ASEAN Journal of Rehabilitation Medicine

Reversal of Chronic Post-Stroke Genu Recurvatum with Progressive Robotic Gait Training: A Case Report

2025-11-13T08:29:51+07:00

Objectives: Genu recurvatum is a common gait abnormality in ambulatory stroke survivors, often persisting into the chronic phase and causing problems such as knee pain or interfering with balance ability. While robotic gait training has shown benefits in subacute populations, its application in chronic stroke with longstanding knee hyperextension remains underreported. This study aim to report whether a systematically progressive robotic gait training program can reverse longstanding post-stroke genu recurvatum in a chronic stroke survivor

Case Presentation: We report the case of a middle-aged female, two years post-right middle cerebral artery infarction, who presented with persistent left knee hyperextension during the stance phase and fear of falling. She underwent a year-long outpatient-based robotic gait training program using the SensibleSTEP^® end-effector device, followed by Body Weight Supported Treadmill Training (BWSTT). The training was based on the principle of “as much support as necessary, but as little as possible,” with progressive adjustment of gait speed, step length, and body weight support. A speed challenge protocol was introduced after the patient achieved basic stance-phase control. Despite a mid-course setback due to spasticity, managed with a tibial nerve phenol block, the patient progressed to full prevention of knee hyperextension and achieved independent ambulation at low speed without the use of gait aids.

Conclusions: Carefully structured robotic gait training, incorporating progressive speed challenges, may help reverse chronic genu recurvatum even years after stroke. This case suggests that robotics can extend the therapeutic window for gait recovery in individuals with chronic stroke.

Evaluation of Baclofen on Speech Production in Post-Stroke Laryngeal Tension Dysphonia and Spastic Dysarthria: A Case Report

2025-11-19T07:41:28+07:00

Objectives: Communication deficits following stroke are prevalent and often debilitating. While conventional speech rehabilitative strategies by speech-language pathologists remain the mainstay of therapy, pharmacological adjuncts that facilitate oromotor and phonatory function may further enhance recovery. This case report describes the use of oral baclofen as an adjunct to conventional speech therapy in a post-stroke patient with severe dysarthria. It also illustrates how the Frenchay Dysarthria Assessment (FDA) can sensitively capture functional changes beyond standard bedside evaluation.

Case description: A 64-year-old English-speaking male with no significant comorbidities presented with a right middle cerebral artery (MCA) infarct which occurred in the context of cerebral amyloid angiopathy for which he underwent successful thrombectomy. He suffered from severe motor speech impairment, including dysphonia and dysarthria. Nasoendoscopy revealed normal vocal cord structure and movement, suggesting laryngeal tension dysphonia. During the initial 10 days of conventional speech-language therapy without baclofen, there was minimal improvement in his speech production as assessed by the same speech-language pathologist using the Perceptual Dysarthria evaluation. Given the persistent oromotor and laryngeal muscle hypertonicity, oral baclofen was introduced to address suspected spastic contributions to the dysarthria and dysphonia.

Results: Over one month, the patient completed 22 structured speech therapy sessions. Following baclofen initiation, the FDA, administered before and after treatment, demonstrated noticeable improvements in multiple domains: lip seal function, lip spread in speech, jaw function in speech, palatal muscle function in speech, and tongue muscle function in protrusion, lateral movement, and speech. Speech intelligibility also improved.

Conclusions: This case highlights the potential of oral baclofen as an adjunctive agent in modestly improving speech production, articulation clarity, and intelligibility post-stroke, and underscores the clinical utility of the Frenchay Dysarthria Assessment in detecting oromotor improvements. Further studies are needed to determine the reproducibility and efficacy

Notes from the Editor-in-Chief

2026-05-04T09:32:55+07:00

A comparison of the Effectiveness of Acupuncture and Ultrasound Treatment in Patients with Neck Pain from Myofascial Pain of the Upper Trapezius: A Randomized Controlled Trial

2025-11-08T12:29:03+07:00

Objectives: To compare the effectiveness of acupuncture and ultrasound treatment in patients with neck pain from myofascial pain of the upper trapezius

Study design: A randomized controlled trial

Setting: Rayong Hospital, Thailand

participant: Patients with myofascial pain syndrome of the upper trapezius muscle.

