Reduction in limb-movement complexity at term-equivalent age is associated with motor developmental delay in very-preterm or very-low-birth-weight infants.

Reduced complexity during the writhing period can be crucial in the spontaneous movements of high-risk infants for neurologic impairment. This study aimed to verify the association between quantified complexity of upper and lower-limb movements at term-equivalent age and motor development in very-preterm or very-low-birth-weight infants. Video images of spontaneous movements at term-equivalent age were collected from very-preterm or very-low-birth-weight infants. A pretrained pose-estimation model and sample entropy (SE) quantified the complexity of the upper- and lower-limb movements. Motor development was evaluated at 9 months of corrected age using Bayley Scales of Infant and Toddler Development, Third Edition. The SE measures were compared between infants with and without motor developmental delay (MDD). Among 90 infants, 11 exhibited MDD. SE measures at most of the upper and lower limbs were significantly reduced in infants with MDD compared to those without MDD (p < 0.05). Composite scores in the motor domain showed significant positive correlations with SE measures at most upper and lower limbs (p < 0.05). The results show that limb-movement complexity at term-equivalent age is reduced in infants with MDD at 9 months of corrected age. SE of limb movements can be a potentially useful kinematic parameter to detect high-risk infants for MDD.

Long-term effects of lumbar flexion versus extension exercises for chronic axial low back pain: a randomized controlled trial.

This study aimed to compare the long-term effects of flexion- and extension-based lumbar exercises on chronic axial low back pain (LBP). This was a 1-year follow-up of a prospective, assessor-blind, randomized controlled trial. Patients with axial LBP (intensity ≥ 5/10) for > 6 months allocated to the flexion or extension exercise group. Patients underwent four sessions of a supervised treatment program and were required to perform their assigned exercises daily at home. Clinical outcomes were obtained at baseline, 1, 3, 6 months, and 1-year. A total of 56 patients (age, 54.3 years) were included, with 27 and 29 in the flexion and extension groups, respectively. Baseline pain and functional scales were similar between both groups. The mean (± standard deviation) baseline average back pain was 6.00 ± 1.00 and 5.83 ± 1.20 in the flexion and extension groups, respectively. At 1-year, the average pain was 3.78 ± 1.40 and 2.26 ± 2.62 (mean between-group difference, 1.52; 95% confidence interval 0.56-2.47; p = 0.002), favoring extension exercise. The extension group tended to have more improvements in current pain, least pain, and pain interference than the flexion group at 1-year. However, there was no group difference in worst pain and functional scales. In this controlled trial involving patients with chronic axial LBP, extension-based lumbar exercise was more effective in reducing pain than flexion-based exercises at 1-year, advocating lumbar extension movement pattern as a component for therapeutic exercise for chronic LBP.Clinical Trial Registration No.: NCT02938689 (Registered on www.clinicaltrial.gov ; first registration date was 19/10/2016).

Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly.

OBJECTIVE: Loss of skeletal muscle mass is known to be associated with multiple morbidities. However, there is a dearth of reports on its association with lumbar lordosis and musculoskeletal pain. The aim of this study was to delineate the cross-sectional relationship between loss of skeletal muscle mass, lumbar lordosis, and chronic low back pain (CLBP). METHODS: A total of 721 medical records were reviewed, and data from 165 older subjects (over 65 years old; 81 men and 84 women) were retrospectively analyzed. Subjects were categorized into either the CLBP group (back pain for more than 6 months; 35 men and 36 women) or the control group (46 men and 48 women). The modified skeletal muscle mass index (MSMI, appendicular skeletal muscle mass [kg]/weight [kg] × 100), assessed by bioelectrical impedance analysis, and lumbar lordotic angle (LLA) were measured and compared between the CLBP group and the control group. The correlation between MSMI and LLA was investigated. RESULTS: The LLA of men and women in the CLBP group was significantly lower than that of the control group (p < 0.05). The MSMI was decreased in the CLBP group compared to the control group (p < 0.05). For both sexes, positive correlations were observed between the MSMI and LLA. CONCLUSION: A close cross-sectional relationship was observed between MSMI, LLA, and CLBP. This suggests a potential interaction between the reduction in skeletal muscle mass and altered lumbar spine sagittal alignment, which could lead to CLBP.

Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study.

BACKGROUND: Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease. METHODS: We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score. RESULTS: The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE. CONCLUSION: Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.

Association of Diaphragm Thickness and Respiratory Muscle Strength With Indices of Sarcopenia.

