Electrical stimulation promotes functional recovery after spinal cord injury by activating endogenous spinal cord-derived neural stem/progenitor cell: an in vitro and in vivo study.

BACKGROUND CONTEXT: Electrical stimulation is a noninvasive treatment method that has gained popularity in the treatment of spinal cord injury (SCI). Activation of spinal cord-derived neural stem/progenitor cell (SC-NSPC) proliferation and differentiation in the injured spinal cord may elicit considerable neural regenerative effects. PURPOSE: This study aimed to explore the effect of electrical stimulation on the neurogenesis of SC-NSPCs. STUDY DESIGN: This study analyzed the effects of electrical stimulation on neurogenesis in rodent SC-NSPCs in vitro and in vivo and evaluated functional recovery and neural circuitry improvements with electrical stimulation using a rodent SCI model. METHODS: Rats (20 rats/group) were assigned to sham (Group 1), SCI only (Group 2), SCI + electrode implant without stimulation (Group 3), and SCI + electrode with stimulation (Group 4) groups to count total SC-NSPCs and differentiated neurons and to evaluate morphological changes in differentiated neurons. Furthermore, the Basso, Beattie, and Bresnahan scores were analyzed, and the motor- and somatosensory-evoked potentials in all rats were monitored. RESULTS: Biphasic electrical currents enhanced SC-NSPC proliferation differentiation and caused qualitative morphological changes in differentiated neurons in vitro. Electrical stimulation promoted SC-NSPC proliferation and neuronal differentiation and improved functional outcomes and neural circuitry in SCI models. Increased Wnt3, Wnt7, and ß-catenin protein levels were also observed after electrical stimulation. CONCLUSIONS: Our study proved the beneficial effects of electrical stimulation on SCI. The Wnt/ß-catenin pathway activation may be associated with this relationship between electrical stimulation and neuronal regeneration after SCI. CLINICAL SIGNIFICANCE: The study confirmed the benefits of electrical stimulation on SCI based on cellular, functional, electrophysiological, and histological evidence. Based on these findings, we expect electrical stimulation to make a positive and significant difference in SCI treatment strategies.

Comparing zero-profile and conventional cage and plate in anterior cervical discectomy and fusion using finite-element modeling.

Conventional cage and plate (CCP) implants usually used in ACDF surgery, do have limitations such as the development of postoperative dysphagia, adjacent segment degeneration, and soft tissue injury. To reduce the risk of these complications, zero-profile stand-alone cage were developed. We used finite-element modeling to compare the total von Mises stress applied to the bone, disc, endplate, cage and screw when using CCP and ZPSC implants. A 3-dimensional FE (Finite element) analysis was performed to investigate the effects of the CCP implant and ZPSC on the C3 ~ T1 vertebrae. We confirmed that the maximum von Mises stress applied with ZPSC implants was more than 2 times greater in the endplate than that applied with CCP implants. The 3D analysis of the ZPSC model von Mises stress measurements of screw shows areas of higher stress in red. Although using ZPSC implants in ACDF reduces CCP implant-related sequalae such as dysphagia, we have shown that greater von Mises stress is applied to the endplate, and screw when using ZPSC implants. This may explain the higher subsidence rate associated with ZPSC implant use in ACDF. When selecting an implant in ACDF, surgeons should consider patient characteristics and the advantages and disadvantages of each implant type.

Biomechanical Effects of Different Sitting Postures and Physiologic Movements on the Lumbar Spine: A Finite Element Study.

This study used the finite element method(FEM) to investigate how pressure on the lumbar spine changes during dynamic movements in different postures: standing, erect sitting on a chair, slumped sitting on a chair, and sitting on the floor. Three load modes (flexion, lateral bending, and axial rotation) were applied to the FEM, simulating movements of the lumbar spine. Results showed no significant difference in pressure distribution on the annulus fiber and nucleus pulposus, representing intradiscal pressure, as well as on the cortical bone during movements between standing and erect sitting postures. However, both slumped sitting on a chair and sitting on the floor postures significantly increased pressure on the nucleus pulposus, annulus fibrosus, and cortical bone in all three movements when compared to standing or erect sitting on a chair. Notably, sitting on the floor resulted in even higher pressure on the nucleus pulposus and annulus fibers compared to slumped sitting on a chair. The decreased lumbar lordosis while sitting on the floor led to the highest increase in pressure on the annulus fiber and nucleus pulposus in the lumbar spine. In conclusion, maintaining an erect sitting position with increased lumbar lordosis during seated activities can effectively reduce intradiscal pressure and cortical bone stress associated with degenerative disc diseases and spinal deformities.

