ASEAN Journal of Rehabilitation Medicine

Efficacy of Transcranial Direct Current Stimulation in the Treatment of Post-Stroke Aphasia: A Randomized Controlled Trial

2023-08-28T17:03:59+07:00

Objectives: To evaluate the efficacy of anodal transcranial direct current stimulation (tDCS) on improving language ability in patients with post-stroke aphasia

Study design: Double-blind randomized controlled trial

Setting: Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital

Subjects: Post-stroke aphasia patients aged 18 years and over, with at least three months from stroke onset

Methods: Forty patients were randomly assigned to intervention and control groups. The intervention group received 2 mA of anodal tDCS over Broca’s area (F5) combined with speech therapy for 20 minutes per session per day on five consecutive days. The control group received sham-tDCS combined with speech therapy in the same protocol as the intervention group. Language skills were evaluated using the Thai Western Aphasia Battery at pre-treatment, post-treatment (after the session of the fifth day of treatment), and 1-month follow-up. The accessor was blinded.

Results: Thirty-two patients completed the assigned sessions. The mean age of the patients was 52.7 (SD=11.4) years. Most of them had an ischemic stroke (71.9%). The mean difference in Thai WAB-AQ scores between the intervention and control groups at post-treatment and 1-month follow-up were -0.05 (95% CI: -4.4, 4.3) and -2.38 (95% CI: -11.7, 6.9), respectively. However, the difference between the two groups did not reach statistical significance at either time point. No serious complication was found.

Conclusions: This study did not show sufficient evidence to support anodal tDCS concurrent speech therapy with additional improvement in language ability beyond those observed in patients undergoing speech therapy alone, among those with post-stroke aphasia.

Efficacy of Rhythmic Auditory Stimulation on Balance in Children with Cerebral Palsy: A Randomized Controlled Trial

2023-09-01T10:06:27+07:00

Objectives: Evaluate efficacy of rhythmic auditory stimulation (RAS) on balance in children with cerebral palsy.

Study design: Randomized controlled trial

Setting: Sri-Sangwan School, Bangkok, Thailand

Subjects: Children with cerebral palsy, GMFCS levels I to III

Methods: Participants were randomly allocated into RAS and control groups. All participants underwent a physical therapy involving exercises and gait training for 3 weeks. RAS group received gait training with RAS. We measured Timed Up and Go-In Children (TUG-IC), Pediatric Balance Scale (PBS), Gross Motor Function Measure (GMFM-66), and gait velocity.

Results: 22 cerebral palsy aged 7-15 years were divided into control and RAS, 11 participants per group. Results revealed improvement of TUG-IC, PBS, and GMFM-66 in both groups. The median (95% CI) difference between before and after training of TUG-IC were 1.51 (-16.35, 21.77) second in control and 0.90 (-29.38, 25.76) second in RAS. The differences in PBS were 1.5 (0.03-3.96) in control and 1 (-3.84, 1.84) in RAS. The change of GMFM-66 was 3.5 (0.38, 5.61) in control and 3 (-3.78, 3.78) in RAS. Whereas gait velocity only increased in control group. RAS showed no statistically significant improvement in TUG-IC, PBS, and GMFM-66. While control group only significantly increased PBS and GMFM-66 (p = 0.047, p = 0.027), no significant difference in TUG-IC or gait velocity. Comparison between RAS and control revealed no significant difference in TUG-IC, PBS, GMFM-66, or gait velocity.

Conclusions: The addition of RAS to physical therapy may not improve efficacy of training beyond effects of physical therapy alone.

Functional Outcome of Patients with Post-acute Traumatic Spinal Cord Injury after a 6-month Home-based Rehabilitation Program and its Related Factors

2023-07-12T09:04:18+07:00

Objectives: The study aimed to evaluate the effectiveness of home-based rehabilitation programs on the functional outcomes of patients with traumatic spinal cord injuries in the post-acute phase and analyze factors associated with improved functional outcomes.

Study design: Prospective cohort study

Setting: Phatthalung Hospital, Thailand.

Subjects: Patients with traumatic spinal cord injuries had a home-based rehabilitation program and 6-month follow-up at a rehabilitation outpatient clinic from April 2022 to January 2023.

Methods: The demographic and medical information was retrieved from the medical record. The Spinal Cord Independence Measure version III was used to evaluate patients’ functional outcomes at the program’s start and the end of the 6-month follow-up period. The Thai-HADs questionnaire was assessed at the 6-month follow-up period. The chi-square and Fisher’s exact tests were used to evaluate the factors related to improved functional outcomes.

