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Papase as a treatment option for the overgranulating wound

Mustafah NM, Chung TY

J Wound Care, 2014 Feb;23(2 Suppl):S10-2.
PMID: 24526167

Overgranulation (also commonly known as hypergranulation) is a common problem in chronic wound management. We describe a case involving a 57-year-old lady with a chronic diabetic foot ulcer, complicated with overgranulation for the past year. She was administered with various treatments, including hydrocortisone 1% cream and hydrofiber, which proved ineffective and further delayed the healing process of her ulcer. We then decided to use crushed Papase tablets applied to her ulcer after a normal saline dressing and prior to an application of secondary dressing. The patient was instructed clearly on the dressing technique to be performed daily at home and was monitored weekly in a foot care clinic. The overgranulation resolved within 5 weeks and the patient continues recieving care to promote epithelialisation.
Fulltext Ability to return to driving after major lower limb amputation

Engkasan JP, Ehsan FM, Chung TY

J Rehabil Med, 2012 Jan;44(1):19-23.
PMID: 22124514 DOI: 10.2340/16501977-0904

The aims of this study were to examine the ability of patients to return to driving cars and riding motorcycles after lower limb amputation, and to explore the factors that significantly affect such ability.
Return to work after spinal cord injury in Malaysia

Ramakrishnan K, Chung TY, Hasnan N, Abdullah SJ

Spinal Cord, 2011 Jul;49(7):812-6.
PMID: 21221119 DOI: 10.1038/sc.2010.186

STUDY DESIGN: Cross-sectional survey.
OBJECTIVES: To determine the employment outcomes of persons with spinal cord injury (SCI) and to investigate the impact of various demographic, injury-related and work-related variables on these outcomes.
SETTING: People living with SCI in Malaysia who are members of a disability support organization.
METHODS: A total of 84 members of the Malaysian Spinal Injury Association, who have had traumatic SCI for at least 2 years and were between 15 and 64 years of age at the time of study, were interviewed through phone using a questionnaire to identify the association between demographic, injury-related and work-related variables and employment outcomes.
RESULTS: The return to work rate in this study was 57.1% (employed at the time of study). The overall employment rate after SCI was 76.2% (worked at some point after injury). Those who were younger at time of injury (<20 years of age), able to drive a modified vehicle, independent in personal care and mobility were positively related to being employed. On the other hand, being hospitalized in the preceding 1 year and receiving financial incentives were negatively related to employment.
CONCLUSION: Functional independence, especially ability to drive, was strongly associated with return to work and should be one of the priority goals of comprehensive rehabilitation of persons with SCI. The negative impact of recent hospitalization as well as financial compensation needs to be probed further.
A Comparative Study of Two Modalities in Pain Management of Patients Presenting with Chronic Brachial Neuralgia

Razak I, Chung TY, Ahmad TS

J Altern Complement Med, 2019 Aug;25(8):861-867.
PMID: 31211607 DOI: 10.1089/acm.2019.0052

Objectives:
The study aims to assess, evaluate, and compare the efficacy of acupressure and hypnotherapy in the management of pain in patients presenting with chronic brachial neuralgia (CBN).
Design:
Randomized controlled trial.
Settings/location:
Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Subjects:
Forty patients with CBN following traumatic brachial plexus injury from 2012 to 2017.
Intervention:
Therapy for a duration of 1 month in two groups; subjects in the hypnotherapy group received a weekly session of clinical hypnotherapy (total of four times) using a standardized protocol, while subjects in the acupressure group were guided by an acupuncturist during the initial session, received 2 month take home supply of acupressure patches, and were reviewed fortnightly.
Outcome measures:
The Visual Analog Scale, the Brief Pain Inventory, and the SF-36v2® Health Survey were recorded at different time points; 1 month pretreatment (week 0), pretreatment (week 4), post-treatment (week 8), and 4 months post-treatment (week 20).
Results:
There was a statistically significant improvement in the average pain intensity from pretreatment to post-treatment score in both groups. The pain intensity increased 4 months later; however, the pain intensity was still significantly reduced in comparison with pretreatment scores. The study suggests that both treatment outcomes are effective in terms of alleviating pain and improving quality of life in subjects with CBN, to a different degree.
Conclusion:
Overall, both therapies were able to improve the pain intensity and quality of life significantly during the treatment period. Hypnotherapy was observed to have a better carryover effect compared to acupressure, especially in terms of improving quality of life and the mental component score.
Design and development of a wheelchair seating pressure relief reminder system for pressure ulcer prevention among paraplegics

