Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Articulate the rationale for including walking on an aquatic treadmill in the rehabilitation of subacute stroke patients; (2) Describe the beneficial effects of a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients; and (3) Determine the appropriate indications for incorporating a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients.Level: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ObjectiveTo investigate the effectiveness of commercial gaming-based virtual reality (VR) therapy on the recovery of paretic upper extremity in subacute stroke patients.MethodsTwenty patients with the first-onset subacute stroke were enrolled and randomly assigned to the case group (n=10) and the control group (n=10). Primary outcome was measured by the upper limb score through the Fugl-Meyer Assessment (FMA-UL) for the motor function of both upper extremities. Secondary outcomes were assessed for motor function of both upper extremities including manual function test (MFT), box and block test (BBT), grip strength, evaluated for activities of daily living (Korean version of Modified Barthel Index [K-MBI]), and cognitive functions (Korean version of the Mini-Mental State Examination [K-MMSE] and continuous performance test [CPT]). The case group received commercial gaming-based VR therapy using Wii (Nintendo, Tokyo, Japan), and the control group received conventional occupational therapy (OT) for 30 minutes a day during the period of 4 weeks. All patients were evaluated before and after the 4-week intervention.ResultsThere were no significant differences in the baseline between the two groups. After 4 weeks, both groups showed significant improvement in the FMA-UL, MFT, BBT, K-MBI, K-MMSE, and correct detection of auditory CPT. However, grip strength was improved significantly only in the case group. There were no significant intergroup differences before and after the treatment.ConclusionThese findings suggested that the commercial gaming-based VR therapy was as effective as conventional OT on the recovery of upper extremity motor and daily living function in subacute stroke patients.

The age-dependent series of stylized computational phantoms developed at the Oak Ridge National Laboratory in the late 1970's to early 1980's has found wide applicability in dosimetry studies ranging from dose coefficient compilations for external and internal photon emitters, simulations of patient radiological exams, and dose reconstruction activities. In the present study, we report on a series of revisions to the Oak Ridge National Laboratory series for their intended use within the MIRD schema of medical internal dosimetry. These revisions were made to (1) incorporate recent developments in stylized models of the head, brain, kidneys, rectosigmoid colon, and extra-pulmonary airways; (2) incorporate new models of the salivary glands and the mucosa layer of the urinary bladder, alimentary tract organs, and respiratory airways; (3) adopt reference values of elemental tissue compositions and mass densities from ICRP Publication 89 and ICRU Report 46; (4) provide for explicit treatment of left and right organs within organ pairs; (5) provide for a systematic tabulation of electron absorbed fractions as a function of energy and subject age for all internal organs; and (6) provide for methods of deriving patient-specific values of the specific absorbed fraction for both electrons and photons through interpolation/extrapolation of their phantom-derived values. While tomographic computational phantoms provide improved anatomic realism given the CT or MR image sets used in their construction, there does not yet exist a comprehensive series of reference pediatric tomographic phantoms, nor the ability to simulate very fine anatomic structures as can be modeled via mathematical approximation. Consequently, stylized pediatric phantoms will continue to fill this data need in medical dosimetry.