Earticle

Purpose: This study aimed to investigate the effects of postural control exercise on the delayed heart rate increase in heart transplant patients. Methods: The subject was a female heart transplant recipient who had a delayed increase in heart rate during exercise. The intensity of exercise was performed at MBorg level 4. The A-B-A’ and A-B-A’-B’ designs were used to identify the changes in heart rate during active-assisted exercise, lower limb postural control exercise, and upper limb postural control exercise. Experiments were performed for four weeks. The heart rates at pre- and post-exercise were compared, and the time to reach MBorg 4 was measured. Results: In the active-assisted exercise, the average heart rates at pre- and post-exercise and after 10 min of exercise were 88, 89, and 87.7 bpm, respectively. In the repetitive comparison of pre- and post-exercise in the lower limb postural control exercise, the difference in the mean heart rate was 3.5 and 3 bpm in stable support and 14 and 14.5 bpm in unstable support, respectively. In the repetitive comparison of pre- and post-exercise in the upper limb postural control exercise, the difference in the mean heart rate was 6 and 4 bpm in stable support and 4 and 4.5 bpm in unstable support. The time required to reach MBorg 4 was short when both the upper and lower postural control exercises were performed in an unstable state. Conclusion: We suggest that combining proper postural control exercise with strength exercise and aerobic exercise, among others, may be effective in rehabilitating patients in the recovery stage after a heart transplant.

Purpose: This study aimed to investigate the effect of angular joint mobilization (AJM) on the shoulder pain, range of motion, and functional improvement in a patient with shoulder adhesive capsulitis. Methods: The patient diagnosed with right shoulder adhesive capsulitis by an orthopedic surgeon was a 60-year-old male, right hand/arm dominant, with a height of 175 cm and weight of 75 kg. The patient received 12 sessions of AJM once or twice per week for eight weeks. AJM was applied for 5 min each of flexion, abduction, external rotation, internal rotation, for a total of 20 min per session. The visual analog scale, the goniometer, and the Oxford shoulder score were used to measure pain, range of motion, and shoulder pain & disability index, respectively. Results: After all the treatments, the pain decreased from 6 to 2 points. The range of motion increased in flexion by 54.3° from 125° to 179.3°, abduction by 38° from 140° to 178°, external rotation by 54.4° from 30.3° to 84.7°, and internal rotation by 25° from 45° to 70°. The shoulder disability index decreased from 33 points to 17 points. Conclusion: This study found that AJM has a positive effect on the improvement of shoulder pain, range of motion, and function in a patient with shoulder adhesive capsulitis. Further studies on AJM are needed in the future.

Purpose: This study aimed to analyze the visual and spatial elements of the gait of a stroke patient who had diverse ankle weight loads applied, according to weight changes. Methods: The subject was a 57-year-old stroke patient diagnosed and hospitalized with a left intracerebral hemorrhage. A weight equivalent to 0%, 1%, and 2% of his body weight was applied to the area 5cm upward from the ankle using a Velcro strap. He was then trained on a treadmill, receiving a six-minute walk test to evaluate his gait ability. A gait analyzer was used to collect visual and spatial elements, such as gait distance, gait velocity, cadence, step length, stride length, and swing phase, according to a weight load equivalent to 0%, 1%, and 2% of his body weight. Results: According to the results of applying 0%, 1%, and 2% of his body weight on the ankle, except for gait velocity, his gait distance, cadence, step length, stride length, and swing phase were higher when 1% of his body weight was applied compared to 0% or 2% of his body weight. Conclusion: Applying a weight equivalent to 1% of the body weight to the ankle positively affected the visual and spatial element of the gait and heightened the efficiency of exercise during treadmill training, a gait-training tool generally used for stroke patients. However, the result is difficult to generalize because the number of subjects was small with only one subject.

Purpose: This study aimed to assess the effect of rowing ergometer training on the aerobic capacity and strength of male high school students over a 12-week period. Methods: Fourteen high school students volunteered to participate in the study. The subjects were divided into two groups: seven subjects in the experimental group and seven in the control group. The subjects in the experimental group performed rowing ergometer training for 75 min per session at three days a week for 12 weeks. The exercise intensity set the maximum heart rate (HRmax) from 40% to 80%. Aerobic capacity was measured by ventilation, cardiac output, and oxygen intake per body weight. Strength was measured by grip strength and back strength before and after training. Results: A significantly increased ventilation (p=0.01), cardiac output (p=0.01), and oxygen intake per body weight (p=0.00) were found in the experimental group. A significantly increased grip strength in the right and left hands (p=0.00, 0.00) and back strength (p=0.04) were observed in the experimental group. Conclusion: Rowing ergometer training can be an effective combined exercise for aerobic capacity and strength of high school students.