OBJECTIVE: To evaluate the relationship between respiratory muscle strength, diaphragm thickness (DT), and indices of sarcopenia. METHODS: This study included 45 healthy elderly volunteers (21 male and 24 female) aged 65 years or older. Sarcopenia indices, including hand grip strength (HGS) and body mass index-adjusted appendicular skeletal muscle (ASM/BMI), were measured using a hand grip dynamometer and bioimpedance analysis, respectively. Calf circumference (CC) and gait speed were also measured. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were obtained using a spirometer, as a measure of respiratory muscle strength. DT was evaluated through ultrasonography. The association between indices of sarcopenia, respiratory muscle strength, and DT was evaluated using Spearman's rank correlation test, and univariate and multiple regression analysis. RESULTS: ASM/BMI (r=0.609, p<0.01), CC (r=0.499, p<0.01), HGS (r=0.759, p<0.01), and gait speed (r=0.319, p<0.05) were significantly correlated with DT. In the univariate linear regression analysis, MIP was significantly associated with age (p=0.003), DT (p<0.001), HGS (p=0.002), CC (p=0.013), and gait speed (p=0.026). MEP was significantly associated with sex (p=0.001), BMI (p=0.033), ASM/BMI (p=0.003), DT (p<0.001), HGS (p<0.001), CC (p=0.001) and gait speed (p=0.004). In the multiple linear regression analysis, age (p=0.001), DT (p<0.001), and ASM/BMI (p=0.008) showed significant association with MIP. DT (p<0.001) and gait speed (p=0.050) were associated with MEP. CONCLUSION: Our findings suggest that respiratory muscle strength is associated with DT and indices of sarcopenia. Further prospective studies with larger sample sizes are needed to confirm these findings.

Injury to the Left Sciatic and Right Common Peroneal Nerves Combined With Multifocal Rhabdomyolysis in a Survivor of the Itaewon Crowd Crush: A Case Report.

We report the case of a 27-year-old survivor of the Halloween crowd crush in Itaewon, Seoul, Korea who was diagnosed with left sciatic neuropathy and right common peroneal neuropathy accompanied by multifocal rhabdomyolysis. The patient presented to the emergency room complaining of pain from her lower back to her whole lower extremities with paraparesis and paresthesia. Her blood test showed the marked elevation of creatine kinase and liver enzymes. Magnetic resonance imaging revealed multifocal signal changes in the abdominalis and pelvic girdle muscles suggestive of rhabdomyolysis. Magnetic resonance neurography demonstrated injury to the left sciatic and right peroneal nerves. Electrophysiologic studies also revealed lesions in the left sciatic and right peroneal nerves. After comprehensive rehabilitation and conservative treatment for three months, her muscle strength improved, and she could walk independently. Although several previous studies have reported peripheral neuropathy in immobilized patients, to the best of our knowledge, no case associated with a crowd crush has been reported. Therefore, we report the case of multifocal neuropathy combined with rhabdomyolysis in a victim of a crowd crush incident with good recovery.

Spontaneous movements as prognostic tool of neurodevelopmental outcomes in preterm infants: a narrative review.

An estimated 15 million infants are born prematurely each year. Although the survival rate of preterm infants has increased with advances in perinatal and neonatal care, many still experience various complications. Since improving the neurodevelopmental outcomes of preterm births is a crucial topic, accurate evaluations should be performed to detect infants at high risk of cerebral palsy. General movements are spontaneous movements involving the whole body as the expression of neural activity and can be an excellent biomarker of neural dysfunction caused by brain impairment in preterm infants. The predictive value of general movements with respect to cerebral palsy increases with continuous observation. Automated approaches to examining general movements based on machine learning can help overcome the limited utilization of assessment tools owing to their qualitative or semiquantitative nature and high dependence on assessor skills and experience. This review covers each of these topics by summarizing normal and abnormal general movements as well as recent advances in automatic approaches based on infantile spontaneous movements.

Orthotic approach to prevention and management of diabetic foot: A narrative review.

Diabetic foot is a common complication affecting more than one-fifth of patients with diabetes. If not treated in time, it may lead to diabetic foot ulcers or Charcot arthropathy. For the management of diabetic foot, shoe modifications and orthoses can be used to reduce pressure on the affected foot or provide the foot with increased stability. In addition, the shoe modifications and orthotic devices can relieve patient discomfort during walking. Appropriate shoe modifications include changing the insole material, modifying the heel height, adding a steel shank or rocker sole, and using in-depth shoes. Alternatively, a walking brace or ankle-foot orthosis can be used to reduce the pressure on the affected foot. The purpose of this narrative review was to provide a reference guide to support clinicians in prescribing shoe modifications and foot orthoses to treat diabetic foot ulcers and Charcot arthropathy.

Comparison Between the Effectiveness of Complex Decongestive Therapy and Stellate Ganglion Block in Patients with Breast Cancer-Related Lymphedema: A Randomized Controlled Study.