Results: A total of 76 patients participated in this study, with 76.3% of patients being men and mean (SD) age of 47.49 (14.85) years. The SCIM scores of 63.16% of patients increased throughout the follow-up period. Age, body mass index, neurological level of injury, level of paralysis, complications related to spinal cord injuries, frequency of encounter with therapists, frequency of self-exercise, and depressive symptoms were statistically significant factors associated with improved functional outcomes.

Conclusions: Home-based rehabilitation has benefits for patients with traumatic spinal cord injuries. Many factors are associated with improved functional outcomes. Healthcare workers and community support can help patients reach the highest level of independence and better reintegrate into their families and communities.

An Observational Longitudinal Study Investigating the Effectiveness of Adjustable Splint on Individuals with Hallux Valgus

2023-09-12T09:47:30+07:00

Objectives: To explore the effectiveness of an adjustable splint to decrease hallux valgus angle and pain at the first metatarso-phalangeal joint. In addition, to discover complications and parti-cipants’ satisfaction

Study design: Prospective cohort analytical study design

Setting: Foot Clinic, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand

Subjects: Thirty-eight patients with hallux valgus deformity at moderate to severe degrees (hallux valgus angle 30°- 50°) were recruited from March to May 2021.

Methods: The participants were asked to use an adjustable splint for 6 hours daily for 12 months and continue their current treatment regimen. They were also asked to record the duration of wearing the splint and complications in a logbook every week. Hallux valgus angle measured from radiography and pain numeric rating scale (pain NRS) were evaluated at baseline, 6 months, and 12 months after getting the splint.

Results: Thirty-two participants returned for follow-up at the end of the study. Per protocol and intention to treat, analyses showed a decreased hallux valgus angle and pain at the first metatarso-phalangeal joint with a statistically significant difference (p = 0.001). The satisfaction scores with the adjustable splint were high in every domain. No participant had serious complications. The common complication was splint slip (33.3%).

Conclusions: Wearing an adjustable splint for 12 months in patients with moderate to severe degrees of hallux valgus could decrease hallux valgus angle and pain at the first metatarso-phalangeal joint without serious complications.

Factors Contributing to Cardiac Rehabilitation Uptake among Patients with Coronary Artery Disease in Thailand: A nationwide Cross-sectional Study

2023-09-18T15:46:35+07:00

Objectives: This study aimed to identify factors contributing to cardiac rehabilitation (CR) uptake among patients with coronary artery disease (CAD) in Thailand.

Study design: A descriptive survey study

Setting: Data collection took place at an urban and a rural hospital.

Subjects: Patients were eligible for the study if they had been referred for CR by the medical staff during their in-patient stay.

Methods: Data were collected from June 2018 to July 2019. Patients with CAD attending either the urban or the rural hospital completed the Cardiac Rehabilitation Barriers Scale (CRBS) questionnaire which surveyed barriers to CR uptake.

Results: The mean age of the 138 respondents was 64 years with 68.8% aged 60 or older; 70% were male, and 67.4% were CR attendees. Patients aged 60-69 were found to have the highest uptake of CR. Rural patients with CAD differed from those from urban areas in having a lower level of education (X² (2, n = 67) = 14.58, p = 0.001, phi= 0.466) and lower family income (X² (2, n = 67) = 9.60, p = 0.008, phi = 0.379). Rural patients with fewer years of formal education and those who were farmers were less likely to attend CR. Rural patients reported more barriers to CR than did urban participants. The main barriers to CR uptake for rural patients were distance from and transportation to the clinic.

Conclusions: While the existing CR hospital-based programs in Thailand may be appropriate for urban patients with CAD, they are less useful for patients living in rural areas. Existing CR programs should be modified to include more nuanced approaches to CR suitable for rural patients.

The Clinical Characteristic and Management of Knee Osteoarthritis in the Outpatient Rehabilitation Department at Siriraj Hospital, A Descriptive Study

2023-11-06T11:40:08+07:00

Objectives: To determine the relationship between demographic, clinical characteristics and management of patients with primary knee osteoarthritis

Study design: Retrospective chart review

Setting: Outpatient Rehabilitation Department of Siriraj Hospital

Subjects: 300 patients diagnosed with primary knee osteoarthritis.

