Earticle

Purpose: Myofascial release (MFR) is an effective treatment for improving muscle stiffness and balance in neurological patients. This study examined long-term effects of MFR on the balance ability of stroke patients. Methods: MFR using a tennis ball was applied to the lower extremity and sacroiliac joint of the affected side of four stroke patients. The four subjects performed the Berg balance scale (BBS) and Timed up and go (TUG) test at the beginning of an 8-week intervention, directly after the intervention, and 2 years later. Results: The BBS scores indicated a trend toward maintenance of balance (p=0.05), but there was no difference in the TUG time (p=0.47). Conclusion: MFR may be a clinically meaningful intervention to maintain balance in stroke patients over a long period. However, the sample size in this study was too small to draw general conclusions. A larger study with more participants is needed.

Purpose: The aim of this study was to investigate the effects of coordinative locomotor training in a chronic stroke patient. Methods: A left hemiplegic patient diagnosed with a right middle cerebral artery stroke participated in this research. The patient’s functional conditions were assessed, and a coordinative locomotor training program was initiated to resolve the problems identified. A set of movements deemed difficult based on the brief International Classification of Functioning, Disability and Health core set for stroke and d4501 (long-distance walking) were agreed as improvement targets. The program comprised warm up, main, cool-down, and home exercises. Repeated measurements were obtained, as follows: five times at baseline (A), 10 times during the intervention (B), and five times after the intervention (A). The study period was 7 weeks, and the intervention period was 1 h per day, twice a week for 5 weeks. Various tools, including the community walking test (CWT), 10-m walking test (10 MWT), 6-min walking test (6 MWT), and timed up and go (TUG) test, were conducted to assess the patient’s walking ability. Changes in functional domains before and after the ICF Qualifier were compared. The mean values of the descriptive statistics were calculated, and a visual analysis using graphs was used to compare the rates of change. Results: The results showed that the CWT, 10 MWT, 6 MWT, and TUG test scores during the intervention period improved and that this improvement remained, even during the baseline period. In addition, the ICF Qualifier before and after the comparison decreased from moderate to mild. Conclusion: Based on the results, we propose that coordinative locomotor training can have positive effects on community ambulation of chronic stroke patients.

Purpose: The purpose of this study was to investigate changes in urinary frequency, residual urine volume, and quality of life following pelvic floor exercises using proprioceptive neuromuscular facilitation (PNF) exercise patterns and EMG biofeedback training in patients with stress urinary incontinence. Methods: The subjects were male patients diagnosed with stress urinary incontinence. This study used a single system design (A-B-C.) At baseline, the patients’ symptoms prior to the treatment intervention were recorded (A section). Next, the patients performed the PNF exercise (B section). Thereafter, they performed the PNF exercise, with EMG biofeedback (C section). The subjects performed the exercises in each section for 1 week for a total of 3 weeks. Urinary frequency, residual urine volume, and quality of life of the subjects were measured. Results: The frequency of urination was 9 times in A, 8 times in A ‘and B, and 7 times in C. The amount of residual urine decreased from 23.78ml in A to 21.85ml in A ‘, 14.85ml in B, and 14.63ml in C. The international prostate symptom score was 16 points in A, 14 points in A ‘, 11 points in B, and 7 points at A. The quality of life score was 4 points in A, 4 points in A ‘, 3 points in B, and 2 points in A. Conclusion: Both the PNF exercise and EMG biofeedback decreased urination frequency and residual urine volume and improved the quality of life of patients with stress urinary incontinence. EMG biofeedback training using the PNF technique was the most effective.

Purpose: This study examined changes in gait speed and stride length after an intervention involving simultaneous scapular and pelvic patterns of proprioceptive neuromuscular facilitation in a hemiplegic patient. Methods: A 58-year-old woman with left hemiplegia who had complained of slowness of gait speed and weakness of leg strength took part in an intervention involving scapular postdepression patterns on the affected side and pelvic postdepression patterns on the nonaffected side. The intervention was performed with the patient lying on her left side, in a half kneeling position, and in a standing posture. Rhythmic initiation was used for teaching the movements to the patient and improvement of kinesthesia, and a combination of isotonic was employed for increasing strength and irradiation of the scapula and pelvic movement. The intervention took place for 30 min. It was implemented twice a day, 5 days a week, for 3 weeks. After three repetitions, the average time taken to complete the 10-m walk test (10 MWT), in addition to stride length, was measured to determine gait speed. Results: After the 3-week program, the patient’s performance in the 10 MWT improved from 21.7sec to 17.1sec, and her stride length improved from 31.4cm to 38.7cm. Conclusion: The results showed that trunk movement exercise, especially coordinative movements of the scapula and pelvis can improve gait speed and stride length by increasing trunk stability and mobility. A combination of pelvic and scapular patterns can facilitate trunk rotation, thereby improving gait speed and stride length.

