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Article: Ultrasound Measurements of Rectus Femoris and Locomotor Outcomes in Patients with Spinal Cord Injury.

Tay, Matthew Rong Jie / Kong, Keng He

2022 Volume 12, Issue 7

Abstract: Patients with incomplete spinal cord injury have decreased mobility, and many do not recover walking ability. The purpose of this study was to investigate rectus femoris muscle thickness and echo intensity on ultrasound and functional outcomes in these ... ...

Abstract	Patients with incomplete spinal cord injury have decreased mobility, and many do not recover walking ability. The purpose of this study was to investigate rectus femoris muscle thickness and echo intensity on ultrasound and functional outcomes in these patients. This was a prospective cohort study in an inpatient rehabilitation center, which recruited 40 consecutive patients with incomplete spinal cord injury. The patients underwent an ultrasound assessment at 6 weeks post-injury. Ultrasound measurements were performed using B-mode ultrasound scanning and standardized protocols. Functional outcomes on discharge, including Lower Extremity Muscle Score (LEMS), Functional Independence Measure (FIM), and Walking Index for Spinal Cord Injury II (WISCI II), were measured. Rectus femoris muscle thickness was significantly correlated with discharge LEMS (Spearman’s rho = 0.448; p = 0.004), FIM motor subscale (Spearman’s rho = 0.595; p < 0.001), FIM walk subscale (Spearman’s rho = 0.621; p < 0.001) and WISCI II (Spearman’s rho = 0.531; p < 0.001). The rectus femoris echo intensity was also significantly correlated with discharge LEMS (Spearman’s rho = −0.345; p = 0.029), FIM motor subscale (Spearman’s rho = −0.413; p = 0.008), FIM walk subscale (Spearman’s rho = −0.352; p = 0.026), and WISCI II (Spearman’s rho = −0.355; p = 0.025). We report that a relationship exists between rectus femoris muscle ultrasonographic characteristics and muscle function and ambulatory outcomes after inpatient rehabilitation. Ultrasound muscle measurements are potentially useful in assessing muscle wasting and function in patients with spinal cord injury.
Language	English
Publishing date	2022-07-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life12071073
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Article ; Online: Caregiver burden in familial caregivers and foreign domestic workers of patients with traumatic brain injury in a multi-ethnic Asian population.

Tay, Matthew / Kong, Keng He

Brain injury

2020 Volume 34, Issue 11, Page(s) 1513–1517

Abstract: Objective: The purpose of this study was to investigate the prevalence and risk factors associated with caregiver burden in familial caregivers and foreign domestic workers of patients with severe traumatic brain injury.: Methods: A total of 77 ... ...

Abstract	Objective: The purpose of this study was to investigate the prevalence and risk factors associated with caregiver burden in familial caregivers and foreign domestic workers of patients with severe traumatic brain injury. Methods: A total of 77 caregivers were consecutively recruited, who were either familial caregivers or foreign domestic workers. All caregivers were evaluated with the Zarit Burden Index (ZBI), Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder 7-item (GAD-7) scale. Logistic regression analysis was conducted to determine factors associated with caregiver burden. Results: The majority of participants were familial caregivers (N = 60), of which 70% experienced significant caregiver burden. In this group, 10.0% caregivers had clinically significant depression and 16.7% caregivers who had clinically significant anxiety. On multivariate analysis, factors found to be associated with caregiver burden were Glasgow Outcome Scale Extended (GOSE) of <7, presence of neuropsychiatric complications, and presence of anxiety. There was also a high prevalence of caregiver burden in foreign domestic workers (29.4%). Conclusion: There is a high rate of caregiver burden in both familial caregivers and foreign domestic workers who care for patients with severe traumatic brain injury. Caregivers experiencing stress should also be monitored for the presence of anxiety or depression.
MeSH term(s)	Adaptation, Psychological ; Anxiety/epidemiology ; Anxiety/etiology ; Asian Continental Ancestry Group ; Brain Injuries, Traumatic/epidemiology ; Brain Injuries, Traumatic/nursing ; Caregiver Burden ; Caregivers ; Cost of Illness ; Humans ; Surveys and Questionnaires
Language	English
Publishing date	2020-08-23
Publishing country	England
Document type	Journal Article
ZDB-ID	639115-1
ISSN	1362-301X ; 0269-9052
ISSN (online)	1362-301X
ISSN	0269-9052
DOI	10.1080/02699052.2020.1809709
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Article ; Online: Ultrasound changes in lower limb muscle architectural parameters and ambulatory outcomes in early stroke survivors.