Purpose: The purpose of this study was to demonstrate the effects of proprioceptive neuromuscular facilitation (PNF) stability techniques on walking speed, trunk stability, and balance in stroke patients. Methods: Ten stroke patients volunteered to participate in the study, and each of subjects was randomly assigned to either the stability technique (ST) group (n=5) or to the treadmill (TM) group (n=5). Each therapeutic exercise program was provided for 30 minutes a day, 5 days per week for 4 weeks. The ST group performed a PNF pattern combined with stabilizing reversal and rhythmic stabilization of the PNF stability technique. Walking speed (measured using a 10-meter walking test), trunk stability (TIS), and balance (BBS, FRT) were evaluated before and after training. All data were analyzed using SPSS version 18.0. The significance level for statistical inspection was set at 0.05. Results: Both groups showed improvements on the 10-meter walking test, the trunk impairment scale, the Berg balance scale, and the functional reaching test. Conclusion: PNF stability techniques are effective for improving trunk stability, balance, and walking speed in stroke patients. For stroke patients, PNF stability techniques are very useful and effective, including in clinical practice.

Purpose: This study aimed to investigate the fully immersive virtual reality (FIVR) program changes in the autonomic nervous system (ANS) by age according to heart rate variability (HRV). Methods: A total of 44 subjects were classified into group 1(aged 20–30), group 2(aged 40–60), and group 3(aged 70 and above). The study analyzed the HRV using a pulse wave analyzer and compared the ANS changes before and after applying the FIVR of the group. The LF, HF, RMSSD, and SDNN were measured. Fifteen minutes of virtual reality applications were applied to all subjects, and 1 min of rest was given in the middle of the session. A was used for anteroposterior comparisons of the ANS. Results: The HF, LF, RMSSD, and SDNN values were not statistically significant in all groups, but they all increased. The RMSSD value was statistically significant because it increased in group 3 (p<0.05). Those of the other two groups were not statistically significant (p<0.05). Conclusion: An FIVR program does not have a negative effect on the ANS response.

Purpose: The purpose of this study is to examine the effects of proprioceptive neuromuscular facilitation (PNF) exercises on the neck disability index and deep neck flexor endurance of acute whiplash injury patients and to provide basic data for PNF exercises for musculoskeletal system disorder patients. Methods: Twenty acute whiplash injury patients were randomly assigned to an experimental group (n=10) and were treated with PNF exercises whereas a control group (n=10) underwent general exercises. Each session lasted 15 minutes and was performed five times a week for two weeks. The degree of pain was assessed using a visual analogue scale (VAS) and the degree of neck disability was measured by the neck disability index (NDI). Craniocervical flexor endurance (CCFE) tests were conducted to measure deep neck flexor endurance. Results: In terms of the intragroup changes in VAS, NDI, and CCFE, there were significant decreases in both the experimental and the control groups. After intervention, there were significant differences between the experimental group and the control group in terms of intergroup changes in VAS, NDI and CCFE. Conclusion: Although the exercises that are generally applied to acute whiplash injury patients are effective on the whole, PNF exercises are considered to be beneficial, given the improvements in the neck disability index and deep neck flexor endurance.

Purpose: This study aimed to compare the immediate effects of various contract–relax (CR) techniques on the peck force and passive range of motion (ROM) of knee extension. Methods: This study recruited 17 adult males and females who obtained below 90° in straight leg raising. The subjects randomly performed one of three different CR techniques (direct CR, indirect CR, and modified CR) on the right knee extension four times per day for three days. The subjects’ peck force during each CR and their passive knee extension on the hip at a 90° flexed position before and after each CR were measured. Results: The peck force was significantly higher in the direct and modified CR than in the indirect CR. The ROM in the passive knee extension significantly increased after direct and indirect CR. Comparing between each CR, the passive knee extension range was significantly more improved in the direct and indirect CR than in the modified CR. Conclusion: Direct and indirect CR are more effective than modified CR in the ROM of passive knee extension. The study results suggest that the modified CR did not have the same effect on the ROM of the knee extension as the direct and indirect CR and that further research is needed to recruit more subjects and to determine the effects on different muscles after modified CR.

