Elastic bandage vs. neoprene thumb stabilizer splint in acute De Quervain’s tenosynovitis.

Background: De Quervain’s tenosynovitis is a common disease among the patients who performed unaccustomed repetitive movement of the thumb side of the wrist. A neoprene thumb stabilizer splint is often used to restrict thumb movement. However, because of its cost, usage of an elastic bandage made of cheaper materials is proposed. Objective: Compare the effectiveness between the elastic bandage and the neoprene thumb stabilizer splint in acute De Quervain’s tenosynovitis. Methods: Forty participants with acute De Quervain’s tenosynovitis were divided into two groups (20 participants each). The first group used the elastic bandage, and the second group used the neoprene thumb stabilizer splint. Visual Analog Scale (VAS) pain, lateral and palmar pinch strength were measured before and after using the bandage and the splint for one or two weeks. Results: The average ages in the bandage and the splint group were 53.15±10.42 and 48±11.7 years, respectively. The VAS pain score of the bandage and splint group over week 0, 1, and 2 were 58.50, 33.90 and 19.55, and 51.60, 35.85 and 25.20, respectively. The bandage and splint group had the lateral pinch strength over the time of 9.40, 10.70 and 11.25 lbs, and 8.90, 9.88 and 10.57 lbs, respectively. Furthermore, they had the palmar pinch strength of 3.63, 4.68 and 5.28 lbs, and 3.07, 3.92 and 4.29 lbs, respectively. Conclusion: The pain and strength were not significantly different between the bandage and the splint group in acute De Quervain tenosynovitis. Using the bandage may be more cost-effectiveness than using the splint.

Effectiveness of constraint-induced movement therapy in chronic stroke patients.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of constraint-induced movement therapy (CIMT) in dexterity with Action Research Arm Test (ARA test), hand grip strength, pinch strength of affected upper extremity in chronic stroke patients. MATERIAL AND METHOD: An observer-blinded randomized control trial, 69 chronic stroke patients were allocated either to constraint-induced movement technique (n = 33) or conservative treatment (n = 36). The CIMT group received 6 hours of daily affected-upper-extremity training and restrained unaffected upper extremities for 5 days per week, totally 2 weeks. The control group received bimanual-upper-extremity training by conservative neurodevelopmental technique without restrained unaffected upper extremities for 2 weeks. RESULTS: The CIMT group had ARA scores, pinch strength of affected upper extremities statistically significant higher than the control group at p < 0.05, but the hand grip strength had no statistically significant difference, p > 0.05. CONCLUSIONS: CIMT of unaffected upper extremities has an advantage for chronic stroke patients which may be an efficacious technique of improving motor activity and exhibiting learned nonuse.

Hemifacial spasm: results of treatment with low dose botulinum toxin injection.

BACKGROUND: Hemifacial Sapsm (HFS) is a common movement disorder in Thailand. Botulinum toxin type A (BTA) is an effective and safe treatment for this condition. The success of BTA treatment depends on the experience of the clinician. OBJECTIVE: To study the demographic data, efficacy and safety of low dose BTA injection in HFS patients. SETTING: The Spastic and Dystonia Clinic, Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. DESIGN: Open-label, prospective case-series study. PATIENTS: All patients with HFS referred for BTA injection from December 1st, 1995 to November 30th, 2003. METHOD: Sex, age, side of spasm, onset of symptoms before BTA injection, underlying diseases, sites of BTA injection, dose of each BTA treatment, duration of response, efficacy, and side-effects were analyzed. 3-5 units of BOTOX were intramuscularly injected per site to all muscles that had spasm. After injection, a 20-minute cold compression on the first day was followed by 20-minute warm compression with massage at each injection site per day for 14 days. RESULTS : A total of 112 patients with HFS were treated with 874 BTA treatments. There were 71 females (63.4%) and 41 males (36.6%). The mean age was 45 years. 75 patients (67%) were affected on the left side. Mean duration of symptoms was 3.4 years. The sites of injection were orbicularis occuli and orbicularis oris muscles in all 874 treatments (100%). The mean dose of all treatments was 25 units. The mean initial dose was 30.5 units. The mean dose for subsequent injection was 23 units. The mean duration between treatments was 4.7 months. The mean initial duration was 3.5 months. The mean duration for subsequent injection was 4.8 months. The outcomes of treatment assessed at 4 weeks after injection classified as excellent (>80% improvement) were found in 845 treatments (96.7%). Most treatments had no complication (91.9%). Ptosis, facial paresis and double vision were mild and transient, lasting 1-4 weeks. There were no long-term complications of BTA treatment in the present series. CONCLUSION: Low dose BTA injection is an effective treatment for hemifacial spasm patients. There was a longer duration of response in subsequent injections and a lower complication rate in the present study when compared to others.

Effect of partial body weight support treadmill training in chronic stroke patients.

OBJECTIVE: To compare the effect of Partial Body Weight Support Treadmill Training (PBWSTT) technique and floor walking training, on floor walking velocities and functional balance in chronic stroke patients. DESIGN: An observer blinded, randomized controlled trial. MATERIAL AND METHOD: Forty-eight chronic stroke patients were randomized into either the experimental group that received PB WSTT (n=24) or the control group that received floor walking training (n=24). Both groups received 25 minutes of daily walking training 5 days per weeks, totally 4 weeks. Treatment outcomes were assessed on floor walking velocities and functional balance by Berg Balance Scale RESULTS: There was no statistically significant difference between both groups after a 4-week training period with regard to floor walking velocities and functional balance at p < 0.05. Patients in both groups had statistically significant improvement in these variables after a 4-week training period when compared to before training at p < 0.05. CONCLUSION: The efficacy of PBWSTT in chronic stroke patients was not statistically different to the efficacy of floor walking training in floor walking velocities and functional balance.

Effect of the "sitting pelvic tilt exercise" during the third trimester in primigravidas on back pain.

A single center, prospective, randomized, single blinded, controlled study comparing the effects and safety of "sitting pelvic tilt exercise" in relieving back pain during the third trimester in primigravida was carried out. The samples were composed of 67 primigravidas who attended the prenatal clinic at King Chulalongkorn Memorial Hospital. All subjects were selected by the random sampling technique and allocated into two groups for the experimental group and the control group; for 32 and 35 pregnants, respectively. The experimental group received the pelvic tilt exercise program for 8 weeks during the third trimester. Pain intensity was measured by visual analogue scale (VAS) at day 0 and day 56 in both groups. The result of the study revealed 1) The mean VAS of back pain in the experimental group was significantly lower at day 56 than at day 0 and lower than the control group at day 56 (p< 0.05) by unpaired t-test 2) There was no incidence of preterm labor, low birth weight or neonatal complication in the experimental group. In conclusion, the "sitting pelvic tilt exercise" during the third trimester in primigravidas could decrease back pain intensity without incidence of preterm labor, low birth weight or neonatal complication.