Kong, Keng He / Tham, Shuen-Loong / Tay, Matthew Rong Jie / Lui, Wen Li / Rajeswaran, Deshan Kumar / Kim, Jongmoon

Singapore medical journal

2023

Language	English
Publishing date	2023-07-26
Publishing country	India
Document type	Journal Article
ZDB-ID	604319-7
ISSN	2737-5935 ; 0037-5675
ISSN (online)	2737-5935
ISSN	0037-5675
DOI	10.4103/singaporemedj.SMJ-2022-210
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Article: Truncal impairment after stroke: clinical correlates, outcome and impact on ambulatory and functional outcomes after rehabilitation.

Kong, Keng He / Ratha Krishnan, Rathi

Singapore medical journal

2019 Volume 62, Issue 2, Page(s) 87–91

Abstract: Introduction: Good trunk performance is important for activities such as sitting and standing. In a cohort of patients with stroke, we sought to evaluate changes in trunk performance after stroke, establish factors correlated to trunk performance and ... ...

Abstract	Introduction: Good trunk performance is important for activities such as sitting and standing. In a cohort of patients with stroke, we sought to evaluate changes in trunk performance after stroke, establish factors correlated to trunk performance and assess the impact of trunk performance on discharge ambulatory and functional status. Methods: This was a retrospective review of the data of patients with stroke admitted to Tan Tock Seng Hospital rehabilitation centre, Singapore, over a two-year period. Data analysed included the National Institutes of Health Stroke Scale (NIHSS), Montreal Cognitive Assessment (MOCA), Fugl-Meyer Assessment (FMA) of limb motor impairment and Functional Independence Measure-motor (FIM-motor) scores, which measures self-care ability. Trunk performance was assessed on the Trunk Impairment Scale (TIS). Results: 577 patients with stroke (mean age 63.2 ± 11.8 years) were analysed. Truncal impairment was present in 96.4% of patients. Mean admission TIS score was 14.3 ± 6.1 and this improved to 17.2 ± 5.2 on discharge (p < 0.001). Admission TIS score was positively correlated with admission MOCA, FMA-upper limb and FMA-lower limb scores, and negatively correlated to NIHSS score and neglect. Admission TIS scores significantly predicted discharge FIM-motor scores (p < 0.001) and ambulatory status (p < 0.001). Conclusion: Truncal impairment was common and improvements in trunk performance were seen after rehabilitation. Trunk performance was significantly correlated to stroke severity, upper and lower limb motor power, cognition and neglect. As admission trunk performance predicted discharge functional and ambulatory status, it is recommended that trunk performance be evaluated for all patients with stroke.
MeSH term(s)	Aged ; Humans ; Middle Aged ; Neurologic Examination ; Recovery of Function ; Retrospective Studies ; Stroke ; Stroke Rehabilitation ; Treatment Outcome ; Upper Extremity
Language	English
Publishing date	2019-12-02
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	604319-7
ISSN	0037-5675
ISSN	0037-5675
DOI	10.11622/smedj.2019153
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Article: Botulinum toxin A injection for post-stroke upper limb spasticity and rehabilitation practices from centers across Asian countries.

