/kg plus pentobarbitol 30 mg/kg), for blood pressure
training on body immune system so that it cause an increase in monitoring. Core temperature (Tco) was monitored continuously
general health. It can be recommended that this research repeat in by a thermocouple inserted into the rectum, while both mean
long-term and/or short term period in men and women, and under arterial pressure (MAP) and heart rate (HR) were continuously
the experimental supervision of detraining period. monitored with a pressure transducer. The Tco of the anesthetized
animals were maintained at about 36°C except in the heat stroke
experiments. Unconscious, unrestrained rats were exposed to an
0502PP111 ambient temperature (Ta) of 40 ± 0.5°C in an incubator, in the
EFFECT OF ACUPUNCTURE IN RAISING absence of food and water, until a maximum Tc of 40.5°C was
THE CONTENT OF MONOAMINE attained (period of the time : 1hr). Following removal from the
heat incubator, food and water were provided ad libitum during
NEUROTRANSMITTER IN BRAIN TISSUE OF undisturbed recovery at Ta of 25 ± 1°C. 2) Histological evalua-
CEREBRAL PALSY RATS tion of intestine injury. Melt paraffin off slides at 65° C for 20
Zhenhuan Liu, Yong Zhao min then treated with Xylene. Moreover treat with 100% EtOH
twice. Air dry slides and stain with H&E stain kit (Novolink). 3)
Nanhai Affiliated Maternity and Children’s Hospital of Guangzhou Reverse transcription-polymerase chain reaction (RT-PCR). Total
University of TCM (China) RNA was extracted from tissues using TRIzol Reagent, followed
Purpose: To detect the content of monoamine neurotransmitter in by cDNA synthesis using oligo dT and reverse transcriptase. 4)
hippocampus, cortex, nucleus basalis of Meynert and brain stem Immunohistochemistry. Wash OCT embedded slides with PBT
of rats with cerebral palsy. Materials and Methods: To observe if (Phosphate Buffer Saline with 0.02% Tween 20). Add primany
acupuncture can change the content. To approach the mechanism of antibody in blocking buffer, to each slide Cover and store slides
action of acupuncture in treating CP rats.Design: Through ischemia at 4°C overnight. Wash slides with PBST. Add diluted secondary
and hypoxia to make models of CP rats. After acupuncture treatment, antibody in blocking buffer and incubate for 90 min. Wash slides
rats are decapitated to get their brains. Separate all required regions with PBST then mount slides. Results: Aquaporin 1, 3, 5, 7, 8, 9,
of the brain and detect the content of monoamine neurotransmit- and 11 were expressed in rat small intestine. Detection mRNA by
ter by spectrophotometer. Participants and Setting: 85 7-day-old RT-PCR that aquaporin 1, 3 mRNA expression were decreased and
rats are selected (11.5~18.4 g, 12.6 ± 2.1g). Refer to literature to aquaporin 7, 8, and 11 mRNA expression were increased in the
build models. Divide all successful models (72 rats) into 3 groups condition of heating 60mins to recover for 0 hr, 1 hr and 6 hr. In
randomly (One with acupuncture I, One with acupunture II, One immunohistologic results shown that aquaporin 1 and 3 were found
without treatment). Besides, set up another group of sham operation in endothelial cell, enterocytes and epithelial cells after heating
(24 rats). Materials and Methods: Randomized controlled trial First and aquaporin 7, 8, and 11 were increased at crypt after heating.
group: Begin the acupuncture 24 hours after the operation.Second Conclusion: Aquaporin 1 and 3 were found in endothelial cell of
group: Begin the acupuncture a week later.Third group:without villi and disappeared after heating shown the damage of intestine,
treatment. Fourth group:with sham operation.Outcome measures and aquaporin 7, 8, and 11 were increased at crypt of intestine after
1) death of rats; 2) content of monoamine neurotransmitter in brain heating. The role of aquaporin 7, 8, and 11 expressed in crypt of
tissue.Statistical methods: SPSSl2.0 (Chi square test and ANOVA). intestine after heat stroke will be further studied.
Results: Compared with the group of sham operation, CP rats’
content of dopamine (DA) and 5-hydroxytryptamine (5-HT) in
nucleus basalis of Meynert, and their content of norepinephrine 0502PP113
(NE) in brain stem are all lower. After acupuncture treatment the UNIFORM DESIGN METHOD FOR OPTIMIZING
above-mentioned monoamine neurotransmitter all rise obviously. PROPORTION OF FERULATE AND ANGELICA
Conclusion: Raising the content of monoamine neurotransmitter
coulb be one conceivable mechanism of action of acupuncture in POLYSACCHARIDES ON ANGIOGENESIS
treating CP rats. Wan Can1,2, Ling-Li Liu1, Wei-Jing Liao1, Xiang Cui1
1
The Department of Rehabilitation Medicine, Zhongnan Hospital of
0502PP112 Wuhan University and 2The Department of Rehabilitation Medicine,
Guangxi Zhuang Autonomous Region People’s Hospital (China)
CHARACTERIZATION OF AQUAPORIN GENES
EXPRESSION IN INTESTINE OF HEAT STROKE Purpose: To define the optimum dosage of two main ingredients in
angelica on angiogenesis. Materials and Methods: 36 male SD rats
RAT MODEL were randomly divided into eight groups: the therapeutic groups (ac-
Yen-Tsun Chen1, Cho-Dang Tsai1, Willy Chou2 cording to the uniform design table U6*(64) and the applying table,
1
Department of Physiology and Biophysics, National Defense Medi- grouping six groups, n = 5), the control group (n = 3) and the ischemia
cal Center and 2Department of Rehabilitation, Chi-Mei Medical group (n = 3). To screening the expression of vascular endothelial
Center (Taiwan) growth factor (VEGF), angiopoietin-1 (Ang-1) and angiopoietin-2
(Ang-2) protein after middle cerebral artery occlusion (MCAO) for
Purpose: Heat stroke is a dangerous disease that causes multiple 2 hours by adopting uniform design methods for the best limited
organs failure including temperature-control disorders, central selection and optimization. Results: 86.250–102.500 mg/kg sodium
nervous system lesions and affects the liver, kidney and blood ferulate with 25.417–96.875 mg/kg angelica polysaccharides could
coagulation. Heat stroke patients are cool down and water sup- increased the expression of VEGF, decreased the ratios of Ang-1
ply as soon as possible, if the saving in time will be able to save and Ang-2 facilitating angiogenesis, while improved the expression
lives. In this study we used rat model to evaluate the change of of Ang-1 in choroid plexus to protect brain blood barrier (BBB) at
aquaporins in intestine during heat stroke condition, aquaporins the time of 22 h after reperfusion. Conclusion: Sodium ferulate
are water channels playing an importance role for water osmosis and angelica polysaccharides possess bilateral regulation role to
to enter cells and tissues, and histological variation of aquaporins angiogenesis and vasopermeability in space and quantity at the
expression was shown in this study. Materials and Methods: 1) earlier period of cerebral ischemia.