Purpose: The aim of this study was to investigate the effects of trapezius and serratus anterior strengthening exercise on the shoulder pain and muscle activation of patients with spinal cord injury and functional shoulder impingement syndrome. Methods: The study consisted of 10 patients with spinal cord injury who were hospitalized in Rehabilitation Hospital U, Uijeongbu, South Korea. The exercise was implemented three times a week for 10 weeks. In each session, the subjects performed one of a total of five types of exercise at mid-level intensity. The shoulder pain and disability index (SPADI) was used to evaluate the patients before and after the intervention. The muscle activation of the upper trapezius, middle trapezius, lower trapezius, and anterior serratus muscle was assessed by surface electromyography (EMG) at the beginning of the experiment and 10 weeks later. Wilcoxon’s singed-rank test was conducted to determine differences in the pain index and muscle activation before and after the exercise. The level of statistical significance was set at α=0.05. Results: SPADI scores significantly decreased after the exercise (p<0.05). In comparisons of muscle activation, there was a significant improvement in the upper trapezius at 60° shoulder joint flexion (p<0.05). There was no significant improvement at 90° shoulder joint flexion. The middle trapezius showed a significant improvement at 120° shoulder joint flexion (p<0.05). Conclusion: Trapezius and serratus anterior strengthening exercise reduced pain in spinal cord injury patients with functional shoulder impingement syndrome. The decreased muscle activation of upper trapezius and increased muscle activation of the anterior serratus muscle at 60° shoulder joint flexion point to positive effects of the exercise on supraduction of the scapula.

Purpose: This study examined the effects of a shoulder-strengthening exercise on muscle strength of shoulder flexors and extensors of caregivers. Methods: The study consisted of 19 caregivers (2 males and 17 females) employed by Medical Center B. All the participants took part in an 8-week shoulder muscle strengthening exercise, based on previous studies. In the first week, the subjects took part in a stretching exercise enhance the range of motion. In the second week, they participated in an exercise aimed at improving shoulder blade stability. From the third to seventh weeks, a resistance exercise of different intensities was applied in a phased manner. Finally, in the eight week, the subjects took part in plyometric exercise. Peak torque, average power, and total work of shoulder flexors and extensors in both sides were measured before and after the exercise at an angular speed of 120deg/sec using an isokinetic device. Wilcoxon’s singed-ranks test was conducted to analyze differences in muscle strength before and after the intervention. Results: After the exercise, there was a significant improvement in peak torque and average power of flexors of the right arm. After the exercise, peak torque, total work, and average power showed a significant improvement in the flexors of the left arm (p<0.05). However, there was no statistically significant difference in extensor muscle strength in either arm after the exercise. Conclusion: Shoulder flexors of caregivers are utilized frequently in the workplace. Implementation of extensor-strengthening exercises, in addition to flexor-strengthening exercises, can contribute to reducing the incidence rate of shoulder injuries among caregivers.

Purpose: The aim of the present study was to investigate the effects of proprioceptive neuromuscular facilitation (PNF) and taping interventions on balance ability, joint position sense, and ankle joint strength. Methods: Thirty subjects who had experienced an ankle sprain within the previous 3 months participated in this study. The subjects were randomly assigned to a PNF group (n=15) or a taping group (n=15). Before and after the interventions, ankle dorsi-flexion and plantar-flexion strength, joint position error, and total center of pressure movements in one leg while in a standing position were measured. Results: Regardless of the group allocation, ankle dorsi-flexion and plantar-flexion strength significantly improved after the interventions (p<0.05). Compared to preintervention measurements, joint position errors were significantly reduced postintervention (p<0.05). The PNF intervention significantly decreased the total lateral movement of the center of pressure in the one leg standing condition (p<0.05). Conclusion: Both PNF and taping interventions improved joint position sense and ankle joint strength. In common with the findings of a previous study, the PNF intervention improved balance ability. Further study is required to investigate the effects of various PNF and taping interventions on ankle performance in subjects with chronic ankle sprains.