Methods: Data was collected from the medical records of patients diagnosed with knee osteoarthritis (OA) knee with ICD-10 codes M17.0, 17.1, or 17.9 at Siriraj Hospital’s Outpatient Rehabilitation Department in 2018, the year before the start of the COVID-19 pandemic.

Results: The study involved 300 patients diagnosed with primary knee OA. The mean age was 69.8 years (SD = 9.6) and 89% were female. The median BMI was 25.3 kg/cm². Most (67%) used civil servant medical coverage. Of the patients, 88.9% had bilateral knee pain and limited walking, and 66.9% of the patients who underwent roentgenographic study of the knees had early radiographic changes (Kellgren and Lawrence (KL) grades 0-1). The hospital records showed topical analgesics was the most commonly prescribed drugs (51.3%), followed by glucosamine sulfate (21.7%) which was associated with significantly milder radiographic changes (p = 0.004). Half the patients received educational information on knee OA and advice on appropriate exercises. Provision of weight reduction advice was associated with patients with higher body mass index (p < 0.001). Hospital-based physiotherapy was prescribed for nearly half the patients (43%). Non-pharmacological prescriptions were not significantly associated with radiographic severity.

Conclusions: The main characteristics of knee osteoarthritis patients in this study included obesity, elderly, female gender, civil servant medical coverage, bilateral knee pain, and mild radio-graphic severity. Weight reduction advice was given more frequently to patients with a higher BMI, and glucosamine sulfate was prescribed more often for patients with mild radiographic severity.

Notes from the Editor-in-Chief

2024-01-08T10:54:27+07:00

Over the past few months, our dedicated team of editors and reviewers has been working tirelessly to curate a collection of articles that provide valuable insights and advancements in various fields. We have maintained the highest standards of quality and integrity in the selection process, ensuring that only the most rigorous and innovative research is included in our journal.

Our commitment to facilitating the dissemination of cutting-edge research is unwavering, and we continue to serve as a bridge between the scientific community and the wider public.

In this issue, the first article, conducted by Charussuriyong P., presents the findings of a randomized controlled trial that assessed the effectiveness of anodal transcranial direct current stimulation in improving language ability in patients with post-stroke aphasia. The study revealed no statistically significant difference between the two groups, both immediately after treatment and at the one-month follow-up.

The second article, conducted by Panompornpanich A. and her team, reports on a randomized controlled trial that evaluated the efficacy of rhythmic auditory stimulation on balance in children with cerebral palsy from Sri-Sangwan School in Bangkok, Thailand. The study concludes that the addition of rhythmic auditory stimulation to physical therapy may not improve the efficacy of training beyond the effects of physical therapy alone.

The third article featured in this issue is a prospective cohort study conducted by Salinpramote B and her colleague. The study aimed to evaluate the effectiveness of home-based rehabilitation programs on the functional outcomes of patients with traumatic spinal cord injuries during the post-acute phase. Additionally, the researchers analyzed factors associated with improved functional outcomes.

Moving on, we have a prospective cohort study by Chadchavalpanichaya N and her colleague. The objective of their study was to explore the effectiveness of an adjustable splint in patients with hallux valgus. The findings revealed that wearing an adjustable splint for 12 months in patients with moderate to severe degrees of hallux valgus resulted in a decrease in hallux valgus angle and alleviation of hallux pain, without any serious complications.

The next manuscript in this issue is conducted by Kotcharoen R and her colleague. Their objective was to identify the factors that contribute to cardiac rehabilitation uptake among patients with coronary artery disease in Thailand. The study concluded that while the existing hospital-based cardiac rehabilitation programs in Thailand are suitable for urban patients with coronary artery disease, they may be less effective for those residing in rural areas. The authors suggested that improvements should be made to the existing programs or the develop-ment of more nuanced approaches specifically tailored for rural patients.

The final manuscript in this issue is conducted by Boonsiripipat P and her colleague. Their study involved a retrospective chart review of a university hospital, aiming to determine the demographic and clinical characteristics of patients with primary knee osteoarthritis. The findings revealed that the main characteristics of knee osteoarthritis patients in this study included obesity, advanced age, female gender, civil servant medical coverage, bilateral knee pain, and mild radiographic severity. Notably, patients with a higher body mass index (BMI) were significantly more likely to receive weight reduction advice.

We hope you find this study insightful and informative. Thank you for your continued support and interest in our journal.