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The South Korean media boasts of its leading success–during the escalation of the coronavirus outbreak–in flattening of the curve thereby mitigating the grave outcomes of the public health crisis. ...

This study aimed to investigate the effectiveness of a 3D-modeling-based customized off-loading cushion to prevent pressure ulcers in people with spinal cord injury (SCI) using wheelchairs. The study included five people with SCI who use the traditionally manufactured customized off-loading cushions. As part of the test, each subject sat on three types of pressure-relief cushions, and the pressure between the seating surface and cushion was measured for 60[Formula: see text]min. The average measured pressure values were compared, and the change in pressure with time was analyzed to verify the clinical effect. The results showed that the CAD/CAM-based customized off-loading cushion exhibited a better decrease in pressure and pressure distribution effect on the ischial tuberosity and coccyx than the adjustable air cushion but did not differ much from the traditionally manufactured customized off-loading cushion. The clinical and economic effectiveness of the customized off-loading cushion based on the computer-aided design and manufacturing (CAD/CAM) technology was analyzed and tested on people with SCI. An occupational therapist evaluating the client followed by designing the customized off-loading strategy has no difference in terms of clinical effect compared to the traditional manufacturing method. However, time, effort, and cost should be considered when choosing an intervention strategy.

The objective of this research study was to investigate the effect of patient-centered robot-assisted intervention for upper limb function improvement in stroke patients. Design: A double-blind randomized controlled trial. Intervention: Subjectively preferred areas of need for performing daily activities were identified by pre-interviewing and applied as target goals in the experimental group using a robotic device. Control-1 underwent a program focused on the robot system involving movements of upper limb joints. Control-2 participated in a conventional rehabilitation program. Methods: Forty-five participants engaged in 60 min of daily therapy, five times weekly for 3 weeks. The experimental group used the Canadian occupational performance measure (COPM) to identify subjectively preferred “patient-centered” focus needed areas to perform robotic device aided daily activities. Control-1 used a robot device-focused rehabilitation involving upper limb joint movements. Control-2 participated in conventional rehabilitation. Pre-post intervention measurements of hand, grip, power, and upper limb ROM were acquired by FMA-UE, MFT, and K-MBI. Results: A significant increase of function in the experimental group was observed in each subclass of function and activities of daily living (ADL) performance. Control-1 showed an increase in function without ADL improvement. Control-2 showed an increase in ADL and proximal areas of upper limb function without an increase in other areas. Conclusion: The “patient-centered” approach significantly improved upper limb function and ADL performance compared to “robot-centered” rehabilitation. Further studies are warranted to confirm these results and for generalizability in clinical application.

Introduction: Telemedicine across many specialties in clinical practice has been established in the literature regarding technology platforms, privacy issues, cost, and clinical effectiveness. Howe...

Background:The mobile screening test system for screening mild cognitive impairment (mSTS-MCI) was developed for clinical use. However, the clinical usefulness of mSTS-MCI to detect elderly with MCI from those who are cognitively healthy has yet to be validated. Moreover, the comparability between this system and traditional screening tests for MCI has not been evaluated.Objective:The purpose of this study was to examine the validity and reliability of the mSTS-MCI and confirm the cut-off scores to detect MCI.Method:The data were collected from 107 healthy elderly people and 74 elderly people with MCI. Concurrent validity was examined using the Korean version of Montreal Cognitive Assessment (MoCA-K) as a gold standard test, and test–retest reliability was investigated using 30 of the study participants at four-week intervals. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were confirmed through Receiver Operating Characteristic (ROC) analysis, and the cut-off scores for elderly people with MCI were identified.Results:Concurrent validity showed statistically significant correlations between the mSTS-MCI and MoCA-K and test–rests reliability indicated high correlation. As a result of screening predictability, the mSTS-MCI had a higher NPV than the MoCA-K.Conclusions:The mSTS-MCI was identified as a system with a high degree of validity and reliability. In addition, the mSTS-MCI showed high screening predictability, indicating it can be used in the clinical field as a screening test system for mild cognitive impairment.