0502PP114 8 (61.5%) patient in the intervention group, 12 (85.7%) in the control

NEGATIVE PRESSURE MAY PROMOTE group (p = 0.42). One patient was re-intubated in the control group.
The mean duration of postoperative hospitalization stay was reduced
MIGRATION IN WOUNDED CELLS in the intervention group (6.03 ± 1.03 vs. 9.24 ± 3.29 day, p = 0.018).
Chih-Chin Hsu1,2, Wen-Chung Tsai1,2, Jannie Ying- Conclusion: Diaphragmatic breathing and coughing technique
Syuan Chen1,2, Carl Pai-Chu Chen1, Simon Fuk-Tan education before open-heart surgery in high risk patient can shorten
Tang1,2, Jong-Shyan Wang3 hospital stay and decrease cost of care.
1
Memorial Hospital and 2Graduate Institute of Rehabilitation Sci- 0502PP116
ence, College of Medicine, Chang Gung University (Taiwan)
PROSTHETIC NEED IN TAIWAN FROM 1997 TO
Purpose: Negative pressure wound therapy has recently gained 2006
popularity in chronic wound care. This study attempted to explore
effects of different negative pressures on cell migration in wound Wai Keung Lee
healing process. Materials and Methods: The electric cell-substrate Department of Physical Medicine and Rehabilitation, Tao Yuan
impedance sensing technique was used to create a 5 10-4 cm2 wound General Hospital, (Taiwan)
in the confluent monolayer Madin-Darby canine kidney cells and
Purpose: To decribe the prosthetic need in Taiwan from 1997 to 2006
continuously monitor cell migration activities. The wounded cells
(10 years). Materials and methods: This study is based on the data
were separately cultured in a self-constructed negative pressure in-
from the National Health Insurance Research Database (NHIRD)
cubator at ambient pressure and negative pressures of 75 mmHg, 125
provided by the Bureau of National Health Insurance (BNHI) and
mmHg and 175 mmHg. The effective time, complete wound healing
managed by the National Health Research Institute (NHRI) in Tai-
time, healing rate, cells radius and wound area over time in cells
wan. The sampling proportion of inpatient and outpatient data is 1
at different pressures were evaluated. Traditional wound-healing
to 20 and 1 to 500 respectively. The sample size for each month was
assays were prepared for fluorescent staining of cells viability,
proportional to the amount of data for that month. Results: The crude
tight junctions and actins. Results: The effective time (1.25±0.27
amount of prostheses range is from 12,000 to 72,000. With the highest
h), complete healing time (1.76±0.32 h), healing rate (2.94±0.62
and lowest being 1998 and 2000 respentively.The gender ratio is male
cm2/h), cell radius (11.5±0.2 m) at complete wound healing of cells
higher than female. It ranges from 2:1 to 1:1. The age distribution
treated at negative pressure of 125 mmHg were significantly differ-
is: above 41 years old is 76.4 %; above 51 years old is 83.6%; above
ent from those at other three pressure conditions. Nearly total loss of
71 years old is 27.3%. Conclusion: The estimated average need of
tight junction activities and prominent cell migration features were
prostheses was about 33,000 per capita in Taiwan for 1997 to 2006.
identified in cells at the specific negative pressure. Conclusion: The
The older the age group, the higher the demand.
study has established a cellular model for observing cell migration at
different pressures uninterruptedly. Loosening of cell-cell junctions
may induce actin assembly to enhance cell migration at negative 0502PP117
pressure of 125 mmHg.
3 YEARS FOLLOW-UP OF THE REHABILITATION
OF TRANSTIBIAL AMPUTATION CAUSED BY
0502PP115 NECROTIZING SOFT TISSUE INFECTIONS : A
THE EFFECT OF PRE-OPERATIVE CASE REPORT
REHABILITATION IN HIGH RISK OPEN HEART Wai Keung Lee, Shih-Kun Chang, Yau-Wai Wai, Won-
SURGERY PATIENTS ON THE LENGTH OF Jean Lin, Huei-Yu Lo, Kien-Jung Wang
HOSPITAL STAY Department of Physical Medicine and Rehabilitation, Taoyuan Gen-
eral Hospital, Department of Health, Executive Yuan (Taiwan)
Willy Chou1, Wen-Chih Lin1, Cheng-Hsin Lin2, Chiao-
Hsin Chen1, Yi-Ru Chen1 Purpose: To follow-up the rehabilitation of transtibial amputation
1
Department of physical medicine and rehabilitation, Chi Mei caused by necrotizing infections. Materials and Methods: To report
Medical Center and 2Department of cardiovascular surgery, Chi a 50 year-old man who suffered from left transtibial amputation and
Mei Medical Center (Taiwan) split thickness skin grafts due to necrotizing soft tissue infections
was trained to overcome the following problems:1. Poor endurance,
Purpose: To evaluate the effect of pre-operative education of dia- cardiopulmonary function and muscle strength of bilateral lower
phragmatic breathing and coughing techniques in high risk patient limbs. 2. The loss of dorsiflexion in the right ankle that resulted from
scheduled for elective open heart surgery on the length of post opera- excision of the anterior tibialis muscle. 3. The fragility of the skin
tive hospital stay. Materials and Methods: From March 2008 to April on the left stump as a result of the split thickness skin graft. 4. The
2009, patients who were scheduled for elective open heart surgery by irregular shape of the stump for prosthetic fitting. Results: After a
the same surgeon were enrolled. 27 patient who met the criteria for 3-year follow-up, the patient can walk with a regular cane 8 hrs per
high risk was randomized into intervention group (n = 13) or control day. The ADL is independent. The most common problem of the
group (n = 14). Intervention group received diaphragmatic breathing silicon socket is over-sweating, but it subsides after 1 year of fitting.
and coughing technique education before surgery by the same physical The satifaction rating changes from the initial 5 to 8 on a 10-point
therapist. All patient received the usual cardiac rehabilitation after scale(being the maximum) after 3 years. Conclusion: It is suggested
surgery. Results: Both groups were comparable at baseline. By hos- to prescribe the above prosthesis for the transtibial amputation caused
pital discharge, post operative pulmonary complication developed in by necrotizing soft tissue infections.

Index 199
Author index
A Chang, Chao-Hung 163 Chen, Jia-Ching 115 Chen, Yung-Hsiang 167

