The purpose of this study was to determine the effectiveness of sit-to-stand training on unstable surfaces in individuals with stroke. Nineteen subjects with chronic stroke were divided into two groups: an experimental group (10 subjects) and a control group (9 subjects). They received 30 minutes of Neuro-developmental therapy (NDT) treatment, and sit-to-stand exercise for 15 minutes three times a week for four weeks. During the sit-to-stand training, the experimental group performed on an unstable AIREX balance pad, but the control group performed on a stable surface. Balance ability and weight-bearing distribution during quiet standing were measured before and after training period using the 7-item Berg balance scale-3P (BBS-3P) and the Five-times-sit-to-stand test (FTSST). In addition, the muscle strength of the knee extensor was evaluated before and after the training period. The results were as follows: 1) The weight-bearing distribution forward of the affected leg, increased significantly in the experimental group after the four-week intervention (p<.05), 2) The 7-item BBS-3P and FTSST increased significantly in the experimental group after the four-week intervention (p<.05), 3) The knee extensor muscle strength in both groups increased significantly after the four-week intervention (p<.05). In conclusion, the results of this study did not show that the sit-to-stand training on an unstable surface was more effective than on a stable surface. However, the results suggested that sit-to-stand training is effective in the balance training of stroke patients.
The study aimed to compare the effect of the treadmill walking training combined with obstacle-crossing (TWT-OC) and treadmill walking training (TWT) on the walking function of patients with chronic stroke. 29 subjects volunteered to participate in this study; they were randomly assigned to either TWT-OC group (15 subjects) or TWT group (14 subjects). Subjects from the TWT-OC group underwent a treadmill walking combined with obstacles-crossing for 30 minutes daily, three days a week for four weeks, whereas subjects from the TWT group received only a treadmill walking. The 10 m walk test (10MWT), 6-min walk test (6MWT), berg balance scale (BBS), timed up and go test (TUG), activities-specific balance confidence-Korean version (ABC-K), and walking ability questionnaire (WAQ) were measured before and after the 4-week training. The TWT-OC group showed significantly better functional mobility of walking and balance measured by 6MWT (p<.01), BBS (p<.01), and TUG scores (p<.05) when compared with those of the TWT group. Further, within-group comparison showed significant improvement in all variables (p<.01) except for 10MWT. These findings suggest that the TWT-OC and TWT may be helpful for improving the walking function of patients with chronic stroke, and the TWT-OC has probably more favorable outcomes for chronic stroke, however, further trials with wider range of subjects are warranted for generalization and clinical relevance.
The smart-phone has become a necessity for most people. In this study, we determined that using a smart-phone for 20 minutes can cause increased neck and shoulder muscle activities and fatigue. Seventeen healthy male smart-phone users who attended Yonsei University played a smart-phone game for 20 minutes and changes in their bilateral cervical erector spinae and upper trapezius muscle activities and fatigue were measured. To assess muscle activities and fatigue, we used the following variables: the median frequency, the 50th percentile Amplitude probability distribution function (APDF) value (median load), and the discrepancy in the 90th percentile APDF value and the 10th percentile APDF value (APDF range). A paired t-test was used to compare pre-smart-phone-use status with post-smart-phone-usestatus. The median frequency of the bilateral cervical erector spinae and the upper trapezius decreased significantly after 20 minutes of smart-phone use (p<.05). In addition, the 50th percentile APDF value of the bilateral cervical erector spinae and the right upper trapezius increased significantly (p<.05). The APDF range of the bilateral cervical erector spinae and the upper trapezius also increased significantly (p<.05). However, the 50th percentile APDF range of the left upper trapezius was not significantly different (p>.05). These findings suggest that using smart-phones for 20 minutes can induce muscle fatigue and increased neck and shoulder muscle activities.
The aim of this study was to compare the electromyographic (EMG) activity levels of the scapular upward rotators [upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA)] and other scapular muscles [posterior deltoid (PD), levator scapulae (LS), and infraspinatus (IS)] during isometric lower trapezius exercises. Twenty males with no medical history of shoulder pain or upper extremity disorders were recruited for this study. EMG activity was recorded from the UT, LT, SA, PD, LS, and IS while subjects performed three different exercises: Prone arm lift (PAL), Backward rocking diagonal arm lift (BRDAL), Modified Prone Cobra (MPC). One-way analysis of variance (ANOVA) was used to determine any significant differences among the three exercises. A lower relative activation of UT, LT, and SA was seen with the MPC than with the other exercises (p<.05). The relatively lower activation of the UT identified, the MPC exercise as the preferred choice for preferential strengthening the LT (p<.05). However, a higher activation in the PD, LS, and IS occurred with the MPC than with the other exercises (p>.05). The recruitment pattern of synergist varied depending on the exercise posture. These findings suggest that exercise posture is an important factor in the selection of strengthening exercise for weak muscle.
