Earticle

Purpose: The purpose of this study was to share an experience about processes and lessons learned to execute evidence-based practice (EBP) in neurological physical therapy. Methods: The most important thing in applying EBP to practice is to search, find, and appraise the existing evidence. Many evidence databases are available, such as CENTRAL, PEDro, PUBMED, and EMBASE. However, the knowledge represented in these databases is not always perfect. The practice model is a set of processes to resolve client problems. Therapists should make hypothesis-focused decisions through EBP. Integrating clinical reasoning and evidence is most important when it comes to the execution of EBP. Results: The process of EBP consisted of following: coming up with clinical questions, followed by searching for, appraising, evaluating, and integrating evidence. To integrate EBP into practice, it is necessary to consider clinical expertise, patient value and preferences, as well as research wth the best evidence. We provided an example of a clinical case with a stroke patient to show how this process and framework concerning clinical reasoning through evidences can be integrateds. During this process, we also utilized information technology to improve EBP ability. Conclusion: We should recognize what manner of information is needed to resolve eash patient’s problem, and we should search for this information efficiently. Then, we should judge the value of the information obtained as it applies, to the clinical setting.

Purpose: The purpose of this study was to investigate the effects of neck patterns in proprioceptive neuromuscular facilitation (PNF) for neck movement and the neck disability index (NDI)　among adults with forward head posture. Methods: Thirty-nine subjects were randomly assigned into two groups. Subjects in the proprioceptive neuromuscular facilitation exercise group (PNFG, n = 20) received 20 minutes of PNF neck pattern (flexion-Rt. lateral flexion-Rt. rotation followed by extension-Lt. lateral flexion-Lt. rotation) 3 times weekly for 4 weeks. Outcomes were measured using absolute rotation angle (ARA), anterior weight bearing (AWB), range of flexion and extension motions (RFEM), and neck disability index (NDI) methods before and after the 4-week intervention period. Results: There were significant effects for the PNFG, pre- and post-intervention, in ARA, AWB, RFEM, and NDI. There were significant differences in ARA, AWB, RFEM, and NDI compared with CG. Conclusion: The results of this study suggest the PNF neck pattern could be beneficial for adults with forward head posture.

Purpose: This study investigates how abdominal muscular exercise based on proprioceptive neuromuscular facilitation (PNF) can affect chronic low back pain patients in terms of their pulmonary function, pain, and functional disability indexes. Methods: Fourteen target subjects with chronic low back were randomly assigned to the control group (n = 7) that performed abdominal muscle exercises and the experimental group (n = 7) that performed PNF abdominal muscular exercises. The exercises were performed five times a week for six weeks. To check the change in pulmonary function, the forced expiratory volume at one second (FEV1) and visible analogue scale (VAS) were measured to check the pain level. The disability level caused by back pain was measured by the Oswestry Disability Index (ODI). A paired t-test was applied to compare the differences between the groups before and after the intervention, and an independent t-test was used to compare the differences between the groups. The level of statistical significance was set as α = 0.05. Results: Before and after the intervention, the experimental group showed a significant change in FEV1 (p < 0.01), and both the experimental and the control groups showed significant changes in VAS and ODI (p < 0.01). A comparison of the differences between the groups indicated that the experimental group showed more significant changes in FEV1 (p < 0.05). Conclusion: According to the study results, PNF abdominal muscular exercise effectively improved pulmonary function, pain, and functional disability indexes in subjects with chronic back pain. The proposed program can be applied to chronic back pain patients as a useful therapy.

