Abstract No.

: 588
TRANSCRANIAL DIRECT CURRENT STIMULATION IMPROVES TACTILE
DISCRIMINATION IN STROKE PATIENTS
Background:
Transcranial direct current stimulation (tDCS) is a non-invasive technique that can
modulate
human cortical excitability(Nitsche and Paulus, Journal of Physiology 527:633-639,
2000).
TDCS of the motor cortex can enhance motor performance after stroke, whereas
reported
effects on sensory performance after stroke are sparse. We recently reported that dualhemisphere tDCS over the primary somatosensory cortex (S1) can enhance tactile
performance in healthy subjects (Fujimoto et al., Clinical Neurophysiology 125:16691674,
2014).
Purpose:
The purpose of this study was to investigate whether dual-hemisphere tDCS over the
somatosensory cortex could enhance a tactile discriminative performance in stroke
patients
with sensory dysfunction.
Methods:
This study employed a double-blind, crossover and sham-controlled experimental design.
Eleven patients with chronic subcortical stroke (mean age, 62.5years; six of them males;
mean time after stroke, 54.5 months) participated in this study. All participants have
upperlimb sensory dysfunction. Tactile discriminative threshold of the impaired index finger was
measured using a grating orientation task before, during, and 10 min after four tDCS
conditions. In the grating orientation task, participants answered whether the orientation
of
the grating placed onto the palmar side of the impaired index finger was parallel or
orthogonal (Van Boven and Johnson, Neurology 44:2361-2366, 1994). For S1 condition,
an
anodal electrode was placed over S1 in the lesion hemisphere, while the cathodal was
positioned over S1 in the opposite hemisphere. For the secondary somatosensory cortex
(S2)
condition, an anodal electrode was applied over S2 in the lesion hemisphere, while the
cathodal was positioned over S1 in the opposite hemisphere. For both S1 and S2
conditions,
tDCS at an intensity of 2mA was applied for 15 min using the DC Stimulator Plus
(NeuroConn,
Ilmenau, Germany). For two sham conditions, the positions of the electrodes and the
current
intensity were similar for the S1 and S2 conditions, while the current was only delivered
for
an initial 15 s. We localized the S1 and S2 regions based on individual T1 MRI image and
a
frameless stereotaxic navigation system (Brain Sight 2; Rogue Research Inc., Montreal,
Canada). The threshold of each intervention and each time point was subjected to a twoway
repeated measure of analysis of variance. Post-hoc test was performed with a paired ttest
adjusted with Bonferroni method. The level of significance was defined as p < 0.05.
Results:
The tactile discriminative thresholds during and at 10 min after S1 and S2 conditions
were
significantly lower compared to each sham condition. The thresholds between S1 and S2

conditions were not significantly different at any time points.

1 / 48

WCPT Congress 2015 1-4 May 2015

Conclusion(s):
Dual-hemisphere tDCS over S1 and S2 can transiently enhance a tactile discriminative
performance in chronic sub cortical stroke patients with sensory dysfunction.
Implications:
The present data suggest that dual-hemisphere tDCS over S1 and S2 may be useful to
improve impaired sensory functions in stroke patients.
Key-Words:
brain stimulation; neurorehabilitation; sensory function
Funding acknowledgements:
This work was supported by grants from the Grants-in-Aid
for Scientific Research (KAKENHI 24680061) to Satoshi Tanaka.
Ethics approval:
The local ethics committee of Tokyo Bay Rehabilitation Hospital
2 / 48

