Evaluation of Pain and Ultrasonography on Shoulder in Poliomyelitis Wheelchair Basketball Players / 대한스포츠의학회지

The purpose of this study was to determine shoulder pain and shoulder ultrasonographic findings in poliomyelitis Wheelchair Basketball (WB) players. Three physicians performed physical examinations and interviewed WB players about their shoulder pain by using Wheelchair User's Shoulder Pain Index (WUSPI), Performance-Corrected WUSPI (PC-WUSPI), and Shoulder Pain and Disability Index (SPADI). One physician performed shoulder ultrasonography on WB players. All confirmed their International Wheelchair Basketball Federation (IWBF) classifications through Korean Wheelchair Basketball Federation (KWBF). Seventeen men and 6 women players were enrolled in the study, with 46 shoulders evaluated. Nine players had unilateral lower extremity weakness and 14 players were bilateral weakness. Six players used wheelchair for daily living, and 17 players used wheelchair only when playing WB. They were 44.35+/-5.42 years old on average. They had played WB for 11.09+/-9.49 years and trained 8.69+/-3.83 hours a week. PC-WUSPI was significantly correlated with age (p=0.014). There were no significant differences between time spent playing WB, training time for WB, types of poliomyelitis involvement, their use of wheelchair, and WUSPI, PC-WUSPI and SPADI. Tendon tear prevalence was significantly different with training time for WB (p=0.021). Most common abnormal shoulder ultrasonographic findings were subscapularis and supraspinatus tendinopathy. Tendinopathy and tendon tear prevalence did not differ significantly with age, time spent playing WB, types of poliomyelitis, and the use of wheelchair. High prevalence of shoulder pain and rotator cuff pathology were found by physical and ultrasonographic examination in the poliomyelitis wheelchair basketball players. Rotator cuff injury prevention program are needed for prevent shoulder pain and rotator cuff pathology.

Effect of Low-Frequency rTMS and NMES on Subacute Unilateral Hemispheric Stroke With Dysphagia

OBJECTIVE: To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on post-stroke dysphagia. METHODS: Subacute (<3 months), unilateral hemispheric stroke patients with dysphagia were randomly assigned to the conventional dysphagia therapy (CDT), rTMS, or NMES groups. In rTMS group, rTMS was performed at 100% resting motor threshold with 1 Hz frequency for 20 minutes per session (5 days per week for 2 weeks). In NMES group, electrical stimulation was applied to the anterior neck for 30 minutes per session (5 days per week for 2 weeks). All three groups were given conventional dysphagia therapy for 4 weeks. We evaluated the functional dysphagia scale (FDS), pharyngeal transit time (PTT), the penetration-aspiration scale (PAS), and the American Speech-Language Hearing Association National Outcomes Measurement System (ASHA NOMS) swallowing scale at baseline, after 2 weeks, and after 4 weeks. RESULTS: Forty-seven patients completed the study; 15 in the CDT group, 14 in the rTMS group, and 18 in the NMES group. Mean changes in FDS and PAS for liquid during first 2 weeks in the rTMS and NMES groups were significantly higher than those in the CDT group, but no significant differences were found between the rTMS and NMES group. No significant difference in mean changes of FDS and PAS for semi-solid, PTT, and ASHA NOMS was observed among the three groups. CONCLUSION: These results indicated that both low-frequency rTMS and NMES could induce early recovery from dysphagia; therefore, they both could be useful therapeutic options for dysphagic stroke patients.

Cardiovascular Response During Submaximal Underwater Treadmill Exercise in Stroke Patients

OBJECTIVE: To evaluate the cardiovascular response during head-out water immersion, underwater treadmill gait, and land treadmill gait in stroke patients. METHODS: Ten stroke patients were recruited for underwater and land treadmill gait sessions. Each session was 40 minutes long; 5 minutes for standing rest on land, 5 minutes for standing rest in water or on treadmill, 20 minutes for treadmill walking in water or on land, 5 minutes for standing rest in water or on treadmill, and 5 minutes for standing rest on land. Blood pressure (BP) and heart rate (HR) were measured during each session. In order to estimate the cardiovascular workload and myocardial oxygen demand, the rate pressure product (RPP) value was calculated by multiplying systolic BP (SBP) by HR. RESULTS: SBP, DBP, mean BP (mBP), and RPP decreased significantly after water immersion, but HR was unchanged. During underwater and land treadmill gait, SBP, mBP, DBP, RPP, and HR increased. However, the mean maximum increases in BP, HR and RPP of underwater treadmill walking were significantly lower than that of land treadmill walking. CONCLUSION: Stroke patients showed different cardiovascular responses during water immersion and underwater gait as opposed to standing and treadmill-walking on land. Water immersion and aquatic treadmill gait may reduce the workload of the cardiovascular system. This study suggested that underwater treadmill may be a safe and useful option for cardiovascular fitness and early ambulation in stroke rehabilitation.