Earticle

The purpose of this study were to identify effects of intermittent positive pressure breathing (IPPB) on pulmonary function and to confirm effects by grades of American Spinal Injury Association (ASIA) in people with cervical spinal cord injury and more than 3 months after onset. 162 patients with cervical spinal cord injury participated and received the IPPB during 15 minutes a day for 2 months. Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were measured by using spirometerbefore and after the IPPB. The results were that %predicted FVC was significantly different between pretest and posttest (p<.05). However, %predicted FVC was not significantly different pretest and posttest IPPB (p>.05). FEV1 was significantly improved in patients with ASIA D grade than other ASIA grades (p<.05). This findings suggest that the IPPB may improve pulmonary function in chronic patient with cervical spinal cord injury.

The aim of this study was to determine the effect of application of action observation physical training on sit to stand and balance in people with chronic stroke. 19 subjects who are suffering from chronic stroke were randomly assigned to either the experimental group(EG)(n1=10) that was performed physical training plus action observation, or the control group(CG)(n2=9) that was carried out only physical training. The intervention was implemented for 30 minutes, 5 times a week for 3 weeks(total 15 sessions). Action observation training for the subjects from the EG was conducted by watching a video tape recorded previously with consisting of 4 tasks reaching and grasping target object in sitting and standing positions,and then the physical training was practiced. The subjects from the CG practiced the physical training in similar pattern with that of the EG. For the measurement of clinical function of the subjects, sit-to-stand(STS) test, timed up and go(TUG) test, and static balance were executed before and after the interventions. In the groups, the STS time and static balance score were significantly improved after the intervention(p<.05); however, there were no significant differences between the groups(p>.05). In the TUG test, the EG showed a significant improvement after the intervention(p<.05), but not for the CG(p>.05). Further, there was a significant difference in the TUG scores between two groups(p<.05). These findings suggest that the action observation training may be beneficial to enhance the physical training of patients with chronic stroke.

The purpose of this study is to identify the effects of a whole-body tilt exercise with mental practice for treating hemispatial neglect. We used a single-subject experimental design alternating with multiple baselines. Three stroke patients with hemispatial neglect participated in this study. The severity of hemispatial neglect and balance ability were measured during baseline and intervention sessions. The whole-body tilt exercise was performed by using a device that allows the body to tilt 20° from the neutral upright position. Mental practice consisted of 5 min of relaxation, main whole-body tilt imagination, and normalization phases. The results were assessed by using the line bisection test, modified Barthel index(MBI), which were separately implemented. For subjects 1, 2, and 3, the repective average hemispatial neglect score decreased by 9.4, 16.2 and 13.8 mm after the whole-body tilt exercise with mental practice; their average MBI increased by 55, 48 and 15 points, respectively. When Subjects performed the whole-body tilt exercise with mental practice, they exhibited greater improvements in the severity of hemispatial and MBI. These findings suggest that a whole-body tilt exercise alone alleviates hemispatial neglect symptoms but the addition of mental practice is even more beneficial.

The purpose of this study was to identify the effects of ways of treadmill training on balance and walking ability of patients with chronic stroke. A total of 16 subjects were selected for this study and they were divided into two different groups; 8 subjects were included in fast speed treadmill gait training and the other 8 subjects were included in comfortable speed treadmill gait training. Each group performed for 25-min, twice per day for 4 weeks. Assessment tools were made with 10m walk test, 6-min walk test, community walk test, timed up and go test, Berg balance scale, and activities-specific balance confidence scale before and after the training. In comparison of pretest and posttest, 10m walk test, 6-min walk test, timed up and go test and Berg balance scale showed statistically significant increase after the training in every group(p<.05). Especially, improvement rate of 10m walk test, 6-min walk test and community walk test showed statistically significant increase more in fast speed treadmill gait training group than in treadmill gait training group with comfortable speed(p<.05). These findings suggest that the treadmill walking training with fast speed may be much more effective in improving walking ability for patients with chronic stroke. Further studies will be continued in this field.

This study was conducted to examine the correlations between the cognitive function, balance and gaits in patients with chronic stroke. This subjects of the study were 37 chronic stroke patients. The Mini Mental State Examination-Korean version and Lowenstein Occupational Therapy Cognitive Assessment(LOTCA) were used to assess cognitive levels, and the Berg balance scale and timed up and go test were used to assess the balance ability and gait function respectively. Pearson correlation coefficients were used to analyze the correlations between the foregoing factors. The cognitive levels and balance showed significantly high correlations(p<.05), and the orientation and visual perception among the sub-items of the LOTCA showed significantly high correlations(p<.05). In addition, the cognitive levels and gaits showed significantly high correlations(p<.05), and the orientation, visual perception, motor praxis, visuomotor organization and thinking operation among the sub-items of the LOTCA showed significantly high correlations(p<.05). These results mean that the cognitive levels of stroke patients are highly correlated with their balance and gait functions, and that each sub-item reflecting a variety of cognitive function of patients with chronic stroke may have significant relationship with with balance and gait. These may be utilized as beneficial information for stroke rehabilitation.

