Page 165 - HA Convention 2015

Parallel Sessions

PS3.1 Allied Health II – Technology Advancement and Innovation 13:15 Theatre 2

3D Motion Analysis — a New Vision in Anterior Cruciate Ligament Rehabilitation Tuesday, 19 May
Tsang RSW
Physiotherapy Department, Prince of Wales Hospital, Hong Kong

Anterior cruciate ligament (ACL) reconstruction is the commonest surgery for sports injury. Rehabilitation period after surgery
usually takes about half to one year, and most of the patients are keen to return to sports. Current evidence-based ACL
rehabilitation protocol suggested that criteria for returning to sports include satisfactory clinical examination, symmetrical
range of motion without pain, isokinetic test parameter hamstrings to quadriceps ratio (>66% for males, >75% for females),
KT2000 test within 2.5mm of contralateral leg, functional hop test (85% or above for contralateral side). All these criteria aims
to maximise patients’ physical abilities and minimise the risk of re-injury.

The prevention of ACL injury or re-injury is a key issue in recent years. More and more studies focusing injury prevention
training programmes emphasise jump and balance training. 3D motion analysis is used to study the knee kinematics and
kinetics on these programmes. Knee motion and knee loading during a drop vertical jump task are concluded as predictors
of ACL injury risk in female athletes. Altered neuromuscular control of the hip and knee during drop vertical jumping task and
postural stability deficits after ACL reconstruction are predictors of a second ACL injury after patients returning to sports.
With the assistance of 3D motion analysis, we can have an objective measurement on knee kinematics and kinetics during
jumping task. It has potential to be developed as a future criteria for returning to sports after ACL reconstruction so as to
reduce the risk of re-injury, with more data support from further studies Local application on 3D motion analysis and its
findings on ACL reconstruction patients will be shared.

PS3.2 Allied Health II – Technology Advancement and Innovation 13:15 Theatre 2

Integrating Transcranial Magnetic Stimulation in Physiotherapy for Patients with Stroke HOSPITAL AUTHORITY CONVENTION 2015
Chau RMW
Physiotherapy Department, Kowloon Hospital, Hong Kong

The benefits of physiotherapy for patients with stroke were supported by various literatures. In pace with the contemporary
advancement in rehabilitation technology, Transcranial Magnetic Stimulation (TMS) was introduced to Hong Kong in early
21st century. TMS is originally envisioned as a non-invasive technique to measure the responsiveness and conduction speed
of neurons and synapses in the brain and spinal cord. It induces a transient magnetic field and electric currents in the brain,
thereby inducing neuronal depolarisation and altering cortical excitability. TMS has been used as a therapeutic intervention
for neurological and psychiatric disorders for enhancing the functions underpinning by stimulated brain regions.

The theory under therapeutic application of repetitive TMS (rTMS) in stroke rehabilitation in regaining motor function is
based on the inter-hemispheric competition model. According to the model, motor deficits after stroke were the results of:
(1) reduced output from the ipsileisonal hemisphere, and (2) excessive inter-hemispheric inhibition from the contralesional
hemisphere to the ipsileisonal hemisphere. Thus, motor recovery can be facilitated by either: (1) increasing the excitability
of the ipsileisonal hemisphere; or (2) decreasing the excitability of the contralesional hemisphere. This can be achieved
by using high-frequency (>1Hz) excitatory rTMS to the ipsileisonal hemisphere or low-frequency (£1Hz) inhibitory rTMS to
the contralesional hemisphere. Both types of stimulation targeted at ipsilesional motor cortex activation via rebalancing
bilateral hemispheres. Such artificial modulation of the cortical excitability may induce a more suitable environment for brain
plasticity, hence promotes motor recovery. The resulting modulation of cortical excitability lasting for one to two hour(s) after
treatment, may facilitate brain plasticity and/or interfere with maladaptive neural activation after stroke that hinders motor
recovery. The effects of rTMS can be further enhanced and sustained by scheduling post-stimulation physiotherapy. The use
of rTMS can be an effective adjunct physiotherapeutic intervention to conventional neuro-rehabilitation.

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