Rosales, Raymond L / Chia, Nicholas V C / Kumthornthip, Witsanu / Goh, Khean Jin / Mak, Choon Soon / Kong, Keng He / Ng, Yee Sien / Chou, Li Wei / Flordelis, M Jeanne / Do, Thuy / Maisonobe, Pascal / Li, Leonard S W / Suputtitada, Areerat

Frontiers in neurology

2024 Volume 15, Page(s) 1335365

Abstract: Purpose: Describe real-life practice and outcomes in the management of post-stroke upper limb spasticity with botulinum toxin A (BoNT-A) in Asian settings.: Methods: Subgroup analysis of a prospective, observational study (NCT01020500) of adult ... ...

Abstract	Purpose: Describe real-life practice and outcomes in the management of post-stroke upper limb spasticity with botulinum toxin A (BoNT-A) in Asian settings. Methods: Subgroup analysis of a prospective, observational study (NCT01020500) of adult patients (≥18 years) with post-stroke upper limb spasticity presenting for routine spasticity management, including treatment with BoNT-A. The primary outcome was goal attainment as assessed using goal-attainment scaling (GAS). Patients baseline clinical characteristics and BoNT-A injection parameters are also described. Results: Overall, 51 patients from Asia were enrolled. Rates of comorbid cognitive and emotional problems were relatively low. Patients tended to have more severe distal limb spasticity and to prioritize active over passive function goals. Most (94.1%) patients in the subgroup were treated with abobotulinumtoxinA. For these patients, the median total dose was 500 units, and the most frequently injected muscles were the biceps brachii (83.3%), flexor carpi radialis (72.9%), and flexor digitorum profundus (66.7%). Overall, 74.5% achieved their primary goal and the mean GAS T score after one treatment cycle was 56.0 ± 13.0, with a change from baseline of 20.9 ± 14.3 ( Conclusion: In the Asian treatment setting, BoNT-A demonstrated a clinically significant effect on goal attainment for the real-life management of upper limb spasticity following stroke.
Language	English
Publishing date	2024-04-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2024.1335365
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Article ; Online: Ultrasound Assessment of Changes in Muscle Architecture of the Brachialis Muscle After Stroke-A Prospective Study.

Kong, Keng He / Shuen-Loong, Tham / Tay, Matthew Rong Jie / Lui, Wen Li / Rajeswaran, Deshan Kumar / Kim, Jongmoon

Archives of rehabilitation research and clinical translation

2022 Volume 4, Issue 3, Page(s) 100215

Abstract: Objective: To investigate changes in ultrasound-derived muscle architecture parameters of the brachialis and correlations in patients with subacute stroke.: Design: Prospective longitudinal observational study.: Setting: Tertiary inpatient ... ...

Abstract	Objective: To investigate changes in ultrasound-derived muscle architecture parameters of the brachialis and correlations in patients with subacute stroke. Design: Prospective longitudinal observational study. Setting: Tertiary inpatient rehabilitation center. Participants: Fifty adult patients (N=50) who were recruited within the first month poststroke. The patients had a mean age of 57.2±12.3 years and 68.0% were male. The majority of patients had significant upper limb weakness with a low mean Motricity Index of 18.5±24.7 and median elbow flexor strength of grade 0. Intervention: Not applicable. Main outcome measures: Ultrasound of the intact and hemiparetic brachialis was performed at 3-time intervals: within 1 month of stroke onset and at 1 and 6 months after first assessment. Clinical variables captured included upper limb motor power and elbow flexor spasticity. Results: Compared to the intact brachialis, there was reduced muscle thickness (1.93 cm vs 2.07 cm, 1.86 cm vs 2.08 cm, 1.85 cm vs 2.05 cm; Conclusions: Changes including decreased muscle thickness and increased echo intensity of the hemiparetic brachialis were noted over time. Elbow flexor spasticity at 1-month assessment interval appears to mitigate against these changes.
Language	English
Publishing date	2022-07-15
Publishing country	United States
Document type	Journal Article
ISSN	2590-1095
ISSN (online)	2590-1095
DOI	10.1016/j.arrct.2022.100215
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Article ; Online: Temporal recovery of activities of daily living in the first year after ischemic stroke: a prospective study of patients admitted to a rehabilitation unit.