Studies on to what extent the combined therapy of modified constraint-induced movement therapy and mental practice is more effective than modified constraint-induced movement therapy alone are lacking. This study aims to compare the effects of the combined therapy with modified constraint-induced movement therapy alone on corticospinal excitability, quality of the movement of the affected upper extremity, upper motor functions, and performance of the affected arm in daily life of hemiplegic stroke patients.The participants comprised 14 people who had suffered stroke and were randomly divided into two groups. All participants participated in modified constraint-induced movement therapy, while only the experimental group partook in additional mental practice. Both groups were tested for corticospinal excitability, quality of movement, hand function, and activities of daily living.Both groups showed significant improvement in the movement quality of reaching and performance of activities of daily living. In the experimental group, functional improvement of the upper limb was also observed. The improvements in corticospinal excitability, upper extremity function, and performance in daily activities were significantly greater in the experimental group compared to the control group.This study confirmed that the combined therapy produces more effective improvement in corticospinal excitability, upper limb function, and performance in daily activities. The combined therapy of mental practice and modified constraint-induced movement therapy could be used as a clinically useful intervention. Implications for rehabilitation Modified constraint-induced movement therapy could be used as an intervention method for people with stroke to make improvements in the quality of movement and performance in activities of daily livings with the affected side. With additional mental practice, upper extremity functions improve, and changes in neurological, functional and performance in daily lives are greater compared to modified constraint-induced movement therapy without mental practice. Impact of mental practice has on rehabilitation should not be underestimated.

The fatigue spreads among the people who live under stressful life and brings about a negative impact on physical function. Here we evaluated the anti-fatigue effects of fermented porcine placenta (FPP) and main constituents, lysine (Lys) and leucine (Leu) with treadmill stress test and forced swimming test (FST) in animal models. The mice were administrated with FPP, Lys, and Leu for 21 days. After treadmill exercise, FPP, Lys, and Leu significantly reduced fatigue-related biochemical parameters, including lactate, lactate dehydrogenase, glucose, creatine kinase, urea nitrogen, cortisol, and pro-inflammatory cytokines, whereas superoxide dismutase activity and glycogen levels were significantly increased by FPP, Lys, and Leu. In the FST, FPP, Lys, and Leu significantly decreased immobility times and up-regulated brain-derived neurotrophic factor expression in brain. Furthermore, FPP, Lys, and Leu significantly decreased production of tumor necrosis factor-α, interleukin (IL)-6, IL-1β, and IL-4 through blockade of caspase-1/nuclear factor-κB pathway in stimulated splenocytes. In addition, FPP, Lys, and Leu significantly promoted proliferation of splenocytes. In conclusion, these findings suggest the potential of FPP as a novel functional food for the regulation of fatigue.

Background: Fatigue is one of the major health conditions induced by excessive stress or abnormal immune function or defective antioxidant systems. Placental extract has been reported to have various effects such as immune modulation and cellular regeneration. Fermented porcine placenta (FPP) is a safe nontoxic material, which is highly valuable as a functional food. The aim of this study was to investigate the anti-fatigue effects of FPP supplementation compared with a placebo product. Methods: In this double-blind, parallel, randomized, and placebo-controlled trial 84 healthy males and females, aged between 30 and 60 years were randomized to 320 mg of FPP once daily or placebo. The main outcome measures included efficacy of fatigue-inducing treadmill exercise on physical fatigue and fatigue-related parameters based on the questionnaire administered. Results: The IL-1&beta, mRNA expression and fatigue severity scale were changed significantly after 8 weeks of treatment with fermented porcine placenta compared with placebo (p &lt, 0.05). Cortisol levels were significantly improved in participants younger than 45 years following treatment with FPP compared with placebo. Furthermore, the lactate and myoglobin levels were improved significantly in participants with BMI &ge, 23 kg/m2 (p = 0.045 and p = 0.011, respectively) following treatment with FPP versus placebo. Conclusions: Our study showed that FPP supplementation significantly ameliorated fatigue-related parameters and subjective symptoms in healthy adults. Therefore, our results indicate that FPP supplementation induced anti-fatigue effect by regulating the inflammatory response.