Chang, Che-Feng 71 Chen, Jia-Jin Jason 28, 57 Chen, Zhen 160
Abarghani, Leila Eidi 20
Chang, Chein-Wei 28, 133 Chen, Jin 31, 109, 149 Cheng, Chih-Hsiu 15, 180
Abrahim, Khosro 117
Chang, Cheng-Chiang 98, 115 Chen, Jo-Tong 54, 78, 99, 131, 165, Cheng, Ching-Chou 96
Acuff, Michael 143
Chang, Chi-Fen 129 166 Cheng, Hsiang-Chun 176
Adirek-udomr, Jutarat 93
Chang-Chien, Hsu-Fan 89 Chen, June-Kai 149 Cheng, Hsin-Yi 93
Akai, Masami 53
Chang, Ching-Hsien 182 Chen, Jyun-Hong 51 Cheng, Huey-Shinn 157
Akrami, Kamyar 55
Chang, Chun-Ching 139 Chen, Kai-Hua 57, 95, 133, 135, 184, Cheng, Hung-Yu 192
Akyuz, Gülseren 75
Chang, Chein-Wei 97 192 Cheng, I-Chung 194
Alon, Gad 66, 67
Chang, Hsiao-Yun 30 Chen, Kuan-Chou 196 Cheng, Jack C. Y. 59
Amatachaya, Sugalya 49, 68
Chang, Jen-Mu 106 Chen, Kuan-Jung 159 Cheng, Shun-Ping 35, 118, 192
Ankam, NS 72
Chang, Jer-Hao 92, 190 Chen, Kuan-Wen 168 Cheng, Ya-Wei 21, 88
Ann, GueHwan 146
Chang, Ju-Ying 165 Chen, Kun-Chung 84 Cheras, Phillip 102
Ao, Lijian 49
Chang, Ji-Chan 86 Chen, Li-Ru 91, 97 Cherng, Rong-Ju 176
Ao, Lijuan 31, 109, 138
Chang, Jia-Hao 182 Chen, Liang-Chang 101 Chern, Jen-Suh 92, 164
Aoki, Kana 16
Chang, Ju-Ying 165, 166 Chen, Liang-Cheng 98, 151 Cherng, Rong-Ju 181
Arastoo, Ali Asghar 52
Chang, Jui-Kun 92, 94, 158, 190 Chen, Meng-Tieh 157, 195 Cheung, T.H. 27
Arayawichanon, Preeda 49, 79, 183
Chang, Kai-Min 98 Chen, Ming-Fong 32 Chi, Pao-Hsiang 182
Areeudomwong, Pattanasin 77
Chang, Ke-Vin 100, 153 Chen, Ming-Hong 71 Chiang, Yi-Pin 91
Arendt-Nielsen, Lars 135
Chang, Kwang-Hwa 145 Chen, Pai-Chu 67, 159 Chiang, Chung-Hsin 172
Aryan, Raabeae 52
Chang, Liang-Wey 29 Chen, Pai-Yin 29 Chiang, Shang-Lin 51, 98, 139
Ayaz, Saeed Bin 188
Chang, Lin-Yen 114 Chen, Pei-Jing 15 Chiang, Yi-Pin 14, 97
Azuma, Yuji 166
Chang, Lochia 30 Chen, Po-Hung 91 Chien, Chen-Lin 121
B Chang, Pei-Wen 120 Chen, Qingfa 107 Chien, Chi-Hsien 78
Chang, Shin-Tsu 51, 98, 100, 101, Chen, San-Pei 96 Chien, Ching-wen 94
Baek, Jong-Hoon 105 115, 123, 139, 151 Chen, Shen-Hsing A. 28 Chin, Takaaki 59
Bai, Chyi-Huey 155 Chang, Shu-Yun 147 Chen, Sheng-Kai 107 Chiou, Hung-Yi 145, 147, 155
Bai, Yuehong 144 Chang, Susan 92 Chen, Shi-Chin 30 Chirawatkul, Arun 180
Baljinnyam, Avirmed 24, 56 Chang, Shih-Kun 198 Chen, Shih-Ching 28, 49, 57, 78, Chiriac, M. 194
Ban, Lee-Kiat 157 Chang, Walter Hong-Shong 104 104, 132, 145, 147, 158, 159, 170, Chiu, Chen-Ming 104
Bang, Moon Suk 61, 64, 93, 139, 170 Chang, Wei-Han 191 183, 191 Chiu, Cheng-Min 104, 127
Batchimeg, Sh. 24, 56 Chang, Wei-Jung 154 Chen, Shih-Jen 66 Chiu, Cheng-Ming 35, 118
Bensmaia, S.J. 21 Chang, Wei-Ning 125 Chen, Shih-Wei 158 Chiu, Hsi-Ting 52
Bensoussan, Laurent 11 Chang, Wen-Dien 106 Chen, Shu-Min 16, 29, 54, 78, 99, Chiu, Ming-Jang 28
Bhat, Jayashree S 22 Chang, Wen-Ming 95, 135 128, 131 Chiu, Nan-Chang 168
Bi, Bo 195 Chang, Yeun-Chung 152 Chen, Sijin 47 Chiu, Shu-Fen 157
Birsan, S. 107, 156, 194 Chang, Yi-Wei 157 Chen, Sijing 188 Chiu, Valeria 157
Bi, Sheng 17 Chang, Ying-Chao 125 Chen, Ssu-Yuan 32, 33, 34 Chiu, Wen-Ta 19, 52, 145, 147
Bih, Liu-Ing 50 Chang, Yuan-Jen 28 Chen, Szu-Fu 19, 71, 72, 115 Chiu, Ya-Ning 98
Bliwise, Donald L. 186 Chang, Yung-Hsien 167 Chen, Tien-Wen 47, 48, 149 Chivers, Leonie K 143
Bodog, F 194 Chao, Wan-Ju 120 Chen, Tingfeng 112 Cho, Jung Mo 106, 169
Boonphakop, Yodchai 15, 79 Chao, Yuan-Hung 91 Chen, Tzu-Wen 157, 194, 195 Chou, Chen-Liang 118
Brown, Justin 45 Chao, Yuna-Hung 71 Chen, Wan-Ju 179 Chou, Chih-Wei 55
Burkland, Rene 187 Chatchawan, Uraiwon 102, 183, 186 Chen, Wei 100, 112, 123, 131 Choi, In-Sung 129, 142, 156
Buttagat, Vitsarut 183 Chen, Carl PC 18, 70, 198 Chen, Wei-Wen 30 Choi, Seung-Ho 105, 122
Byun, Chan Woo 169 Chen, Chen-Yin 112 Chen, Wen-Chi 167 Choi, Won-Ah 105, 122
Byun, Seung-Deuk 123 Chen, Chia-Hsin 47, 71, 149 Chen, Wen-Hong 167 Chong, Gao 124
Chen, Chia-Ling 83, 164, 173, 182, Chen, Wen-Shan 96 Chou, Chen-Liang 35, 79
C 183, 192 Chen, Wen-Shiang 18, 152 Chou, Chen-Yu 114, 120
Cai, Chunbo 132 Chen, Chiao-Hsin 185, 198 Chen, Weng-Pin 67, 159 Chou, Cheng-Liang 192
Cai, Feng-Long 159 Chen, Chien-Cheng 72 Chen, Wenhua 101, 122 Chou, Chia-Yeh 156
Cai, Kefu 130 Chen, Chien-Min 95, 173 Chen, William P W 21 Chou, Chih-Wei 55
Can, Wan 197 Chen, Chih-Kuang 59 Chen, Wun-Schen 95 Chou, Ching-Chieh 136
Cao, Manlin 144 Chen, Chin-Hsing 28 Chen, Xiang 84, 109 Chou, Li-Wei 54, 81, 96, 139, 177
Carnevale, Claudine V. 186 Chen, Ching-Chi 89, 172 Chen, Yan-Wen 120 Chou, Nai-Kuan 33, 34
Chae, Jong Hee 170 Chen, Da-Wei 128 Chen, Ya-Ping 137 Chou, Pesus 133
Chaisuksan, Seksan 35 Chen, Fun-Jou 167 Chen, Yan-Hao 152 Chou, Shih-Wei 55, 183, 191
Chak, W.K. 87 Cheng, Cheng-Chang 170 Chen, Yea-Tzy 70 Chou, Tzu-Yi 172
Chalermsan, Rungthip 185 Cheng, Huey-Shinn 195 Chen, Yen-Jung 99 Chou, Willy 114, 120, 178, 179, 185,
Chan, C.C.H. 27 Chen, Hsieh Ching 92 Chen, Yen-Tsun 197 189, 197, 198
Chan, Chai-Wei 189 Chen, Hsin-Shui 81, 128 Chen, Yi-Lin 169 Chou, Ya-Hui 91
Chan, Chetwyn C H 21 Chen, Hsin-Yu 152 Chen, Yi-Ling 139 Chou, Yi-Chieh 35, 118
Chan, Da-Fang 114 Chen, Hsing-Hong 133 Chen, Yi-Ru 114, 171, 185, 198 Chou, Yi-Chun 132
Chan, Nar-Chi 87 Chen, Hsun-Ying 177 Chen, Ying 94 Chou, Yi-Jiun 135
Chan, Peter 15 Chen, Hui-Chun 146 Chen, Ying-Bei 20 Chow, Daniel H. K. 59
Chan, Rai-Chi 66, 88 Chen, Hui-Wen 94, 127 Chen, Ying-Ru 196 Chu, Heng-Yi 51, 98, 123
Chan, Sam C C 21 Chen, Hung-Chou 90 Chen, Yu-Kuang 116 Chu, Mei-Mang 136
Chan, Yuan-Chi 136 Chen, Hung-Sheng 78 Chen, Yu-Ren 140 Chu, Ngok-Kiu 159
Chan, Yuan-Shuo 193 Chen, I-Hsuan 28 Chen, Yu-Wei 179 Chu, Yi-Jing 106
Chanavirut, Raoyrin 185 Chen, I-Ju 192 Chen, Yueh-Hsia 91, 106 Chua, Karen Sui Geok 114
Chang, Bin-Chi 143 Chen, Jannie Ying-Syuan 198 Chen, Yung-Cheng 89 Chuang, Chih-Cheng 96