WCPT Congress 2015 1-4 May 2015

Abstract No.
: 772
PHONOPHORESIS OF FISH OIL IMPROVES TENDON HEALING IN A RAT MODEL
Background:
Phonophoresis is a common treatment modality of physical therapy. Fish oil has been
shown
to promote connective tissue healing by suppression of inflammation, promoting collagen
synthesis and relieving pain. No study has investigated the effects of phonophoresis of
fish oil
on tendon healing.
Purpose:
The aims of the present study was to investigate the effect of ultrasound phonophoresis
of
fish oil, and compare that with the normal therapeutic ultrasound and topical fish oil on
healing of Achilles tendon rupture.
Methods:
Hemitenotomy of right medial Achilles tendon was performed in 44 Sprague-Dawley rats.
Daily treatment of either topical placebo ointment (control group, CON), topical fish oil
(fish
oil group, FO), therapeutic ultrasound (US) or ultrasound phonophoresis of fish oil (FU)
was
applied to the rats. The treatment started one day after surgery over a four-week period.
On
day 28, the rats were sacrificed and their Achilles tendons were tested for load-relaxation,
stiffness and ultimate tensile strength (UTS). The results were normalized against the
body
weight of the rats.
Results:
FU was superior to other groups as significant improvement was observed in all
outcomes ie.
load-relaxation, stiffness and UTS (p< 0.05). There was also significantly higher UTS in
FO
and US than CON (p< 0.05). FO demonstrated significantly higher stiffness than CON
(p<
0.05).
Conclusion(s):
Preliminary results revealed that ultrasound, fish oil ointment and therapeutic ultrasound
treatment, either applied separately or in combination, would improve the biomechanical
properties of repairing rat Achilles tendons at 4 weeks post injury. The combination of fish
oil

and ultrasound was superior to the either treatment alone.

Implications:
Fish oil is a natural and safe compound with beneficial effects towards connective tissues
healing, it may be considered as a potential treatment supplement for management of
tendon rupture.
Key-Words:
fish oil; Achilles tendon rupture; phonophoresis
3 / 48

WCPT Congress 2015 1-4 May 2015

Funding acknowledgements:
No external funding support for this research
Ethics approval:
Animal Ethics Review Committee of The Hong Kong Polytechnic University
4 / 48

WCPT Congress 2015 1-4 May 2015

Abstract No.
: 1003
DO COMMUNITY BASED ACTIVITY DAYS BENEFIT CHILDHOOD CANCER
PATIENTS?
Background:
Long term survival after childhood cancer is approaching ~80%. Survivors have an
increased
risk of future health problems, suboptimal physical activity and reduced QOL. Previous
studies have reviewed hospital based interventions aimed at improving physical
functioning
and assessed their impact on QOL. Sheffield Children's Hospital (SCH) has developed a
successful community based activity day, Do It For You (DIFY) for children and young
people
(CYP) with cancer. We provide a wide range of Community based sporting and
recreational
activities for our service users and their families to participate in over the course of the
day
with the hope that they will continue to particpate in community activities in the future.
Purpose:
The main objective of this study is to assess whether an annual community based activity
day, attended by CYP with cancer and their families, organised by members of the
healthcare
team, increases levels of physical activity in those attending.
The secondary objectives are to determine whether;
1. Increased physical activity is sustained over a one year period?
2. Physical activity levels vary between CYP currently undergoing cancer treatment and
those
who have completed treatment?
Methods:
Single centre (SCH), longitudinal pilot study assessing activity levels of school aged CYP
with
cancer, before (T=0) and 3 months after (T=1) a community based intervention, (DIFY).
Questionnaires were adapted from the Godin Leisure-Time Exercise Questionnaire.
Questionnaires were completed by parents and or the child dependent on age. Ethics
approval and informed consent was obtained.
Results:
68 patients were recruited to the study, with a mean age of 9.8 years (range 4-18). 41/68
(60%) were male. Diagnoses were varied and representive of the population. 50/68
(74%)
had completed treatment. 54% reported significant ongoing health problems at T=0.
A 68% response rate was obtained at T=1. An increase in total self-reported exercise was
seen at T=1 (48.9) compared to baseline (42.8). This did not reach statistical significance
(P-

value 0.4).
In most cases, respondents reported the same types of physical activity at T1 as at
baseline.
Independent exercise is where the greatest change was seen with 8 (17%) participants
reporting this at T1 but not baseline.
The ON-treatment sample increased their leisure time activity more than the OFFtreatment
sample, indicated by the higher effect size statistics for the ON-treatment compared with
the
OFF-treatment samples.
Conclusion(s):
This pilot study is limited by the small sample size. Although not statistically significant
the
5 / 48