Kong, Keng-He / Lee, Jeanette

NeuroRehabilitation

2014 Volume 35, Issue 2, Page(s) 221–226

Abstract: Background: The ability to perform basic activities of daily living (ADL) independently is a marker of functional recovery after a stroke. However, there few studies documenting their long-term recovery.: Objective: To document temporal recovery of ... ...

Abstract	Background: The ability to perform basic activities of daily living (ADL) independently is a marker of functional recovery after a stroke. However, there few studies documenting their long-term recovery. Objective: To document temporal recovery of activities of daily living (ADL) and establish predictors of ADL in a cohort of ischemic stroke patients in the first year after stroke. Methods: Prospective cohort study of 163 patients with first-ever ischemic stroke admitted to a rehabilitation centre. The Modified Barthel Index (MBI) was used to measure the patient's ability to perform the following 10 ADLs: feeding, grooming, dressing, bathing, toileting, bladder and bowel continence, transfers, ambulation and stair climbing. It was assessed on rehabilitation admission, discharge, and at 3, 6 and 12 months after stroke. The Motricity Index was used to measure motor power of the hemiplegic limb. Results: The mean age was 63.8 (10.7) years, with 111 males and 52 females. The mean total MBI scores on rehabilitation admission, rehabilitation discharge, 3, 6 and 12 months after stroke were 41.3 (24.6), 72.9 (20.5), 88.4 (18.6), 90.5 (17.2) and 84.2 (20.4) respectively. Median scores of feeding, grooming, toileting, bladder/bowel continence, transfers and ambulation plateaued by 3 months after stroke. Median scores of dressing and stair climbing plateaued at 6 months and that for bathing, 12 months after stroke. None of the patients were functionally independent (defined as MBI score of 100) on rehabilitation admission, but this improved to 8.6% on discharge, and 32.1%, 41.4% and 50.3% at 3, 6 and 12 months after stroke respectively. The MBI and Motricity scores were strongly correlated at all periods of follow up (r = 0.67 to 0.69, p < 0.0001). Univariate analysis showed that age, neglect, a cortical stroke, admission MBI, NIHSS, Motricity Index and Abbreviated Mental Score scores were predictors of functional independence at 12 months after stroke. On logistic regression, only age remained significant, younger patients being more likely than older patients to be functionally independent. Conclusion: Most recovery of ADL occurs by 3 months after stroke. For individual ADLs, dressing, stair climbing and bathing appear to take a longer time to recover. Older age was a negative predictor of functional dependence at 12 months after stroke.
MeSH term(s)	Activities of Daily Living ; Aged ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Longitudinal Studies ; Male ; Middle Aged ; Patient Discharge/statistics & numerical data ; Prospective Studies ; Recovery of Function ; Rehabilitation Centers ; Self Care ; Singapore ; Stroke Rehabilitation ; Walking
Language	English
Publishing date	2014-01-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1087912-2
ISSN	1878-6448 ; 1053-8135
ISSN (online)	1878-6448
ISSN	1053-8135
DOI	10.3233/NRE-141110
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Article ; Online: A Doppler-Tolerant Ultrasonic Multiple Access Localization System for Human Gait Analysis.

Ashhar, Karalikkadan / Khyam, Mohammad Omar / Soh, Cheong Boon / Kong, Keng He

Sensors (Basel, Switzerland)

2018 Volume 18, Issue 8

Abstract: Ranging based on ultrasonic sensors can be used for tracking wearable mobile nodes accurately for a long duration and can be a cost-effective method for human movement analysis in rehabilitation clinics. In this paper, we present a Doppler-tolerant ... ...