Md Nadzri N, Hamzaid NA, Chung TY

J Med Eng Technol, 2021 Oct;45(7):574-581.
PMID: 34184592 DOI: 10.1080/03091902.2021.1936238

Individuals with paraplegia spend their time on the wheelchair for life. Adapting to prolonged wheelchair seating for almost all activities of daily living is challenging. The loss of abilities to sense any pain or excessive seating pressure cause them to remain seated on the wheelchair without any pressure relief activities. This situation leads to secondary complications including pressure ulcer which further degrades the individual's health. To overcome this, a wheelchair seating pressure relief training system (WSETs) was developed. Optimal placement of the force sensitive resistors (FSR) as seating pressure sensors on the cushion were determined, and their responses were investigated with 5 paraplegics. Two different FSR orientations, A and B, were compared. Each paraplegic sat in resting position and then performed pressure relief activities (PRA) which included whole body push-up, left and right lean and forward lean, before returning to resting position. Orientation B, with more forward positioned FSRs, showed higher sensitivity, implying better capture of high-risk area of pressure ulcer development. The FSR sensor readings were significantly different among pressure relief activities in all subjects (p
Fulltext Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre

Fauzi AA, Chung TY, Latif LA

Singapore Med J, 2016 Apr;57(4):198-203.
PMID: 27075668 DOI: 10.11622/smedj.2016074

TThis study aimed to determine the risk factors of diabetic Charcot arthropathy of the foot among diabetic patients with and without foot problems.
The effect of feet position on standing balance in patients with diabetes

Mehdikhani M, Khalaj N, Chung TY, Mazlan M

Proc Inst Mech Eng H, 2014 Aug;228(8):819-23.
PMID: 25205748 DOI: 10.1177/0954411914547714

Feet displacement is recognized to be an important element in standing and is also linked to postural instability in elderly people with diabetes. This study investigates standing balance in diabetic patients in four asymmetric feet displacements. Quiet standing balance was investigated using the Biodex Balance System in 18 diabetic patients and compared with 18 control elderly subjects. The four standing conditions, namely, comfortable feet position, preferred feet position with a stance width of 17 cm and 15° angle between the medial borders, feet side by side, and heel side by side with a 30° angle between medial edges of feet were evaluated (i.e. eyes opened, eyes closed). The overall stability was calculated by measuring anterior-posterior and medial-lateral indices in standing conditions. Differences among feet positions were compared using an analysis of variance and the independent t-test. The diabetic patients were unstable in the medial-lateral direction when standing with feet side by side versus heel side by side with a 30° angle between medial edges of feet (p = 0.012 and 0.011, respectively), while in controls the anterior-posterior stability scores between standing in preferred foot position with stance width of 17 cm and 15° angle between the medial borders versus feet side by side, and heel side by side with a 30° angle between medial edges of feet versus preferred foot position with stance width of 17 cm and 15° angle between the medial borders had significant difference (p
Photobiomodulation Therapy in Carpal Tunnel Release: A Randomized Controlled Trial

Chuah JP, Khoo SS, Chung TY, Jayaletchumi G

Photobiomodul Photomed Laser Surg, 2023 Aug;41(8):402-407.
PMID: 37506348 DOI: 10.1089/photob.2023.0018

