Earticle

After stroke, walking recovery is considered one of fundamental goals to achieve functional gains, requiring enhanced balance capability. In such reason, clinicians have been focusing on planning and execution of a variety of therapeutic approaches with structured movement strategies depending on the functional level of patients who are suffering from chronic stroke. This study aimed to identify the efficacy of controlled strep training in a patient with chronic stroke. In this study, main intervention, controlled step training, consisted of facilitation exercise and step-controlled training, which focuses on stabilization of lumbopelvic region and lower limb on affected side, and weight-bearing and shifting in controlled manner. Controlled step training was performed for 30 min, three times weekly for 3 weeks (a total of 9 sessions). Outcome measures included a 5 times sit-to-stand test, timed up-and-go test, Berg balance scale, and 10-m walk test. After the intervention, all parameters were improved by a range of 1.52% to 16.41%. These results suggest that controlled step training is probably helpful to enhance walking and balance functions after stroke. Further studies will be continued to warrant out findings.

The purpose of this study was to investigate effects of group exercise training on skeletal muscle mass, glucose, blood pressure, vital capacity, and functional performance of lower extremity in frail elderly. 35 subjects (3 males, 32 females) were participated in this study. Exercise program consisted of breathing, strengthening, postural correction, and aerobic training was applied for 55-minutes/day, 1 day/week, 12 weeks. Design of this study was pre and post test. We measured body fat percentage, skeletal muscle mass, glucose level, systolic blood pressure, and forced vital capacity for body function. Sit to stand test and timed up and go test were performed for functional performance of lower extremity. There were significant differences in the skeletal muscle mass, glucose level, systolic blood pressure, forced vital capacity, numbers of sit to stand, and timed up and go test (p<.05). Thus it is suggested that group exercise program including breathing and aerobic training may paly a significant role in improving pulmonary function and functional performance of lower extremity in frail elderly.

The aim of this study was to investigate whether bridging exercise with visual feedback effects symmetric weight load and electromyographic (EMG) activity on the trunk and hip muscles between the dominant and non-dominant side. Forty-one healthy subjects volunteered for this study. Tensile force of left and right on the lower extremity and EMG activity of the erector spinae (ES), multifidus (MF), gluteus maximus (GM), and hamstring (H) muscles in the both side was recorded during the bridging exercise under the following 2 experimental conditions: non-visual feedback and with visual feedback. There were significantly decreased difference values of EMG activity on the ES, MF, GM and H muscles and difference tensile force value of between the both sides during bridging exercise with visual feedback than without visual feedback. And the MF/ES activity ratio was significantly increased during bridging exercise with visual feedback than without visual feedback. These findings suggest that the bridging exercise with visual feedback could be effective in facilitation of symmetric weight load and muscle activity on the trunk and hip,

In stroke rehabilitation, a final goal addresses the successful return to premorbid life and community re-integration, which includes functional recovery and active participation in everyday activities. Individuals with post-stroke hemiparesis have been characterized by sensory and motor paralysis, decreased strength and endurance, spasticity, loss of dexterity, and cognitive deficit. These factors contribute to producing a variety of functional problems in gross and fine motors. In particular, reduced standing balance and walking dysfunction are major components to hinder independence in daily life after stroke; therefore, the recovery of walking function is considered as ultimate goal in stroke rehabilitation. Based on neurophysiological knowledge, numerous traditional approaches such as neurodevelopmental treatment, proprioceptive neuromuscular facilitation, and Brunnstrom and Rood approaches have been commonly used to restore their function, providing theoretical conception and therapeutic procedures to manage stroke patients. Taken under research-based results, recent trends have proven clinical efficacy of task-oriented training, which demonstrates motor learning principles and its contributions in neurological rehabilitation. However, despite training effects, adding basic procedures including the correction of joint malalignment and restoration of kinetic linkage of the body did not have great interest as possible option for reinforcing functional gains in stroke. It requires the development of more organized therapeutic approach based on resolving leading causes to functional problems. Novel concept of ‘Neuromuscular Control and Reset (NCR)’ provides possible mechanism of problem-solving strategies for detecting neutral positions of misaligned joints and keeping them by resetting the ability of neuromuscular control, which facilitates optimal motor control patterns in safe and effective templates. It comprises specific processes to address the correction of pathological joint mechanics, recovery of movement mechanics, and improvement of functional activities. This study describes the theoretical background for applying the NCR concept to regain the level of functional performance of patients with post-stroke hemiparesis.

