Treadmill training with music cueing: a new approach for Parkinson’s gait facilitation.

Background: It has been pointed that cueing techniques may have influence upon gait training in Parkinson’s disease (PD). Objective: Study the effects of music cue on treadmill training in PD patients. Subject and methods: A randomized single-blind controlled trial was conducted. Thirty male PD patients, aged 60 to 80 years with Hoehn and Yahr stage 2-3 were allocated into three groups (each 10 patients). Group A: treadmill with music three days and home walking three days/week, Group B: treadmill three days and home walking three days/week, and Group C: home walking six days/week. Each group received four weeks training followed by selfpractice for other four weeks. Gait performances at pre-program, fourth, and eighth week were compared. Results: The results showed that A, B, and C, stride length gained 12%, 5.2%, and 6.7% (p=0.042), walking-speed gained 8.6%, 6.5%, and -2.4%, six-minute walk distance gained 10.2%, 5.4%, and 2.9%, and Timed Up and Go (TUG) gained 14.2%, 12.5%, and 7.6%. Conclusion: Music cue enhanced gait training in mild to moderate PD patients.

Lumbar disc degeneration in Thai elderly: a population-based study.

OBJECTIVE: Determine the prevalence and related factors of lumbar disc degeneration in the Thai elderly. MATERIAL AND METHOD: A population-based study was done at Rom Klao community, Bangkok. Seven hundred and ninety-two cases (306 males, and 486 females) out of 1166 elderly people aged > or =50 (mean age of 61.07 +/- 7.8 years) were assessed. The lateral spinal radiographs were interpreted as spondylosis grade 0-3 according to the degree of severity. RESULTS: Males had more prevalence of grade 2-3 spondylosis than females (58.8% vs. 52.9%), but females had higher prevalence of spinal listhesis (14.4% vs. 8.8%). Age was a strong predicting factor for disc degeneration (OR = 1.088, 95% CI = 1.065-1.111, p = 0.000). Females had more risk to develop spinal listhesis (OR = 1.84, 95% CI = 1.11-3.05, p = 0.020) and low back pain (OR = 1.82, 95% CI = 1.29-2.56, p = 0.001). BMI was a predicting factor for spondylosis (OR = 1.066, 95% CI = 1.02-1.10, p = 0.000). About 27% of the cases reported moderate-severe low back pain and had lower Barthel ADL index (p = 0.018). CONCLUSION: Lumbar disc degeneration and low back pain were highly prevalent among the Thai elderly. Therefore, they need proper health care for disability prevention.

Electrodiagnosis and recovery of facial paralysis at King Chulalongkorn Memorial Hospital.

OBJECTIVE: To study electrodiagnostic findings and recovery patterns of patients with facial nerve paralysis. MATERIAL AND METHOD: Seventy-six medical records of patients who had a facial paralysis and had their electrodiagnosis performed in a 2-year period were reviewed. Patients were invited for re-evaluation. The patients would be evaluated according to House-Brackmann Facial Nerve Grading Scale (HBFNGS), residual impairment, disability, emotional and social consequences. RESULTS: Complete data were obtained from 50 patients whose mean age was 47.0 +/- 17.9 years. Seventy-two percent were diagnosed as Bell's palsy. There was significant correlation between %CMAP amplitude and HBFNGS (grade I-VI) at r = 0.5; p < 0.01. All cases of Bell's palsy with CMAP amplitude > or = 70% of normal side regained full recovery. Patients with CMAP amplitude > or = 30% had good recovery. Bell's palsy with CMAP amplitude < 10% and with other causes had poor outcome. Nine patients had synkinesis. Most of them were of traumatic cause and had severe nerve degeneration. No evidence showed that electrical stimulation was a factor inducing synkinesis. CONCLUSION: Percent CMAP amplitude could moderately predict the outcome of Bell's palsy better than other causes of facial palsy. The paralysis from traumatic cause with low %CMAP amplitude had more chance to develop synkinesis.

Falls among stroke patients in Thai Red Cross rehabilitation center.

OBJECTIVE: To determine the incidence and risk factors of falls among stroke patients. MATERIAL AND METHOD: A prospective cohort study was designed to study the stroke patients who were admitted to the Thai Red Cross Rehabilitation Center from February 2004 to July 2005. Related variables offaller and non-faller groups were compared. RESULTS: Of 151 patients, 24 (15.9%) experienced at least one fall. The incidence rate was 3.44/1000 patients/ day. Most of the falls (71.4%) occurred during the daytime, in the bathroom (37.1%), and by the bedside (22.9%). Falls frequently occurred while transferring (22.9%) and walking (20%). Barthel ADL Index (BAI) score was the variable that significantly differentiated the fallers from the non-fallers (p = 0.013). Patients with BAI score of > or = 12 had 3 times more risk to fall. CONCLUSION: About 16% of stroke patients fell during rehabilitation. More attention should be paid during the transfer and ambulation. Furthermore, a safety area should be provided in every bathroom and by the bedside.

Effects of imagery-weight exercise.

OBJECTIVE: To study the effects of imagery-weight exercise on muscle strength. MATERIAL AND METHOD: Preliminary study of a before and after designed experiment was conducted at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, from June to September 2004. Fifteen healthy sedentary volunteers: 5 males, 10 females, mean age 28.7 +/- 3.5 years were enrolled The participants were instructed to perform imagery-weight exercise training with their non-dominant arms. The program consisted of 3 sets of 10 repetitions of elbow flexion, 3 days/week, for 8 weeks. The arm muscles strength were assessed with computerized isotonic machine. One-Repetition Maximum (1-RM) at before and after the training program, was compared RESULTS: The mean 1-RM of elbow flexors increased by 44.9% (from 6.78 +/- 2.10 kg to 9.83 +/- 2.32 kg, p = 0.000). The mean 1-RM of elbow extensors increased by 32.0% (from 4.03 +/- 1.98 kg to 5.33 +/- 2.32 kg, p = 0.000). CONCLUSION: Imagery-weight exercise is another effective technique of low impact strength training.

Star excursion balance training: effects on ankle functional stability after ankle sprain.

OBJECTIVES: To study the effects of Star Excursion Balance training on functional stability of athletes with ankle sprain. MATERIAL AND METHOD: Thirty-two male athletes with grade 2 ankle sprain, aged 15-22 years old were enrolled. They were random sampling into training group (n=15) and control group (n=17). All received conventional physical therapy program for 4 weeks. The training group also underwent the Star Excursion Balance training 3 days per week for 4 weeks. Single leg stance time (SLST) was assessed at pre- and post-training. Re-injuries were recorded during 3 months follow-up. RESULTS: After the program, subjects from both groups demonstrated significant improvement in SLST The training group gained SLST of the injured sides 2 times more than the control group (p = 0.002 tested with eyes closed, p = 0. 007 tested with eyes open), and also improved the SLST during eyes closed of the normal sides (p = 0.015). Re-injuries were found in 1/15 of the training group and 2/17 of the control group. CONCLUSION: Star Excursion Balance training is more effective than the conventional therapy program in improving functional stability of the sprained ankle.