Post-stroke spasticity is a common complication that limits the functional performance of patients. Botulinum toxin (BTx) is an effective treatment for spasticity. Numerous researchers have applied extracorporeal shock wave therapy (ESWT) to address post-stroke spasticity, yielding positive clinical outcomes. We aimed to clarify the add-on effects of ESWT on BTx therapy for spasticity in patients with post-stroke. Sixteen eligible patients with upper extremity spasticity after stroke were recruited for this study. They were randomized to either a BTx with focused ESWT treatment group or a BTx alone group. Spasticity, measured using the modified Ashworth score (MAS) and modified Tardieu scale (MTS), showed statistically significant improvements in the elbow and wrist flexor muscles in both BTx + ESWT group and BTx alone groups. However, no significant differences were observed between the two groups with time flow. The BTx + ESWT group showed significantly decreased MAS of the finger flexors at follow-up and increased R1 (MTS) of the finger flexors at 3 weeks after treatment, which was not observed in the BTx alone group. This is the first study to identify the add-on effect of ESWT on BTx injections to improve post-stroke upper limb spasticity.

Polydeoxyribonucleotide (PDRN) is safe and effective in wound healing, cellular growth, synthesis of extracellular matrix protein, and inflammation reduction via activation of adenosine A2 receptors. We report a 28-year-old male patient treated with PDRN injections for chronic non-healing wound refractory to negative pressure wound therapy, skin graft, or growth factors. Three injections of PDRN were administered at the wound site into the anterior and medial sides of the left stump on the 1st, 4th, and 9th days of hospitalization. The PDRN ameliorated wound healing by enhancing cell growth, tissue repair, and angiogenesis. PDRN application represents a potential treatment for non-healing wounds obviating the need for additional therapies, and hospitalization, as well as improve patient's activities of daily living.

The purpose of this study was to clarify the association between improvement of spasticity in hemiplegic patient’s upper extremity with Botulinum toxin injection and improvement in postural balance and gait function. For this prospective cohort study, sixteen hemiplegic stroke patients with upper extremity spasticity were recruited. The plantar pressure with gait parameters, postural balance parameters, Modified Ashworth Scale, and Modified Tardieu Scale were evaluated before, 3 weeks and 3 months after Botulinum toxin A (BTxA) injection. Spasticity of hemiplegic upper extremity before, and after BTxA injection were significantly changed. Plantar pressure overload in affected side was reduced after BTxA injection. The mean X-speed and the horizontal distance decreased in postural balance analysis with eyes-opened test. Improvement in hemiplegic upper extremity spasticity showed positive correlation with gait parameters. In addition, improvement in hemiplegic upper extremity spasticity was positively correlated with change in balance parameters in postural balance analysis with eyes-closed and dynamic tests. This study focused on the effect of stroke patient’s hemiplegic upper extremity spasticity on their gait and balance parameters and identified that the BTxA injection on hemiplegic patient’s spastic upper extremity improve postural balance and gait function.

Objective To evaluate the gait pattern of patients with gait disturbances without consideration of defilades due to assistive devices. This study focuses on gait analysis using the inertial measurement unit (IMU) system, which can also be used to determine the most appropriate assistive device for patients with gait disturbances.Methods Records of 18 disabled patients who visited the Department of Rehabilitation from May 2018 to June 2018 were selected. Patients’ gait patterns were analyzed using the IMU system with different assistive devices to determine the most appropriate device depending on the patient’s condition. Evaluation was performed using two or more devices, and the appropriate device was selected by comparing the 14 parameters of gait evaluation. The device showing measurements nearer or the nearest to the normative value was selected for rehabilitation.Results The result of the gait evaluation in all 18 patients was analyzed using the IMU system. According to the records, the patients were evaluated using various assistive devices without consideration of defilades. Moreover, this gait analysis was effective in determining the most appropriate device for each patient. Increased gait cycle time and swing phase and decreased stance phase were observed in devices requiring significant assistance.Conclusion The IMU-based gait analysis system is beneficial in evaluating gait in clinical fields. Specifically, it is useful in evaluating patients with gait disturbances who require assistive devices. Furthermore, it allows the establishment of an evidence-based decision for the most appropriate assistive walking devices for patients with gait disturbances.

Park G, et al. Ann Rehabil Med. 2017 Oct;41(5):887-891. https://doi.org/10.5535/arm.2017.41.5.887

Background and Objectives: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy. Ultrasonography is a widely used diagnostic method for CTS, and the median-to-ulnar nerve cross-sectional area ratio (MUR) is a well-known parameter. However, the ulnar nerve may be affected by various conditions of the median nerve; therefore, we considered finding further parameters. The aim of the study is to identify the correlation between the median nerve-to-ulnar artery cross-sectional area ratio (MUAR) and existing ultrasonographic parameters used as diagnostic indicators of CTS. Materials and Methods: Sixty-seven wrists from forty-two patients who were diagnosed with CTS by electrodiagnostic studies within 4 years before enrollment were retrospectively analyzed in this study. The median nerve cross-sectional area (CSA), ulnar nerve CSA, and ulnar artery CSA at full dilation were measured. In addition to well-defined CTS ultrasonographic parameters, the MUAR were calculated. All measurements were gathered at three levels. The reproducibility was evaluated through intraclass correlation coefficients (ICCs) and Bland–Altman plots. Results: The MUAR at the carpal tunnel inlet showed a strong positive correlation with the MUR at the same level (ρ = 0.738, p < 0.05) and the median nerve wrist forearm ratio (ρ = 0.541, p < 0.05). In addition, the MUAR at the carpal tunnel outlet presented a strong positive correlation with MUR at the carpal tunnel inlet (ρ = 0.528, p < 0.05). The MUAR at 12 cm proximal to the distal wrist crease showed a strong positive correlation with the MUR at the corresponding level (ρ = 0.613, p < 0.05). Intra-rater and inter-rater reliability showed a high degree of agreement (ICCs > 0.90). Conclusions: This study demonstrates correlations between known CTS parameters and MUAR and suggests the possibility of MUAR as a reliable CTS diagnostic tool. Further research is recommended to validate these findings.