Purpose: This study aimed (1) to identify asymmetry observed in electromyography (EMG) activity patterns of lower limb muscles between affected and unaffected sides of stroke patients during sit to stand (STS) movement and (2) to identify the muscles of the paretic lower limb that affected STS performance in stroke patients. Methods: This study consisted of 27 patients (15 males and 12 females) with poststroke hemiparesis. The activation of the rectus femoris (RF), tibialis anterior (TA), and gastrocnemius (GCM) of the affected side and unaffected side during STS movement were recorded using surface EMG. In addition, EMG lower limb muscle activation patterns were measured in the all section, pre-thigh off (pre-TO), and post-thigh off (post-TO) section. All measurements were obtained during five repetitions of the STS (FTSTS) movement. An independent t-test was performed to compare the affected side and unaffected side of the lower limb during the STS movement. A stepwise linear regression analysis was conducted to identify the muscles that affected STS performance. Results: Activation of both the RF and TA significantly affected the lower limb during the STS movement (p<0.05). Two muscles showed a difference on the post-TO section. The results of the stepwise multiple regression analysis showed that the RF and TA muscles of the affected lower limb were affected in FTSTS. Conclusion: These results provide a basis for reinforcement training, focusing on the RF and TA muscles of the affected side of stroke patients to improve asymmetric movement and performance in STS movement.

Purpose: Smartphones, which are widely used worldwide to detect acceleration and position, have been used in the area of rehabilitation medicine in recent clinical research studies and tests. The aim of the present study was to determine the feasibility of using a smartphone application based on center of movement (COM) displacement to measure gait parameters in stroke patients in the clinical field of rehabilitation medicine. Methods: The study consisted of 30 stroke patients. The COM was measured using a smartphone application, Gait Analysis Pro, during a 6-m walk. Each patient performed three 6-m walking trials, and the smartphone application measured gait duration, gait speed, step length, cadence, and vertical and lateral displacement of the COM. The Kolmogorov–Smirnov test was conducted to determine the normality in gait parameters, and a repeated one-way analysis of variance (ANOVA) was performed to determine the consistency among the three trials. A p value of 0.05 was considered statistically significant in all the tests. Results: In all the measured parameters, the smartphone application showed a normal distribution, as shown by the results of the Kolmogorov–Smirnov test. There were no significant differences among the three repetitive walking trials. Conclusion: These results suggest that the smartphone application can be used for evaluating gait in stroke patients, as well as in healthy adults. However, prior to using the smartphone application in the clinical field, further research involving three-dimensional gait analysis is needed to enhance the confidence level of the findings.

Purpose: This study investigated the effects of proprioceptive neuromuscular facilitation (PNF) exercise on the range of motion (ROM), pain, and functional activity of patients who received total knee arthroplasty (TKA). The purpose of this study was to provide fundamental data regarding the use of PNF exercise among patients with musculoskeletal disease. Methods: Fourteen patients who received TKA were randomly divided into an experimental group (n=7) that took part in PNF exercise and a control group (n=7) that performed general rehabilitation exercise. Both groups performed the respective exercises for 30 minutes, five times a week for 2 weeks. For the measurement of ROM, the range of knee flexion was measured using a clinometer smartphone application. A visual analogue scale (VAS) was used for the measurement of the level of pain. The timed up and go test (TUG) was conducted to measure functional activity. A paired t-test was performed to compare within-group changes before and after the PNF exercise. Differences between the experimental group and control group were analyzed by an independent t-test. For all tests, the level of statistical significance was set at α=0.05. Results: After the exercise, there was a significant within-group change in VAS and TUG scores in the experimental group and control group (p<0.01). There was also a significant between-group difference in VAS and TUG scores after the intervention (p<0.05). Conclusion: General rehabilitation exercise is commonly applied as a treatment for TKA patients and is relatively effective. The application of PNF exercise may be useful in such patients, considering its effects on ROM improvement, pain reduction, and functional enhancement.

