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The Effects of Dynamic Functional Electrical Stimulation With Treadmill Gait Training on Functional Ability, Balance Confidence and Gait in Chronic Stroke Patients

  • Cho, Young-Ki;Ahn, Jun-Su;Park, Yong-Wan;Do, Jung-Wha;Lee, Nam-Hyun;Kwon, Oh-Yun
    • Physical Therapy Korea
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    • v.21 no.4
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    • pp.23-33
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    • 2014
  • The aim of this study was to evaluate the effects of walking on a treadmill while using dynamic functional electrical stimulation (Dynamic FES) on functional ability and gait in chronic stroke patients. This was a prospective, randomized controlled study. Twelve patients with chronic stroke (>24 months) who were under grade 3 in dorsiflexor strength with manual muscle test were included and randomized into intervention (Dynamic FES) ($n_1$=7) and control (FES) ($n_2$=5). Both the Dynamic FES group and FES group were given a neuromuscular development treatment. The Dynamic FES group has implemented a total of 60 minutes of exercise treatment and gait training with Dynamic FES application. The FES group, with the addition of applying FES while sitting, has also implemented a total of 90 minutes of gait training on treadmill after the exercise treatment. Both two groups accomplished the program, twice a week, for a total of 24 times in a 12-week period. Exercise treatment, gait training on treadmill, and both Dynamic FES and FES were implemented for 30 minutes each. Korean version activities-specific balance confidence scale (K-ABC) was measured to determine self-efficacy in balance function. Timed up and go (TUG) test was performed to evaluate the physical performance. K-ABC, TUG, Berg balance scale (BBS), modified physical performance test (mPPT) and G-walk were evaluated at baseline and at 12 weeks. After 12 weeks, statistically significant differences (p<.05) were apparent in the Dynamic FES group in the changes in K-ABC and BBS. mPPT, TUG, gait speed, stride length and stance phase duration (%) were compared with the FES group. K-ABC had higher correlation to BBS, along with mPPT to TUG. Our results suggest that walking with Dynamic FES in chronic stroke patients may be beneficial for improving their balance confidence, functional ability and gait.

Measuring Quality of Life in Cerebral Palsy Children According to the Severity Using the Visual Analogue Scale, Time Trade-Off, and EQ-5D-Y Proxy (뇌성마비 환아 중증도별 시각화척도, 시간교환법, EQ-5D-Y Proxy를 이용한 삶의 질 측정)

  • Lee, Go-Eun;Kim, Nam Kwen;Yun, Young Ju;Wang, Hye Min;Kim, Jeong Hun;Lee, Dong Hyo
    • Journal of Oriental Neuropsychiatry
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    • v.28 no.2
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    • pp.49-59
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    • 2017
  • Objectives: To measure the quality of life in patients according to virtual cerebral palsy severity by using the Korean version of EQ-5D-Y proxy, Visual Analogue Scale (VAS), and Time Trade-Off method (TTO). Methods: The study was conducted in parents of children and adolescents aged 4 to 15 years in Seoul. We analyzed the difference in the utility value according to five levels of cerebral palsy severity in the Gross Motor Function Classification System (GMFCS) and test-retest reliability. Results: 1. There were significant differences in VAS, TTO, and EQ-5D-Y proxy according to the cerebral palsy severity (p<.001). 2. VAS was significantly different according to the respondent's visit to the medical institution, the presence of disease in the respondent, a visit to the child's medical institution, the age of the child, and the sex of the child. The value of TTO was significantly different according to the respondent's visit to the medical institution, respondent's sex, and the age of the child. Also, EQ-5D-Y proxy was significantly different according to the age of the child. 3. Intraclass correlation coefficient values were more than 0.6 for both VAS and TTO at all stages. But for the EQ-5D-Y proxy, the value was less than 0.6 at all stages. Conclusions: The quality of life assessment using EQ-5D-Y proxy showed significant differences in the severity of cerebral palsy. However, large-scale studies using EQ-5D-Y proxy are needed because of low test-retest reliability.

