The purpose of this study were to determine the intra-rater and inter-rater reliability of shoulder
passive range of motion measurement using the “Clinometer + bubble level”, a smartphone application and to compare with the intra-rater and inter-rater reliability of measurement using a goniometer. Twenty six patients with stroke were recruited for this study. Two raters measured the passive range of motion of four types of shoulder movements (forward flexion; FF, abduction; ABD, external rotation at 90° abduction; ER90 and internal rotation at 90° abduction; IR90) using a goniometer and a smartphone to determine within-day inter-rater reliability. A retest session was performed thirty minutes later to determine within-day intra-rater reliability. The reliability was assessed using intraclass correlation coefficients (ICC) and the standard error of measurement (SEM). The ICC (2,1) for the inter-rater reliabilities of the goniometer and smartphone were good in FF and ABD [ICC (2,1)=.75∼.87] and excellent in ER90 [ICC (2,1)=.90∼.95]. The intra-rater reliabilities for the goniometer and smartphone were good or more than good, with an ICC (3,1) value >.75, the exception was IR90 measured by rater 2 on the smartphone. These results suggest that smartphone could be used as an alternative method tool for measurement of passive shoulder range of motion in patients with stroke.
The purpose of this study was to determine the effect of gait initiation training on gait and center of
pressure (CoP) during gait initiation in stroke patients. Twenty-three subjects were randomly assigned to either an experimental group (EG) or a control group (CG). The EG received gait initiation training with increased CoP posterior distances the maximum the rear on gait training. The CG received general gait training. Both groups received training three times a week over a period of four consecutive weeks. The figures for CoP distances the maximum the rear, CoP distances time the mover the maximum the rear, the Tinetti Performance-Oriented Mobility Assessment (POMA), and gait velocity were recorded both before and after the training sessions for both groups. The EG’s results for CoP distances the maximum the rear, CoP distances time the mover the maximum the rear, and POMA improved after training (p<.05). In terms of the rate of change of CoP distances the maximum the rear, the EG demonstrated a significantly higher increase (p<.05) than did the CG. The results of this study suggest that increased CoP distances the maximum the rear affect the gait initiation and gait performance of stroke patients. Further studies with a larger sample size are necessary to verify the accuracy of the results of this study.
The purpose of this study was to investigate the effects of visual cue deprivation during sideways
treadmill training in individuals with stroke. Twenty-eight stroke patients were divided into two groups, and each group participated in a sideways treadmill training session for 20 minutes, three times per week for 4 weeks. The eyes close group (15 subjects) performed this treadmill training with visual cue deprivation, while the eyes open group (13 subjects) performed it without visual cue deprivation. Gait function was measured in both groups before and after the training sessions with the Biodex Gait Trainer 2, which determined walking speed, distance, step length, and time on each foot. Balance was measured before and after each training period in both groups using the Five-Times Sit-to-Stand Test (FTSST), the Timed Up and Go test (TUG), and the seven-item Berg Balance Scale-3P (7-item BBS-3P). The eyes close group showed significantly improved gait function, walking speed, distance, step length, and time on each foot after training (p<.05). The eyes close group showed improved balance ability, FTSST, TUG, and 7-item BBS-3P test after training (p<.05). The findings indicated that sideways treadmill training with visual cue deprivation positively affects gait ability of stroke patients. Therefore, sideways treadmill training with visual cue deprivation may be useful for the recovery of gait ability of stroke patients.
The purpose of this study was to investigate the immediate effect of fabric ankle-foot orthosis on
spatiotemporal gait parameters, compared to a barefoot condition in children with spastic cerebral palsy. Eleven children with spastic cerebral palsy participated in this study. Spatiotemporal gait parameters were measured with the GAITRite system. Fabric ankle-foot orthosis significantly improved Timed Up and Go test time and gait velocity. There was no significant difference in cadence. The step time significantly improved in both the more and less affected foot compared to the barefoot condition. The step length of the affected foot also significantly improved, but there was no significant difference in the step length of the less affected foot. There was significant improvement in the stride length of both the affected and less affected foot, but no significant difference in single stance or double stance. The fabric ankle-foot orthosis could improve stability, and selective control of the joint and promote better walking in children with cerebral palsy. Consequently, the fabric ankle-foot orthosis might be an alternative assistive device for neurological populations as a primary role instead of the typical ankle-foot orthosis.