Discharge transitional care programme for older adults after hip fracture surgery: a quasi-experimental study.

Background: Hip fractures require extended periods of recovery and rehabilitation, subjecting older adults to discontinuous care. Discharge transition is a critical point of heightened vulnerability for older adults. Aims: This study aimed to evaluate the effectiveness of a transitional care programme on the physical functions and quality of life (QOL) of older adults after hip fracture surgery. Methods: Seventy-five older adults were assessed from pre-discharge to 6 weeks after hip surgery, and their physical functions, including walking status and activities of daily living, were measured. The QOL was measured using the European Quality of life-5 Dimensions-5 Levels (EQ 5D 5L). Results: There was a significant strong effect of time (B = 10.565; 95% CI = 2.584-18.547; p = 0.009) on the EuroQol Visual Analog Scale (EQ-VAS) for the experimental group. However, there were no significant effects of time on physical functions and EQ-5D-5L scores. Conclusions: The discharge transitional care programme improved the EQ-VAS of older adults following hip fracture surgery 6 weeks post-surgery. However, there were no significant differences in physical functions and EQ-5D between the groups.

Biomechanical Effect of Disc Height on the Components of the Lumbar Column at the Same Axial Load: A Finite-Element Study.

Intervertebral discs are fibrocartilage structures, which play a role in buffering the compression applied to the vertebral bodies evenly while permitting limited movements. According to several previous studies, degenerative changes in the intervertebral disc could be accelerated by factors, such as aging, the female sex, obesity, and smoking. As degenerative change progresses, the disc height could be reduced due to the dehydration of the nucleus pulposus. This study aimed to quantitatively analyze the pressure that each structure of the spine receives according to the change in the disc height and predict the physiological effect of disc height on the spine. We analyzed the biomechanical effect on spinal structures when the disc height was decreased using a finite-element method investigation of the lumbar spine. Using a 3D FE model, the degree and distribution of von-Mises stress according to the disc height change were measured by applying the load of four different motions to the lumbar spine. The height was changed by dividing the anterior and posterior parts of the disc, and analysis was performed in the following four motions: flexion, extension, lateral bending, and axial rotation. Except for a few circumstances, the stress applied to the structure generally increased as the disc height decreased. Such a phenomenon was more pronounced when the direction in which the force was concentrated coincided with the portion where the disc height decreased. This study demonstrated that the degree of stress applied to the spinal structure generally increases as the disc height decreases. The increase in stress was more prominent when the part where the disc height was decreased and the part where the moment was additionally applied coincided. Disc height reduction could accelerate degenerative changes in the spine. Therefore, eliminating the controllable risk factors that cause disc height reduction may be beneficial for spinal health.

Indirect Decompression Using Oblique Lumbar Interbody Fusion Revision Surgery Following Previous Posterior Decompression: Comparison of Clinical and Radiologic Outcomes Between Direct and Indirect Decompression Revision Surgery.

OBJECTIVE: This study compared the radiological and clinical outcomes with transforaminal lumbar interbody fusion (TLIF) to evaluate the effect of indirect decompression through oblique lumbar interbody fusion (OLIF) as revision surgery. METHODS: We enrolled patients who underwent single-level fusion with revision surgery at the same level as the previous decompression level. We retrospectively reviewed 25 patients who underwent OLIF from 2017 to 2018 and 25 who received TLIF from 2014 to 2018. Radiologic and clinical outcomes were evaluated by cross-sectional area (CSA) of the spinal canal, thickness and area of ligamentum flavum (LF), subsidence, disc height, fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS). RESULTS: Compared with OLIF, the thickness and area of the LF after surgery were significantly less in TLIF, and the resulting CSA extension was also significantly higher. However, both groups showed improvement in ODI and VAS after surgery, and there was no difference between the groups. Complications related to the posterior approach in TLIF were 4 cases, and in OLIF, there were 2 cases that underwent additional posterior decompression surgery and 6 cases of transient paresthesia. CONCLUSION: Since complications associated with the posterior approach can be avoided, OLIF is a safer and useful minimally invasive surgery. Therefore, appropriate indications are applied, OLIF is a good alternative to TLIF when revision surgery is considered.

