Earticle

Purpose: This study investigates the effects of task-oriented training for a left trunk flexion pattern using real-time ultrasound imaging in a stroke patient with unilateral neglect symptoms. Methods: This study used the ABA experimental design, which is a single-subject research method among individual case research methods. For the ABA experimental design, changes in the degree of unilateral neglect, balance ability, and the thickness of the lateral abdominal muscle were visually analyzed during the baseline process, in the intervention period, and after the intervention. The experiments were performed 24 times in total for 8 times in each of the 3 periods. The unilateral neglect was measured using the Albert test, balance ability was measured using the Berg balance test, and the thickness of the lateral abdominal muscle was measured using ultrasound imaging. The subject was a 50-year-old male patient with unilateral neglect caused by right cerebral hemorrhage. He performed task-oriented training for a voluntary left trunk flexion pattern using real-time ultrasound imaging during the intervention period. Results: The result of comparing the data collected during the intervention period with the data point average of the baseline process showed that balance ability improved and the tendency line was above the baseline. The tendency line of unilateral neglect was below the baseline and showed a decreasing tendency. The thickness of the lateral abdominal muscle showed an increasing trend and the tendency line was above the baseline. Conclusion: The results of this study suggest that the task-oriented training for left trunk flexion pattern using real-time ultrasound imaging has a beneficial effect on balance ability, the degree of unilateral neglect, and the strength of the lateral abdominal muscle in unilateral neglect patients.

Purpose: This study verifies the muscle activity around the amputation site during proprioceptive neuromuscular facilitation (PNF) pattern exercise for the upper extremities on the non-amputated part in upper extremity amputees and provides basic data on effective exercise around an amputation site. Methods: Manual resistance was applied to the PNF upper extremity pattern of the non-amputated part to generate muscle activity around the amputation site. The resistance was adjusted to an intensity that could cause maximal isometric contraction. The muscle activity of the amputation site and the non-amputated part was measured using a surface electromyogram for the upper trapezius, middle trapezius, infraspinatus, serratus anterior, and pectoralis major. Results: During the scapular exercise in the painless range, the amputated side showed significantly lower muscle activity and a lower muscle contraction ratio compared with the non-amputated side. During the PNF pattern exercise in the painless range, the amputated side showed lower muscle activity and a lower muscle contraction ratio compared with the non-amputated side. When the direct scapular exercise of the amputated side was compared with the PNF pattern exercise of the non-amputated side, their muscle contraction ratios were similar. Conclusion: This study confirmed the effectiveness of the PNF pattern exercise of the non-amputated part as a way to indirectly train the injured site with no pain for rehabilitation of patients with serious body injuries, such as amputation. It is necessary to develop effective exercise programs for the rehabilitation of the amputation site based on the results of this study.

Purpose: This study was an investigation of the effects of the bridge exercise with the sensory feedback of combined abdominal drawing-in on transverse abdominal and balance in patients with stroke. Methods: Forty subjects were randomly assigned into two groups. Subjects in the bridge exercise group (BG, n = 20) or feedback drawing-in bridge exercise group (FDBG, n = 20) were studied for 30 minutes each, twice daily, for four weeks. Outcomes were measured using affected weight distribution (AWD), anterior limit of stability (ALOS), posterior limit of stability (PLOS), timed up-and-go test (TUG), the Berg balance scale (BBS), and transverse abdominis thickness (TRA) before and after the four-week intervention period. Results: There were significant effects in the FDBG pre-intervention and post-intervention in AWD, ALOS, PLOS, TUG, BBS, and TRA. Conclusion: The results of this study suggest that the bridge exercise with sensory feedback combined with abdominal drawing-in could be beneficial for patients with stroke in terms of transverse abdominal and balance.