Methods: Sixty patients with myofascial pain syndrome of the upper trapezius muscle were enrolled. Thirty patients were randomly assigned to the experimental group which received acupuncture treatment at points GB20, SI11, DU14, SI15, GB21, and EX-HN15, along with electrical stimulation. The acupuncture points were stimulated in pairs: GB20 with EX-HN15 and GB21 with SI11. Continuous wave electrical stimulation was applied at a tolerable current level for 25 minutes. The thirty patients in the control group were treated with ultrasound diathermy using a Sonopuls 190 at a frequency of 1 MHz and an intensity of 0.8-1 watts/sq cm. Treatment duration was 5-10 minutes. Both groups received treatment twice a week for a total of four weeks. The outcome measures were the numeric rating scale (NRS) and the Thai version of the Neck Disability Index (Thai-NDI) scores, assessed before the intervention and at week 4 following treatment.

Results: There were no significant differences in demographic characteristics between the two groups. Following treatment, mean pain scores decreased from 7.13 (SD = 1.36) to 3.43 (SD = 1.72) in the acupuncture group and from 7.17 (SD = 1.42) to 4.50 (SD = 2.30) in the ultrasound therapy group. The between-group difference was statistically significant (p = 0.046). Both groups showed reductions in Thai-NDI mean scores after treatment, from 18.90 (SD = 7.19) to 10.10 (SD = 6.25) and from 21.70 (SD = 6.93) to 12.77 (SD = 6.40) in the experimental and control groups, respectively, with no statistically significant difference observed between the two groups.

Conclusions: Acupuncture treatment demonstrated positive effects as shown by lower post-treatment pain scores (NRS). Therefore, it can be considered an appropriate method for the management of myofascial pain of the upper trapezius muscle.

Survival Analysis of Amyotrophic Lateral Sclerosis: An Ambispective Cohort Study in a Thai Tertiary Care Center

2026-01-21T10:30:07+07:00

Objectives: To determine the median survival time and identify independent prognostic factors for mortality in amyotrophic lateral sclerosis (ALS) patients at a tertiary-care hospital in Thailand.

Study design: Ambispective cohort study

Setting: Outpatient rehabilitation department of a tertiary care hospital in Thailand

participant: Forty-four patients diagnosed with ALS according to the Awaji criteria

Methods: We analyzed clinical data from patients treated between January 2012 and July 2022. Survival time curves were generated using the Kaplan-Meier method. To identify predictors of mortality, a full multivariable Cox proportional hazards model was first constructed, followed by a parsimonious model retaining variables with p < 0.20.

Results: The cohort had a male-to-female ratio of 1.3:1 and a mean age at onset of the study of 56.6 years. The median overall survival time from symptom onset to death was 37.0 months (95%CI: 31.0-44.0). In the final multivariable Cox model (C-index = 0.80), a longer interval from symptom onset to diagnosis was the only statistically significant independent predictor of improved survival time (HR = 0.11, 95%CI: 0.01-0.90, p = 0.04). While the presence of major complications (HR = 3.05, p = 0.06), hypertension (HR = 2.98, p = 0.08), and male sex (HR = 2.24, p = 0.17) showed strong clinical trends toward increased mortality, none reached statistical significance in the refined model. Riluzole use was not associated with a survival benefit in this cohort (HR = 0.77, p = 0.74).

Conclusions: The median survival time of Thai ALS patients was 37 months. The time from symptom onset to diagnosis is a key indicator of survival time, likely reflecting the underlying biological speed of the disease. While complications and comorbidities such as hypertension influence the clinical course, larger multicenter studies are needed to validate these prognostic markers in the Southeast Asian population.