Background: Carpal tunnel release (CTR) is widely accepted as an effective treatment for carpal tunnel syndrome. However, the recovery is often delayed and incomplete. Photobiomodulation therapy (PBMT) produces a nonthermal effect on living tissues; it promotes healing, remodels and reduces inflammation of an injured nerve. The purpose of this study was to compare the outcome of CTR between patients who underwent postoperative PBMT and without PBMT. Materials and methods: We recruited 105 patients who had open CTR from January 2019 to January 2021. Fifty-six patients fulfilled the study criteria and were randomized into two groups: with PBMT (n = 28) and without PBMT (n = 28). Demographic and clinical data were obtained preoperatively. The PBMT group had ten 3-min sessions over 3 weeks using 808 nm, 50 mW PBMT to deliver 9 J per session to the CTR incision scar. Clinical outcomes were assessed at 1, 3, and 6 months postoperatively. Data analysis was performed with SPSS software. Results: There were significant improvements in the Functional Status Scale in the Boston Carpal Tunnel Questionnaire (p = 0.018) and pain (visual analogue scales) in the morning (p = 0.019) at 1 month postoperatively in the PBMT group compared with the non-PBMT group. Improvement of tip pinch strength at 3 months (p = 0.022) and 6 months (p = 0.024), lateral pinch strength at 1 month (p = 0.042) and 3 months (p = 0.05), and tripod pinch strength at 3 months (p = 0.005) was significantly better in the PBMT group. Thumb 2-point discrimination (2PD) at 3 months (p = 0.018) and 6 months (p = 0.016) and index finger 2PD at 3 months (p = 0.039) were also significantly improved in the PBMT group. There were no side effects of PBMT reported. Conclusions: Patients who underwent PBMT post-CTR had better outcomes. PBMT may be a valuable adjunct to post-CTR care.
A comparison of pressure distributions between two types of sockets in a bulbous stump

Gholizadeh H, Abu Osman NA, Eshraghi A, Arifin N, Chung TY

Prosthet Orthot Int, 2016 Aug;40(4):509-16.
PMID: 25583929 DOI: 10.1177/0309364614564022

BACKGROUND: This article describes a total surface bearing prosthetic socket for a patient (25-year-old female) with a bulbous stump.
CASE DESCRIPTION AND METHODS: The subject had unstable excessive soft tissue at the distal end of the residuum. After 2 years of prosthetic use, she experienced several problems, including pain in the residual limb and knee joint. Pressure distribution was evaluated during ambulation. We also designed a total surface bearing socket with Velcro as suspension system to distribute the load evenly on the residual limb, and to facilitate donning procedure.
FINDINGS AND OUTCOMES: The main site of weight bearing in the old prosthesis (patellar tendon bearing) was anterior proximal region of the residual limb, especially the patellar tendon. The pressure was almost 10 times higher than the distal region during level walking. Pressures were distributed more evenly with the total surface bearing socket design, and the donning was much easier.
CONCLUSION: Pressure distribution within the socket could be affected by socket design and suspension system. Using the total surface bearing socket and Velcro as suspension system might facilitate donning of prosthesis and reduce traction at the end of residual limb during the swing phase of gait.
CLINICAL RELEVANCE: Proper socket design and suspension system based on the amputees' need can facilitate rehabilitation process and lead to the amputee's satisfaction. The pressure is distributed more uniformly over the residual limb by the total surface bearing socket compared to the patellar tendon bearing socket for lower limb amputees with unusual stump shape.
Comparative study of the circumferential and volumetric analysis between conventional casting and three-dimensional scanning methods for transtibial socket: A preliminary study

Mehmood W, Abd Razak NA, Lau MS, Chung TY, Gholizadeh H, Abu Osman NA

Proc Inst Mech Eng H, 2019 Feb;233(2):181-192.
PMID: 30518308 DOI: 10.1177/0954411918816124