Purpose: Cognitive function is a main concern for rehabilitation progression in individuals who have sustained brain damage, even among those whose motor function has returned after brain damage. The purpose of this study was to investigate how cognitive impairment relates to functional independence in postural stability and gait performance in patients with chronic hemiparetic stroke. Methods: This was an observational design in an outpatient rehabilitation hospital. Twenty-eight adults with chronic hemiparetic stroke, receiving a course in an outpatient rehabilitation program, participated in this study. They were divided into two groups (i.e., non-cognitive impairment and cognitive impairment groups) via a cut-off score of 23 or less on a mini-mental state examination. Functional independence was assessed with the timed up-and-go test (TUG), 10-meter walk test (10mWT), five times sit-to-stand test (FTSST), Berg balance scale (BBS), and modified Barthel index (MBI). The independent t-test was used for statistical analysis when comparing the two groups. Results: The cognitive impairment group had less functional independence, balance, and gait performance than those of the non-cognitive impairment group had. The former also showed a statistically significant decrease in their TUG score, FTSST score, BBS score, and MBI score compared to the latter, but not in their 10mWT score (p<0.05). Although the non-cognitive impairment group walked faster than the cognitive impairment group did, that difference was not statistically significant (p>0.05). Conclusion: The results of this study suggest that cognitive impairment relates to functional independence in postural stability and the activities of daily living. In rehabilitation settings, cognitive impairment would be considered a major component in therapeutic rehabilitation to overcome the patients difficult physical problems and to treat for improving functional independence more after stroke.

Purpose: Continuous use of a smartphone increases the angle of forward bending of the user’s cervical vertebrae, causing pain in the shoulders and back, including the thorax, lumbar region, and vertebrae. Although there are many studies on changes in the cervical spine due to smartphone usage, the changes in the shoulders, thoracolumbar spine, and pelvic have rarely been compared. The purpose of this study is to investigate the change in the spinal segments, shoulders, and pelvic when using a smartphone with both hands while in the standing position. Methods: This study was conducted on 35 adults in their twenties. The selection criteria for the subjects were limited to those in a similar age group, thus excluding posture differences according to age, and to those who did not have specific diseases or pain in the spinal and musculoskeletal system for 12 months prior to the study. In this study, we used a 3D spinal diagnostic imaging system (Back Mapper, Frickenhausen) to compare the changing conditions in each vertebral segment before and during smartphone usage with both hands while in the standing position. Posture differences according to smartphone usage were compared using the paired t-test for the motion of each spinal segment. Results: This study showed that the thoracic and lumbar angle increased posteriorly during smartphone usage (p<0.05). In addition, the anterior rotation angle of the shoulder bone significantly increased, but no significant difference occurred in the pelvic region. Conclusion: Based on the results of this study, smartphone usage with both hands while in the standing position showed that the spine, as a whole, forms a kyphotic curve. Therefore, we propose to present a postural guideline for correct smartphone usage, considering the change in each vertebral segment.

Purpose: This study investigated the effects of neck pattern of proprioceptive neuromuscular facilitation (PNF) on balance and walking ability in patients with chronic stroke. Methods: Fourteen participants with chronic stroke were randomly assigned to vestibular rehabilitation and then divided into two groups: the neck pattern group or treadmill group. Each group underwent 20 sessions (20 minutes/day, five days/week, for four weeks). Patients were assessed with the Berg balance scale (BBS) and gait parameters (gait speed, cadence, step length, and double-limb support period) using a GAITRite system. Results: Vestibular rehabilitation for the neck pattern group and the treadmill group showed significant intragroup improvement on the BBS and in terms of gait speed, cadence, step length, and double-limb support period (p < 0.05). Vestibular rehabilitation was more effective for the neck pattern group than for the treadmill group in terms of the BBS (p = 0.00; 95% CI, 1.49–5.94), gait speed (p = 0.01; 95% CI, 0.05–0.16), cadence (p = 0.02; 95% CI, 0.54–4.99), and step length (p = 0.00, 95% CI, 1.55–4.62). Conclusion: This study used the neck pattern of PNF for vestibular rehabilitation in patients with chronic stroke. The results showed significant improvement in the patients’ balance and walking ability. Therefore, the neck pattern of PNF for vestibular stimulation may be more effective than treadmill training to improve balance and walking ability in patients with chronic stroke.

Purpose: This study is an investigation of the effects of long-term smart phone usage and of stretching on muscle stiffness, concentration, and visual acuity. Methods: Forty healthy young adults voluntarily participated in the study and were measured for muscle stiffness, concentration, and visual acuity before smartphone usage and after 30 minutes, 60 minutes, and 90 minutes of smartphone usage. The participants were randomly allocated to the intervention group (n=20) and the control group (n=20). Five minutes after the stretching exercise and eye exercise intervention, the participants were remeasured. Results: After long-term smartphone usage, increases in muscle stiffness and concentration were statistically significant (p<0.05), whereas decreases in visual acuity were statistically significant (p<0.05). After the stretching exercise and eye exercise intervention, muscle stiffness significantly decreased (p<0.05) and visual acuity significantly increased (p<0.05). Concentration, according to the stretching exercise and eye exercise intervention, showed no significant pre- or post-test difference. Conclusion: The results from this study indicate that long-term smartphone usage effectively improved concentration but increased muscle stiffness and decreased visual acuity. Appropriate stretching and eye movement during long-term smartphones usage should mitigate the effects on muscle stiffness and visual acuity. Furthermore, smartphones should be considered an effective tool for concentration training when coupled with the development of appropriate applications.