This study aimed to investigate the influence of shoe heel height and muscle fatigue on static and dynamic balance in young women. Thirty women who were used to wearing high heels volunteered to participate in this study. The shoe heel heights were 0 ㎝ and 7 ㎝. And ankle plantar flexor fatigue was experimentally induced. Static and dynamic balance were measured using the one leg standing test (OLST) and the star excursion balance test (SEBT) in anterior, posteromedial, and posterolateral directions, respectively. Values in the OLST (shoe heel height 0 ㎝, 28.83±3.24 sec to 26.12±6.13 sec; and 7 ㎝, 24.75±7.09 sec to 16.86±9.32 sec) and the SEBT in anterior (shoe heel height 0 ㎝, 71.02±4.57% to 69.50±3.66%; and 7 ㎝, 64.17±3.53% to 59.61±4.06%) and posteromedial (shoe heel height 0 ㎝, 92.01±5.61% to 90.38±7.10%; and 7 ㎝, 83.09±7.29% to 76.83±9.28%) directions were significantly reduced when fatigue-inducing exercise was performed (p<.05). Furthermore, within these parameters, there were significant interaction effects between shoe heel height and fatigue condition (p<.05). These findings suggest that shoe heel height and muscle fatigue contribute to some changes in static and dynamic balance in young women, probably leading to negative effects on physical function during a variety of activities of daily living.
The purpose of this study was to examine the differentiation of proprioception, invertor and evertor muscle strength, and time to peak torque at a velocity of 300 °/sec of the ankle joint in people with or without functional ankle instability (FAI). Nineteen subjects with a history of ankle sprain participated. All subjects were divided into FAI group (n1=9, Cumberland ankle instability tool (CAIT)≤24) and a control group (n2=10) based on their CAIT scores. Isokinetic dynamometer was used to measure the sense of active joint position of the ankle at mid-range and end-range of an inversion motion and invertor as well as the evertor muscle strength and time to peak torque at 300 °/s. The FAI group showed a statistically reduction in invertor and evertor muscle strength and time to peak torque when compared to the control group (p<.05). Muscle strength and time to peak torque of the invertor and evertor, as well as the sense of active joint position at end-range were also lower in the FAI group than in the control (p<.05). Correlations between CAIT score and position sense at end-range (r=-.577) and invertor muscle strength (r=.554) were statistically significant (p<.05). Individuals with FAI showed reduction in invertor and evertor muscle strength and recruitment time as well as in proprioception of the ankle joint. Thus, proprioception and invertor and evertor muscle strength of the ankle joint at fast angular velocity may be investigated when examining and planning care for individuals with FAI.
This study was to determine the reliability and validity of manual measurements of patellar height to standard radiographic measurements in 30 knees of 15 subjects. Patellar height was measured using manual and radiographic methods. The manual measurements were performed by two examiners using digital vernier calipers with the subject sitting and the knees in 30° of flexion. The radiographic measurements were performed in the same position. The reliability of the manual measurements was assessed by means of intraclass correlation coefficients [ICC(3,1)], and the validity was investigated using the Pearson’s product-moment correlation coefficient and an independent t-test. The intra- and inter-rater reliabilities of the manual measurement of patellar height were excellent (ICC=.86 and .88 respectively). The validity of patellar height measured manually compared to the radiographic method was good (Pearson’s r=.69). In conclusion, the manual method is an objective, qualitative measurement of patella height.
Pediatric home-based physical therapy (PHBPT) provides professional rehabilitation programs at the patient’s home, where the activities of daily life are actually performed. PHBPT also allows to avoid the difficulties of transporting children with disabilities to the clinic. Despite these advantages, PHBPT is not yet widely practiced in Korea. There is little objective information regarding the opinions of the main stakeholders on PHBPT. To investigate the awareness and demand of PHBPT among the main stakeholders, 41 pediatric physical therapists (PT) (of 60 contacted) were recruited from different regions of Korea on the basis of the regional population distribution. The recruited PTs completed their questionnaires and also participated in collecting questionnaires from 35 medical doctors (MD) with whom they worked and from randomly selected 201 parents of children with disabilities recruited. The overall response rate was 85.5%. The awareness of PHBPT differed between PTs (95.1%) and parents (67.2%) (p<.001). The survey showed that 82.9% of MDs had at least heard about PHBPT. Significantly more parents (83.5%) than MDs (57.1%), and 70.0% of PTs, wanted to start PHBPT service immediately (p<.001). Significantly more parents (90.0%) than PTs (73.2%) were willing to participate in PHBPT (p<.001). Opinions on the details of policies and procedures (i.e., necessity for prescription, treatment cost, and treatment frequency) differed among the respondent groups, but all favored a minimal qualification of 6∼10 years of pediatric experience and a treatment session duration of 1 hour. These findings provide objective information to support health service administrators to understand the current demand and develop feasible policies and procedures of PHBPT in Korea.