IRS-2 Partially Compensates for the Insulin Signal Defects in IRS-1-/- Mice Mediated by miR-33

  • Tang, Chen-Yi;Man, Xiao-Fei;Guo, Yue;Tang, Hao-Neng;Tang, Jun;Zhou, Ci-La;Tan, Shu-Wen;Wang, Min;Zhou, Hou-De
    • Molecules and Cells
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    • v.40 no.2
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    • pp.123-132
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    • 2017
  • Insulin signaling is coordinated by insulin receptor substrates (IRSs). Many insulin responses, especially for blood glucose metabolism, are mediated primarily through Irs-1 and Irs-2. Irs-1 knockout mice show growth retardation and insulin signaling defects, which can be compensated by other IRSs in vivo; however, the underlying mechanism is not clear. Here, we presented an Irs-1 truncated mutated mouse ($Irs-1^{-/-}$) with growth retardation and subcutaneous adipocyte atrophy. $Irs-1^{-/-}$ mice exhibited mild insulin resistance, as demonstrated by the insulin tolerance test. Phosphatidylinositol 3-kinase (PI3K) activity and phosphorylated Protein Kinase B (PKB/AKT) expression were elevated in liver, skeletal muscle, and subcutaneous adipocytes in Irs-1 deficiency. In addition, the expression of IRS-2 and its phosphorylated version were clearly elevated in liver and skeletal muscle. With miRNA microarray analysis, we found miR-33 was down-regulated in bone marrow stromal cells (BMSCs) of $Irs-1^{-/-}$ mice, while its target gene Irs-2 was up-regulated in vitro studies. In addition, miR-33 was down-regulated in the presence of Irs-1 and which was up-regulated in fasting status. What's more, miR-33 restored its expression in re-feeding status. Meanwhile, miR-33 levels decreased and Irs-2 levels increased in liver, skeletal muscle, and subcutaneous adipocytes of $Irs-1^{-/-}$ mice. In primary cultured liver cells transfected with an miR-33 inhibitor, the expression of IRS-2, PI3K, and phosphorylated-AKT (p-AKT) increased while the opposite results were observed in the presence of an miR-33 mimic. Therefore, decreased miR-33 levels can up-regulate IRS-2 expression, which appears to compensate for the defects of the insulin signaling pathway in Irs-1 deficient mice.

Effects of an Abdominal Obesity Management Program on Physiological Bio-markers of Middle-aged Women in Korea: A Meta-analysis (국내 중년기 비만 여성의 생리적 지표에 대한 복부비만관리프로그램의 효과: 메타분석)

  • Kim, KyengJin;Hong, HaeSook;Park, WanJu;Ko, SangJin;Na, YeonKyung
    • Journal of Obesity & Metabolic Syndrome
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    • v.25 no.3
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    • pp.138-148
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    • 2016
  • Background: The purpose of this study is to analyze the effects of an abdominal obesity management program in middle-aged women in Korea. Methods: Examination of databases, including the Research Information Sharing Service, Database Periodical Information Academic, and Korean Studies Information, resulted in identification of 772 studies performed up to 2014, of which 43 satisfied the inclusion data. Data analysis was performed using R version 3.2 to calculate the effect sizes, explore possible causes of heterogeneity, and check for publication bias, using a funnel plot and its trim-and-fill analysis. Results: The mean effect size of the management program was small (g=0.22), along with the anthropometric index (g=0.18), metabolism index (g=0.21), fat-distribution (g=0.36), and inflammatory index (g=0.36). Moderator analysis was performed to determine heterogeneity, but no significant differences were found between the randomized controlled trial (RCT) group and non-RCT group. In addition, the length of the session was found to be statistically significant after performing a meta-regression. Finally, a funnel plot with a trim-and-fill analysis was produced to check for publication bias, but no significant bias was detected. Conclusion: Based on these findings, the abdominal obesity management program affects middle-aged women in Korea. Further research is needed to target other age groups with abdominal obesity.

