Earticle

Purpose: This study identified the effects of dual-task gait training on balance, gait function, and activity of daily living in patients with Parkinson’s disease. Methods: This study used a single-subject design. Two patients with Parkinson’s disease participated in this study. Dual-task gait training was performed 1 hour per day 8 times during intervention phase. The subjects were measured 8 times in the baseline phase, 8 times in the intervention phase, and 8 times in the follow-up phase. The outcome measurements included a timed up and go test (TUG), a Berg balance scale (BBS), a 10 meter walk test (10MWT), a 6 minute walk test (6MWT), a dynamic gait index (DGI) and a Korean modified Barthel index (K-MBI). Results: When compared to the average of the baseline process, the data collected during the intervention period showed that the TUG and 10MWT results improved and the tendency line was above the baseline. In addition, BBS, 6MWT, DGI, and K-MBI values for both patients increased remarkably after the training. Conclusion: The results of this study revealed that dual-task gait training may be helpful to improve balance, walking function, and activity of daily living for patients with Parkinson’s disease. Further studies need to confirm our findings.

Purpose: This study investigated the effects of trunk exercise using less-affected extremities on gait and balance in chronic stroke patients. Methods: Thirty subjects with chronic stroke disease were divided into two groups: a trunk exercise group that used less-affected extremities (n=15) and a general trunk exercise group (n=15). All interventions were conducted 30 min a day, 6 times per week, for 3 weeks. Gait parameters were measured before and after the intervention using Zebris FDM-1.5. In addition, all subjects were evaluated using the Trunk Impairment Scale, the Berg Balance Scale, and the Functional Gait Assessment before and after the intervention. Results: Both groups showed improvements on all outcome measured pre- to post-intervention (p<0.05). The groups exhibited significant differences for TIS, BBS, FGA, gait speed, step length, and cadence at post-intervention (p<0.05). Conclusion: This study showed that trunk exercise using less-affected extremities has therapeutic benefits on gait and balance in individuals with chronic stroke disease.

Purpose: This study investigated the effects of virtual reality-based task training (VRBTT) using a smart glove on upper extremity function and activity of daily living in stroke patients. Methods: Twenty-nine patients with chronic stroke disease were randomly allocated to two groups: the VRBTT group (n=14) and the control group (n=15). All patients received 30 minutes of standard occupational therapy, 5 times a week, for 8 weeks. The VRBTT group performed an additional 30 minutes of virtual reality-based rehabilitation training, 5 times a week, for 8 weeks. Results: Both groups showed significant improvements in upper extremity function, yielding an increase in FMA and K-WMFT (p<0.05). There was a more significant increase in the VRBTT group before and after interventions (p<0.05). There was no significant difference in MAS for the control group (p>0.05); however, there was a significant increase for the VRBTT group (p<0.05). In the activities of daily living, there was a significant difference in the values for K-MBI (p<0.05). In addition, both groups showed a significant increase for K-MBI and K-RNLI (p<0.05). Conclusion: This study showed that VRBTT using smart gloves can have a more positive effect on upper extremity function and activities of daily living in stroke patients than conventional intervention methods. A variety of virtual reality-based contents and glove-shaped wearable devices will help stroke patients in rehabilitation clinics recover and return to society.

Purpose: This study examined the effects of wheelchair handle directions on the trunk muscle activity of adult males when climbing ramps. It also evaluated the wheelchair attendant’s physical discomfort during tasks. Methods: Healthy males aged over 20 years were chosen and the direction of wheelchair handle grip was randomly selected. The grips included a general grip with ulnar deviation, a medial grip with wrist pronation, and a neutral grip with a neutral wrist. The trunk muscle activity was measured using surface electromyography. Furthermore, the physical discomfort of wheelchair attendants was subjectively evaluated using the Borg CR-10 Scale, which rates the perceived exertion. In addition, the SPSS 18.0 program was used perform repeated measure ANOVA to compare muscle activity and subjective discomfort during the interventions. The contrast test was also conducted with a significance level (α) of 0.05. Results: There was significant difference between the general grip and the medial grip in the rhomboid major muscle and the lumbar erector spinae muscle (p<0.05). In addition, there was significant difference between the general grip and the neutral grip in the rhomboid major muscle and the lumbar erector spinae muscle (p<0.05). Further, there was significant difference between the general grip and the neutral grip in subjective discomfort (p<0.05). Conclusion: In this study, adult male trunk muscle activity and subjective discomfort were lowest when using the neutral grip while climbing ramps. Accordingly, we suggest that neutral grips will help improve the function of the musculoskeletal system and reduce the subjective discomfort by putting less strain on the trunk muscles and maximizing efficiency with less force.

