Krisna Piravej

Purpose: We developed an innovative telerehabilitation system using a 3D camera with motion sensors that provided real‐time feedback. This study is aimed at evaluating its efficacy in improving balance, gait, and mobility, as well as its feasibility in patients with idiopathic Parkinson′s disease (PD). Materials and Methods: Participants with idiopathic PD self‐selected into either a telerehabilitation (tele) group or a hospital‐based rehabilitation (hospital) group. The tele group received two initial sessions of hospital‐based rehabilitation sessions, followed by 14 telerehabilitation sessions using the innovative system. The hospital group received 16 sessions of hospital‐based rehabilitation. Outcome measures included Berg Balance Scale (BBS) score, Chula Parkinson Mobility Scale (Chula PMS) score, gait speed, and step length. The feasibility of the telerehabilitation system was also assessed. Results: Forty‐six participants were recruited (tele group: n = 23; hospital group: n = 23). Both groups showed statistically significant improvements in the BBS scores (tele: post–pre = 3.50, p < 0.001; hospital: post–pre = 4.35, p < 0.001), with no statistically significant difference between the groups (mean difference: −0.85, p = 0.454). Chula PMS score also improved significantly in both groups (tele: post–pre = 3.45, p < 0.001; hospital: post–pre = 5.70, p < 0.001) without a statistically significant difference between the groups (mean difference: −2.25, p = 0.086). The attendance rate exceeded 90% in both groups. Conclusions: The motion sensor telerehabilitation significantly improved balance and mobility in PD patients with no statistically significant differences between the two groups. Feasibility was high. However, the BBS improvements did not reach the minimal clinically important difference, indicating the need for further investigation. Trial Registration: Thai Clinical Trials Registry identifier: TCTR 20220924001

Physical medicine and rehabilitation blend scientific expertise with compassionate care to enhance quality of life and restore functionality for individuals with complex conditions

Background: Stroke and traumatic intracranial hemorrhage (tICH) are major causes of disability worldwide, with stroke exerting significant negative effects on the brain, potentially elevating tICH risk. In this study, we investigated tICH risk in stroke survivors. Methods and Results: Using relevant data (2017–2019) from Taiwan's National Health Insurance Research Database, we conducted a population‐based retrospective cohort study. Patients were categorized into stroke and nonstroke groups, and tICH risk was compared using a Cox proportional‐hazards model. Among 164 628 patients with stroke, 1004 experienced tICH. Patients with stroke had a higher tICH risk than nonstroke counterparts (adjusted hazard ratio [HR], 3.49 [95% CI, 3.17–3.84]). Subgroup analysis by stroke type revealed higher tICH risk in hemorrhagic stroke survivors compared with ischemic stroke survivors (HR, 5.64 [95% CI, 4.97–6.39] versus 2.87 [95% CI, 2.58–3.18], respectively). Older patients (≥45 years) with stroke had a higher tICH risk compared with their younger counterparts (65 years. Conclusions: Stroke survivors, particularly those with hemorrhagic stroke and those aged ≥45 years, face elevated tICH risk. Interventions targeting the high‐risk period are vital, with fall injuries potentially contributing to tICH incidence.

To investigate the impact on physical performance and walking abilities associated with fall risk and disability in the senior population, we created a telerehabilitation system. This is a multi-site, community setting, pre–post experimental study. We recruited participants from four rural areas in Thailand. All participants received eight weeks of tele-exercise, three sessions per week, via the telerehabilitation system. After the intervention, all participants underwent the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) test, and the six-minute walk test (6MWT) using a wearable sensor system. A total of 123 participants participated in the study and 2 participants dropped out while conducting the study, thus 121 participants were included in the analysis. In comparison to the baseline, we discovered a considerable improvement in the SPPB score (0.65 ± 0.22, p < 0.001), TUG (−1.70 ± 0.86, p < 0.001), and 6MWT (10.23 ± 7.33, p = 0.007). Our study demonstrates the benefits of telerehabilitation on SPPB, TUG, and 6MWT related to disabilities and fall risk. This telerehabilitation technology demonstrated its viability in the community environment and demonstrated its capacity to offer fundamental components of remote rehabilitation services within the healthcare system.

BACKGROUND: Worldwide, chronic low back pain (CLBP) is one of the most common causes of physical and psychological disabilities. The factors that affect low back pain (LBP) between Western and Eastern countries are different. OBJECTIVE: We assessed the factors associated with LBP and their impact in German and Thai CLBP participants. METHODS: This cross-sectional study was conducted in 100 Thai and 100 German CLBP participants. Data were collected before the participants received treatment in the outpatient rehabilitation clinic. We used standardized questionnaires to assess the demographic and socioeconomic data, clinical features of the pain, the impact of pain during daily activities, and psychological consequences. RESULTS: We found a statistically significant difference between the two groups for minimal pain intensity (NRS German = 3.01, Thai = 1.83), and the participants’ acceptable pain intensity (NRS German = 1.97, Thai = 3.88). The German participants had a higher negative impact score in their daily living compared to the Thai participants (German = 23.5, Thai = 10). Also, the German participants suffered more often from depression (CES-D score; German = 17, Thai = 4). However, the average back pain intensity was the same for both groups. CONCLUSION: German CLBP participants had significantly more depressive symptoms and pain-related impairments compared to the Thai participants. On the other hand, there were no differences in maximum and average pain severities.

The aim of the study was to study the combined effects of transcranial direct current stimulation (tDCS) and physical therapy on the walking ability of patients with Parkinson disease (PD). The study used an experimental, double-blinded, randomized controlled trial. After intervention, group 1 (only tDCS) demonstrated a significant increase in gait speed by 0.13 to 0.14 m/sec (17.8%-19.2%) and an increase in step length by 5.9 to 6.1 cm (14.0%-14.5%), whereas group 2 (tDCS and physical therapy) revealed a significant increase in gait speed by 0.10 to 0.13 m/sec (14.9%-19.4%) and step length by 4.5 to 5.4 cm (10.6%-12.8%) and group 3 (sham tDCS and physical therapy) showed a significant increase in gait speed by 0.09 to 0.14 m/sec (13.0%-20.3%) and step length by 3.0 to 5.4 cm (6.8%-12.3%). All these results lasted for at least 8 wks after intervention. Upon comparing the parameters of gait among the three groups at every follow-up visit, no significant difference was observed. Anodal tDCS or physical therapy could be used alone or together as a combination treatment to improve the walking speed of patients with Parkinson disease. The effects lasted for approximately 8 wks. The combination treatment was not superior to the use of tDCS or physical therapy alone.