Analysis of the Necessity of Medical Records Related to Radiological Examination (방사선검사의 의무기록에 관한 요구도 분석)

  • Hong, Dong-Hee;Lim, Cheong-Hwan;Lim, Woo-Taek;Joo, Young-Cheol;Jung, Hong-Ryang;Kim, Eun-Hye;Yoon, Yong-Su;Jung, Young-Jin;Choi, Ji-Won;Jeong, Sung-Hun;Park, Myeong-Hwan;Yang, Oh-Nam;Jeong, Bong-Jae
    • Journal of radiological science and technology
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    • v.44 no.5
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    • pp.513-523
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    • 2021
  • The purpose of this study was to discuss the required items and feasibility of medical records of radiological examinations performed by radiological technologists at medical institutions. An online survey was conducted to a total of 10,000 radiation-related workers, of which 1,026 (10.3%) responded. As a research method, self-made questionnaires were used. The online survey was conducted from September 10 to September 20, 2021 for the survey period. For response data, a Chi-square test was performed according to demographic characteristics using SPSS 27.0 version (IBM Inc., Chicago, Ill, USA), and it was judged to be significant when the P value was less than 0.05. The reliability of the questionnaire response was found to be Chronbach α=0.933. More than 90% of the medical records related to radiological examinations are necessary, and they answered that a curriculum, remuneration curriculum, and legal system for medical records should be prepared. More than 90% of the respondents agreed with the proposal of the Radiological Technologist Independent Act for legal preparation, and most of the information required for medical records is currently recorded in DICOM images. According to the demographic characteristics, the medical record requirement for radiological examination, curriculum, continuing education, and legislation were found to be higher with higher education and higher with longer working experience. In addition, most of the radiology departments showed a high demand for medical records, so most of them responded positively to the medical records requirements for radiological examinations. This study analyzed the medical record requirements for radiological examinations, and as shown in the results, medical record requirements for radiological examinations was found that most radiological technologists felt need for the new law and supported it. In addition, if the information recorded in the DICOM image is used, it is considered that medical records could be easily prepared without additional work by the radiological technologists.

Evaluating the Effectiveness of Chuna Manual Therapy for low back pain in the Pilot Insuring Project of the National Health Insurance (건강보험 시범사업 기관에 내원한 요통환자에 대한 추나요법 유효성 평가 연구)

  • Ryu, Jiseon;Kim, Dongsu;Shin, Byung-Cheul;Lim, Byungmook
    • Journal of Society of Preventive Korean Medicine
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    • v.22 no.3
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    • pp.1-10
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    • 2018
  • Backgrounds : In 2017, National Health Insurance implemented the pilot insuring project for Chuna manual therapy(CMT). 65 Korean Medicine(KM) hospitals and clinics were selected in the project to monitor the provision of insured CMT. Objectives : This study aimed to evaluate the effectiveness of CMT for low back pain provided in the real world setting. Methods : Patients with low back pain who agreed to participated in the study were enrolled and requested to complete questionnaires. Patients who received CMT regardless of receiving other KM therapies were classified to Chuna group, and patient who received KM therapies without CMT to KM group. Pain(pain-VAS) and back function(KODI, Oswestry disability index-Korean version), quality of life were assessed at baseline, 4 weeks, and 8 weeks. Additionally, patients who received CMT twice and more, and who's pain-VAS 20 and over were included, and patients who used pain injection were excluded in the analysis. Results : Of 371 patients who completed all questionnaire (mean age=42.6years, SD=12.45; 61% female), 96 were excluded, 170 were in Chuna group, and 105 were in KM group. Proportions of patients who had low back pain for more than twelve weeks in the Chuna group and KM group were 57.7% and 24.8%, respectively. Pain and back function were significantly improved on 4weeks and 8weeks in both groups, but there was no difference between two groups. For the patients in the sub-acute and chronic stage(>=12 weeks), change of total KODI scores in the Chuna group was higher than KM group(p=0.013) at 4weeks. Conclusions : CMT with other KM therapies can improve back function in the sub-acute and chronic patients. For insurance policy decision, economic evaluation of CMT is needed.