Purpose: This study aims to investigate the effects of a group computerization cognitive rehabilitation program on cognitive function in patients with cognitive impairment. Methods: The subjects of this study comprised 34 patients with cognitive impairment (15 males and 19 females) who were randomized into two groups. The experimental group (n = 17) were trained with the group computerization cognitive rehabilitation program, while the control group (n=17) received traditional cognitive therapy. The interventions for both groups were performed for 1 hour per day, once a week for 12 weeks. The cognitive functions of the subjects before and after the experiment were measured using the Korean mini-mental state examination (K-MMSE), global deterioration scale (GDS), clinical dementia rating (CDR), and Lowenstein occupational therapy cognitive assessment (LOTCA). A paired t-test was conducted to examine the intragroup differences before and after the experiment, and ANCOVA was performed to check intergroup differences. Results: The intragroup comparison results showed that the cognitive function of the group that were trained with the group computerization cognitive rehabilitation program improved after the experiment more than for the group that received traditional cognitive therapy. The intergroup comparison results showed significant differences in orientation, visual perception, and visuomotor organization between the two groups. Conclusion: The results of this study confirmed that the group computerization cognitive rehabilitation program was more effective in improving cognitive function than the traditional cognitive therapy in patients with cognitive impairment. Based on the results of this study, the group computerization cognitive rehabilitation program can be used as an effective intervention method for patients with cognitive impairment.

Purpose: This study was an investigation of the effect of unstable supporting exercise in young adults with functional ankle instability. The study tested the use of a jumper and virtual reality (VR) training via a VR-head mounted display (HMD) system to provide functional improvement in proprioception, range of motion (ROM), ankle muscle strength, agility, and balance. Methods: The subjects comprised 61 young adults (in their twenties) with functional ankle instability to decide as less than 24 points using Cumberland ankle instability tool. The subjects were divided into three groups: VUS (VR-HMD and unstable supporting exercise, n = 20), VSS (VR-HMD and stable supporting exercise, n = 19), and NUS (non-VR-HMD and unstable supporting exercise, n = 22). The exercise program was conducted three times per week for three weeks. VR training via a VR-HMD system and a VR application on a smart mobile device were used with the VUS and VSS groups, and unstable supporting exercise was used in the VUS and NUS groups for 30 minutes. Proprioception, ROM, ankle muscle strength, agility, and balance were measured before and after training. Results: The VUS group showed significant differences in most results, including proprioception, ROM, ankle muscle strength, agility, and balance to compare before and after, and the VSS and NUS groups partially. Moreover, the VUS group had significant differences in most results when compared with the other groups. Conclusion: Unstable supporting exercise and VR training via a VR-HMD system improved functional ankle instability in terms of proprioception, ROM, ankle muscle strength, agility, and balance.

Purpose: This study aimed to investigate lower extremity muscle activation to the variable weight shift on the affected side of patients with hemiplegia. Methods: Eighteen patients with chronic hemiplegia volunteered to participate in this study. All participants performed three types of weight shift (sideways, forward, and backward) in limits of stability on the affected side. Muscle activation in a paralyzed leg was measured with electromyography on the gluteus medius, tensor fasciae latae, rectus femoris, and biceps femoris; furthermore, the attached area was recommended by SENIAM projects. Each weight shift was performed three times, and then the mean value of the three measurements was analyzed. The data were analyzed by measuring the symmetrically standing position with the reference voluntary contraction (RVC) and was standardized with the percentage of RVC method. Results: No significant difference in lower extremity muscle activation occurred according to the three types of variable weight shift. However, significant differences in lower extremity muscle activation did occur with each weight shift position. In addition, activation increased at the rectus femoris and decreased at the gluteus medius and tensor fasciae latae. Conclusion: Hip abductor muscle strength training and variable weight shifts on the affected side must increase to improve patients’balance and limits of stability.