The purpose of this study was to determine the reliability of distance measurements from the medial border of the scapula to the spinous process of the thoracic vertebrae when obtained using tape and photography measurements. The study included 20 healthy subjects (10 males, 10 females); for a total of 40 scapula measurements. The distance measurements made using tape or photography methods were conducted with the subject in a standing position. Repeated tape and photography measurements were conducted in two sessions on different days by two examiners to assess the inter-rater and intra-rater reliability of the two methods. The reliability of scapular distance measured using tape and photography methods was tested using intraclass correlation coefficients (ICC(3,1)) and the standard error of measurement (SEM). The inter-rater reliability of the tape measurement method was excellent (ICC=.77) and the intra-rater reliability was fair to good (ICC=.74). The inter-rater and intra-rater reliabilities of the photography measurement method were excellent (ICC=.76 and .76 respectively). Our results suggest that photography measurement is an objective and qualitative measurement tool for scapular distance measurements.
Active straight-leg raise (ASLR) is a physical evaluation procedure to test lumbar spine stability. Several previous studies have reported various methods to control the activation of abdominal muscles during ASLR. We investigated the effects of three different hip positions in frontal plane on abdominal muscles to increase or decrease the difficulty level of lumbar spine stability exercise during ASLR in pain free subjects. Eleven young and healthy subjects voluntarily participated in this study (6 men, 5 women; mean age=24.0±1.2 years, height=160.0±7.3 ㎝, weight=55.0±10.6 ㎏, body mass index=21.5±2.3 ㎏/㎡). The subjects had three trials on each ASLR with hip 10° adduction, neutral hip, and hip 30° abduction. Separate repeated-measures analysis of variance (ANOVA) and the post hoc Bonferroni tests (with α =.05/3=.017) were performed for each muscle among the three different hip positions in frontal plane (ASLR with hip 10° adduction, neutral hip, and hip 30° abduction). The ipsilateral external oblique (EO), contralateral EO, ipsilateral internal oblique/transverse abdominis (IO/TrA), and contralateral IO/TrA were significantly greater in ASLR with hip 30° abduction compared with ASLR with hip 10° adduction. Also, the ipsilateral EO, contralateral EO, and ipsilateral IO/TrA were significantly greater in ASLR with hip 30° abduction compared with ASLR with neutral hip. These results suggest that ASLR with hip 30° abduction and neutral would be useful method to strengthen the EO and IO/TrA. And, ASLR with hip 10° adduction would be effective in early stages of lumbar stabilization program due to low activation of EO and IO/TrA during maintaining of ASLR position with low load.
The purposes of this study were: 1) to show the item difficulty hierarchy of walking/moving construct of the International Classification of Functioning, Disability and Health-Activity Measure (ICF-AM), 2) to evaluate the item-level psychometrics for model fit, 3) to describe the relevant physical activity defined by level of activity intensity expressed as Metabolic Equivalent of Tasks (MET), and 4) to explore what extent the empirical activity hierarchy of the ICF-AM is linked to the conceptual model based on the level of energy expenditure described as MET. One hundred and eight participants with lower extremity impairments were examined for the present study. A newly created activity measure, the ICF-AM using an item response theory (IRT) model and computer adaptive testing (CAT) method, has a construct on walking/moving construct. Based on the ICF category of walking and moving, the instrument comprised items corresponding t walking short distances, walking long distances, walking on different surfaces, walking around objects, climbing, and running. The item difficulty hierarchy was created using Winstep software for 20 items. The Rasch analyses (1-parameter IRT model) were performed on participants with lower extremity injuries who completed the paper and pencil version of walking/moving construct of the ICF-AM. The classification of physical activity can also be performed by the use of METs that is often preferred to determine the level of physical activity. The empirical item hierarchy of walking, climbing, running activities of the ICF-AM instrument was similar to the conceptual activity hierarchy based on the METs. The empirically derived item difficulty hierarchy of the ICF-AM may be useful in developing MET-based activity measure questionnaires. In addition to convenience of applying items to questionnaires, implications of the finding could lead to the use of CAT method without sacrificing the objectivity of physiologic measures.