Purpose: This study investigated the three-dimensional moment values of the hip joint for subjects with artificial leg length alterations and subjects with unaltered leg lengths. Methods: Forty-two healthy adults (8 men, 34 women) participated in this study. The selected subjects were able to walk normally, had less than a 1 cm leg length discrepancy, and were instructed to wear shoes that fit their feet. The study participants performed 8 dynamic gait trails to measure the hip joint moment using a three-dimensional motion analysis system. Kinetic and dynamic three-dimensional gait analysis data were collected from infrared cameras, and a force plate was used to standardize the weight of each subject. Results: There were significant correlations between the differences in the leg length discrepancy during right extension, right flexion, right internal rotation, and left extension in hip joint moments (p<0.05). There were significant correlations between the differences in shoe conditions during left extension, right flexion, right extension, and right internal rotation in the hip moments (p<0.05). Conclusion: This study suggests that a leg length discrepancy can affect hip joint moment, which may further exacerbate musculoskeletal disorders, such as osteoarthritis in lower extremity joints. Therefore, further studies should be conducted to verify the impact of clinical interventions on differences in hip joint moment values to correct leg length discrepancies and prevent osteoarthritis in lower extremity joints.

Purpose: This study investigated the muscular activity of abdominal muscles during a variety of plank exercises following changes in the leg and head positions. Methods: Thirty healthy individuals participated in this study. They performed six variations of plank exercises, including three changes in head position and two changes in leg position. Each plank was defined as head neutral-leg neutral, head up-leg neutral, head down-leg neutral, head neutral-leg wide, head up-leg wide, and head down-leg wide. During the plank excises, the muscle activities of the rectus abdominis, internal oblique, erector spinae, and upper trapezius were measured. Results: The head down position significantly increased the rectus abdominis activity compared to other head positions (p<0.05). On the other hand, the upper trapezius muscle activity was significantly higher with the head up position compared to other head positions (p<0.05). Regardless of head positions, both the rectus abdominis and internal oblique muscles were significantly activated with leg wide position compared to the leg neutral position (p<0.05). Conclusion: Head and leg positions could change the muscular activities of abdominal muscles during plank exercises. For example, the head down position is effective for activating the rectus abdominis while the leg wide position could be advantageous for enhancing the internal oblique and rectus abdominis.

Purpose: This study determined the effects of elastic bands in coordinative locomotor training on the body alignment of elementary school baseball players. Methods: Thirty subjects were recruited for this study and separated into two groups: the coordinative locomotor training group with elastic bands (n=15) and the non-training control group (n=15) were five times a week for eight. The trunk inclination, trunk imbalance, kyphotic angle and lordotic angle were used to evaluate body alignment. Results: The experimental group showed significant improvements in trunk inclination, trunk imbalance, kyphotic angle and lordotic angle (p<0.05). Conclusion: Coordinative locomotor training impacted postural alignment in elementary school baseball players.

Purpose: This study evaluated the relationship between pelvic pressure and irradiation of the proprioceptive neuromuscular facilitation (PNF) upper arm pattern exercises with an elastic band while in a sitting position. Methods: Fourteen subjects with asymptomatic pelvic pressure participated in this study. Pelvic pressure was measured using a Gaitview® system while sitting and performing PNF bilateral upper arm patterns. Resistance strength was provided by the blue elastic band. The statistical significance of the results was evaluated using a repeated one-way ANOVA and the independent t-test. The Bonferroni method was used for the post-hoc test. Results: The results revealed a significant change in the pelvic pressure when performing the PNF arm pattern. The average resistance pressure on the pelvis, with the elastic band, significantly increased after the initial sitting position (F=3.91, 3.92; p<0.05). No significant pelvic pressure changes were noted for each PNF upper arm pattern (p>0.05). Conclusion: The results of this study showed a positive relationship between pelvic pressure and the irradiation of PNF upper arm pattern exercises with resistance in the sitting position.

