Correction: Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head

We found that the original version of this paper contains an error in the descriptions of Fig. 4 (page 875)..

Effects of Repetitive Transcranial Magnetic Stimulation Over Trunk Motor Spot on Balance Function in Stroke Patients

OBJECTIVE: To assess the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) on balance function in patients with chronic stroke. METHODS: Thirty participants with chronic stroke were enrolled in this study. High frequency (10 Hz) rTMS was delivered with butterfly-coil on trunk motor spot. Each patient received both real and sham rTMS in a random sequence. The rTMS cycles (real or sham) were composed of 10 sessions each, administered over two weeks, and separated by a 4-week washout period. Balance function was measured by Berg Balance Scale and computerized dynamic posturography to determine the effect of rTMS before and one day after the end of each treatment period, as well as at a 1-month follow-up. RESULTS: The balance function was significantly improved after high frequency rTMS as compared with that after sham rTMS (p<0.05). There was no serious adverse effect in patients during the treatment period. CONCLUSION: In the chronic stroke patients, high frequency rTMS to the trunk motor area seems to be a helpful way to improve balance function without any specific adverse effects. Further studies are needed to identify the underlying mechanism and generate a detailed protocol.

Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head

OBJECTIVE: To evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head. METHODS: Nineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm²) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm²). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months. RESULTS: In both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05). CONCLUSION: Lower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.

The Dose-Related Effects of Extracorporeal Shock Wave Therapy for Knee Osteoarthritis

OBJECTIVE: To investigate the dose-related effects of extracorporeal shock wave therapy (ESWT) for knee osteoarthritis. METHODS: Seventy-five subjects were recruited, 60 of which met the inclusion criteria. The patients were randomly classified into two groups: group L, which was a low-energy group (n=30; 1,000 shocks/session; energy flux density [EFD], 0.040 mJ/mm2) and group M, which was a medium-energy group (n=30; 1,000 shocks/session; EFD, 0.093 mJ/mm2). For each group, 1,000 shock waves were delivered to the medial tibial plateau area, once a week, for 3 weeks. The main outcome measures were the visual analogue scale (VAS), the Roles and Maudsley (RM) score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Lequesne index. Each assessment was performed at the baseline and at 1, 4, and 12 weeks after ESWT. RESULTS: In both groups, the VAS, the RM and WOMAC scores, and the Lequesne index were significantly improved over time (p<0.001), and group M showed greater improvement over group L at the 1, 4 and 12 weeks assessments. CONCLUSION: In this study, medium-energy group (group M) showed greater improvement in regard to relieving pain and restoring functional outcome than the low-energy group (group L). Therefore, EFD can be considered to have significant influence when treating with ESWT for knee osteoarthritis.

Effect of Dominant Versus Non-dominant Vision in Postural Control

OBJECTIVE: To assess the effect of dominant and non-dominant vision in controlling posture in quiet stance. METHOD: Twenty-five healthy elderly subjects aged over 60 years old and twenty-five young subjects aged under 30 years old were assessed by computerized dynamic posturography. Postural stability was measured in two conditions; dominant eye open and non-dominant eye open. We used the sensory organization test (SOT) for evaluating sensory impairment. A SOT assessed the subject's ability to use and integrate somatosensory input, vision, and vestibular cues effectively to maintain balance. The SOT was conducted 3 times, and the average value of the 3 trials was used for data analysis. Equilibrium scores reflected the subject's anteroposterior sway. The highest possible score was 100, which indicated that the subject did not sway at all, and a score of 0 indicated a fall from the footplate. Determination of ocular dominance was performed by a hole-in-the card test. RESULTS: For the twenty-five young subjects in this study, equilibrium score in two conditions did not differ. However, for elderly subjects over 60 years, the equilibrium score in dominant vision was higher than in nondominant vision (p<0.05). CONCLUSION: In young subjects, there were no significant differences in postural control between dominant vision and non-dominant vision. However, in elderly subjects, postural control in non-dominant vision was significantly impaired. Therefore, the evaluation of a dominant eye should be considered in rehabilitation programs for elderly people.

Effects of Muscle Fatigue on Shoulder Proprioception

OBJECTIVE: To investigate the changes of shoulder proprioception in normal subjects, according to the direction of the evoked fatigue on the shoulder muscle group. METHOD: 20 healthy volunteers (14 males and 6 females, age 20~35 years) with entirely normal shoulders participated in this study. Before fatigue exercises, the proprioception tests were performed during active reposition (ARP) and passive reposition (PRP) of dominant shoulder, using isokinetic dynamometer, System 3 Pro (Biodex medical system, New York, USA). Three trials each of active and passive repositioning (2degrees/sec) were recorded. We also estimated the results of the peak torque shoulder movements. The subjects performed maximal efforts with five repetitions on the direction of flexion, abduction, internal rotation and external rotation. The mean values of maximal concentric voluntary contraction (MVC: peak torque of each muscle group contraction) were recorded. We repeated fatigue exercises until the peak torque dropped to 30% three times consistently, then retested the proprioception of shoulder joints. We compared the proprioceptive changes of the shoulder with pre-fatigue test and post-fatigue test on the direction of shoulder movements. RESULTS: There were significant differences of shoulder proprioception between pre-fatigue test and post-fatigue test of ARP in shoulder abduction and external rotation (p<0.05). CONCLUSION: In our study, the proprioception of shoulder joint decreased more prominently on external rotation and abduction movements under severely provoked muscle fatigue around the shoulder joint.