Stroke is characterized by various symptoms such as sensory-motor paralysis, spasticity, reduced muscular strength and endurance, and limited joint mobility on affected side, thereby leading to functional impairments. In stroke rehabilitation, the recovery of walking function is ultimate goal to re-integrate community life and facilitate active participation in daily activities. In general, most clinicians have adopted specific approaches to treat functional impairments caused by stroke in their own decision, which followed theoretical frameworks based on neurophysiological knowledge. However, researches failed to clarify therapeutic evidences on the clinical efficacies of traditional approaches. Taken with motor learning principles, task-oriented approach and functional training is more likely to facilitate functional recovery in patient-centered way following stroke. In most cases, musucloskeletal impairments such as misalignment of joint and muscle imbalance have been in little attention in stroke rehabilitation; however, specific solution for these problems needs to manage a variety of functional impairments and demonstrate improved effects of the training. Concept of ‘Neuromuscular Control and Reset (NCR)’ reflects this issue along with focusing on the benefits of functional training, and this introduces an combination of the advantages of ‘Top-down approach’ and ‘Bottom-up approach’. Algorithm of the NCR concept provides detailed procedure to help decision-making process of physical therapists, which includes four types of a reset: joint malalignment, muscle imbalance, and impaired joint stability and sensory-motor control. This study aimed to illustrate the therapeutic principles of the NCR concept and application method of algorithm offering the specific process of evaluation and treatment to enhance the walking function of patietns with post-stroke hemiparesis.

Purpose: The purpose of this study is an investigation of the changes in static balance and gait parameters after treadmill walking with using a smartphone in various head positions. Methods: The subjects of this study were 20 healthy college students (7 male, 13 female). Subject walked in treadmill at the speed of 2km/h for 3 minutes without using smartphone and with both hands using smartphone in straight ahead and down head. During the task, static balance and gait parameters were collected. A one-way repeated analysis of variance with the level of a significant level of .05 was used. And Bonferroni correction (α=.05/3=.0017) executed to evaluate the significance of between-exercise pairwise comparisons. Results: Our result presented that center of gravity way velocity sway velocity and total sway distance with the eyes closed on the unstable sponge surface, ware significantly greater in walking without using a smartphone condition than head straight ahead. There were no significant differences in gait parameter. Conclusion: Walking with straight ahead would enhance the equilibrium information and cause a positive effect on static balance only

This paper aimed to investigate the effects of balance training on a balance ball on balance functions in patients with subacute stroke. Ninety patients with subacute stroke were randomly assigned to either ankle plantar flexion exercise on the balance ball (PFBG) (EG-1: n1=30) and ankle plantar flexion exercise on the ground (PFGG)(EG-2: n2=30), or the control group (CG, n3=30). All participants underwent general rehabilitation trainings in daily routine schedule. In addition, the EG-1 and –2 performed the PFBG and PFGG five times a week for 2 weeks (a total of ten sessions) respectively. However, the CG didn’t receive any treatments for improving balance function except the routine exercise. A tool to measurebalance function was a functional reach test (FRT). Subjects of the EG-1 and –2 showed significantly greater post-test values compared to pre-test values in the FRT score (p<.05). Furthermore, change between pre- and post-test values was significantly greater for the EG-1 and EG-2 than the CG, with more favorable change for the EG-1 compared to the EG-2 (p<.05). This finding suggests that balance training used calf muscle strengthening using a balance ball is probably helpful to improve balance function in patients with subacute stroke. Further studies will be needed to assure the generality of this study.