Chuang, Chiung-Cheng 104 Fu, Hao 108 Hou, Wen-Chi 100, 169 Huang, Wen-Tzeng 28
Chuang, Tien-Yow 19 Fu, Xiao 185 Hou, Wen-Hsuan 25, 51 Huang, Xiaolin 11, 141, 186
Chuang, Yao-Chia 91, 97, 168 Fu, Yi 25 Hou, Yi-You 107 Huang, Yi-Win 115
Chuang, Yi-Wen 173, 192 Fu, Yu 138 Hou, Yuh-Ming 172 Huang, Ying-Zu 41
Chun, Chin-Teng 125 Fujiwara, Toshiyuki 65 Hou, Zhonghong 162 Huang, Yu 112
Chun, Seong Min 52 Fukubayashi, Toru 53 Hsiao, Pei-Chi 89, 151, 179 Huang, Yu-Chi 95, 116, 131
Chun, Sewoong 93 Furukawa, Toshiaki 168 Hsiao, S.S. 21 Huang, Yu-Hsiang 163
Chung, Ai-Hui 147 Fuseya, Hiroshi 127 Hsiao, Shu-Fang 34 Huang, Yu-Hui 50
Chung, Chia-Ying 183 Hsieh, Ching-Lin 51, 146, 150, 172 Huang, Yu-ting 181
Chung, Kao-Chi 165, 166 G Hsieh, Chiu-Lan 196 Huang, Zhen 126, 189
Chung, Myung Eun 97 Hsieh, Eou-Ting 97 Hung, Jen-Wen 125, 170
Gan, Lu 109
Chung, Sun Gun 103 Hsieh, Fang-I 155 Hung, Su-Ying 35, 118
Gao, Qiuye 188
Chung, Tze Yang 50, 140, 141 Hsieh, Lin-Fen 57, 96, 102, 136 Hwang, Ai-Wen 85
Geng, Hong 131
Chung, Yu-Hsiu 120 Hsieh, Ming-Fu 98, 123, 151, 169 Hwang, Chiao-Wen 135, 153
Gerasimenko, Yury 46
Cieza, Alarcos 10 Hsieh, Pei-Chun 16 Hwang, Chueh-Lung 121
Gheraat, Mohammad Ali 20, 196
Cifu, David X. 17, 62 Hsieh, Ru-Lan 30, 170
Giustini, Alessandro 11 I
Cioara, F. 107 Hsieh, Shiau-Fu 97
Goh, KJ 64
Conroy, Vincent M. 67 Hsieh, Wan-Ling 66 Ida, Hirofumi 53
Goharpey, Shahin 52
Courtine, Grégoire 46 Hsieh, Wei-Chi 95, 133, 135, 136, 184 Idris, Ferial Hadipoetro 149
Gong, Zunke 100, 112
Craig, J.C. 21 Hsieh, Wen-Yih 128 Iguchi, Tetsuhiro 59
Gongwei, Jia 139
Cui, Qiuhong 109 Hsieh, Yu-Ting 133 Ikada, Michi 152
Gong, Zun-Ke 131
Cui, Xiang 197 Hsieh, Yueh-Ling 54, 81 Ikeda, Takuya 34
González, Juan Manuel Guzmán 55
Hsin, Yi-Jung 131, 162 Imamura, Marta 73, 76
D Gorodnichev, Ruslan 46
Hsu, Allen Chia-Lin 132, 183, 191 Intarakamhaeng, Pattrawut 32
Grabois, Martin 12
Dai, Jie 113 Hsu, Ar-Tyan 105 Ishii, Yui 168
Grill, Warren M 159
Dawei, Yuan 110 Hsu, Chen-Jung 33, 34 Isomura, Tsuneshi 161, 162
Grimby, Gunnar 73, 75
Dee, Shu-Wei 154 Hsu, Chia-Yu 91, 168 Ito, Osamu 34
Gunawan, Darmadi J. 80
Deepa, N. Devadiga 111 Hsu, Chien-Wei 135 Itotani, Keisuke 152
Gu, Shao-Qin 164, 167, 188
Delarque, Alain 11 Hsu, Chih-Chin 13, 198 Iwamoto, Tetsuya 127
Gu, Xudong 158
Deletis, Vedran 45 Hsu, Chyong-Hsin 82
Guangyao, Wu 113
Deliagina, Tatiana G. 41 Hsu, Hsiao-Wei 92, 190 J
Guangyuan, Zhang 40
DeLisa, Joel A. 72 Hsu, Hsiu-Ching 32
Gullapalli, Rao P 66 Jalaei, Bahram 20
Denda, Hiroshi 16 Hsu, Hsiu-Yun 16
Guo, Lan-Min 38, 177, 178 Jaw, Fu-San 78, 183
Deng, Li 103 Hsu, Hung-Chih 81, 95, 133, 135,
Guo, Lan-Yuen 107 Jayashree, S. Bhat 110, 111
Deylam, Mohammad Javad 196 173, 184, 192
Guo, Tiecheng 11, 134 Ju, Ming-Shaung 29
Deylami, Abolfazl 196 Hsu, Kao-Chih 151
Guo, Yu 110 Jung, Il Young 170
Dimitrijevic, Milan R. 43, 44, 46 Hsu, Kao-Zhi 169
Guo, Yuna 131 Jeng, Jiann-Shing 28, 52
Ding, Hui 189 Hsu, Li-Ju 28
Guohui, Zhang 40 Jeng, Shiau-Chian 89, 90
Ding, Jianying 175 Hsu, Lin-Ya 153
Gutenbrunner, Christoph 10 Jeng, Suh-Fang 82
Ding, Xiaojing 196 Hsu, Ya-Wen 147
Hsu, Yung-Nan 187 Jeong, Jin Seok 106, 169
Dong, Xinchun 193 H Ji, Jie 130
Dou, Zulin 25, 69 Hsueh, I-Ping 146
Hachisuka, Kenji 58 Hsueh, Wen Hui 117 Ji, Tsen-Jieu 89, 172
Dovat, L. 114 Jiang, Cheng 195
Du, Jubao 160 Hakemi, Laleh 31 Huang, Rei-Jane 150
Hamamura, Sayaka 59 Huang, Tung-Jung 95 Jiang, Joe-Air 106
Duan, Hongguang 131 Jiang, Rui-Shu 31, 113
Han, Jae-Young 129, 142, 156 Huang, Yu-Chi 26, 95
Han, Suzheng 109 Hu, Fu-Chang 140 Jiang, Zhide 99
E Jiang, Zhimei 38, 178
Han, Tai Ryoon 51, 52, 68, 128, 191 Hu, Gwo-Chi 91, 97
Ebihara, Satoru 34 Han, Ting-I 81 Hu, Jiang-Bo 131 Jiang, Zhongli 22, 37, 39, 118, 187
Edgerton, V. Reggie 46 Han, Xiaohua 186 Hu, Jie 151 Jin, Caijun 178
Embrey, David G. 66 Hanayama, Kozo 141 Hu, Meihua 131 Jin, Dongmei 129, 195
Endo, Munemoto 118 Handa, Yasunobu 57 Hu, Xintian 167 Jin, Jing 22
Endo, Naoto 16 Hang, Ting-I 154 Hu, Xi-Quan 20, 31, 39, 113 Jin, Juan 189
Engkasan, Julia Patrick 50, 74, 140, Hashimoto, Yasunari 65 Hu, Xiquan 11, 126 Jin, Lu 35, 40
141 Hasnan, Nazirah 141 Hu, Yanli 178 Jin, Yu 184
Eungpinichpon, Wichai 102, 183, 186 Hatanaka, Megumi 152 Hu, Yingzhou 167 Jones, Chulee U 35
He, Chengqi 103 Hu, Yujun 103 Joo, Min-Cheol 130
F He, Hongchen 103 Huai, Juan 124 Ju, Yan-Ying 93
Fan, Chiung-Wen 150 He, Li 109 Huang, Baoyun 92 Ju, Yun-Huei 170, 181
Fan, Jina-Zhong 150 Hennesse, Christopher 79 Huang, Chi-Tsou 46 Juan, Hui-Chun 89, 151, 178
Fan, Wen-Jia 159 Ho, Chung-Sheng 133 Huang, Chien-Fang 147 Jun, Jae-Bum 85
Fan, Wenxiang 108 Ho, Chung-Yu 79 Huang, Chun-Chiang 47, 48 Jung, Il Young 103
Fang, Jie 39, 126 Ho, Ruei-Kai 128 Huang, Chung-Wei 157 Jung, Shuan-Kuang 167
Fang, Kuan-Ming 95, 184 Hoe, Zheng-Yu 163 Huang, Gang 114
Fang, Li-Jung 82 Hofstoetter, Ursula S. 43, 44 Huang, Hong-Shi 137, 138 K
Fang, Yan-nan 129, 195 Hong, Chang-Zern 54, 56, 78, 81, Huang, Hsiao-Yuan 170 Kagechika, Kenji 94, 117, 136, 137,
Fang, Zheng-Yu 141 131, 133, 136, 184 Huang, Hsiu-Chen 172 138, 154, 160
Feng, Chi Kuang 88 Hong, Chao-Chi 86 Huang, Jen-Ju 107 Kakaew, Salinee 102
Feng, Gao 21 Hong, Chia-Hui 188 Huang, Jie 141 Kanazawa, Yoshimitsu 94, 138
Feng, Hua 177 Hong, Jan Yueh-Chen 68 Huang, Kang-Ming 99, 131 Kaneuji, Ayumi 154
Feng, Lili 112 Hong, Joon Beom 103 Huang, Kuo-Tung 120 Kang, Eun-Young 86
Feng, Xiaomin 112 Hong, Rong-Bin 114, 171, 178 Huang, Mao-Hsiung 19, 47, 48, 149 Kang, In-Soon 169
Franceschini, Marco 25 Hong, Yu-Chung 97 Huang, Shih-Wei 91 Kang, Jiunn-Horng 78, 104, 132, 183
Francisco, Gerard E. 63 Hong, Zhang 40 Huang, Ting 164 Kang, Seong Woong 105, 122
Frontera, Walter R. 53 Horng, Yi-Shiung 157 Huang, Wei 186 Kang, YoonKyoo 80, 146
Fu, Chung-Pei 179 Hosaka, Noboru 16 Huang, Wei-Pin 89, 90 Kang, Zhuang 31, 113