Survey on the Relationship between the Number of Medical Technologists and the Medical Test Count (검사건수에 따른 임상병리사의 인원편성에 관한 설문조사 분석)

  • Kim, Junghyun;Kim, Dae-Eun;Yoon, Joong-Soo;Lee, Jeong Soo;Park, Tae-Wha
    • Korean Journal of Clinical Laboratory Science
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    • v.51 no.1
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    • pp.93-104
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    • 2019
  • This study examined the relationship between the number of medical technologists and the medical test count. Data was obtained from 441 medical technologists in a hospital through a self-reported questionnaire. The Pearson correlation test, student's t-test, ANOVA or descriptive statistics were performed for data analysis. The distribution of medical technologist according to the size of hospitals was small 5.8, medium 14.9, large 25.8, and super 45.4. The analysis demonstrated a relationship between the number of medical technologists and the number of medical tests in the field, number of clinical tests per MT, and number of optimal medical test per MT according to the hospital size (P<0.001). The average time for quality control by the department at a higher hospital was less than two hours. In terms of the satisfaction of salary, work environment, test accomplishment, and welfare service, the dissatisfaction of medical technologists in small and medium hospitals was higher than those in large and super hospitals. Overall, a focus on intensifying systemic supplementation and improving the condition of medical technologists is needed to provide reliable data for medical examinations in medical areas.

Comparison of Personal Characteristic Factors Relating to Quality of Life in Patients with End-Stage Renal Disease

  • Sittisongkram, Soontaree;Sarakwan, Jamras;Poysungnoen, Phakatip;Meepaen, Malee
    • Asian Journal for Public Opinion Research
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    • v.7 no.2
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    • pp.94-112
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    • 2019
  • Objective: The objective of this study was to compare the quality of life (QOL) of patients with end-stage renal disease (ESRD) between patients receiving hemodialysis (HD) and patients receiving continuous ambulatory peritoneal dialysis (CAPD) and to compare personal characteristic factors relating to the quality of life in patients with ESRD. Method: This study used a descriptive research design. The sample was recruited using purposive sampling that included 76 ESRD patients receiving either HD or CAPD at a dialysis clinic in Phraphutthabat Hospital, Saraburi Province, Thailand. Data was collected using the Quality of Life Questionnaire for Chronic Kidney Disease ($KDQOL-SF^{TM}$) version 1.3. Independent t-test and ANOVA procedures were used to analyze study data. Results: The results revealed that the HD patients had a moderate level of QOL. The highest scoring dimension of QOL was the encouragement of staff at the dialysis unit and patient satisfaction with the treatment (${\bar{X}}=100$, SD=.00), followed by social support (${\bar{X}}=89.29$, SD =16.88) and cognitive function (${\bar{X}}=88.57$, SD=11.82). On the other hand, the lowest scoring QOL dimension was physical problems (${\bar{X}}=50$, SD=51.89), and pain (${\bar{X}}=50$, SD=39.03), followed by work status (${\bar{X}}=53.57$, SD=45.84) and burden from kidney disease (${\bar{X}}=58.48$, SD=31.07). The CAPD patients also had a moderate QOL. The highest scoring QOL dimension was the encouragement of staff in the renal unit and patient satisfaction with the treatment (${\bar{X}}=100$, SD=.00), followed by social support (${\bar{X}}=95.61$, SD=14.20) and cognitive function (${\bar{X}}=88.83$, SD=13.52). The worst scoring QOL dimensions were work status (${\bar{X}}=44.44$, SD=42.72), general health (${\bar{X}}=53.61$, SD=39.05), and pain (${\bar{X}}=62.70$, SD=41.14). The difference overall and in each dimension of QOL in ESRD patients who were treated with HD and CAPD was not statistically significantly different. The QOL was not significantly different among patients with different personal characteristics except for income and duration of treatment; in those cases, the difference in QOL was statistically significant (p=.05). Conclusion: The overall QOL and life expectancy of patients with ESRD treated with HD and CAPD are not affected by gender, age, marital status, education, occupation, or type of health coverage. QOL was not significantly different, except for patients with different incomes and duration of renal replacement therapy, whose QOL was significantly different. The QOL of patients receiving dialysis should be studied to develop a QOL program for patients with chronic kidney disease who receive dialysis.