WCPT Congress 2015 1-4 May 2015

results do show an increase in self reported exercise 3 months post the DIFY day. It also
shows an increase in self directed exercise rather than interventions prescribed by
members
of the health care team. Data will continue to be collected for the study for one year.
Further
research is required to assess the impact of such community based schemes.
Implications:
If further research supports these results, it would be appropriate to suggest that
community
based activity days may be a cost effective intervention to improve the general health
and
well being of survivors of childhood cancer potentially reducing future health care cost
and
reducing barriers to participation.
Key-Words:
community activity; childhood cancer; health promotion
Funding acknowledgements:
No funding for this project was sort
Ethics approval:
NRES Committee - North of Scotland
6 / 48

WCPT Congress 2015 1-4 May 2015

Abstract No.
: 1017
EVALUATION OF THE ONLY PONSETI CLUB FOOT CLINIC IN THE NORTH OF
PAKISTAN
Background:
In 2012, across Pakistan, only 43% of women delivered with the help of a skilled birth
attendant[1]. Consequently, there is no systematic screening for club foot at birth.
Currently
it is estimated that there are a minimum of 2,611 children with club foot younger than 5
years old in Federally Administrated Tribal Area and Khyber Pakhtunkhwa (KP) regions in
the
north of Pakistan.
Until 2012, children with club foot from these regions were treated in governmental
hospitals
or in private clinics. The techniques of treatment used were expensive, not standardised
and
there was no proper follow up of patients. As many patients were also approaching the
Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS), PIPOS in collaboration
with the
International Committee of the Red Cross (ICRC) decided to set up a Ponseti club foot
clinic in

Peshawar (KP).
In January 2014, this clinic, run by one physiotherapist and his assistant was still the only
known Ponseti club foot clinic in the region and an evaluation of this program was
needed to
determine whether the procedures and practices meet good standards of care and to
monitor
the standard of service delivery.
[1] Retrieved from http://UNICEF.org/sowc2013/index.html
Purpose:
This evaluation was aiming to
1. Identify and quantify the needs of the clinic in term of material, equipment and human
resources
2. Appreciate the satisfaction of the parents of the children
3. Review the clinical records to see if they were filled properly
4. Plan further development of the services.
Methods:
A qualitative methodology was used, namely through the review of background
documents,
site visits and guided discussions and interviews with the physiotherapist, his assistant,
the
manager of PIPOS physiotherapy department, the store keeper and some few parents of
patients (selected randomly).
Results:
The evaluation pointed out that
1. The proportion of patients coming for cast versus shoe brace has changed over the
time
but the work organisation did not follow this evolution
2. The clinic cannot meet all the needs of the population. In Nov 2013, there were 50
patients
on the waiting list. Therefore the clinic does not advertise and works in relative isolation
3. For security and financial reasons access to services remains difficult for the patients
4. Physiotherapist compliance with Ponseti protocol of treatment is good but the provision
and quality of shoe braces is not satisfactory
7 / 48

WCPT Congress 2015 1-4 May 2015

5. Collection of data is good but not routinely analysed

6. Clinic services are not evaluated on regular basis which hampers proper monitoring
7. Patient feed-back has never been recorded.
Conclusion(s):
The evaluation has demonstrated a certain number of strengths, but also weaknesses
such
as a lack of accessibility, missing networking, inappropriate project monitoring and limited
means.
Implications:
The programme should be directed toward first improving the organisation and then the
quality of services. These points will be considered carefully by PIPOS and the ICRC in
order
to assure best functional outcomes for the children with club foot in the north of Pakistan.
Better networking with better resourced areas of Pakistan would also be advantageous.
Key-Words:
Ponseti; Club foot clinic; Pakistan
Funding acknowledgements:
Funded by the International Committee of the Red Cross CH - Geneva
Ethics approval:
Ethic approval was not required