Index 201
Kanlayanapho, Rosalai 93 Kuo, Chien-Huang 97, 133 Leelayuwat, Nareumon 77 Lin, Chih-Ming 153
Kantaratanakul, Visal 32 Kuo, Chung-Hsien 163 Lei, Jin-Wen 16, 128 Lin, Chii-Wann 72
Kao, Chen-Yang 193 Kuo, M.C.C. 27 Lei, Zhongjie 103 Lin, Ching-Yang 141, 154
Kao, Chung-Lan 66 Kuo, Te-Son 49, 158 Leigh, Ja-ho 51, 68, 128 Lin, Ching-ying 147
Kao, Laure Kuei-Tsu 126 Kuo, Terry B.J. 133 Leong, Chau-Peng 26, 95, 131 Lin, Chu-Hsu 95, 135, 184
Kao, Mu-Jung 81, 141, 154 Kuo, Ya-Wen 15 Leung, Kwok Pui 185 Lin, Chueh-Ho 163, 193
Kao, Ti-Li 148 Kuo, Yur-Ren 95 Leung, T. 27 Lin, Feng 39, 118, 187
Karagianni, Martha JP 143 Kurihara, Yuka 168 Lew, Henry L. 19, 95 Lin, Fong-Cheng 141, 154
Karagiannis, Tom C 143 Kuriiwa, Kazuhiko 154 Li, Ai-Hua 108 Lin, Hsin-Tai 91
Karuppali, Sudhin 112 Kutner, Nancy 186 Li, Chuan 150 Lin, Hsu-Kuei 78
Kasahara, Takashi 141 Kwa, Moreena 74 Li, Cui-E 119 Lin, Jau-Hong 170
Kassai, Fumihito 124, 191 Kwack, Kyu-Sung 171 Li, Guangqing 158 Lin, Jau-Jia 182
Katerina, Hilari 150 Kwon, Bum-Sun 86 Li, Hailing 109 Lin, Jaung-Geng 132
Kato, Junichi 152, 166 Kwong, K.L. 87 Li, Hongling 114 Lin, Kwan-Hwa 28
Kato, Mayu 168 Kwon, Jeong-Yi 86 Li, Hongwei 118 Lin, Ming-Chuan 157
Kawano, Mitsuhiro 103 Kwoon, Jung-Gu 169 Li, Hui 158 Lin, Na-Ling 92
Kawasaki, Hirotaka 136 Ky Tong, Raymond 129 Li, Jianan 33, 34, 47, 119, 150, 158, Lin, Pay-Shin 157, 195
Kawashima, Kimiko 65 164, 167, 188 Lin, Pei-Hung 152
Kawate, Nobuyuki 186 L Li, Jianping 150 Lin, Pei-Ling 145
Kawauchi, Motohiro 118 Lai, Cheng-Hsiu 55 Li, Jianxin 92 Lin, Pei-Yi, 28
Ke, Jyh-Yuh 90, 163, 191 Lai, Chien-Hung 57, 104, 132, 159, Li, Juan 95 Lin, Sang-I 28
Keawduangdee, Petcharat 15 183 Li, Jun 17, 49 Lin, Shan-Ju 140
Keiko, Sakata 34 Lai, Chung Liang 161 Li, Leonard S.W. 33, 185 Lin, Shih-Cherng 67, 159
Kevorkian, C. George 193 Lai, Der-Chung 172 Li, LI 124 Lin, Shu-Hua 97, 133
Khanali, Fataneh 117 Lai, Hsuan-Chu 79 Li, Li-yun 37, 129 Lin, Song 34
Khrisanapan, Wilaiwan 35 Lai, Jin-Shin 28, 32, 33, 34 Li, Liansheng 183 Lin, Su-Hsien 132
Kidarsa, Lydia 161 Lai, Min-Hsin 51, 98, 100, 101, 151 Li, Ling 112 Lin, Tung-Liang 101, 120, 125
Kikuchi, Naohisa 34, 87 Lai, Weng-Hang 145 Li, Mei 112 Lin, Tzu-Chi 196
Kim, Bong-Ok 86 Lains, Jorge 24, 54 Li, Ming-Chun 181 Lin, Wei-Yung 167
Kim, Dong-Hyup 123 Lam, Tsz Ping 59 Li, Nuo 174 Lin, Wen-Chih 185, 198
Kim, Dong Jin 104, 127, 176 Lambercy, O. 114 Li, Pengdong 92 Lin, Xiafei 25
Kim, Gye-Yeop 129 Lan, Ching 32, 33, 34 Li, Ping-Chia 190 Lin, Yang-Hua 153, 163, 180
Kim, Hee-Jin 127 Lan, Howard Haw-Chang 101 Li, Qi 31 Lin, Yi-Shan 148
Kim, In-Gyu 142 Lan, Yue 20, 69 Li, Qingqing 167 Lin, Yin-Tsong 49
Kim, Jang-Hee 171 Lau, Yiu-Chung 95, 131, 162 Li, Qingtian 144 Lin, Yu-Chun 67
Kim, Joon Sung 97 Lee, Bai-Chin 32 Li, Shujing 39 Lin, Cheng-Hsin 120
Kim, Jung Yoon 93, 139 Lee, Chao-Chih 134 Li, Tsung-Ying 51, 98, 100, 101, Lin, Chou-Ching K. 29
Kim, Jung Yun 170 Lee, Hsin-Yi 96 123, 151 Lin, Chueh-Ho 194
Kim, Keewon 51, 103, 191 Lee, Joong Youp 170 Li, Xiaojie 36 Lin, Chun-Hsiang 115
Kim, Keo Sik 51, 154 Lee, Posen 190 Li, Xiao-Jie 89, 177, 178, 179 Lin, Jau-Jia 30
Kim, Ki Jung 176 Lee, Sang Chul 104 Li, Yan 158 Lin, Keh-Chung 26
Kim, Kyoung-Yoon 129 Lee, S.C. 87 Li, Yi-Wen 152 Lin, Meng-Chih 120
Kim, Min-Young 86 Lee, Szu-Chieh 90 Li, Ying 39 Lin, Ming-I 170
Kim, Myeong-Ok 86 Lee, Wen-Chung 30 Li, Yongmei 31, 49, 109, 138 Lin, Pei-Hsuan 180
Kim, Sang-Joon 86 Lee, Chia-Ling 47 Li, Yongqiang 47 Lin, Tsung-Ching 104
Kim, Sang Jun 139, 170 Lee, Chien-Hsuan 159 Li, Yuan-Bao 142 Lin, Tzer-Bin 30
Kim, Sei Joo 106, 169 Lee, Goo Joo 191 Li, Yu-Ling 155 Lin, Won-Jean 198
Kim, Seong-Woo 86 Lee, Heng-Ju 179 Li, Yuan-bao 142 Lin, Yi-Jia 55
Kim, Seoung-Kyu 169 Lee, Il Jae 85, 171 Li, Zhe 141 Lin, Zinlin 26
Kimura, Akio 127, 164 Lee, Il Yung 85 Li, Zheng-Yu 171 Lindoyo, Yenny 98
Kimura, Hiroaki 118 Lee, Ki Young 85 Liang, Chung-Chao 115 Liou, Cian-Ci 120
Kimura, Shinji 16 Lee, Kuo-Lung 145, 147, 148 Liang, Fang-Chen 90 Liou, Rong-Tai 172
Kiyoi, Junko 154 Lee, Li-Rong 180 Liang, Pei-Jung 26 Liou, Shou-Jhuang 195
Kluayhomtho, Sujittra 35 Lee, Lin-Chien 115 Liang, Chung-Chao 107, 192 Liou, Syu-Han 195
Ko, Hsiu-Fen 150 Lee, Michael 189 Liang, Huey-Wen 140 Liou, Tsan-Hon 52, 145, 147
Ko, Mei-Zu 178 Lee, Min-Kyung 156 Liao, Chia-Fa 180 Liping, Huang 124
Ko, Myoung Hwan 51 Lee, Myung Ae 85 Liao, Chia-Fang 153 Liu, Shao-Yi 104
Ko, Yi-Hsin 28 Lee, Sam-Gyu 129, 142, 156 Liao, Chien-Chang 132 Liu, Wen-Yu 183
Kobe, Akio 136, 154 Lee, Sang Yoon 191 Liao, Chien-Chih 177 Liu, W.L. 185
Kodama, Mitsuhiko 141 Lee, Sheldon 153 Liao, Hua-Fang 82, 85 Liu, Yandong 109
Koh, Chia-Lin 146 Lee, Shi-Uk 93 Liao, Kwong Kum 88 Liu, Boyu 193
Kohzuki, Masahiro 34 Lee, Shin-Da 147 Liao, Linrong 91 Liu, Chieh-Yu 133, 192
Kollias, Spyros S. 44 Lee, Shiuann Sheng 92 Liao, Wei-Jing 37, 129, 195, 197 Liu, Chin-Hsuan 190
Kong, Keng-He 64 Lee, Si-Huei 35, 79, 118 Liaw, Jiung-Woei 163 Liu, Chin-Wei 47, 48
Kongbunkiat, Kannikar 186 Lee, Soon-Kyu 105, 122 Liaw, Lih-Jiun 105 Liu, Fu Kang 72
Kovindha, Apichana 47 Lee, Su-Ya 107 Liaw, Mei-Yun 120 Liu, Haibin 91
Koyama, Yuji 141 Lee, Sung-Uk 169 Lien, Hen-Yu 108, 153, 180 Liu, Hao 92
Kruapanich, Chathipat 186 Lee, Tzong-Shyuan 71 Lien, Shwu-huei 106 Liu, Ho-Ling 152
Kuah, C.W.K. 114 Lee, Wai-Keung 98, 198 Lien, Wei-Chih 78 Liu, Hongliang 162
Kuai, Chengwei 123 Lee, Wen-Chung 170 Lieu, Fu-Kong 115 Liu, Jinglong 20, 110
Kuan, Ta-Shen 54, 78, 80, 81, 131 Lee, Winson 59 Lin, Amy I-Hui 50 Liu, Jiun-Horng 172
Kumar, Arun 14 Lee, Xin-Xian 122, 146 Lin, Cheng-Hsin 185, 198 Liu, Jung-Tai 151, 179
Kumthornthip, W 64 Lee, Yang-Soo 123 Lin, Cheng-Yuan 104, 127 Liu, Karen P.Y. 27
Kung, Bing-Cheng 128 Lee, Yu-Chun 101, 125 Lin, Chia-Chen 154 Liu, Kuang-Che 165
Kung, Pin-Cheng 29 Lee, Zee-Ihn 86 Lin, Chia-Chin 147 Liu, Ling-Li 155, 197
Kunjara, Rapeephon 32 Lee-Shu, Sandra L. F. 59 Lin, Chien-Chung 128 Liu, Mai-li 37, 129