Neuroimaging Findings of First-Visit Headache Patients (두통 초진 환자에서 신경영상검사 소견)

  • Kim, Byung-Su;Kim, Soo-Kyoung;Kim, Jae-Moon;Moon, Heui-Soo;Park, Kwang-Yeol;Park, Jeong Wook;Sohn, Jong-Hee;Song, Tae-Jin;Chu, Min Kyung;Cha, Myoung-Jin;Kim, Byung-Kun;Cho, Soo-Jin
    • Journal of the Korean neurological association
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    • v.36 no.4
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    • pp.294-301
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    • 2018
  • Background: Neuroimaging can play a crucial role in discovering potential abnormalities to cause secondary headache. There has been a progress in the fields of headache diagnosis and neuroimaging in the past two decades. We sought to investigate neuroimaging findings according to headache disorders, age, sex, and imaging modalities in first-visit headache patients. Methods: We used data of consecutive first-visit headache patients from 9 university and 2 general referral hospitals. The International Classification of Headache Disorders, third edition, beta version was used in headache diagnosis. We finally enrolled 1,080 patients undertook neuroimaging in this study. Results: Among 1,080 patients (mean age: $47.7{\pm}14.3$, female: 60.8%), proportions of headache diagnosis were as follows: primary headaches, n=926 (85.7%); secondary headaches, n=110 (10.2%); and cranial neuropathies and other headaches, n=43 (4.1%). Of them, 591 patients (54.7%) received magnetic resonance imaging (MRI). Neuroimaging abnormalities were found in 232 patients (21.5%), and their proportions were higher in older age groups and male sex. Chronic cerebral ischemia was the most common finding (n=88, 8.1%), whereas 76 patients (7.0%) were found to have clinically significant abnormalities such as primary brain tumor, cancer metastasis, and headache-relevant cerebrovascular disease. Patients underwent MRI were four times more likely to have neuroimaging abnormalities than those underwent computed tomography (33.3% vs. 7.2%, p<0.001). Conclusions: In this study, the findings of neuroimaging differed according to headache disorders, age, sex, and imaging modalities. MRI can be a preferable neuroimaging modality to identify potential causes of headache.

Convergence Effects of Proprioceptive Neuromuscular Facilitation on Dynamic Balance in Chronic Stroke : A Meta-Analysis (고유수용성신경근촉진법이 만성 뇌졸중 환자의 동적 균형에 미치는 융복합적 효과: 메타분석)

  • Park, Se-Ju;Lee, So-In;Jung, Ho-Jin
    • Journal of the Korea Convergence Society
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    • v.12 no.4
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    • pp.275-284
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    • 2021
  • The study attempted to systematically and comprehensively analyze individual studies in which proprioceptive neuromuscular facilitation (PNF) was performed with chronic stroke patients. Selection criteria included type of participants (stroke patients), intervention (PNF), comparison (intervention group or non-intervention group), outcomes (effect on dynamic balance), and study design (randomized controlled trial). We searched seven literature databases, and selected 17 papers that met our selection criteria. For meta-analysis, effect size of each individual study was extracted using the R project for Statistical computing version 4.0.3. Rob 2.0 tool, developed by the Cochrane group, was used to evaluate the quality of each individual study. The overall effect size PNF with dynamic balance was 0.59 (95% CI=0.41-1.77), which was significantly different than the median effect size (p<0.05). The sub-group for dynamic balance was analyzed, for effect sizes of BBS (0.50), TUG (0.78), and FRT (0.51). Thus, PNF intervention has a positive impact on improve of dynamic balance by chronic stroke patients.