Contribution of the multifidus muscle for control of upright posture in subjects with spina bifida occulta.

CONTEXT: The multifidus muscle plays a role in controlling lumbosacral position and postural sway. One of its attachment sites is the exact site of spina bifida occulta (SBO). OBJECTIVE: To investigate the role of the muscle for postural control in SBO. DESIGN: Cross-sectional cohort. PARTICIPANTS: Eighty subjects with SBO (38 in minor; 42 in major) and controls. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Subjects stood upright on a platform at 0 degrees and on an inclined surface (10 degrees and 20 degrees) with feet in plantarflexion/dorsiflexion, together with eyes open and closed. The platform system measured posture to obtain sway area and sway mean for statistics. RESULTS: Upon sway area/mean, the group differences of major/minor SBO vs. control were all significant. Sway means of minor SBO were lower than those of major SBO at corresponding inclined degrees. CONCLUSIONS: Subjects with SBO demonstrated increased sway as compared to controls.

Efficacy of near-infrared irradiation on intractable hiccup in custom-set acupoints: evidence-based analysis of treatment outcome and associated factors.

OBJECTIVE: The condition intractable hiccup (IH) is generally an incapacitating disorder indicating neurologic or non-neurologic disorders. Linearly polarized, near-infrared irradiation (SL) is shown to be effective in the treatment of IH where it is applied on custom-set acupoints. The aim of this study was to investigate the treatment efficacy of IH by SL on the acupoints and to survey the relationship between IH and comorbid-related factors. MATERIAL AND METHODS. A total of 35 patients with IH were enrolled prospectively and divided into central and non-central groups. All patients received SL using an SG-type lens unit on the relevant acupoints and were followed-up for up to 6 months for efficacy of the novel therapy. RESULTS: There was no significant difference between patients with IH produced by central or non-central origins (p=0.7105) regarding the therapeutic effect of SL; however, the effects of age, bed-shaking, gun-waving motion and nasogastric (NG)-tube placement were significant. The severity index of IH was analyzed and found to be associated with the seasons. For those patients with elevated levels of aspartate aminotransferase (ASAT) after therapy, it took a significantly shorter (p=0.0029) period of time to treat IH with this novel therapy (p=0.0029). Thirty-four patients had complete resolution of IH within a few days of beginning SL, with partial resolution in 1 patient only. CONCLUSIONS: Without potential side effects, SL on custom-set acupoints could be a complementary therapy for patients with IH regardless of central or non-central origins.

First-ever Ischemic Stroke after a Flight in a Patient with Prior Poliomyelitis.

Survivors of poliomyelitis sometimes travel by air with mobility assistance. However, prolonged seating during long-haul flights may also possibly produce stroke events on polio-inflicted patients. A 48-year-old polio-inflicted male suffered a stroke after an extended flight. A two-dimensional echocardiography was normal without detected patent foramen ovale or dyskinetic segment. The venodynamic variables were all within normal limits. MR Imaging studies revealed acute cerebral infarction in the distribution of the right middle cerebral artery and posterior watershed area. Hematological examination revealed positive anti-cardiolipin IgG antibody which might contribute to the risk of thrombosis as an underlying condition in addition to immobilization. This is the first presentation of ischemic stroke after a flight in a patient with prior poliomyelitis. In addition to decompression sickness, economy class stroke syndrome and postpoliomyelitis syndrome, the physician should also take other coagulation disorders into consideration during the investigation.

Resolution of intractable hiccups after near-infrared irradiation of relevant acupoints.

BACKGROUND: Intractable hiccups are occasionally encountered in the presence of stroke but are usually difficult to manage. METHODS: We describe two stroke patients with intractable hiccups that were refractory to pharmacological treatment but were well resolved by application to relevant acupoints with the modality linear polarized near-infrared ray equipment on PC 6 (Nei Guan), ST 36 (Zu San Li), and DU 9 (Chih Yang), which are the empirical acupoints aimed at regulating gastrointestinal mobility and function of the thoracic organ. RESULTS: The first patient who received the treatment for only one time came out with a dramatic termination of intractable hiccups 3 hours later and with no recurrence thereafter. We applied the same treatment on the second patient once a day for 8 consecutive days, which led to progressive amelioration of intractable hiccups. CONCLUSIONS: This is the first report about the complete resolution of intractable hiccups due to stroke using near-infrared irradiation to acupoints, rather than using conventional pharmacologic therapy, traditional acupuncture, or moxibustion. Consequently, these findings suggest that linear polarized near-infrared ray irradiation, with its noninvasive properties, might be an alternative treatment for intractable hiccups after stroke.

Isokinetic muscle strength of the trunk and bilateral knees in young subjects with lumbar disc herniation.

STUDY DESIGN: Cross-sectional study comparing normal subjects and patients with lumbar disc herniation. OBJECTIVE: To evaluate trunk and knee muscle strength in patients with L4-L5 and/or L5-S1 disc herniation. SUMMARY OF BACKGROUND DATA: Numerous studies have shown that patients with low back pain have weaker trunk muscles. The strength of trunk and knee muscles has not been investigated simultaneously in patients with lumbar disc herniation. METHODS: Forty-one controls and 2 patients were included. Isokinetic strength of the trunk and bilateral knees was tested on a calibrated isokinetic testing machine (Biodex System 3 Pro) regardless of the laterality of the radiculopathy. The testing was carrying out at two different velocities: 60 degrees and 120 degrees per second. RESULTS: Total trunk strength and knee strength were significantly lower in these patients (4.34 +/- 1.06 and 4.06 +/- 1.16 vs. 6.21 +/- 1.05 and 5.83 +/- 1.09 Nm/kg at 60 degrees and 120 degrees per second, respectively, P < 0.001). In patients with unilateral sciatica, there was no significant difference (P > 0.05) in unilateral knee strength between sciatica-involved and -uninvolved limbs (1.89 +/- 0.5, 1.08 +/- 0.45, 1.48 +/- 0.58, 0.93 +/- 0.41 vs. 1.68 +/- 0.45, 0.91 +/- 0.38, 1.41 +/- 0.48, 0.79 +/- 0.39 Nm/kg in sciatica-uninvolved vs. sciatica-involved limbs during extension and flexion at 60 degrees and 120 degrees per second, respectively). Total trunk strength was significantly correlated with total knee strength in both groups. CONCLUSIONS: In the patients with lumbar disc herniation, muscle strength of the trunk and knees was decreased to a similar extent. Weaker knee strength was found on either side of the lower extremity in the patients with unilateral sciatica, regardless of its location.