Purpose: This study investigates the influence of applying proprioceptive neuromuscular facilitation (PNF) leg patterns on the activation of three types of mesogluteal fibers at the opposite side. Methods: The target subjects of this study were 19 healthy men who voluntarily agreed to participate in the program. For all subjects, the following four PNF leg patterns were applied while they were in a standing position, and then, the activation of the gluteus medius at the opposite side was measured: (1) flexion abduction internal rotation pattern, (2) flexion adduction external rotation pattern, (3) extension abduction internal rotation pattern, and (4) extension adduction external rotation pattern. In each position, a pattern was executed three times in 5 s, and the average of each measurement was used for the statistics. Results: Among the PNF leg patterns, the activation of the mesogluteal fibers at the opposite side was most significant under the application of the extension abduction internal rotation pattern. The activation of the back muscular fiber was significantly high under the application of the flexion abduction internal rotation pattern. Conclusion: Selective application of PNF leg patterns can improve the functional activity of each mesogluteal fiber.

Purpose: This study seeks to examine the effect of a program with functional taping and CLT on the program on fall efficacy and balance of stroke patients with knee pain on the non-affected side, as well as to develop effective programs and training methods to improve the functions of such patients. Methods: The subjects included 31 patients with hemiplegia caused by stroke. The subjects were randomly divided into an experimental group (n = 15), which participated in a program for functional taping and CLT, and a control group (n = 16), which participated in general exercise therapy. The control group underwent general exercise therapy for 30 minutes, three days per week for a six-week period. VAS, FES and TUG were conducted to evaluate changes in pain degree, fall efficacy, and balance. Results: After the intervention, significant differences (p < 0.05) were seen in the VAS, FES and TUG in both groups. The experimental group showed more significant improvement than the control group (p < 0.05). Conclusion: The results from this study indicate that the CLT program is extremely effective for improving fall efficacy and balance.

Purpose: Treatments using a mirror neuron system, such as 3D virtual reality therapy, are used in stroke rehabilitation, but they need to be constructed according to a detailed procedure. The aims of this study were to analyze electroencephalograms (EEG) during relaxation and action while observing first person perspective (1AE) and third person perspective (3AE) videos of the right hand for 20’s. Methods: Thirty participants (Male=4, Female=26) were recruited for this study. Participants were selected by a vividness of movement imagery questionnaire (VMIQ). EEG was measured during relaxxation and during action with 1AE and 3AE videos, focusing on the supination and pronation actions of participants’ right hands. An absolute mu rhythm, a relatively high alpha power, and a relative beta power were identified. In each group, one-way repeated measures ANOVA was used for statistical analysis. Results: Measurement of absolute mu rhythms was significantly suppressed for both 1AE and 3AE compared with relaxation in C3 and C4 regions. High alpha wave measurements were significantly suppressed for both 1AE and 3AE in all regions, while beta wave measurements were significantly increased only for 3AE in F3 and F4 regions. Conclusion: Based on this study, we suggest that the mirror neuron system is activated during actions accompanied by action observation, especially actions with 3AE video observation, which can be a great therapeutic mathod in stroke rehabilitation.

Purpose: Patients with Parkinson’s disease suffer many restrictions in daily life. This case report investigated how intervention with proprioceptive neuromuscular facilitation (PNF)-based physical therapy can affect the activities of Parkinson’s patients. Methods: The subject was a 67-year-old female patient diagnosed with Parkinson’s disease 3 years ago. Since the last five months, overall activities have become difficult for her, and she finally visited a hospital to take outpatient physical therapy because of the gait difficulties she suffered. The patient’s medical history, system review, body structure and function, and activities were evaluated. The patient had difficulties in activities such as lying down, sitting, standing, maintaining a standing position, and walking. The PNF-based intervention was used for treating the impairments and improving the activities. The intervention was performed for 30 min a day, three times a week, for eight weeks. The qualifier of the international classification of functioning, disability, and health was used to measure the result, and the measurement was conducted before and after the intervention for eight weeks. Results: According to the result, the scores for maintaining a standing position, moving around within the home, and going to the toilet improved to “no problem” from “moderate problem.” The scores for shifting the body’s center of gravity, walking short distances, and washing oneself improved from “moderate problem” to “mild problem.” The scores for sitting and standing improved to “no problem” and “mild problem” from “complete problem.” The scores for preparing meals and doing housework improved from “severe problems” to “mild problem” or “moderate problem.” The scores for walking long distances, moving around outside the home and other buildings, and using transportation did not show significant changes. Conclusion: Intervention with PNF-based physical therapy improved the activity of patients with Parkinson’s disease, thus proving its effectiveness. The case report suggested that a therapist can use PNF as a physical therapy intervention for patients with Parkinson’s who suffered restrictions in daily activities.