Abstract	Ranging based on ultrasonic sensors can be used for tracking wearable mobile nodes accurately for a long duration and can be a cost-effective method for human movement analysis in rehabilitation clinics. In this paper, we present a Doppler-tolerant ultrasonic multiple access localization system to analyze gait parameters in human subjects. We employ multiple access methods using linear chirp wave-forms and narrow-band piezoelectric transducers. A Doppler shift compensation Technique is also incorporated without compromising on the tracking accuracy. The system developed was used for tracking the trajectory of both lower limbs of five healthy adults during a treadmill walk. An optical motion capture system was used as the reference to compare the performance. The average Root Mean Square Error values between the 3D coordinates estimated from the proposed system and the reference system while tracking both lower limbs during treadmill walk experiment by 5 subjects were found to be 16.75, 14.68 and 20.20 mm respectively along X, Y and Z-directions. Errors in the estimation of spatial and temporal parameters from the proposed system were also quantified. These promising results show that narrowband ultrasonic sensors can be utilized to accurately track more than one mobile node for human gait analysis.
MeSH term(s)	Adult ; Female ; Gait/physiology ; Humans ; Leg/physiology ; Male ; Transducers ; Ultrasonics/methods ; Wearable Electronic Devices
Language	English
Publishing date	2018-07-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2052857-7
ISSN	1424-8220 ; 1424-8220
ISSN (online)	1424-8220
ISSN	1424-8220
DOI	10.3390/s18082447
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Article: Interview Functional Independence Measure score: self-reporting as a simpler alternative to multidisciplinary functional assessment.

Vadassery, Shaji Jose / Kong, Keng He / Ho, Wai Mun Lorraine / Seneviratna, Aruni

Singapore medical journal

2018 Volume 60, Issue 4, Page(s) 199–201

Abstract: Introduction: The Functional Independence Measure (FIM) is a validated, objective assessment of functional status. It is widely used in rehabilitation centres but may not be practical for all patients due to time and/or personnel constraints. Studies ... ...

Abstract	Introduction: The Functional Independence Measure (FIM) is a validated, objective assessment of functional status. It is widely used in rehabilitation centres but may not be practical for all patients due to time and/or personnel constraints. Studies show positive and negative agreement on self-reported FIM scores for patients with spinal cord injuries and amputees. We tested the validity of the self-reported FIM motor score among stroke patients. Methods: We conducted a prospective double-blind comparative study of patient self-reporting against multidisciplinary assessment, using the standard FIM algorithm. All eligible stroke patients (n = 47) admitted to our rehabilitation centre were included. 33 patients were included in the final analysis. Results: There was substantial agreement on overall FIM motor score between patient self-reporting and multidisciplinary assessment (intraclass correlation coefficient [ICC] 0.651, 95% confidence interval 0.404-0.811). The scores of individual motor items also showed fair-to-good agreement (ICC range 0.431-0.618), except for eating, grooming, bathing and dressing of the lower body (ICC < 0.400). Conclusion: There was no FIM assessment for 14 (29.8%) patients, highlighting the need for alternative assessment tools. Discrepancies in some scores could be due to patients' ignorance of their own limitations or feelings of embarrassment about reporting. Our results may not be valid for patient populations with cognitive or communication deficits. However, a modest agreement between patient self-reporting and multidisciplinary assessment of FIM motor score was demonstrated. Although patients tend to overrate their performance, self-reported FIM motor scores could be an alternative in situations where multidisciplinary FIM assessment is difficult.
MeSH term(s)	Algorithms ; Disability Evaluation ; Double-Blind Method ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Self Report ; Stroke/physiopathology ; Stroke Rehabilitation
Language	English
Publishing date	2018-09-05
Publishing country	Singapore
Document type	Comparative Study ; Journal Article
ZDB-ID	604319-7
ISSN	0037-5675
ISSN	0037-5675
DOI	10.11622/smedj.2018048
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Article: Of rehabilitation medicine and the rehabilitation physician.

Kong, Keng He

Annals of the Academy of Medicine, Singapore

2007 Volume 36, Issue 1, Page(s) 1

MeSH term(s)	Humans ; Rehabilitation
Language	English
Publishing date	2007-01-23
Publishing country	Singapore
Document type	Editorial
ZDB-ID	604527-3
ISSN	0304-4602
ISSN	0304-4602
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