BACKGROUND: Breast cancer-related lymphedema (BCRL) of the upper extremities often follows breast cancer treatment. Although complex decongestive therapy (CDT) is currently the standard treatment for BCRL, stellate ganglion block (SGB) has also been reported to be effective. OBJECTIVES: This study aimed to determine the effectiveness of SGB in the treatment of BCRL, and to assess the impact of the treatment on the quality of life (QoL) compared to CDT. STUDY DESIGN: A randomized controlled trial. SETTING: A single academic hospital, outpatient setting. METHODS: A total of 38 patients with BCRL were recruited. Patients were randomly divided into 2 groups. Patients enrolled in the CDT group underwent 10 sessions of CDT for 2 weeks, whereas patients in the SGB group received 3 consecutive SGBs every 2 weeks. Changes in circumference, volume, and bioimpedance in the upper extremity were measured at baseline and 2 weeks after treatment and compared between the 2 groups. EuroQol-5 dimensions (EQ-5D) and EuroQol visual analog scale (EQ VAS) for QoL and subjective improvement were monitored. RESULTS: In both groups, side-to-side difference of circumference after the treatment was decreased significantly from baseline (P < 0.05), and side-to-side difference of volume was reduced significantly in the SGB group (P < 0.05). No statistically significant difference was noted in the treatment effect between the 2 groups. Results of the EQ-5D, EQ VAS, and questionnaires regarding subjective symptoms administered at baseline and 2 weeks after each intervention revealed no statistically significant difference in the treatment effects between CDT and SGB. LIMITATIONS: Further long-term follow-up studies with a greater number of patients that include analysis according to the severity and duration of symptoms are needed. CONCLUSIONS: The results of this study suggest that SGB is an effective treatment for BCRL and may be considered as an alternative to CDT. KEY WORDS: Stellate ganglion block, complex decongestive therapy, breast cancer, lymphedema, breast cancer-related lymphedema, quality of life, bioimpedance, secondary lymphedema.

Needs for Medical and Rehabilitation Services in Adults With Cerebral Palsy in Korea.

OBJECTIVE: To investigate medical comorbidities and needs for medical and rehabilitation services of adults with cerebral palsy (CP) in Korea. METHODS: This was a prospective cross-sectional study. One hundred fifty-four adults with CP were enrolled in the study between February 2014 and December 2014. Information was obtained from participants regarding functional status, demographic and socioeconomic data, medical problems, and requirements for and utilization of medical and rehabilitation services. RESULTS: The participants included 93 males and 61 females with a mean age of 40.18±9.15 years. The medical check-up rate of adults with CP was lower than that of healthy adults and the total population with disabilities (53.2% vs. 58.6% vs. 70.4%). A quarter of the subjects failed to visit the hospital during the past year, and the main reason was the financial burden. Due to a cost burden and lack of knowledge, more than one-third of the subjects had unmet needs for rehabilitation services; the majority reported needs for rehabilitation services, such as physical therapy for pain management. CONCLUSION: The medical check-up rate was lower in the adults with CP, even though their medical comorbidities were not less than those of healthy people. Several non-medical reasons hindered them from receiving proper medical and rehabilitation services. Such barriers should be managed effectively.

Barriers to Outpatient Hospital-Based Cardiac Rehabilitation in Korean Patients With Acute Coronary Syndrome.

OBJECTIVE: To investigate factors associated with enrollment and participation in cardiac rehabilitation (CR) in Korea. METHODS: Patients admitted to four university hospitals with acute coronary syndrome between June 2014 and May 2016 were enrolled. The Cardiac Rehabilitation Barriers Scale (CRBS) made of 21-item questionnaire and divided in four subdomains was administered during admission. CRBS items used a 5-point Likert scale and ≥2.5 was considered as a barrier. Differences between CR non-attender and CR attender, or CR non-enroller and CR enroller in subscale and each items of CRBS were examined using the chi-square test. RESULTS: The CR participation rate in four hospitals was 31% (170 of the 552). Logistical factors (odds ratio [OR]=7.61; 95% confidence interval [CI], 4.62-12.55) and comorbidities/functional status (OR=6.60; 95% CI, 3.95-11.01) were identified as a barrier to CR enrollment in the subdomain analysis. Among patients who were enrolled (agreed to participate in CR during admission), only work/time conflict was a significant barrier to CR participation (OR=2.17; 95% CI, 1.29-3.66). CONCLUSION: Diverse barriers to CR participation were identified in patients with acute coronary syndrome. Providing the tailored model for CR according to the individual patient's barrier could improve the CR utilization. Further multicenter study with large sample size including other CR indication is required.