Purpose: The purpose of this study was to investigate the effect of temporary visual block existence and nonexistence on the change in foot pressure and foot area in stroke patients. Methods: Sixty-one chronic stroke patients volunteered to participate in the study. Foot pressure and foot area were measured using the Biorescue system. The subject maintain a comfortable standing position on the pressure-measuring plate one meter away from the computer. The sequence of the visual variation data while standing on the measuring plate was collected randomly. The data were collected with three repetitions and used the five-second measuring values except the first second and the last second according to each visual condition. All data were analyzed using SPSS version 21.0. The significance level for the statistical inspection was set as 0.05. Results: The comparison between the visual existence and nonexistence status showed statistically significant effects on foot pressure and foot area. The visual nonexistence status showed more improvement in foot pressure symmetry and area than visual existence status. Conclusion: This study shows that the foot pressure and foot area for the chronic stroke patients changed according to the visual states. It is predicted that these data will be used in rehabilitation training programs and to present temporary changes in visual status for stroke patients.

Purpose: This study aimed to investigate the correlation between trunk stabilization muscle activation and the parameters of gait analysis in healthy individuals. Methods: Thirty healthy adults (15 male, 15 female) with no history of lower back pain (LBP) or current musculoskeletal and neurological injuries were studied. Trunk stabilization muscle activation (e.g., external oblique, internal oblique, transverse abdominis, erector spinae) were assessed using surface electromyography. To analyze gait, we measured temporal parameters (e.g., gait velocity, single support phase, double support phase, swing phase, and stance phase) and a spatial parameter (e.g., H-H base of support). Results: A statistically significant correlation was found between the internal oblique, transverse abdominis, and erector spinae muscle activity and gait velocity, single support phase, double support phase, swing phase, and stance phase. No statistically significant correlation was found between the external oblique muscle activity and the gait velocity, single support phase, double support phase, swing phase, and stance phase. No statistically significant correlation was found between the external oblique, internal oblique, transverse abdominis, and erector spinae muscle activity and the spatial parameter. Conclusion: This study demonstrated that a relationship exists between trunk stabilization muscle activation and temporal parameter (i.e., gait velocity, single support phase, double support phase, swing phase, and stance phase) during gait analysis. Therefore, the trunk’s stabilizer muscles play an important role in the gait of healthy individuals.

Purpose: The purpose of this study is to show the effect of elastic band on balance and functional ability in chronic stroke patients living in community. Methods: The subjects who participated in the study were 9 patients with chronic stroke. One of them gave up during the study, finally 8 patients performed . The intervention was conducted once a week for 10 weeks. In this study functional reach test (FRT), timed up and go test (TUG), Tinetti performance oriented mobility assessment (Tinetti-POMA) were measured for balance . The coordination training of arms and legs using the elastic band was performed in three positions as supine, side lying, sitting. One arm performed flexion-adduction- external rotation with elbow flexion pattern and the opposite side(diagonal) leg was performed flexion-adduction-external rotation with knee flexion pattern, the other arm’s pattern was extension-abduction-internal rotation with elbow extension and the opposite side (diagonal) leg was in extension-abduction-internal rotation with knee extension pattern. The training was performed in each position for 15 minutes in per position. The participants had a five minute break after each training. Results: The results are as follows. FRT and Tinetti-POMA showed significant increase statistically in each position. The TUG showed significant decrease statistically in each position. Conclusion: Even though the coordination training with elastic band had performed once a week, it showed positive effects on balance in chronic stroke patients. Therefore, if we can suggest the appropriate frequencies of coordination training of arms and legs using the elastic band, it can be a method to improve daily life and life quality to patients with chronic stroke.

Purpose: This study is a comparison of spatiotemporal parameters between straight and curved walking in individuals with chronic hemiparetic stroke, investigating whether those patients can adapt their walking according to task demands and environmental changes. Methods: Twenty-eight patients who diagnosed with their first stroke at least six months prior to this study were recruited. They were measured for spatiotemporal parameters in three different walking conditions: straight walking, walking with an inner curve to the more-affected leg, and walking with an inner curve to the less-affected leg. This study also measured secondary clinical factors, such as the timed up-and-go test, the trunk impairment scale, and the dynamic gait index. The statistical methods for the three different walking conditions, using the averaged value of each condition, was repeated measures ANOVA. Results: The difference in cadence was statistically significant when comparing straight walking, walking with an inner curve to the more-affected leg, and walking with an inner curve to the less-affected leg. Swing duration (%) was also a statistically significant difference between straight walking and walking with an inner curve to the more-affected leg. However, differences in other spatiotemporal parameters were not statistically significant among the three conditions. Conclusion: The results of this study suggest that stroke survivors could adapt their walking according to straight and curved walking conditions, although cadence and swing duration were different between straight and curved walking groups.