Purpose: This study investigated the effects of motion taping on muscle stiffness, muscle tone, and pain in middle-aged women with shoulder impingement syndrome. Methods: The participants comprised 30 middle-aged women with shoulder impingement syndrome. This study measured muscle stiffness, muscle tone, and pain. In the experimental group, the tape was attached after physical therapy; the control group only received physical therapy. In the intervention period, the treatment program was conducted three times a week for a total of four weeks, and the values before and after the intervention were compared and analyzed. For statistical processing, a correspondence test was performed before and after the intervention at a significance level of 0.05, and the comparison between the groups, before and after the intervention, was made using an independent test. Results: In the experimental group, there was a difference in muscle stiffness, muscle tone, and intensity of pain. In addition, there was a significant difference between the control group’s emotional domain regarding muscular stiffness and pain and the experimental group. However, there was no significant difference in muscle tone and grade of pain, and intensity of pain for the control group. Conclusion: This study showed that, when physical therapy and motion taping were administered to middle-aged women with shoulder impingement syndrome, it had a more positive affect on the sensory and emotional parts of the muscle tone and pain compared to physical therapy alone.

Purpose: This study identified the co-activation of quadriceps and hamstring muscles during hamstring strengthening exercises in healthy adults. Methods: Twenty-one participants were required for the present study design to achieve 80% power, 0.8 effect size (η2), and an alpha level of 0.05. Thus, this study recruited 21 healthy adults. All participants performed Nordic exercises, bridge exercises, and one-leg deadlifts randomly. The activity of the rectus femoris, vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF), and semitendinosus (SM) were measured. In addition, the ratios of VM/VL and hamstring/quadriceps (HQ) were measured during the three hamstring strengthening exercises using electromyography. One-way ANOVA was used to compare the co-activation of quadriceps and hamstring muscles in the three exercises. Results: The activity of VM and VL during the performance of one-leg deadlifts was significantly higher than the other two exercises. The BF had significantly higher activity during the Nordic exercises compared to the other two exercises. In addition, the SM activation was significantly greater during Nordic exercises than one-leg deadlifts. Additionally, there was significant difference in HQ ratio among hamstring strengthening exercises. In specific, the one-leg deadlifts yielded a significantly lower HQ ratio. Conclusion: This study revealed that one-leg deadlifts are effective in rehabilitation for anterior cruciate ligament injury. In addition, Nordic exercises can be recommended to facilitate hamstring muscle activation.

Purpose: This study identified the effect of abdominal muscle contraction using changes in waist circumference for healthcare workers with back pain due to inadequate posture during working hours. Methods: In this study, we provided educational training focused on posture alignment and utilized waist circumference change sensors to induce the contraction of abdominal muscles as a method to address low back pain in healthcare workers. All 32 participants received the same training and then were assigned to two groups: wearing the keeping core band (CB) and not wearing the keeping core band (NCB). For the CB group, the waist circumference change sensor was applied for 6 weeks during working hours. Wilcoxon’s signed-ranks test and paired t-tests were used to compare the differences between the groups. All statistical significance levels were set to ɑ=0.05. Results: Trunk muscle endurance increased significantly in the CB group. There was no significant difference in stability index to evaluate static postural control, but active hip abduction tests, which evaluate dynamic postural control, showed significant decrease in the CB group. Conclusion: These results suggest that the induction of abdominal contraction using the waist circumference change sensor may improve the trunk muscle endurance and the postural control ability of the hip and pelvis of healthcare workers.

Purpose: This study investigated the effect of plantar-flexor muscle fatigue on the force sense and joint reposition sense of ankle joints in the healthy adults. Methods: Fifteen healthy subjects (male: 9, female: 6) participated in this study. A digital dynamometer was used to measure the force sense error while a wireless motion capture device was used to measure the joint reposition sense error. To induce plantar-flexor muscle fatigue for a dominant lower extremity, the subjects were asked to perform plantar flexion until exhaustion while barefoot. The differences in force sense error and joint reposition sense error for the ankle joint were measured immediately. The Wilcoxon test was used to compare these values before and after inducing plantar-flexor muscle fatigue. Results: The force sense error and joint reposition sense error of ankle joints after inducing plantar-flexor muscle fatigue increased significantly compared to the values before inducing muscle fatigue. Conclusion: This study suggests that plantar-flexor muscle fatigue could degrade the force sense and joint reposition sense in ankle joints. In addition, it could deteriorate ankle proprioception.