Transtibial prosthetic sockets can be fabricated either by the conventional way, which involve using plaster of Paris bandages for casting. This will include modifications through hand, scanning and digital imaging of software. The aim of this study is to determine the circumferential profiles and conduct a volumetric analysis of a conventional socket that has fabrication using biosculptor technology. In doing this, a male transtibial amputee, age 28 years old with stable health condition was studied, where circumferential measurements were taken at intervals of 1 cm from the distal end of the residual limb to the medial tibial plateau level. Furthermore, the interior volume of both sockets and residuum were determined directly using water displacement method. A comparative value for the calculation of volume was also carried out using engineering mathematical equations. From these measurements, a total surface bearing transtibial sockets was fabricated to compare the changes of circumferential values of both sockets. The finding shows a percentage of the difference between the volume of the residual limb and conventional sockets to be 6.09%, whereas the biosculptor fabrication socket was 7.84% using the water displacement method. A comparison of circumferential profiles and volumetric analysis findings on the contrary showed that socket fabricated using the biosculptor technology is interchangeable with the conventional socket with more advantages, where biosculptor technology produces cheaper sockets and faster process with digital function in the procedure, unlike the conventional manual technique.
Photobiomodulation After Neurotization (Oberlin Procedure) in Brachial Plexus Injury: A Randomized Control Trial

Foo YH, Tunku Ahmad Yahaya TS, Chung TY, Silvanathan JP

Photobiomodul Photomed Laser Surg, 2020 Apr;38(4):215-221.
PMID: 32301668 DOI: 10.1089/photob.2019.4757

Objective:
To investigate effect of photobiomodulation (PBM) on nerve regeneration after neurotization with the Oberlin Procedure (ulnar fascicle to motor branch to biceps) to restore elbow flexion in patients with brachial plexus injury.
Materials and methods:
This prospective randomized controlled trial was conducted with 14 patients with high brachial plexus injury who underwent neurotization with the Oberlin Procedure to restore elbow flexion. The patients were randomly allocated to two groups of equal numbers: control group and PBM group. In this study, the PBM used has a wavelength of 808 nm, 50 mW power, continuous mode emission, 4 J/cm2 dosimetry, administered daily for 10 consecutive days, with an interval of 2 days (weekends). The outcome of surgery was assessed after 1, 2, 3, and 6 months. The nonparametric Mann-Whitney U-test and chi-square test were utilized to compare the results between both groups.
Results:
After 3 months postoperatively, more patients in the PBM group had demonstrated signs of reinnervation and the mean muscle power was significantly higher in the PBM group. No adverse effects resulted from the administration of PBM.
Conclusions:
PBM is a treatment modality that can improve nerve regeneration after neurotization with the Oberlin Procedure.
Fulltext Analysis of Interrelationships among Voluntary and Prosthetic Leg Joint Parameters Using Cyclograms

Jasni F, Hamzaid NA, Mohd Syah NE, Chung TY, Abu Osman NA

Front Neurosci, 2017;11:230.
PMID: 28487630 DOI: 10.3389/fnins.2017.00230

The walking mechanism of a prosthetic leg user is a tightly coordinated movement of several joints and limb segments. The interaction among the voluntary and mechanical joints and segments requires particular biomechanical insight. This study aims to analyze the inter-relationship between amputees' voluntary and mechanical coupled leg joints variables using cyclograms. From this analysis, the critical gait parameters in each gait phase were determined and analyzed if they contribute to a better powered prosthetic knee control design. To develop the cyclogram model, 20 healthy able-bodied subjects and 25 prosthesis and orthosis users (10 transtibial amputees, 5 transfemoral amputees, and 10 different pathological profiles of orthosis users) walked at their comfortable speed in a 3D motion analysis lab setting. The gait parameters (i.e., angle, moment and power for the ankle, knee and hip joints) were coupled to form 36 cyclograms relationship. The model was validated by quantifying the gait disparities of all the pathological walking by analyzing each cyclograms pairs using feed-forward neural network with backpropagation. Subsequently, the cyclogram pairs that contributed to the highest gait disparity of each gait phase were manipulated by replacing it with normal values and re-analyzed. The manipulated cyclograms relationship that showed highest improvement in terms of gait disparity calculation suggested that they are the most dominant parameters in powered-knee control. In case of transfemoral amputee walking, it was identified using this approach that at each gait sub-phase, the knee variables most responsible for closest to normal walking were: knee power during loading response and mid-stance, knee moment and knee angle during terminal stance phase, knee angle and knee power during pre-swing, knee angle at initial swing, and knee power at terminal swing. No variable was dominant during mid-swing phase implying natural pendulum effect of the lower limb between the initial and terminal swing phases. The outcome of this cyclogram adoption approach proposed an insight into the method of determining the causal effect of manipulating a particular joint's mechanical properties toward the joint behavior in an amputee's gait by determining the curve closeness, C, of the modified cyclogram curve to the normal conventional curve, to enable quantitative judgment of the effect of changing a particular parameter in the prosthetic leg gait.
Fulltext Foot ulcers and their association with diabetic Charcot foot complications