Mechanisms Analysis for Fatal Accident Types Caused by Multiple Processes in the Workplace: Based on Accident Case in South Korea.

This study aimed to develop the accident mechanism of fatal accidents taking place in multiple processes at the workplace. Multiple processes were defined as the existence of multiple work types and work processes in the same workspace. Recently, various processes are frequently conducted simultaneously in one workplace with the participation of several companies, and more workers are increasingly experiencing industrial accidents while working in multiple processes. To prevent accidents in the multiple processes caused by the sameness of work period and space, the accident process was investigated by analyzing the investigation reports on serious industrial accidents in South Korea, and then the accident mechanism model was developed. By utilizing the developed model, the major safety measures to be taken by the contractor for each of the 8 types of accidents caused by the multiple processes were drawn. The roles and responsibilities of the contractor to be implemented in order to prevent accident occurrence in multiple processes were proposed through the accident mechanism of each type of fatal accident. It is expected that the accidents taking place in the multiple processes can be prevented with the drawn results.

Factor Analysis Affecting Degree of Depression in Family Caregivers of Patients with Spinal Cord Injury: A Cross-Sectional Pilot Study.

This study was conducted to determine the degree of depression in family caregivers of spinal-cord-injury patients and to identify factors influencing family caregivers' depression. The final study subjects were 30 (family caregivers: 6 males and 24 females). The CES-D of family caregivers; general characteristics of spinal-cord-injury patients and family caregivers; and information on physical health, household income, leisure, social activity, family relationship, and life-in-general status of family caregiver were collected. A frequency analysis, normality test, Mann-Whitney test, Kruskal-Wallis test, Spearman Correlation analysis, hierarchical regression analysis, and spider network through a path model analysis were performed. As for the general characteristics, when the patient was economically active, the caregiver's depression was mean ± SD; 2.04 ± 0.71; otherwise, it was mean ± SD 2.86 ± 0.74, indicating that the caregiver of the non-economic activity patient was more depressed (p = 0.013). In Model 1 of the multiple regression analysis to understand the effect on the depression of the caregiver, it was confirmed that the depression of the caregiver decreased as the family caregiver had more leisure and social activities (B = -0.718, p = 0.001). In Model 2, it was found that the depression of caregivers increased when the patient did not engage in economic activity (B = 0.438, p = 0.016). In the spider-web form through the path model analysis, as the family's economic level increased, physical health increased by B = 0.755 (p < 0.001), and the increase in physical health (B = 0.424, p = 0.042) was, in turn, a factor in the increase of engagement in leisure and social activities. Various policies will be needed for the successful return to society of spinal-cord-injury patients by ensuring that their leisure and social activities and establishing measures to support their economical income.

Risk factors influencing COVID-19 mortality rate in OECD countries: A cross-sectional study.

SUMMARY: The coronavirus disease (COVID-19) has spread globally; however, the COVID-19 mortality rate varies largely across countries. The purpose of this study was to investigate the factors affecting mortality and increase in mortality rate by time trends in 30 member countries of the Organization for Economic Co-operation and Development (OECD). These countries have different national health and medical characteristics in terms of health care use, health equipment, health resource, health risk, and health status at different time points. The results revealed that the lower 25% of countries had an increase in the mortality rate of 27.21% which was higher than the upper 25% of countries' increase in the mortality rate of 20.51%. Therefore, the affected countries should strengthen their medical infrastructure to prepare for such large-scale outbreaks in the future. It is imperative to reduce the health inequality between population groups and achieve health equity, regardless of the income gap, rather than vaccination of specific countries. This will require the management of non-communicable diseases, a solid health insurance system, a stable supply of medical supplies, and strengthening the competency of health care workers.

Physical Activity and Quality of Life in Adult Men and Women with Distorted Perception of Weight Status: Nationwide Surveys (KNHANES 2016-2018).