Liu, Mei-Fang 105 Mizuochi, Kazuya 34 Park, Hyo-In 130 Shang, Qing 38, 170
Liu, Meigen 65 Moghaddam, Farid Rezaie 20 Park, Joo-Hyun 86 Shang, Xiaoying 109, 117, 137
Liu, Ping-Yen 78 Mok, V. 27, 64 Park, Jung-Hyun 169 Shang, Xifu 108
Liu, Shou-Chuang 194 Moon, Jae Ho 122 Park, Myong-Chul 85, 171 Shao, Zhenhai 144
Liu, Shouguo 47 Mori, Nobuyoshi 34 Park, Soo Kyoung 170 Sharafoddinzadeh, Naser 52
Liu, Su 130 Mozhgani, Parviz 53 Parsian, Heshmat Alah 117 Shau, Yio-Wha 14
Liu, Ting-Yuan 95 Mu, Jing-Song 77, 148, 149 Parsian, Samaneh 117 Shen, Guangyu 130
Liu, Wen-Yu 89, 90, 153, 180, 194 Mu, Shu-Chi 82 Paul-Brent, Peta-Anne 102 Shen, Xuanlin 164
Liu, Yanping 114 Murai, Hoshi 127 Pay-Shin, Pay-Shin 194 Sherwood, Arthur M. 42
Liu, Yinhua 35 Murakami, Masahito 166 Pei, Yu-Cheng 21 Shi, Dong-Liang 102
Liu, Yu-Chun 177 Muraoka, Mikio 16 Peng, Chih-Wei 49, 57, 104, 159 Shi, Hon-Yi 171
Liu, Zhenhuan 110, 173, 174, 175, Muratani, Tosiyuki 154 Peng, Chiung-Chi 196 Shi, Yan-Li 119
176, 189, 197 Musienko, Pavel 46 Peng, Robert Y. 196 Shi, Yanli 117
Liu, Zhihao 101 Myers, Stephen 102 Peng, Yi Yuan 161 Shiang, Tzyy-Yiang 104
Lo, Hsin-Chang 160 Peng, Yuan 129, 195 Shieh, Jeng-Yi 83, 99, 180
Lo, Huei-Yu 98, 198 N Phadungkit, Suphaporn 79 Shieh, Kun-Ruey 133
Lo, I-Min 189 Na, Young-In 85 Phiwjinda, Katavut 68 Shih, Chun-Chuan 132
Lo, Miao-Chi 28 Nagano, Yasuharu 53 Pong, Ya-Ping 26, 95, 116 Shih, Pei-Pi 147
Lo, Shu-Chen 151 Nagasaka, Makoto 34 Pongprapai, Sukajan 32, 55 Shih, Shu-Hua 145
Lo, Sing-Kai 170 Nagatomi, Akiyoshi 118 Posawang, Pornsawan 180 Shih, Tung-Sheng 147
Lo, Sui-Foon 167 Naghdi, Nasser 20 Prananta, Marietta 161 Shih, Yi-Fen 145, 155
Lo, Te-Hsiang 155 Naito, Kenji 53 Prasad, Naresh 14 Shimasaki, Akira 117
Lo, Yuk-Keung 163 Nakajima, Sawako 164 Premalatha, B.S. 112 Shimbo, Takehiko 162
Lochia, Chang 144 Nakata, Kimihiko 137 Promdee, Kluaymai 185 Shimozaki, Shingo 94, 138
Lofriman, Yayat Hadiyat 80 Nakata, Minori 136 Puntumethak, Rungthip 15, 77, 79, 93 Shin, Hyung-Ik 93
Long, Yan 112 Nakazawa, Kimitaka 53 Shin, Yong-Beom 86
Lu, Chiu-Ping 152, 164 Namwongsa, Suwalee 134 Q Shindo, Keiichiro 65
Lu, Gang 31 Nan, L.V. 171 Qian, Long 113 Shyue, Song-Kun 71
Lu, Hsin-Ying 196 Nanulaitta, Erwin A.D. 80 Qian, Xuguang 175 Si, Huiliang 94
Lu, Lu 30, 70, 85, 108, 129, 144, 150 Nasu, Wataru 94, 138 Qian, Yifei 164 Sim, Kyu Hun 106, 169
Lu, Shao-Chi 100, 101, 169 Neawla, Salinee 185 Qian, Zhao 40 Sin, Sai Wing 59
Lu, Shin-Yo 79 Ng, Bobby K. W. 59 Qiao, Pingyun 86 Sinha, Akshay Kumar 14
Lu, Shoubin 109 Ng, Gabriel Y.F. 27 Qiming, Yang 123 Siritaratiwa, Wantana 49, 93
Lu, Xiao 34, 167 Ng, L.Y. 185 Qin, Yanjing 109 Soheily, Shahram 117
Lu, Yi-Ying 157 Ni, Chao-Min 148, 149 Qing, Shang 171 Somashekara, HS 22
Lu, Zhi-Hai 179 Ni, Ni Chao-Min 77 Qiu, Zhuoying 36 Son, Soo Yon 154
Lu, Zhihai 38 Nian, Zuo 123 Qu, Qingming 158 Song, Weiqun 37, 113
Lu, Zhiyan 130 Nielsen, Gary 102 Quan, Cheng 112 Song, Chul Gyu 51, 154
Luangaram, Saowanee 134 Nik-bakht, Hojat Alah 117 Song, Weiqun 151, 160
Luh, Jer-Junn 28 Nikolic, Dejan 187 R Soon, Yin Tjan 165
Lum, C.M. 27 Noh, Se-Eung 130 Srisim, Kitiyawadee 68
Luo, Benyan 22 Radish, Kumar B. 22, 110, 111 Stokes, Maria 96
Nohara, Ryuji 119 Raiessadat, Ahmad 56
Luo, Chun 151 Stokic, Dobrivoje S. 65
Luo, Qiu 49 Rathore, Farooq A. 49, 188 Strong, Po-Chin 35, 118
O Rathore, Tayyab 49, 188
Luo, Yu-kun 17 Stucki, Gerold 10, 12
Luo, Yuejia 21 Ochi, Mitsuo 118 Rattay, Frank 43, 44 Su, Bai-Horng 81
Luo, Zheng-An 28 Oda, Mayumi 154 Rau, Chi-Lun 147 Su, Hui-I 169
Lü, Zhisu 22 Oh, Byung-Mo 51, 52, 68, 128, 191 Raza, Ali 49 Su, Hui-Min 121
Oh, Ju Sun 97 Rey-Matias, Reynaldo 56 Su, Mao-Yuan Marine 32
Oh, Shin J. 74, 76 Rha, Dong-Wook 104, 127, 176 Su, Shin-Chang 195
M Okuyama, Sou 166 Rosales, R 64 Su, Shin-Cheng 157
Ma, Hui-Ing 26 Olver, John 63 Rosetzsky, Allan 135 Su, Syi 34
Ma, Hsiao-Li 145 Osada, Sachiko 127 Rothwell, John 41 Su, Wei-I 100
Ma, Li 112 Ota, Tetsuo 164 Roy, Roland R. 46 Sui, Chern-Chern 189
Maeda, Noriaki 152, 166 Otani, Yoshitaka 152 Roys, Steven 66 Sum, C. 27
Maharattanawongsa, Sawitree 68 Otsuki, Shingo 119 Ruckpanich, Piyanuj 32 Sun, Hsien-Pin 135
Makita, Shigeru 122 Outerbridge, Kerry 102 Sun, Hyung-Suk 142
Mao, Rongqiu 94 Ouyang, Ya-Tao 142 S Sun, Jie 100, 112
Masakado, Yoshihisa 141, 168 Ouyang, Yata 91 Sain, J 64 Sun, Jiguang 164
Matias, Reynaldo Rey 24 Ouyang, Yingyi 167 Samaraweera, Buddhima 112 Sun, Jui-Sheng 71
Mato, Lugkana 68 Santakit, Nareerat 102 Sun, Junmo 113
Matsuda, Yasuhiro 161, 162 P Sashika, Hironobu 34, 67, 87 Sun, Pei-Chen 122, 146
Mayr, Winfried 43, 44 Palaniappan, K 165 Sato, Shinji 119 Sun, Shu-Fen 135, 153, 163
McKay, Barry 42 Pan, Hui-Juan 102 Sawadpanich, Rukfun 32 Sung, In-Young 86
Mei-Yi, Wu 178 Pan, Jen-Li 97, 133 Schneck, Carson 144 Sung, Tzu-Ying 153
Melvin, John L. 24, 72 Pan, Lei 167 Sedighipour, Leya 56 Sung, Wei-Hao 141
Meng, Dianhuai 22, 99, 164 Pan, San-Qiang 39 Seifner, Roman 46 Sung, Wen-Hsu 163, 193, 194
Meng, Ling-Fu 152 Pan, Shin-Liang 52, 98 Seki, Kazunori 57 Suvarnnato, Thavatchai 79
Meng, Nai-Hsin 117, 154, 172 Pan, Yu 160 Sekiya, Takaaki 57 Suzuki, Fumika 34
Miao, Yun 77, 148 Pang, Wei 38, 178 Selb, Melissa 11
Min, You Sun 52 Pao, Sun-hua 14 Seo, Han-Gil 68, 128 T
Min, Yu 126 Park, Byung Kyu 106, 169 Seo, Jeong Hwan 51, 154 Takada, Kaoruko 34, 87
Minassian, Karen 43, 44 Park, Chang-Il 81 Seo, Kwan Sik 103 Takagi, Yasutaka 94, 117, 136, 137,
Mio, Sun 140 Park, Eun Sook 176 Seto, Chieko 168 138, 160
Mircea, I. 107, 156, 194 Park, Gi-Young 13, 17, 169 Shan, Chunlei 22 Takanashi, Noboru 168
Mizuma, Masazumi 124, 186, 191 Park, Hea-Woon 169 Shang, Chi-Yung 180 Takeuchi, Takahito 25