People with Spinal cord injuries are having difficulty in health care, and complications cause physical, social and economic losses. In severe cases, complications lead to death and require systematic management. In this study, ICT-based health care service was developed to manage the respiratory function and urinary function of the people with spinal cord injuries and to help adapt to daily living activities and social participation through home visit occupational therapy. A pilot study was conducted with five clients with spinal cord injuries to investigate the effectiveness of the intervention services. As a result, it was confirmed that satisfaction, importance, and difficulty were appropriate. In the future, RCT clinical studies will be needed to diversify intervention services and expand the number of patients.

In the Republic of Korea, 90.5% of those living with spinal cord injury (SCI) are faced with medical complications that require chronic care. Some of the more common ones include urinary tract infections, pressure sores, and pain symptomatology. These and other morbidities have been recognized to deteriorate the individual&rsquo, s health, eventually restricting their community participation. Telerehabilitation, using information and communication technology, has propelled a modern-day movement in providing comprehensive medical services to patients who have difficulty in mobilizing themselves to medical care facilities. This study aims to verify the effectiveness of health care and management in the SCI population by providing ICT-based health care services. We visited eight individuals living with chronic SCI in the community, and provided ICT-based health management services. After using respiratory and urinary care devices with the provision of home visit occupational therapy, data acquisition was achieved and subsequently entered into a smart device. The entered information was readily accessible to the necessary clinicians and researchers. The clients were notified if there were any concerning results from the acquired data. Subsequently, they were advised to follow up with their providers for any immediate medical care requirements. Digital hand-bike ergometers and specialized seating system cushions are currently in development. The ICT-based health care management service for individuals with SCI resulted in a favorable expected level of outcome. Based on the results of this study, we have proposed and are now in preparation for a randomized clinical trial.

Background It is necessary to analyze the kinematic properties of a paralyzed extremity to quantitatively determine the degree of impairment of hemiplegic people during functional activities of daily living (ADL) such as a drinking task. This study aimed to identify the kinematic differences between 16 hemiplegic and 32 able-bodied participants in relation to the task phases when drinking with a cup and the kinematic strategy used during motion with respect to the gravity direction. Methods The subjects performed a drinking task that was divided into five phases according to Murphy's phase definition: reaching, forward transport, drinking, backward transport, and returning. We found that the groups differed in terms of the movement times and the joint angles and angular velocities of the shoulder, elbow, and wrist joints. Findings Compared to the control group, the hemiplegic participants had a larger shoulder abduction angle of at most 17.1° during all the phases, a larger shoulder flexion angle of 7.6° during the reaching phase, and a smaller shoulder flexion angle of 6.4° during the backward transporting phase. Because of these shoulder joint patterns, a smaller elbow pronation peak angle of at most 13.1° and a larger wrist extension peak angle of 12.0° were found in the motions of the hemiplegic participants, as compensation to complete the drinking task. The movement in the gravity direction during the backward transporting phase resulted in a 15.9% larger peak angular velocity for elbow extension in the hemiplegic participants compared to that of the control group. Interpretation These quantitative kinematic patterns help provide an understanding of the movements of an affected extremity and can be useful in designing rehabilitation robots to assist hemiplegic people with ADL.