Purpose: The purpose of this study was to compare cerebral motor area activation between the diagonal and straight movements of the lower extremity. Methods: The subjects of this study consisted of two right-handed adults. Functional magnetic resonance imaging was conducted to measure brain activation following the diagonal and straight movements of the lower extremity. The primary motor area, premotor area, and supplementary motor area, which are closely related to exercise, were set as the regions of interest. Results: The brain activation by diagonal movement was an average of 1036 ± 75 voxel, and brain activation by straight exercise was an average of 773 ± 55 voxel. Conclusion: Based on these results, we conclude that the activation of the cerebral motor area is more effective for diagonal movements than for straight movements.

Purpose: This case report examines the influence of proprioceptive neuromuscular facilitation (PNF) combined with a dynamic neuromuscular stabilization approach on balance in patients with cerebellar atrophy. Methods: The target subject of this case report was a 34-year-old woman who was informed of the purpose of this research and voluntarily agreed to participate in it. The case report conformed to research ethics based on the Helsinki Declaration. The target subject was confirmed to have cerebellar atrophy from an unknown cause in 2009 and was diagnosed with slight ataxia. At that time, she could carry out daily activities without physical therapy. On May 19, 2015, she suffered both a subdural hemorrhage (SDH) and subarachnoid hemorrhage (SAH) in a traffic accident. She was urgently moved to the emergency room and managed by nonsurgical treatment, and then, the cerebellar atrophy and ataxia gradually deteriorated. To evaluate the patient’s balance capacity before and after intervention, the trunk impairment scale (TIS), trunk impairment scale (OLST) during eye-closing/opening, timed up and go test (TUG), and visual analogue scale (VAS) were conducted. The PNF intervention program was executed for 30 min, four times a week, for three weeks. Results: The TIS and OLST during eye-closing/opening were improved by as much as a point, by 8.15 s and 6.21 s, respectively, after applying the PNF program. TUG and VAS decreased by 1.33 s and 3 points, respectively, after intervention. According to the result, the OLST during eye-closing/opening and VAS improved remarkably in comparison with those before intervention. Conclusion: As the final result of the case report, PNF intervention combined with DNSA more effectively improved the static balance capacity, such as the OLST during eye-closing/opening and VAS, compared to the dynamic balance capacity. In addition, the intervention duration and period of the exercise program are recommended to be more than 1 h a day for four weeks considering the learning ability of a patient with cerebellar atrophy.

Purpose: This study investigates the influence of elastic resistance exercise using proprioceptive neuromuscular facilitation (PNF) on the daily activities of a patient with incomplete spinal cord injury. The result will be proposed as background data for effective intervention in a patient with incomplete spinal cord injury. Methods: The target subject was a patient with incomplete spinal cord injury to the cervical cord (C6). Elastic resistance exercise based on PNF was performed for 30 min daily, five times a week, for eight weeks. The ASIS motor scale was applied to test the muscular strength of the upper limb, and the spinal cord independence measure Ⅱ (SCIMⅡ) was used to evaluate the capacity of daily activity. Results: By applying elastic resistance exercise based on PNF, the muscular strength of the upper limb increased and the performance of daily activity improved. Conclusion: Because elastic resistance exercise based on PNF positively influences the ASIA motor scale and SCIMⅡ of the patient with incomplete spinal cord injury. It can be used for training programs to improve the capacity of daily activity of the patient.