Index 203
Tam, Eric 61 Viton, Jean-Michel 11 Wei, Li 113 Xu, Yiming 144

Tam, Ka-Wai 90 Wei, Ni 195 Xue, Xinping 114
Tam, Sandra Y. P. 59 W Wei, Pei-Shan 152
Tan, Li-Ping 177 Wei, Shun-Hwa 66, 163, 193, 194 Y
Wada, Futoshi 58
Tanaka, Hiroyuki 94, 138 Wei, Ta-Sen 29, 65, 91, 113
Wai, Yau-Wai 98, 198 Yamachika, Yurie 164
Tanaka, Shiro 119 Wei, Tie Hua 116
Wakabayashi, Hidetaka 34, 67, 87 Yamada, Hiroshi 94, 138
Tang, Dan 91, 92, 142, 167 Wei, Tye 150
Wan, Chunxiao 33, 119, 150 Yamada, Shin 127, 164
Tang, Simon Fuk-Tan 13, 18, 23, Wei, Xiaomei 25
Wan, Ruiping 174 Yamada, Takuya 164
43, 63, 67, 70, 93, 153, 159, 180, Wei, Yu-Chun 115
Wang, Chin-Man 90 Yamaguchi, Masao 136
183, 198 Weidner, Morten 135
Wang, Changchun 114 Yamasaki, Makiko 161
Tang, Hsiang-Wei 157 Wen, Hongmei 25
Wang, Ching-Ching 120 Yan, Tiebin 11, 26, 126, 129, 195
Tang, I-Ning 108 Wen, Wan-Shun 195
Wang, Chun-Hou 84, 161 Yan, Wang 134
Tang, Pei-Fang 28 Weng, Li-Jen 85
Wang, Da-Hsing 72 Yang, Chengjian 33, 119
Tang, Qiang 116 Weng, Ming-Chang 47
Wang, Guifang 69 Yang, Cheryl CH 133
Tang, Qing 95 Weng, Ming-Cheng 48, 149
Wang, Haiyan 100 Yang, Chich-Haung 107
Tang, Yung-Wen 182 Weng, Xuchu 22
Wang, Hong-Xing 164, 167 Yang, Chung-Yong 86
Tanimoto, Yukihiro 186 Won, Jeong-Gu 17
Wang, Huei-Shyong 180 Yang, Clement SH 133, 192
Tanprasert, Pravit 32 Won, Sung-Yoon 127
Wang, Hui-Fang 102 Yang, Feifei 31, 49, 109
Tansey, Keith E. 45 Won, Sun Jae 106, 169
Wang, Hui-Yi 170 Yang, Hanwen 35, 40
Tasi, Ming-Sue 125 Wong, Alice M.K. 55, 58, 86, 89, 90,
Wang, Jaw-Lin 15 Yang, Jeng-Feng 54, 114
Tay, San San 153, 193 108, 135, 157, 163, 180, 183, 191
Wang, Jie 109 Yang, Jianzhuo 110
Teo, C.L. 114 Wong, Kam-Fai 135
Wang, Jihong 123 Yang, Lin 103
Terabayashi, Hirofumi 127, 164 Wong, KS 64
Wang, Jin 196 Yang, Liqiang 131
Thaweewannakij, Thiwaporn 68 Wong, Man Sang 59
Wang, Jiun-Jie 67 Yang, Pan-Chyr 121
Thivato, Thanita 102 Wong, Y.M. 27
Wang, Jong-Shyan 32, 157, 198 Yang, Pei-Yu 154, 172, 176
Tin, Kin-hung 21 Wu, Ai-Ju 129, 182
Wang, Ju 91 Yang, Qin 142
Ting, K.H. 27 Wu, Bin 40
Wang, Jue 36 Yang, Sai-Wei 136
Ting, Hua 147 Wu, Bo 109
Wang, Jue-Long 135, 153, 163 Yang, Seung-Hoon 129
Tochikura, Michi 168 Wu, Chin-Wen 52, 147
Wang, Jun 92 Yang, Shu-Han 189
Torkan, Farzaneh 31 Wu, Dongyu 109
Wang, Jung-Der 157 Yang, Shu-Yu 120
Torng, Pao-Chuan 69, 88, 181, 182 Wu, Hing-Man 178
Wang, Kien-Jung 198 Yang, Tsui-Fen 88
Tou, Isabel 89 Wu, Hong-Ying 150
Wang, Li-Ping 179 Yang, Tsung-Hsun 131
Tou, Tou Isabel 120 Wu, Hua 158
Wang, Lianfang 112 Yang, Wan-Tong 37, 129, 195
Tsa, Yi-Ju 153 Wu, I-Hsien 151
Wang, Lin-Yi 95 Yang, Wei-Shiung 121
Tsai, Cho-Dang 197 Wu, Jane 15, 68, 74
Wang, Lin-Yi 143 Yang, Xiaoxu 21
Tsai, Ko-Lun 35, 79, 118 Wu, Jih-Huah 106
Wang, Ling 103 Yang, Yan-Yan 137
Tsai, Mei-Wun 136 Wu, Jixiang 162
Wang, Ling-Yi 30 Yang, Yea-Ru 28
Tsai, Sen-Wei 101, 120 Wu, Meng-Tien 193
Wang, Ming-Fang 172 Yang, Yonghong 103
Tsai, Su-Ju 30, 50 Wu, Ming 108
Wang, Ninghua 140, 151 Yang, Yuanbin 160
Tsai, Tzung-Chang 128 Wu, Pei-Hsuan 159
Wang, Po-Chin 153 Yang, Yun-huang 37, 129
Tsai, Wen-Chung 13, 70, 198 Wu, Peilin 192
Wang, Quoxin 99 Yang, Zong-Han 113
Tsai, Wen-Ji 99 Wu, Qiuhan 162
Wang, Ray-Yau 28, 112 Yao, David 31
Tsai, Yu-Chin 120 Wu, Shih-Hui 102, 136
Wang, Rongli 140, 151 Yao, Feng-In 176
Tsai, Yi-Ta 95 Wu, Shuang 112
Wang, Rufeng 184 Yao, Hong 39
Tsai, Yu-Chia 128 Wu, Tai-Yi 97, 133
Wang, Shoei-Shen 33, 34 Yao, Liqing 49
Tseng, Cheng-Hao 116 Wu, Ting-Fang 145
Wang, Shuu-Jiun 66 Yao, Shu-Fen 172
Tseng, Ching-Shiang 30, 96 Wu, Tsung-Ju 91
Wang, Ting-Ming 99 Yao, Yunhai 158
Tseng, Chin Yen 161 Wu, Yee-Hwa 94
Wang, Tong 11, 22, 99, 167, 196 Yazdi, Mohammad Jafar Shaterzadeh 52
Tseng, Hsu-Min 195 Wu, Yen-Wen 121
Wang, Tyng-Guey 69, 98, 100, 152, 153 Ye, Xiang-Ming 183, 195
Tseng, I-Fang 164 Wu, Ying 49
Wang, Tzyy-Jiuan 136 Yeh, Chih-Jung 84
Tseng, Mei-Hui 179 Wu, Ying-Tai 120, 121
Wang, Wei 158 Yeh, Chun-Yu 160
Tseng, Shiuan Yu 161 Wu, Yung-Tsan 100, 101, 123, 139
Wang, Wen-Ting 137, 138 Yeh, Huan-Jui 98
Tseng, Song-Hung 78 Wu, Zongyao 76, 162
Wang, Wenli 138 Yeh, Kuo-Kuang 89
Tseng, Sung-Hui 90, 132, 183
Wang, Xiang 99 Yeh, Tian-Shin 100
Tseng, Wen-Yih Issac 32 X
Wang, Xiaodong 184 Yeh, Tsui-Ting 78
Tseng, Yen-Cheng 172
Wang, Xiaotong 35, 40 Xia, Qing 77, 148 Yeh Chien-Nan 178
Tseng, Yin-Ting 129
Wang, Xin 140 Xian, Qinglin 167 Yen, Shih-Yin 171
Tsou, Kuo-Inn 82
Wang, Xinping 94 Xiang, Yun 129, 195 Yen, Sunto 132
Tsou, Kuo-Su 82
Wang, Yan 95 Xiao, Fengming 38 Yen, Wei-Chang 54
Tsuang, Yang-Hwei 71
Wang, Yen-Ho 48, 52, 140 Xiao, Min 99 Yen, Wei-Jang 131
Tsubokawa, Misao 136
Wang, Yi-Hsi 120 Xiao, Mingyue 47 Yi, Wenchao 47
Tsuchiya, Hiroyuki 94
Wang, Yi-Zhao 141 Xie, Bin 140, 151 Yim, Shin-Young 85, 86, 171
Tung, Heng-Hsin 120
Wang, Yin-Jung 156 Xie, Wei 103 Yimdee, Jindaporn 185
Tulaar, Angela B.M. 54, 80
Wang, Yong-Hui 124 Xing, Yanli 116 Yin, Hsin-Pei 192
Tumurbaatar, N. 56
Wang, Yu-Bin 102 Xiong, Xianghu 48 Yin, Yong 167
Tung, Li-Chen 84, 172
Wang, Yu-Lin 89 Xu, Fei 109 Ying, Tsung-Ho 50
Wang, Yuanjiao 183 Xu, Giuangxu 158 Yoda, Mitsumasa 186
U
Wang, Yun-Er 165 Xu, Guang-Xu 11, 164, 167 Yoo, Soon Hee 97
Uchida, Ryusei 122 Wannakrairot, Khunying Mallika 32 Xu, Jian 103 Yoon, Dukyong 85
Uddin, M Taslim 16 Wannapakhe, Jiraporn 49 Xu, Jiang 141 Yoon, Joon Shik 106, 169
Ueda, Keisuke 118 Wanpen, Sawitri 15, 77 Xu, Jing 33 Yoshimura, Mika 161
Ushiba, Junichi 65 Ward, Anthony B 62 Xu, Jingfei 134 Yoshioka, Naomi 186
Watanabe, Hideyasu 124, 191 Xu, Qian 151 You, Chun-Jing 128
V Watanabe, Tomoko 127 Xu, Tao 11 Young, Mark A. 53
Varma, Ajit Kumar 14 Wathanadilok, Ubonwon 180 Xu, Xiang-dong 142 Young, Sherry Hy 153
Villanueva, John 79 Wee, S.K. 114 Xu, Xiaoxiao 38 Yu, Bo 101