Purpose: This study aimed to examine the elderly physical fitness test for elderly people living in urban areas and to evaluate the physical fitness level according to gender and age groups. Methods: The subjects were 180 elderly people aged 65 and over living in urban areas. The elderly people were classified into early old age, middle old age, and advanced old age groups. Five items of the physical fitness test for the elderly (arm curl, chair stand, 2 min step test, back scratch, and chair sit and reach). Results: In analyzing the average of each item by gender and age, a significant difference was found in the results of each item as age increased in all sports, but no difference was observed according to gender except dumbbell lifting. Conclusion: Although the physical fitness level of all ages decreased from early age to late age, the difference in physical fitness according to gender was not significant except the arm curl test. The results of this study can be used as basic data for a new “age-specific exercise program” for the elderly.

Purpose: This study aimed to explore the effects of additional trunk exercises on an unstable surface on the balance and walking ability of individuals with chronic stroke. Methods: Sixteen patients with chronic stroke participated in this study. The participants were randomly assigned to two groups: experimental group (n=8) and control group (n=8). All the participants underwent a typical physical therapy program for 30 min a day. Moreover, the experimental group participated in a 30 min trunk exercise program on an unstable surface, whereas the control group participated in a 30 min trunk exercise program on a stable surface. Both groups performed the exercises five times a week for three weeks. The Berg Balance Scale (BBS) was used to measure changes in balance. The gait variables were measured using the GAITRite system (CIR System Inc., Clifton, NJ, USA) to examine changes in walking ability. Results: Both groups showed a significant intragroup improvement in balance, gait speed, cadence, stride length, and double support period (p<0.05). In the intergroup comparisons after the intervention, the experimental group showed significant improvements over the control group in balance, gait speed, cadence, stride length, and double support period (p<0.05). Conclusion: This study applied additional trunk exercises on an unstable surface to chronic stroke patients, and the results showed a significant improvement in the patients’ balance and walking abilities. Therefore, trunk exercise on an unstable surface may be applicable as an intervention method to improve the balance and walking ability of chronic stroke patients.

Purpose: This study aimed to compare balance ability according to the immersion level of virtual reality-based training for the balance enhancement of the elderly. Methods: This study included 48 elderly people aged 65 years and older (male 16, female 32). According to the immersion level of applied virtual reality training, 16, 17, and 15 persons were randomly assigned to full immersion, semi-immersion, and control groups. The subjects who were assigned to the full immersion group and semi-immersion group received virtual reality training for 6 weeks at 20 min at a time, 3 times per week. The control group received no intervention. Balance ability was evaluated by measuring the stability limit and the tandem walking test before and after the intervention. Results: Results showed significant differences among the three groups in the limit of stability of all directions and the tandem walking test after the intervention. The results of the limit of stability showed a significantly higher value in the full-immersion group than in the control group, and the results of the tandem walking test showed a significantly lower value in the full-immersion and semi-immersion groups than in the control group. Conclusion: The results indicate that the head-mounted display equipment for applying full-immersion virtual training is the most effective in enhancing the balance ability of the elderly.

Purpose: Leg length discrepancy (LLD) is one of the risk factors for postural imbalance. This study aimed to investigate the effect of induced leg length discrepancy on the limitation of stability (LOS) and static postural balance. Methods: Thirteen adults (males, 7; females 6) participated in this study. The LOS and static postural balance [sway length, sway area, and sway velocity of center of gravity (COG) displacement] were measured by the balance trainer system. The subjects were asked to move the COG for the anterior, posterior, and left and right directions maximally and to keep standing on the platform with and without induced LLD for 30 s in the open and closed eyes conditions, respectively. The LLD was artificially induced to 2 cm using insole. Wilcoxon test was used to compare the LOS and the static postural balance between with and without induced LLD. Results: The anterior and posterior LOS significantly decreased in induced LLD (p<0.05), and the left and right LOS were not significantly different between with and without LLD (p>0.05). Sway length, sway area, and sway velocity of the COG displacement significantly decreased in induced LLD (p<0.05). Conclusion: This study suggests that induced LLD could decease the antero–posterior LOS and increased the static postural balance. Therefore, the LLD could disturb the postural balance.