Rahman NA, Fauzi AA, Chung TY, Latif LA, Chan SC

Aust J Gen Pract, 2020 2 3;49(1-2):48-53.
PMID: 32008261 DOI: 10.31128/AJGP-07-19-4991

BACKGROUND AND OBJECTIVES: Diabetic Charcot foot (DCF) can cause gross structural deformities of the foot and ankle. The main objective of this study was to identify complications of DCF and its associated factors.
METHOD: This is a retrospective cohort study. Data on medical background, previous DCF treatment and complications were obtained. Multiple logistic regression analysis was performed to measure factors related to various complications of DCF.
RESULTS: Ninety-eight patient records were retrieved. Of the 83 patients who were still alive, 75.9% (n = 63) had recurrent ulcers, 53.0% (n = 44) had undergone foot surgery and 45.8% (n = 38) had undergone amputation. Patients with a history of recurrent ulcers have the highest predilection to amputation (odds ratio: 8.5; 95% confidence interval: 1.8, 39.1).
DISCUSSION: In terms of DCF complications, foot ulcers are an independent predictor of recurrent foot ulcers, foot surgery and amputation. Regular foot assessment of patients with DCF to prevent ulcers is strongly recommended.
Anton-Babinski Syndrome in a Recurrent Ischemic Stroke Patient: A Case Report

Pong MY, Yap JF, Chung TY, Chan SC, Sabirin S

Cureus, 2023 Sep;15(9):e44599.
PMID: 37795056 DOI: 10.7759/cureus.44599

Anton-Babinski syndrome (ABS) is a rare neuropsychiatric condition characterized by visual anosognosia (denial of vision loss) and confabulation in the presence of intact anterior visual tracts. The most common cause of ABS is a cerebrovascular accident involving bilateral occipital lobe injuries with varying degrees of cortical blindness. In this report, we present the case of a woman with suspected ABS following a recurrent ischemic stroke in Malaysia. Establishing a proper diagnosis of stroke is crucial for modifying rehabilitation goals to ensure improved functional outcomes.
The utility of ALS staging systems in a multi-ethnic patient cohort

Abdul Aziz NA, Toh TH, Loh EC, Capelle DP, Goh KJ, Abdul Latif L, et al.

Amyotroph Lateral Scler Frontotemporal Degener, 2021 08;22(5-6):341-349.
PMID: 33726578 DOI: 10.1080/21678421.2021.1893336

Objective: To compare two ALS staging systems, King's clinical staging and Milano-Torino (MiToS) functional staging, using prospective data from a multi-ethnic cohort of ALS patients. Methods: The stages of disease were determined prospectively based on existing definitions. The two systems were compared for timing of stages using box plots, correspondence using chi-square tests and association using Spearman's rank correlation. Results: The distribution of stages differed between the two systems. The proportions of disease stages of the King's staging system were more evenly distributed whereas in MiToS, there was greater weight seen at the later stages of disease. At the early stages, patients moved consecutively in the MiToS staging system but not in the King's staging system where patients tended to skip stages to reach later stages. Both systems had good correlation (Spearman's rho = 0.869) and the King's stage 4 most frequently corresponded to MiToS stage 2. Conclusion: We found the King's staging was helpful in determining the stages of disease burden, whereas both were helpful in determining the time to functional dependence with MiToS further refining the levels of dependence.

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