Purpose: This study examined the effects of the abdominal drawing-in maneuver (ADIM) on muscle activity in the trunk and legs while subjects walk on a ramp. Methods: The subjects were healthy adult males (n=15) and females (n=8) in their twenties. The subjects were asked to maintain the ADIM contraction for 15 minutes using a pressure biofeedback unit. Their muscle activity was then measured while ascending or descending the ramp with or without the ADIM contraction maintained. Activity in the sternocleidomastoid, splenius capitis, rectus abdominis, external oblique abdominal, transversus abdominis, erector spinae, vastus medialis, and vastus lateralis muscles was measured using surface electromyography (TM DTS, Noraxon, USA). A paired t-test was conducted using SPSS 18.0 (IBM) for statistical data processing. Results: Maintaining the ADIM contraction during ascension led to a significant increase (p<0.05) in muscle activity for the rectus abdominis, transversus abdominis, vastus medialis, and vastus lateralis, but a significant decrease (p<0.05) in muscle activity for the erector spinae, when compared to the same activity without the ADIM maintained. Furthermore, maintaining the ADIM contraction during descent led to a significant increase (p<0.05) in muscle activity for the rectus abdominis, external abdominal oblique, transversus abdominis, vastus medialis, and vastus lateralis, but a significant decrease (p<0.05) in muscle activity for the erector spinae, when compared to the same activity without the ADIM maintained. Conclusion: As a result of this study, it maintains the ADIM and reduces lumbar muscle activity at the waist and increases muscle activity in the legs when walking on a ramp. Therefore, maintaining the ADIM contraction during ramp walking is recommended as training to improve the function of patients’ muscular skeleton.

Purpose: This study suggests clinical reasoning strategies for therapists with little experience in clinical reasoning for the evaluation and treatment of patients with neurological disorders. Methods: The suggested method was the mnemonic PT STRESS whose initials represent the body structure and functions that can affect the activity limits and the items that can cause problems at the functional level in patients with neurological disorders. Results: PT STRESS stands for pain (P), ability of the trunk (T), sensation (S), tone (T), range of motion (R), emotion and endurance (E), muscular strength (strength), and stability (S). It tests and measures problems in the body structure and functions. Conclusion: This study suggests easy clinical reasoning strategies that can be used by therapists who have insufficient experience in the evaluation or treatment of patients with neurological disorders. However, more factors need to be considered in the future with regard to clinical reasoning of the diverse problems of patients with neurological disorders.

Purpose: This study compares and examines the effects of proprioceptive neuromuscular facilitation (PNF) on patients with chronic low back pain through systematic literature review and meta-analysis. Methods: Domestic literature was searched with combinations of keywords including “proprioceptive neuromuscular facilitation,” “PNF,” “back pain,” and “low back pain” using the Research Information Sharing Service (RISS), Korean Studies Information Service System (KISS), and Korean Medical Database (KMbase). Six studies (n=148) were finally included in the analysis through a selection and exclusion process. The quality of the studies was evaluated using the PEDro scale. Results: According to the meta-analysis results, the low back pains of the PNF group and the contrast group showed a standardized mean difference (SMD) of 2.21 (95% CI: -3.35, -1.07, p=0.01, I²=83%) after intervention. Thus, the PNF group showed a statistically significant decrease in low back pain compared with the control group. In addition, the SMDs of the Oswestry Disability Index (ODI), lung function, and the Roland and Morris Disability Questionnaire (RMDQ) were -1.34 (95% CI: -1.88, -0.79, p<0.01, I²=35%), 1.14 (95% CI: 0.49, 1.79, p=0.01, I²=0%), and -1.59 (95% CI: -2.56, -0.62, p=0.01, I²=46%), respectively. Thus, the PNF group showed statistically significant differences from the control group. Conclusion: At present, there is some limit to obtaining definite results about effect sizes because there are relatively few randomized controlled experiments that analyze the effects of PNF exercise in patients with chronic low back pain. Therefore, continuous efforts should be made to conduct randomized clinical trials and long-term efficacy studies in the future.