Purpose: This study aimed to investigate the effect of an intensive rehabilitation program on the pain, range of motion (ROM), muscle strength, function, quality of life (QoL), and depression of patients with traumatic rotator cuff injury caused by an industrial accident. Methods: Seventeen patients with traumatic rotator cuff injury caused by an industrial accident participated in this study. The 12-week treatment included 30 min of manual therapy and 30 min of exercise therapy twice a day, five times a week. The outcomes were measured for evaluating the pain, ROM, muscle strength, function, QoL, and depression before the commencement of the program and after 4, 8, and 12 weeks. Results: According to the time of applying the intensive rehabilitation program, the pain (p<0.01), ROM (p<0.01), muscle strength (p<0.01), function (p<0.01), and depression (p<0.05) significantly improved with time. However, QoL was not statistically significant. Conclusion: This study confirmed the excellent effect of an intensive rehabilitation program on the pain, ROM, muscle strength, function, and depression of patients with traumatic rotator cuff injury caused by an industrial accident. However, this study was limited by the absence of a control group. This pilot study highlights the need for more extensive research with a larger sample.

Purpose: The neurodynamic test used to implicate symptoms arising from the nerve is proposed to selectively increase the strain of the nerve without increasing the strain of adjacent tissue, although this has not yet been established in the time of nerve tension application. This study aimed to investigate the acute effects of nerve stretching time on nerve excitability using compound nerve action potential (CNAP) analysis. Methods: Thirty healthy young adults (mean age=23.10 years) with no medical history of neurological or musculoskeletal disorder voluntarily participated in this study. Nerve excitability was assessed using the median nerve conduction velocity test. The amplitude of the CNAP was measured under three conditions: resting phase (supra-maximal stimulus, without nerve stretching), baseline phase (two-thirds of the supra-maximal stimulus, without nerve stretching), and stretch phase (two-thirds of the supra-maximal stimulus, with 1–5 minutes nerve stretching). One-way repeated measures ANOVA was conducted to compare the latency and amplitude of CNAP. A post-hoc test was analyzed using the contrast test. Results: The latency was significantly delayed after 1 min. of nerve stretching in comparison with the baseline test. However, no significant difference was found during the nerve stretching (1–5 min.). The amplitude was significantly increased by nerve stretching. Conclusion: Nerve stretching can induce nerve excitability without any nerve injury. Based on the results, more than 1 min. of nerve stretching as a neurodynamic test can be a useful method in the clinical setting.

Purpose: This study aimed to determine whether the abdominal muscles, which are the major lumbar stabilizers along with the respiratory muscles, are affected by smoking. We compared abdominal muscle activity between smokers and non-smokers during the sit-to-stand movement. Methods: A total of 28 healthy adult males (14 smokers and 14 non-smokers) in their 20s–30s voluntarily participated in the study. The subjects performed the sit-to-stand movement, and then their abdominal muscle activity was measured. The surface electromyography system was employed to measure the maximal voluntary isometric contraction (MVIC) values of the subjects’ rectus abdominis, external oblique abdominal, internal oblique abdominal, and transversus abdominis muscles. Then, the values were quantified into %MVIC. Results: The activity of the rectus abdominis muscle was higher in the smokers than in the non-smokers. Conversely, the activity of the internal oblique abdominal and transversus abdominis muscles, which are deep abdominal muscles, was higher in non-smokers than in smokers, but the difference was not statistically significant. Conclusion: Smoking can inhibit the activity of smokers’ deep abdominal muscles and increase the activity of their superficial muscles, thus making it detrimental to their musculoskeletal system.

Purpose: This study aimed to describe and identify the relationship between gait and contracted ratios of the transverse abdominal (TrA), internal oblique (IO), and external oblique (EO) muscles. Methods: This study was conducted on 50 elderly people. The contracted ratios of the lateral abdominal muscles (LAM) were measured using the abdominal drawing-in maneuver (ADIM) and ultrasonographic imaging. Gait was measured using the timed up and go test and the 10 m walk test. Results: The contracted ratios of the TrA and IO muscles significantly increased after ADIM. Those of the TrA muscles showed a significant correlation with gait in the limited community ambulatory group. The contracted ratios of the IO and EO muscles showed a significant correlation with gait in the community ambulatory group. Conclusion: Our findings suggest a specific training on the relationship between gait speed and the activation of the LAM in elderly people.