This study analyzed the distorted perception of weight in adults aged 20 years or older and investigated the difference in the amount of physical activity and health-related quality of life (HRQOL). This study examined 21,326 adults regarding their body mass index (BMI), subjective body recognition (SBR), physical activity (according to the Global Physical Activity Questionnaire; GPAQ), and HRQOL (EuroQol-5 Dimension; EQ-5D) from the 7th Korea National Health and Nutrition Examination Survey (2016−2018). Independent t-test, analysis of variance (ANOVA), chi-square test, and multiple regression analysis were conducted. The group with the same BMI and SBR significantly showed a long time of activity vigorous-intensity (F = 21.25, p = 0.003) and moderate-intensity time (F = 17.24, p < 0.001). In the 'BMI = SBR' group, the sub-group with normal BMI and normal SBR showed the highest vigorous-intensity (mean ± SD = 7.20 ± 26.05, F = 37.86, p < 0.001) and moderate-intensity (mean ± SD = 13.89 ± 30.18, F = 43.27, p < 0.001) activity times. The sub-group with normal BMI and normal SBR had the highest percentage of responding as normal in the five EQ-5D sub-items. For the score of the EQ-5D Index, the highest score was shown in the group that felt subjectively more obese than the actual BMI (F = 56.83, p < 0.001). In the 'BMI = SBR' group, these factors related to physical activity (vigorous-intensity, moderated-intensity, and walking) are factors influencing health-related quality of life in this regression model (F = 396.57, p < 0.001, R2 = 0.165). Various health promotion programs and policy recommendations to reduce the distorted perception of weight are required.

Analysis of the physiological load on lumbar vertebrae in patients with osteoporosis: a finite-element study.

This study aims to investigate the difference in physiological loading on the spine in three different motions (flexion-extension, lateral bending, and axial rotation) between osteoporotic and normal spines, using finite element modelling. A three-dimensional finite element (FE) model centered on the lumbar spine was constructed. We applied two different material properties of osteoporotic and normal spines. For the FE analysis, three loading conditions (flexion-extension, lateral bending, and axial rotation) were applied. The von Mises stress was higher on the nucleus pulposus at all vertebral levels in all movements, in the osteoporosis group than in the normal group. On the annulus fibrosus, the von Mises stress increased at the level of L3-L4, L4-L5, and L5-S in the flexion-extension group and at L4-L5 and L5-S levels in the lateral bending group. The values of two motions, flexion-extension and lateral bending, increased in the L4 and L5 cortical bones. In axial rotation, the von Mises stress increased at the level of L5 of cortical bone. Additionally, the von Mises stress increased in the lower endplate of L5-S and L4-L5 in all movements, especially lateral bending. Even in the group with no increase, there was a part that received increased von Mises stress locally for each element in the three-dimensional reconstructed view of the pressure distribution in color. The von Mises stress on the lumbar region in the three loading conditions, was greater in most components of osteoporotic vertebrae than in normal vertebrae and the value was highest in the nucleus pulposus. Considering the increase in the measured von Mises stress and the local increase in the pressure distribution, we believe that these results can contribute to explaining discogenic pain and degeneration.

COMPARISON OF SURGEON MUSCULAR PROPERTIES BETWEEN STANDARD OPERATING MICROSCOPE AND DIGITALLY ASSISTED VITREORETINAL SURGERY SYSTEMS.

PURPOSE: To quantitatively analyze surgical ergonomics between standard operating microscope (SOM) and digitally assisted vitreoretinal surgery (DAVS) systems. METHODS: The surgeon conducted procedures on 110 patients; 52 patients underwent a combined phacoemulsification and pars plana vitrectomy (Phaco-PPV group, 24 using SOM and 28 using DAVS), and 58 patients underwent phacoemulsification (Phaco group, 30 using SOM and 28 using DAVS). The surgeon's muscle tone and stiffness in the sternocleidomastoid and the two positions of the upper trapezius (UT), which are 2-cm intervals along the UT muscle fibers, UT1 and UT2, were measured at preoperative, intraoperative, and postoperative time points. RESULTS: In the Phaco-PPV group using the SOM, intraoperative muscle tone and stiffness were higher than preoperative and postoperative values in the sternocleidomastoid ( P < 0.001, respectively), UT1 ( P < 0.001, respectively), and UT2 ( P < 0.001 and P < 0.01, respectively). In the Phaco group using the SOM, intraoperative muscle tone and stiffness were higher than pre- and postoperative values in the sternocleidomastoid ( P < 0.001, respectively) and UT1 ( P < 0.001 and P < 0.01, respectively). By contrast, when the surgeon used the DAVS, there were no differences in muscle properties at any measurement site or during any time point in the Phaco-PPV and Phaco groups ( P > 0.05). CONCLUSION: This study provides quantitative measurement of retina surgeon ergonomics, suggesting that compared with a SOM, the DAVS can reduce intraoperative muscle fatigue.