This study aimed to investigate the effect of shoes heel height on the EMG activities of lower limb muscles. Twenty young healthy females volunteered to participate in this study. To measure the EMG activities of the quadricep, hamstring, medial gastrocnemius and tibialis anterior muscles, the subjects were asked to stand wearing harness, assuring the safety during unexpected body perturbation. The perturbation was made by using a wing pendulum ball, which produces anterior displacement of the subjects’ head, neck, and trunk as it gently pushed the upper back(T10 level) without provoking a stepping response. Shoe heel height was established under 3 conditions: barefoot, 4㎝, and 10㎝ heels. The EMG activities of the selected muscles was normalized to maximum voluntary isometric contraction(MVIC). One-way repeated ANOVA with post-hoc Bonferroni's correction was used to compare the EMG activities according to shoes heel height. The collected data were statistically analyzed with SPSS 12.0. During the ankle strategy, the EMG activity of the quadriceps, hamstring, medial gastrocnemius, and tibialis anterior muscles were significantly augmented with increasing heel height(p<.05). The findings indicate that high-heeled shoes may have disadvantages in maintaining the balance function because of the extra muscular efforts in the lower extremities. This study provides useful information of future studies how heel height affects muscle activity around the lower extremities.

It has generally been accepted that the recovery of independent walking in the community have been recognized as one of the important goals in stroke rehabilitation. Previous reports to improving waking skill after stroke have concentrated on the outcome of ambulation training with a variety of tasks in changing uncontrolled environments of community. The current study was designed to evaluation the effect of community ambulation training on walking skill of patients with post-stroke hemiparesis. Twenty eight patients were randomly allocated to the experimental group(EG) or the control group(CG), with 15 and 13 subjects, respectively. All patients underwent routine physical therapy. In addition, the EG performed community ambulation training in for an hour, 3 times a week for a 4 weeks. Outcome measures were assessed by using 10m walk test(10MWT), community walk test(CWT), modified Barthel index(MBI) and berg balance scale(BBS) before and after the training. In the EG, significant improvement in the change values of the 10MWT (40.87±ﾝ26.67 m/s versus 11.19±22.39 m/s), CWT (28.98±-13.49 min 4.20±Q15.10), MBI (4.45±t5.01 versus 1.35±�2.15) and BBS (1.35±ｻ2.15 versus 5.14±ﾝ6.48) was observed than in the CG (p<.05). In comparison of comparing pre- and post-test score, there were significant differences for all variables in the EG(p<.05), whereas in the CG, significant differences showed in only MBI and BBS. These results suggest that the ambulation training can be provide additional effect when integrated ambulation training into a complex and changing environment patients with post-stroke hemiparesis and may be used as one of adjunct of therapeutic approachs for returning to community life.

The purpose of this study was to identify the effect of submerged treadmill gait training on gait and static balance of people with hemiparesis. Thirteen patients with hemiparesis were randomly assigned to either the experimental group(EG) that performed a submerged treadmill training, or control group(CG) that carried out a general treadmill training, with 7 and 6 subjects respectively. The treadmill training of the two groups was conducted for 30 minutes. Gait and balance function of the subjects were assessed by a 10-m walk test(10MWT) test and a timed up and go(TUG) test, and balance measurement system before and after the intervention period. Gait function(10MWT and TUG) of th EG was significantly improved after the intervention(p<.05), but not for the CG(p>.05). Significant difference did not appear in static balance scores between the groups (p>.05). These findings suggest that the use of an submerged treadmill training may be beneficial in improving gait function of people with hemiparesis. Thus, the submerged treadmill training may be clinically used as an adjunct for gait training of people with hemiparesis.

The purpose of this study is to investigate the effect of task-oriented voluntary trunk rotation among stroke patients with unilateral neglect; the focus was to detect any reduction of unilateral neglect or increase in balancing ability. This study used a single subject experimental design with multiple baselines. Participant 1, 2 and 3 performed 4, 8 and 12 sessions each during the baseline phase, and 16, 12 and 8 sessions at the intervention, respectively. The results were assessed by using the line bisection test, Berg Balance Scale(BBS), which were separately implemented. The Line bisection scores of participant 1, 2 and 3 were improved by 38.9%, 44% and 35.9%, trunk rotation in task-oriented voluntary trunk rotation. The BBS scores of participant 1, 2 and 3 were improved by 39.6%, 31.6% and 7.7% each, compared to the baseline. The findings suggest that task-oriented voluntary trunk rotation is adaptable to clinical applications to reduce unilateral neglect and to enhance balancing ability to the target patients. Future studies with wider range of participants and longer experiment span, are required in order to strengthen the result of the research.