Asymmetric sitting posture may cause asymmetric buttock pressure and unilateral low back pain
(LBP). The purpose of this study was to compare the differences of buttock pressure between both sides, and pelvic angle (sagittal and coronal planes) during typing in a sitting position on a pressure mat (Baltube) in individuals with and without unilateral LBP. Ten subjects with unilateral LBP and ten subjects without unilateral LBP were recruited for this study. Buttock pressure was measured using a pressure mat and pelvic angles were measured using a palpation meter. The subjects performed typing in a sitting posture for 30 minutes. Pressure data were collected and averaged at initial term (from start to first minutes) and final term (last minutes of 30 minutes). Angles of pelvic tilting were measured after 30 minutes typing. Pressure asymmetry values (difference in pressure between both sides) were calculated at the initial and final terms. A two-way analysis of variance was used to compare the differences between the initial and final pressure asymmetry values in subjects with and without unilateral LBP. An independent t-test was applied to compare the pelvic tilt angles between the two groups. To compare the change of pressure from the initial term to the final term between the symptomatic and asymptomatic sides in the unilateral LBP group, a paired t-test was applied. In the unilateral LBP group, the pressure asymmetric value at the final term was significantly greater than that of the initial term (p<.05). The angle of pelvic tilting in coronal plane was significantly greater in the unilateral back pain group compared to the without unilateral LBP group (p<.05), however, there was no significant difference in the angle of pelvic tilting in the sagittal plane between the two groups (p>.05). In the unilateral LBP group, the change of pressure from the initial term to the final term was significantly less in the symptomatic side (-6.90 ㎜Hg) than the asymptomatic side (5.10 ㎜Hg). This asymmetric sitting posture may contribute to unilateral LBP in the sitting position. Further studies are needed to determine if asymmetric weight bearing in sitting causes unilateral LBP or if unilateral back pain causes asymmetric weight bearing, and if the correction of asymmetric weight bearing in sitting can reduce unilateral LBP.
The aim of this study was to compare the duration of hamstring flexibility improvement after 3
stretching interventions in people with limited hamstring flexibility. Twenty-two subjects (12 men, 10 women) with limited hamstring flexibility of the dominant leg received 3 stretching interventions— modified dynamic stretching (MDS), hold-relax (HR), and static stretching (SS)—in a random order. All the subjects received all 3 interventions at intervals of at least 24 hours to minimize any carry-over effect. Modified dynamic stretching was applied as a closed kinetic chain exercise in the supine position by using the sling suspension system (Redcord Trainer®). The SS and HR interventions were individually performed in the straight leg raising (SLR) position, and all 3 interventions were performed for 3 minutes. Outcome measures included passive knee extension (PKE) measurements. Five post-test measurements were recorded for all subjects at 3, 6, 9, 15, and 30 minutes after the interventions. MDS was associated with a significant increase in knee extension range of motion even at 30 minutes post-treatment. In contrast, the HR and SS stretching methods showed increased hamstring flexibility for only 6 minutes post-treatment. Improvements in the range of motion of knee extension (indicating enhancement in hamstring flexibility) with MDS were maintained longer than those with the HR and SS interventions. Therefore, MDS may be more effective than the other interventions for maintaining hamstring flexibility.
For professional drivers, there is a possibility to have musculoskeletal disorders on ankle joint due to repetitive pedaling operation. Therefore, this study have focused to examine ankle active range of motion (AROM), dorsiflexor strength, and pressure pain threshold (PPT) of tibialis anterior muscle (TA) in taxi drivers compared to a age-matched control group. Thirty male taxi drivers with at least 10 years of driving experience and thirty male sedentary workers were evaluated for ankle AROM, dorsiflexor strength, and PPT of TA. Multiple independent t-tests were used to identify significant differences between two groups. For the results, taxi drivers had significantly less AROM in dorsiflexion and greater AROM in external tibial rotation compared to the control group. Also, dorsiflexor strength and PPT of TA in taxi drivers was significantly lower than in the control group. This study indicates that the repetitive ankle movements associated with driving have an effect on ankle AROM, dorsiflexor strength, and PPT of TA and may lead to work-related musculoskeletal disorders on ankle. Professional drivers may need to be educated to prevent a potential musculoskeletal disorders associated with repetitive movement.
Cross knee curl-up is an ideal variation of abdominal curl up exercise to strengthen abdominal
musculature without excessive lumbar flexion which can increase the loads on the disc and ligaments. In addition, slowly forced expiration can facilitate the activation of the abdominal musculature. The purpose of this study was to determine the effects of slowly forced expiration on activity of abdominal muscles, such as rectus abdominis (RA), external oblique (EO), and transverse abdominis/internal oblique (TrA/IO), while cross knee curl-up. Eleven young and healthy subjects (6 males and 5 females) participated. All subjects performed the cross knee curl-up slowly forced expiration and natural breathing. Paired t-test was performed in normalized electromyogram (EMG) muscle activity of the bilateral RA, EO, and TrA/IO to compare the differences between the cross curl-up with slowly forced expiration and natural breathing. Statistical significance was set at .05. There were no significant differences in normalized EMG muscle activity of the bilateral RA, EO, and TrA/IO between the cross curl-up with slowly forced expiration and natural breathing. The finding of this study designates that slowly forced expiration does not induce increasing activity of abdominal muscle in cross knee curl-up; hence, learning step of breathing control might not be necessary to strengthen abdominal muscle in cross knee curl-up.