Purpose: This study examined the correlations between a forward head posture and the endurance and maximal voluntary contraction of the deep neck flexor, neck pain, and the changed position of the mandible. Methods: The subjects of this study were 50 male and female adults who work at a desk for at least four hours a day. The head–spine angle was photographed with a camera, and the endurance and maximal voluntary contraction of the deep neck flexor and the changed position of the mandible were measured using pressure biofeedback. The Neck Disability Index was used to measure neck pain. To examine the correlations between a forward head posture and the endurance and maximal voluntary contraction of the deep neck flexor as well as the changed position of the mandible, a Spearman’s correlation analysis was conducted. The statistical significance was set at 0.05. Results: A forward head posture and the endurance of the deep neck flexor showed a statistically significant positive correlation, and a forward head posture and neck pain showed a statistically significant negative correlation. In addition, the endurance of the deep neck flexor and neck pain showed a statistically significant negative correlation. Conclusion: The results of this study show that a forward head posture and the endurance of the deep neck flexor were correlated; in addition, a forward head posture and neck pain were correlated. Therefore, enhancing the endurance of the deep neck flexor can assist in correcting an imbalanced forward head posture, which can reduce neck pain.

Purpose: This study examined the effect of calf muscle fatigue on postural sway according to foot posture (a pes cavus, a normal foot, and a pes planus). Methods: The subjects of this study were 12, 11, and 9 students of U University with a pes cavus, a normal foot, and a pes planus, respectively, according to a Navicular Drop Test. Postural sway was measured with a balance instrument (BioRescue, RM Ingenierie, France) while the subjects stood static on two legs as well as during one-leg standing using the dominant leg in two conditions (with the eyes open and with the eyes closed for 30 seconds). Muscle fatigue was then induced in the calf muscle of the dominant leg, and both muscle fatigue and postural sway were measured using an EMG. To compare the degree of postural sway between the three groups after muscle fatigue was induced, the change values were calculated. The results were analyzed using a Kruskal–Wallis test, and a post-hoc test was conducted using the Bonferroni correction. Results: Significant inter-group differences were detected for postural sway during two-leg standing with the eyes closed and during one-leg standing with the eyes open and with the eyes closed (p<0.05). The post-hoc test showed significant differences between the pes cavus and normal foot groups and between the pes planus and normal foot groups for all three variables (p<0.05). However, no significant difference was detected between the pes cavus and pes planus groups (p>0.05). Conclusion: The results of this study show that the pes cavus and pes planus cause more fatigue and postural sway than a normal foot. Therefore, attention should be paid to changes in balance caused by muscle fatigue.

Purpose: This tutorial review investigated the effect of prior fatigue and passive stretches on eccentric contraction-induced muscle injuries, as well as the underlying mechanisms of eccentric contraction-related injuries. Methods: Contraction-induced muscle damage is the most common disabling problem in sports and routines. The mechanisms underlying the pathology and prevention of muscle damage lessened by prior fatigue or stretches are critical in assessing musculoskeletal injuries. Even though there are treatments to reduce eccentric contraction-induced muscle injuries, fatigue negatively influences them. Therefore, we reviewed previous studies on eccentric contraction-induced muscle injuries with prior treatments using the MEDLINE and PubMed databases. Results: Prior passive stretching had a preventative and therapeutic effect, but prior lengthening contractions did not. On the other hand, prior isometric contractions involving relatively small forces may not provide a sufficient stimulus to induce protection. As a result, high force isometric contractions may be necessary. The studies supported the positive effects of prior fatigue, concluding that it was a factor in determining the amount of damage caused by eccentric exercise. This was due to a reduction in force and increased temperature. Studies that did not support the positive effects of prior fatigue concluded that a shift in optimal length to a longer length and reduced energy absorption during lengthening are evidence that fatigue is not related to muscle injuries induced by lengthening. Conclusion: The variability of the experiment models, conditions, muscles, and treatment methods make it necessary to interpret the conditions of previous studies carefully and draw conclusions without making direct comparisons. Thus, additional studies should be carefully conducted to investigate the positive effect of fatigue on lengthening.