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.

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.

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.

Cross-cultural adaptation to the Thai language of the neuropathic pain diagnostic questionnaire (DN4).

OBJECTIVE: To cross-culturally adapt the neuropathic pain diagnostic questionnaire (DN4) to Thai language MATERIAL AND METHOD: Phase 1: Forward and backward translation followed by assessment of semantic equivalence. Phase 2: Testing of the questionnaire in 30 neuropathic pain patients who were seen and diagnosed by experts, followed by modifications to produce a final version. RESULTS: All the Thai translated pain descriptors except 'tingling' got high percentages of understanding among neuropathic pain patients in the first round of testing. After some adaptation of the Thai word for 'tingling' had been made, the new translated word was retested, and all subjects doing the retest understood the word very well. CONCLUSION: The Thai DN4 questionnaire was systematically translated and validated. This offers a simple Thai neuropathic pain diagnostic tool for clinical use.

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.

Thai Short-form McGill Pain Questionnaire.

OBJECTIVE: To validate the Thai Short-Form McGill Pain Questionnaire (Th-SFMPQ). MATERIAL AND METHOD: A postal survey to find the most corresponding terms to those used in the original English short-form McGill Pain Questionnaire had been performed The Thai version was created and validated. Sixty patients who had either musculoskeletal or neuropathic pain were assessed by two interviewers with this Th-SFMPQ. RESULTS: Forty four women and sixteen men participated in this study. Average age was 44.3 +/- 12.8 years and 80% of them had musculoskeletal pain. Means of sensory score was 8.98, affective score was 5.73, total score was 14.71, total count was 7.33, Present Pain Intensity (PPI) was 3.21 and Visual Analog Scale (VAS) was 53.61. Cronbach's a value was 0.7881 and inter-rater validity value of PPI was more than 0.7. The correlation coefficient was quite high (r > 0.8) for all scales. Regarding content validity, three pain descriptors (ie. stabbing, gnawing, and splitting) did not meet 33% in Melzack's criteria. CONCLUSION: The Th-SFMPQ has good internal consistency and inter-rater validity. Three uncommon descriptors should be substituted by other words or discarded in later version.

Effects of shoe lift on weight bearing in stroke patients.

OBJECTIVES: To determine the effect of shoe lift, cueing and cueing with shoe lift on weight bearing in paretic leg of stroke hemiparetic patients and compare the effect between each condition. DESIGN: Cross-sectional experimental study. SETTING: Department of Rehabilitation Medicine and Department of Ear Nose and Throat, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University. SUBJECT: Ten hemiparetic patients as a result of unilateral stroke. MATERIAL AND METHOD: Weight symmetry of each patient was measured by posturography during quiet stance and in conditions of compelled weight shift. Each patient was started with quiet standing, standing with shoe lift under the sound leg; cueing and cueing with shoe lift under the sound leg respectively. Weight symmetry scores were recorded for comparing the weight distribution between each foot. RESULTS: There were 10 hemiparetic patients. Seven were male. The average age was 53.4 +/- 8.45 years. There were 5 right hemiparesis and 5 left hemiparesis. The average onset was 12.3 +/- 15.73 months. In the right hemiparetic patients, weight bearing in the paretic leg was significantly improved when cueing with shoe lift compared with quiet standing and with shoe lift (Backward p = 0.012, Forward p = 0.011 and Backward p = 0.001, Forward p = 0.036 respectively). In the left hemiparetic patients, weight bearing in the paretic leg was significantly improved when cueing compared with quiet standing (Backward p = 0.046), and when using the shoe lift (Backward p = 0.016). Cueing with shoe lift could significantly improve weight bearing in the paretic leg when compared with shoe lift alone (Backward p = 0.015). Shoe lift alone could improve weight bearing in the paretic leg of the right and left hemiparetic patients but was not statistically significant (p > 0.05). CONCLUSION: Cueing with shoe lift under the sound leg can significantly improve weight bearing of the paretic leg of the right and left stroke hemiparetic patients.