Comparative Analysis of Functional Outcomes in Stroke Patients: First Admission Versus Readmission to Inpatient Rehabilitation

2025-11-07T09:00:52+07:00

Objectives: To explore potential differences in functional outcomes of stroke patients undergoing inpatient rehabilitation between their first admission and readmission to the rehabilitation ward.

Study design: Observational study design: retrospective chart review

Setting: Siriraj Hospital, Bangkok, Thailand. The inpatient ward (25 beds) of the Department of Rehabilitation Medicine, which has a limited admission period of up to 3 weeks.

participant: Stroke patients over 18 years of age who were admitted between January 1, 2015, and December 31, 2020.

Methods: Using matched demographics, a comparison of functional outcomes between the first admission and readmission of stroke patients were conducted. Functional outcomes were evaluated based on changes in the Modified Barthel Index (MBI), rehabilitation efficiency (average increase in MBI scores per day), and rehabilitation effectiveness (potential improvement) comparing patients after their first admission and those following readmission.

Results: The demographic characteristics of patients at their first admission and readmitted patients showed no significant differences in age, sex, underlying disease, stroke classification, hemineglect, aphasia, dysphagia, motor power of the upper extremities, onset-to-admission interval, length of stay, or admission MBI score (p > 0.05). Functional outcomes were calculated and are presented as follows: The median of MBI changes were 2 (1, 5) for the first admission and 2 (1, 4) at readmission, with r = 0.09, p = 0.19; rehabilitation efficiency was 11 (6, 27) for the first admission and 10 (3, 18) at readmission, with r = 0.14, p = 0.05; and rehabilitation effectiveness was 25 (9, 50) for the first admission and 20 (5, 37) at readmission, with r = 0.12, p = 0.10.

Conclusions: The improvement in functional outcomes of stroke patients upon readmission to the rehabilitation ward showed no statistically significant difference compared to the improvement during their first admission when the length of stay was limited to 3 weeks. This suggests that in hospitals with a short length of stay, readmitting patients for further rehabilitation may be warranted. However, the results may not generalize to settings with a longer average length of stay. A study investigating the prognostic factors for functional outcome improvement in readmitted stroke patients is warranted.

The Second International Spinal Cord Injury (InSCI) Community Survey in Thailand: Overview of Bio-Psycho-Social Perspectives of Individuals with Spinal Cord Injury

2025-12-24T08:29:06+07:00

Objectives: To describe the health status, socioeconomic cha-racteristics, and spinal cord injury (SCI) profiles of individuals with SCI living in the community in Thailand

Study design: Descriptive cross-sectional study

Setting: Fourteen hospitals across Thailand

Participant: Thai individuals with SCI living in the community who had previously received rehabilitation at participating hospitals and who met the inclusion criteria were invited to participate in the second International Spinal Cord Injury (InSCI) community survey in Thailand.

Methods: Participants completed the Thai-translated version of the second InSCI questionnaire. After data cleaning, bio-psycho-social aspects were analyzed descriptively.

Results: A total of 693 respondents were included. Most participants were male (74.9%), paraplegic (65.4%), and had incomplete lesions (65.4%), with traumatic causes (79.2%). The median age at the time of the survey was 49 years (IQR: 38-62), and the median duration of SCI was 8 years (IQR: 5-14). Nearly half were married or cohabiting (46.9%), 64.1% needed assistance, and 55.7% lived in urban areas. Over half (51.4%) had completed secondary education, while 64.5% reported a household income below 17,200 baht per month. Most respondents were covered by the Thai universal health coverage scheme (68.4%), and 51.1% were satisfied with their general health. The three most prevalent secondary health conditions were spasticity (77.5%), pain (71.1%), and bowel problems (70.4%). The percentage of receiving treatment was lowest for sexual problems (12.8%).

Conclusions: The majority of Thais with SCI in the community had traumatic, incomplete paraplegics, experienced multiple secondary health conditions, reported low socioeconomic status, needed assistance, and only half were satisfied with their overall health