Objective To investigate the effects of a 6-week indoor hand-bike exercise program on fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels and physical fitness in people with spinal cord injury (SCI). Design Randomized controlled trial. Setting National rehabilitation center (outpatient). Participants Participants with SCI (N=15; exercise group: n=8, control group: n=7). Interventions This study involved 60-minute exercise sessions on an indoor hand-bike. Participants in the exercise group exercised 3 times per week for 6 weeks. Main Outcome Measures Health parameters (body mass index [BMI], waist circumference, percent body fat, insulin level, and HOMA-IR level) and fitness outcomes (peak oxygen consumption [Vo 2 peak], shoulder abduction and adduction, shoulder flexion and extension, and elbow flexion and extension). Results Participation in a 6-week exercise program using an indoor hand-bike significantly decreased BMI (baseline: 22.0±3.7m/kg 2 vs postintervention: 21.7±3.5m/kg 2 , P =.028), fasting insulin (baseline: 5.4±2.9μU/mL vs postintervention: 3.4±1.5μU/mL, P =.036), and HOMA-IR (baseline: 1.0±0.6 vs postintervention: 0.6±0.3, P =.03) levels compared with those in the control group. Furthermore, this training program significantly increased Vo 2 peak and strength in shoulder abduction, adduction, flexion, and extension and elbow flexion and extension compared with those in the control group. Conclusions Exercise using an indoor hand-bike appears to be an effective modality to improve body composition, fasting insulin, and HOMA-IR levels and fitness in people with an SCI.

The function of lower-extremity rehabilitation robotics usually includes standing up movements. These standing up movements can cause spasticity in people with disabilities of the lower extremities. In this paper, we review the spasticity and the methods of existing systems for handling the spasticity of people with physical disabilities. We observe and detect the spasticity via the EMG signals of the lower extremities of a subject with paraplegia. Through this process, we are able to suggest ways to deal with risk factors, such as spasticity, when using rehabilitation robots.

To assess multiple facets of awareness, understanding, value, needs, and desirability to resolve issues regarding unmet medical needs of individuals with a disability by adopting telerehabilitation. The survey included collection and analysis of current services as well as of supplementary and future services of rehabilitative interventions in South Korea.Thirty-six health professionals who were members of the Korean Academy of Rehabilitation Medicine and 57 individuals with spinal cord injury responded to a survey of those belonging to two non-profit professional groups, one group belonging to the Korean Spinal Cord Injury Association and joining the National Spinal Cord Injury Wheelchair Games and the other group belonging to the Jeong-Sang-Hye (High Quad Spinal Cord Injury Association) and having joined one of the focus groups of the Korea National Rehabilitation Research Institute. The two surveys were designed specifically for investigating each group's perspectives of awareness, understanding, value, needs, and desirability of telerehabilitation.The survey responses indicated that there is great interest in the possibility of telerehabilitative services among individuals with spinal cord injury. In particular, there was a strong interest expressed in services that can be used to resolve issues on unmet medical needs of individuals with a disability related to health monitoring, sustaining health, rehabilitation interventions, and independence of activities of daily living.Telerehabilitation holds great promise as a bridge to traditional face-to-face clinical service delivery. From the results, there are a few categories in the survey that indicate notable differences between the two groups regarding the awareness, desirability, order of preference in rehabilitation service, and telerehabilitation expenses.

Analyzing activities of daily living (ADL) for the development of practical upper limb rehabilitation robots is challenging in stroke patients. Basic ADL tasks using an upper limb are defined based on clinical assessment tools. The motions of 8 healthy participants and 8 stroke patients were recorded during defined ADL tasks, and then analyzed with respect to completion time, linearity of motion, and range of motion of the joints. Completion time and motion trajectories were significantly different between stroke subjects and healthy participants. For tasks involving the transfer of an object from a table to the user's mouth, wrist radial-ulnar deviation motions should be taken into account while designing robots for gross movements via elbow and shoulder joints. Our findings can be extended to the design of trajectories of rehabilitation robots as well as of simplified robots.

A novel lower-extremity robotic exercise system with weight bearing and locomotion abilities has been developed for the severely disabled. The purpose of this study was to investigate the needs of users and clinical experts when using this robotic exercise system. The system consists of an exoskeleton, weight-bearing system, interface, and system platform. The results of this research are based on the opinions of focus groups and clinical experts who were interviewed after applying the robotic system. Comfort, safety, and natural appearance while wearing the system were considered. User feedback, received from the initial design and development of our system, has contributed to the implementation of our rehabilitation robot.