Purpose: We sought to examine whether using the rhythmic stabilization (RS) technique before proprioceptive neuromuscular facilitation (PNF) wrist taping affected pain and grip strength in patients with wrist pain to provide a basis for the application of PNF taping. Methods: The study consisted of 41 badminton enthusiasts (aged 20–40 years) who reported discomfort and pain due to overuse of their wrists. The subjects were randomly assigned to an experimental group (n=20) or a control group (n=21). In the experimental group, PNF wrist taping was applied after application of the PNF RS technique, and PNF wrist taping was applied after stretching in the control group. The tape was applied five times a week for 3 weeks. Pain was measured using the visual analog scale (VAS). Grip strength was measured using a dynamometer. The paired t-test was performed to compare grip strength and pain within the groups before and after the intervention. Covariance analysis was conducted to compare differences between the experimental group and control group. The level of significance was set as α=0.05. Results: Within-group changes in grip strength and VAS were significantly different in the control group and experimental group (p<0.01). Grip strength and VAS showed more improvement in the experimental group than in the control group (p<0.01). Conclusion: PNF wrist taping after stretching and the PNF RS technique both significantly reduced pain and improved grip strength in club badminton players with wrist pain. These improvements were significantly greater in the experimental group in which the PNF RS technique was applied. The results suggest that PNF may be considered useful to improve grip strength and reduce wrist pain.

Purpose: The aim of this study was to investigate the effect of goal-oriented side walking training on balance and gait in chronic stroke patients. Methods: This study involved 18 chronic stroke patients who were divided into an experimental group (n=9) and a control group (n=9). The experimental group performed goal-oriented side walking training, and the control group performed general side walking training. The walking variables assessed were walking speed, stride length, and 10-m walking time. The balance variables assessed were foot pressure, timed up and go test (TUG), and Berg balance scale (BBS). These variables were measured before and after the exercise. Wilcoxon’s signed-rank test was used to compare the participants’ performances before and after the intervention in both groups. The Mann–Whitney U test was conducted for between-group comparisons after the intervention. Statistical significance was set at α=0.05 Results: Walking speed, stride length, 10-m walking time, TUG, and foot pressure were significantly improved in both groups after the exercise (p<0.05). The between-group comparison showed a significant improvement in the goal-oriented side walking group (p<0.05). However, there were no significant between-group differences in 10-m walking times (p>0.05) and BBS (p=0.05). Conclusion: The results revealed that goal-oriented side walking training was effective in improving the balancing and walking ability of chronic stroke patients.

Purpose: The aim of this study was to explore the effects of dynamic balance training on pain, physical function, and dynamic balance in individuals with knee osteoarthritis. Methods: Fourteen patients with knee osteoarthritis participated in this study. The patients were randomly assigned to two groups: an experimental group (n=7) or a control group (n=7). All the patients took part in a lower extremity strength program for 30 min. In addition, the experimental group participated in a 30-min dynamic balance program. Both groups performed the program five times a week for 3 weeks. Outcomes, including the numeric rating scale (NRS), Western Ontario and MacMaster Universities Arthritis Index (WOMAC), and Community Balance and Mobility Scale (CB&M), were measured at baseline and after 3 weeks. Results: Both groups showed pre-to-post intervention improvements on all outcome measures (p<0.05). The experimental group showed a significant improvement in WOMAC (p = 0.00; Z = -2.82) and CB&M (p = 0.03; Z = -2.20) scores after the intervention as compared with those of the control group. Conclusion: The results revealed that dynamic balance training improved physical function, as well as balance ability, in patients with knee osteoarthritis as compared with that of a control group with no balance training.

Purpose: The aim of this study was to investigate the effect of mandible position on proprioception and range of motion (ROM) during neck stabilization exercise using a sling in healthy adults. Methods: The subjects were randomly assigned to either a sling exercise and mandible open group (n=10) or a sling exercise and mandible closed group (n=12). The sling exercise-mandible open group and sling exercise- mandible closed group took part in an exercise program for 30min, three times per week for 4 weeks. After each training session, head repositioning accuracy (HRA) and the ROM of the cervical spine were measured. Wilcoxon’s test was conducted to verify changes within each group, and the Mann–Whitney U test was performed to examine between-group differences. Results: The HRA of the cervical spine was significantly increased during left rotation and extension in the sling exercise-mandible open group. In addition, there were significant differences in both rotations and extension in the two groups. The ROM of the cervical spine increased significantly during both rotations in the sling exercise-mandible closed group. In addition, there was a significant difference in right rotation and extension in both groups. Conclusion: Cervical stabilization exercise using a sling, with the mandible closed increased proprioception and the ROM of the cervical spine.