The Effects of Paraspinal Muscle Volume on Physiological Load on the Lumbar Vertebral Column: A Finite-Element Study.

STUDY DESIGN: Analytical biomechanical study using a finite-element (FE) model. OBJECTIVE: We investigated the effects of paraspinal muscle volume to the physiological loading on the lower lumbar vertebral column using a FE model. SUMMARY OF BACKGROUND DATA: The FE model analysis can measure the physiological load on the lumbar vertebral column. Which changes as the surrounding environment changes. In this study, our FE model consisted of the sacrum, lumbar spine (L3-L5), intervertebral discs, facet joints, and paraspinal muscles. METHODS: Three-dimensional FE models of healthy lumbar spinal units were reconstructed. The physiological loads exerted on the lumbar vertebra column were evaluated by applying different paraspinal muscle volumes (without muscles, 50%, 80%, and 100% of healthy muscle volume). RESULTS: As the paraspinal muscle volume increased, the loads exerted on the vertebral column decreased. The mean load on the intervertebral disc was 1.42 ±â€Š0.75 MPa in the model without muscle, 1.393 ±â€Š0.73 MPa in the 50% muscle volume model, 1.367 ±â€Š0.71 MPa in the 80% muscle volume model, and 1.362 ±â€Š0.71 MPa in the 100% muscle volume model. The mean loads exerted on the posterior column of lumbar spine were 11.79 ±â€Š4.70 MPa in the model without muscles, 11.57 ±â€Š4.57 MPa in the model with 50% muscle volume, and 11.13 ±â€Š4.51 MPa in the model with 80% muscle volume, and 10.92 ±â€Š4.33 MPa in the model with 100% muscle volume. The mean pressure on the vertebral body in the model without paraspinal muscle, and with 50%, 80%, and 100% paraspinal muscle volume were 14.02 ±â€Š2.82, 13.82 ±â€Š2.62, 13.65 ±â€Š2.61, and 13.59 ±â€Š2.51 MPa, respectively. CONCLUSION: Using FEM, we observed that the paraspinal muscle volume decreases pressure exerted on the lumbar vertebral column. Based on these results, we believe that exercising to increase paraspinal muscle volume would be helpful for spinal pain management and preventing lumbar spine degeneration.Level of Evidence: N/A.

Does polydeoxyribonucleotide has an effect on patients with tendon or ligament pain?: A PRISMA-compliant meta-analysis.

BACKGROUND: Pain in the tendons or ligaments is extremely common, accounting for 30% of the causes of visiting general practitioners. Polydeoxyribonucleotide (PDRN) is emerging as a new treatment for musculoskeletal pain. However, the effects of PDRN in patients with tendon or ligament pain are unclear. Therefore, this study aimed to determine the impact of PDRN in patients with tendon or ligament pain through a meta-analysis. METHODS: Electronic literature search of PubMed, Embase, SCOPUS, and Cochrane Library databases of all articles on PDRN treatment for patients with tendon or ligament pain published in the English language from inception until January 31, 2020. The search identified 262 citations. RESULTS: One randomized controlled trial and 3 retrospective observational studies were included. Pain due to tendon or ligament disorders showed significant improvement after PDRN injection (standardized mean difference [SMD] = -1.43, 95% confidence interval [CI] = -1.80 to -1.06, P < .00001). In the subanalysis of patients with rotator cuff tendinopathy, rotator cuff tendinopathy-induced pain significantly improved (SMD = -2.34, 95% CI = -3.61 to -1.07, P = .0003) after PDRN injection. However, there was no difference in shoulder pain and disability index score and strength of shoulder abduction in patients with rotator cuff tendinopathy (shoulder pain and disability index score, SMD = 1.16, 95% CI = -1.20 to 3.52, P = .34; strength of shoulder abduction, SMD = 0.42, 95% CI = -0.03 to 0.88, P = .07). CONCLUSION: Effective pain relief was achieved in patients with tendon or ligament disorders after PDRN injection. To more precisely determine this effect, a meta-analysis with a larger number of clinical trials is warranted.