Yu, Hong 144 Zhang, Dahua 160 Zhang, Xiongwei 158 Zhou, Huichang 39
Yu, Hui-Shan 171 Zhang, Guo-Dong 195 Zhang, Yabming 160 Zhou, Jiangbao 38, 86
Yu, Lehua 139 Zhang, Hong-Ling 117, 119 Zhang, Yan 103 Zhou, Jing-jie 131
Yu, Min-Yuan 92, 125, 190 Zhang, Hui-Chun 171 Zhang, Yang 124 Zhou, Li 189
Yu, Shang-Ming 28 Zhang, Huichun 38 Zhang, Yanming 113 Zhou, Linqiu 79, 144
Yu, Tzai-Chiu 107 Zhang, Huiping 114 Zhang, Yue-Xing 67 Zhou, Mou-Wang 47, 137, 138
Yu, Xun 99 Zhang, Jianping 164 Zhang, Yunxi 167 Zhou, Niang 183
Yu, Zhiliang 158 Zhang, Jirong 112 Zhang, Zhiqiang 22 Zhou, Qiumin 99
Yun, Hong 114 Zhang, Lihong 174 Zhao, Jiayan 193 Zhou, Shifang 184
Yuan, Hai 35 Zhang, Lihua 178 Zhao, Wenjian 174 Zhou, Xiangli 162
Yue, Shou-Wei 124 Zhang, Luxi 92 Zhao, Xiaoyu 22 Zhou, Xuya 191
Yuen, M.L. 27 Zhang, Mingming 36 Zhao, Yan-ling 142 Zhu, Gen-Ying 138
Yun, Hyun-Sik 156 Zhang, Pande 39 Zhao, Yaotao 109 Zhu, Lin 160
Yun, Miao 77 Zhang, Qi-Xing 115 Zhao, Yong 174, 197 Zhu, Renjing 22
Yura, Shinya 160 Zhang, Qiuyang 123 Zheng, Hai-Qing 20, 39 Zhu, Si Xuan 161
Zhang, Shi-Ling 179 Zheng, Haiqing 126 Zhu, Xiaojun 196
Z Zhang, Shuang 84 Zheng, Jin-Lin 20 Zhu, Xiaoming 109
Zampolini, Mauro 63 Zhang, Wei 178 Zheng, Xiuyuang 129 Zhuang, Zhi-qiang 129, 195
Zeng, Fan-Shuo 137 Zhang, Wen 122 Zheng, Ya-Dan 31, 113 Zhuge, Yi 35
Zhai, Hong-wei 100, 131 Zhang, Xia 47, 188 Zhenhuan, Liu 175 Zhuo, Dahong 73
Zhai, Kaihua 193 Zhang, Xifang 167 Zhongli, Jiang 37 Zikic, Ana 187

Jurnal of Rehabilitation Medicine 2

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Journal of ISSN 1650-1969

April 29 – may 2, 2010, Taipei, Taiwan

Editor-in-Chief Jan Lexell, Lund, Sweden

© 2008 Foundation of Rehabilitation Information. ISSN 1650-1977

Thursday, April 29, 2010

Friday, April 30, 2010

J Rehabil Med Suppl 48

Neuroprotection Strategies in Experimental Traumatic Brain Injury Szu-Fu Chen 0430B3

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

saturday, may 1, 2010

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

sunday, may 2, 2010

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

Pre-conference workshop (April 29, 2010)

0429WS4 on ICF Core Set development” and “Measurement tools” is to

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

KEYNOTE SPEECH (April 30, 2010)

J Rehabil Med Suppl 48

Oral presentations (April 30, 2010)

J Rehabil Med Suppl 48

0430A2 lesion to the surrounding structures could be demonstrated so that the

0430A3 Purpose: Foot problems in leprosy subjects are of major concern.

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

0430J5 Event Related Potentials (ERPs), 2) Auditory Brainstem Responses

J Rehabil Med Suppl 48

various cytokines/chemokines. The injured brain also has a muted 0430B5FP

J Rehabil Med Suppl 48

Brain Disorders: Neural Plasticity and Cognition 0430F3

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

0430K2 Methods: The author presents information from his experiences as

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

the paretic upper limb generated a larger pronation/supination torque 0430D4FP

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

surface vessels in group C increased. Conclusion: The Angelica 0430N3FP

J Rehabil Med Suppl 48

J Rehabil Med Suppl 48

thesaurus as experiment materials. Both patients with aphasia 0430N10FP