Purpose: The aim of this study was to investigate the isolated activation ratio of the quadriceps femoris muscle on different support surfaces during squat exercise. Methods: Twenty participants (10 males and 10 females) voluntarily agreed to participate in the research after receiving an explanation about the purpose and process of the study. Each participant performed squat exercises on three different support surfaces (a flat surface, a form roller, and an unstable surface). Muscle activities of the rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were measured by electromyography. The isolated activation ratio of the quadriceps femoris muscle was calculated using the %isolation formula. Results: For the squat exercise, the %isolation value of the VM was significantly higher on the unstable surface than on the flat surface and form roller. In contrast, the %isolation values for the RF for the squat exercise were significantly higher on the flat surface and form roller than on the unstable surface. There was no significant differences in the %isolation values of the VL on the three different surfaces. Conclusion: The findings indicate that squat exercise on different surfaces results in differential activation of the quadriceps femoris muscle, which suggests that squat exercise on a multi-directional unstable surface could increase the isolated activation ratio of the VM.

Purpose: This study examined the effect of proprioceptive neuromuscular facilitation (PNF) rehabilitation exercise on postoperative range of motion (ROM), pain, and function of breast cancer patients. The purpose of this study was to provide fundamental data regarding the use of PNF rehabilitation exercise for patients with breast cancer. Methods: Fourteen patients who underwent surgery due to breast cancer were randomly divided into an experimental group (n=7) that performed PNF rehabilitation exercise and a control group (n=7) that performed general rehabilitation exercise. Both groups performed the respective exercises for 30 minutes, five times a week for 4 weeks. For the measurement of ROM, the range of shoulder abduction was measured using a clinometer smartphone application. The shoulder pain and disability index (SPADI) was used to measure the level of pain and functional activity. A paired t-test was conducted to compare within-group changes before and after the PNF rehabilitation exercise. Differences between the experimental group and control group were analyzed by an independent t-test. For all tests, the level of statistical significance was set at α=0.05. Results: After the exercise, there was a significant within-group change in the ROM and SPADI in both the experimental group and control group (p<0.01). There was also a significant between-group difference in the ROM and SPADI after the intervention (p<0.05). Conclusion: Rehabilitation exercise is generally applied as a treatment for patients with breast cancer after surgery and is relatively effective. The application of PNF rehabilitation exercise may be useful in such patients, considering its effects on ROM improvement, pain reduction, and functional enhancement.

Purpose: The purpose of this study was to investigate the influence of opposite lower extremity lateral muscle activation by proprioceptive neuromuscular facilitation (PNF) exercise targeting the lower extremities. Methods: Nineteen patients with chronic hemiplegia volunteered to participate in this study. PNF flexion, abduction, and internal rotation patterns; initial, end range, and extension patterns; abduction and internal rotation patterns; and initial and end range patterns were applied to the dominant lower extremity. Activation of lateral muscles (multifidus, gluteus medius, tensor fascia lata, and peroneous longus) of the paralyzed leg was then measured by electromyography (EMG). Results: There were significant differences in lateral muscle activation, depending on the PNF pattern applied, with the differences more significant in flexion, abduction, internal rotation, and end range patterns. Conclusion: PNF flexion, abduction, and internal rotation patterns can improve lateral muscle activation of one leg in the standing position in the gait cycle.

Purpose: The aim of this study was to examine the activation of the contralateral upper and lower extremities and trunk muscle during ipsilateral upper extremity diagonal isokinetic exercise. Methods: Twenty-one healthy male subjects with no history of shoulder injury undertook ipsilateral diagonal isokinetic exercise at 60, 120, and 180°/sec, utilizing a standard Biodex protocol. Muscle activation amplitudes were measured in the upper trapezius, pectoralis major, biceps brachii, rectus abdominis, external oblique, rectus femoris, adductor longus, and biceps femoris muscles using electromyography. A one-way analysis of variance and paired t-tests were conducted, and the data were analyzed using SPSS, version 21.0. Results: The results revealed no statistically significant interaction between motion and angular velocity and no statistically significant contralateral muscle activation according to angular velocity (p˃0.05). However, they revealed statistically significant contralateral muscle activation according to motion (p˂0.05). Conclusion: These results suggest that the movements involved in contralateral upper extremity diagonal isokinetic exercise can enhance muscle strength in patients affected by stroke, fracture, burns, or arthritis.