Step-by-step inpatient rehabilitation for critical illness after coronavirus disease 2019: A CARE-compliant case report.

INTRODUCTION: Since the coronavirus disease (COVID-19) outbreak in Wuhan, China, in December 2019, COVID-19 has become a worldwide pandemic. Muscle weakness and deconditioning caused by COVID-19-induced critical illness requires rehabilitation. PATIENT CONCERNS: A 74-year-old male patient complained of general weakness after COVID-19, requiring ventilator treatment. DIAGNOSIS: He was confirmed as having COVID-19 using a polymerase chain reaction test. INTERVENTIONS: During admission in the intensive care unit, medical staff wearing level D protective equipment performed the bedside manual range of motion exercise. After a negative COVID-19 test, the patient was transferred to a general ward, where sitting balance training and pulmonary rehabilitation were additionally performed by rehabilitation therapists wearing protective gear. When the patient was able to stand up with support, standing balance training and sit-to-stand training were performed. OUTCOMES: After a month of rehabilitation, the patient could sit alone, but he needed help with standing balance. The Berg Balance Scale score improved from 0 to 4, and the Modified Barthel Index score improved from 8 to 18. He was able to breathe in room air without an oxygen supply. LESSONS: This case report shows an example of how safe and effective rehabilitation can be provided to COVID-19 patients.

The Influencing Factors of Gender Differences on Mental Burdens in Young Physiotherapists and Occupational Therapist.

BACKGROUND: Gender differences in personal discrimination experience, burnout, and job stress among physiotherapists and occupational therapists are considered as associated factors of job loss, poor job quality, high turnover, and economic losses due to the outflow of medical personnel. Thus, the purpose of this study is to analyze the level of burnout, personal discrimination experience, and job stress according to gender differences for young physiotherapists and occupational therapists. Furthermore, we used regression analyses to determine the contribution of gender differences in personal discrimination experience and job stress to self-reported burnout, considering gender and two age groups (younger than 30 years old vs. 30 years old and over). METHODS: A total of 325 professional physiotherapists and occupational therapists were part of this study (n = 325; male n = 131; female n = 194. Age: 20-29 years old, n = 178; ≥30 years old, n = 147). Data were collected using a questionnaire including our three study variables (scales: the Maslach Burnout Inventory (MBI), a modified version of the gender section of the Medical School Graduation Questionnaire from the Association of American Medical Colleges; and the Korean version of the Job Content Questionnaire (JCQ)). Further, data on socio-demographic factors, job-related factors, health-related factors, and subjective job satisfaction were also collected. RESULTS: There were significant positive correlations between job stress and gender differences in personal discrimination experience and job stress and burnout in women 30 years old and over. Personal experience of gender discrimination (ß = 0.179, p = 0.015) and job stress (ß = 0.162, p = 0.028) explained a significant 42.4% of the variance in burnout in the case of younger female participants (20-29 years old). However, this model did not explain a significant amount of the variance in burnout in the case of younger male participants (R2 = 0.156, p = 0.072). Regarding participants aged 30 years and over, our results showed that only job stress (but no personal experience of gender discrimination) was a relevant predictor for both males (ß = 0.471, p < 0.001) and females (ß = 0.373, p = 0.001). CONCLUSION: In this study, female therapists showed higher levels of burnout than male therapists. In particular, personal discrimination experience and job stress significantly contributed to burnout in younger female therapists while job stress was the most relevant predictor variable of burnout for both males (under 30 years old and 30 years old and over) and females in their thirties and beyond. For young female physiotherapists and occupational therapists, safe working environments should be created to reduce work-related mental burdens. It is also necessary to consider policies and regulations that can prevent job stress for therapists and measures that can positively resolve the unavoidable job stress.

Submandibular Push Exercise Using Visual Feedback from a Pressure Sensor in Patients with Swallowing Difficulties: A Pilot Study.

Objectives: We aimed to determine the usefulness and effectiveness of a submandibular push exercise with visual feedback from a pressure sensor in patients with dysphagia through continuous exercise sessions. Methods: Twelve patients with dysphagia of various etiologies were included. A total of five exercise sessions (every 3 or 4 days) over three weeks were conducted. During the submandibular push exercise, patients were instructed to maintain a maximum force for 3 s, repeated for 1 min to measure the number of exercises, the maximum pressure, and the area of the pressure-time graph. We statistically compared the values of each exercise trial. Results: Among the 12 patients, eight completed the exercise sessions. As the number of exercise trials increased, the maximum pressure and the area in the pressure-time graph showed a significant increase compared to the previous attempt (p < 0.05). The maximum pressure and the area of the pressure-time graph improved from the first to the fourth session (p < 0.05). The values were maintained after the fourth session, and there was no significant difference between the fourth and the fifth exercise (p > 0.05). There was no significant difference between successful and non-successful groups, except for the Modified Barthel Index (p < 0.05). Conclusion: Through repetitive exercise training, the submandibular push exercise using visual feedback from a pressure sensor can be applied as an exercise method to strengthen swallowing related muscles, such as the suprahyoid and infrahyoid muscles. However, additional studies including more patients and a long-term study period are warranted to evaluate the effects of the exercise for improvement of dysphagia.

Inversion Table Fall Injury, the Phantom Menace: Three Case Reports on Cervical Spinal Cord Injury.

BACKGROUND: An inversion device, which is used to suspend one's body and perform traction therapy, was introduced as an inversion table under the name of "Geokkuri" in South Korea. Fall injuries while hanging on inversion tables are among the most devastating spine injuries, as the likelihood of severe neurological sequelae such as tetraplegia increases. However, its enormous danger has been overlooked and this devastating injury has become a common clinical entity over time. The limited number of studies reported imply the lack of interest of researchers in these injuries. We reviewed three cases of spinal cord injury sustained on inversion tables in different environments and report the potential danger associated with the use of inversion tables to facilitate a safer exercise environment.

Effectiveness of Intravenous Immunoglobulin for Management of Pain in Patients with Postpolio Syndrome.

Objective: Many patients with postpolio syndrome (PPS) experience pain. In this study, we aimed to review previous studies to investigate the effectiveness of intravenous immunoglobulin (IVIG) for managing pain in patients with PPS. We performed a narrative review. Methods: In PubMed, we searched for the keywords ((Immunoglobulin OR IVIG) AND (poliomyelitis OR poliomyelitis syndrome)). We included articles in which IVIG was infused in patients with PPS and pain severity was measured before and after treatment. Results: In the results, five articles (4 randomized controlled trials and 1 prospective observational study) were included in this review. Four of the studies reported that IVIG had a positive pain-reducing effect in patients with PPS. In addition, 4 studies evaluated the outcomes related to muscle strength and function. Of these studies, 3 showed some improvement in measurements for muscle strength and function. Conclusion: In conclusion, IVIG might be one of the beneficial options for managing pain in PPS. Pain reduction might be responsible for the improvement of muscle strength or function. To confirm the benefits of IVIG in reducing pain, more high-quality studies are required.

Comparison of three different types of exercises for selective contractions of supra- and infrahyoid muscles.

Several exercise methods, such as the Shaker exercise, tongue press exercise, chin tuck against resistance (CTAR) exercise, and submandibular push exercise, have been introduced to strengthen the muscles involved in swallowing. In this study, we compared the effectiveness of the CTAR, submandibular push, and Shaker exercises for the induction of selective supra- and infrahyoid muscle contractions using surface electromyography (EMG). This study is a prospective non-randomized controlled study. Twenty-five healthy subjects and 20 patients experiencing swallowing difficulty were enrolled. During the three different types of exercises, the root mean square (RMS) values of the sternocleidomastoid (SCM), suprahyoid (anterior belly of the digastric and mylohyoid muscles), and infrahyoid (sternothyroid and thyrohyoid muscles) muscles were analyzed using surface EMG. Differences in the activity of swallowing muscles among the three different exercises were analyzed using one-way repeated measured analysis of variance. In terms of both the maximum and mean RMS values of the suprahyoid muscle, the submandibular push exercise showed a larger RMS value than the CTAR and Shaker exercises in healthy subjects (p < 0.05). In terms of both the maximum and mean RMS values of the suprahyoid muscle, the Shaker exercise and submandibular push exercise showed a larger RMS value than the CTAR exercise in patients with swallowing difficulty (p < 0.05). The submandibular push exercise may be effective as a swallowing muscle exercise owing to its superiority in inducing selective contractions of the supra- and infrahyoid muscles. The CTAR and Shaker exercises are also effective in this regard.