This case report describes the effectiveness of cervical corrective exercises in a patient with cervical radiculopathy (CR) who experienced radicular pain, upper limb paresis, and limited functional activity. A 39-year-old male with cervical radiculopathy performed the cervical corrective exercises for reducing pain. Pain intensity, cervical posture, and active range of motion of cervical intersegmental spine motion were measured baseline, after 4 weeks, and after 8 weeks with self-reported questionnaire and radiographs. After 8 weeks of intervention, the patient demonstrated alleviated radicular symptoms, improved neck posture and active range of flexion and extension of the cervical intersegmental spine. Especially in the angle between the cervical vertebra 6 and 7, the angle was changed from -4.69° to 3.30° during resting position after intervention. The present case indicates that the cervical corrective exercises might be a possible treatment to effectively reduce radicular symptoms, improve neck posture, and active cervical intersegmental motion for patient with CR.
The purpose of this study was to evaluate the effects of mobilization of the sciatic nerve on hamstring flexibility, lower limb strength, and gait performance in patients with chronic stroke. This study was a randomized clinical trial with a crossover design. Sixteen subjects were recruited for this study. The subjects were randomly divided into two intervention groups and underwent either of the following two interventions: sciatic nerve mobilization or static stretching of the hamstring. We assessed hamstring flexibility, lower limb strength, and gait performance using a digital inclinometer, a hand-held dynamometer, and the 10-meter walk test, respectively. Subjects had a 24-hour rest period between each session in order to minimize carryover effects. Measurements for each test were assessed prior to and immediately after the intervention sessions. Using a two-way analysis of variance test with repeated measures, data from the two trials were analyzed by comparing the differences between both techniques. The level of statistical significance was set at .05. Sciatic nerve mobilization resulted in significantly better knee extensor strength (p=.023, from 15.32±5.98 to 18.16±6.95 ㎏) and knee flexor strength (p=.011, from 7.80±4.80 to 8.15±4.24 ㎏) in the experimental group than in the control group. However, no significant effects of static stretching of the hamstring were observed on hamstring flexibility from the ankle plantar flexion (p=.966) and ankle neutral positions (p=.210) and on gait performance (p=.396). This study indicated that the sciatic nerve mobilization technique may be more effective in muscle activation of the knee extensor muscle and knee flexor muscle than hamstring static stretching technique in patients with chronic stroke.
The purpose of this study was to investigate the effects of visual electromyography (EMG) biofeedback on the EMG activity of the lower trapezius (LT), serratus anterior (SA), and upper trapezius (UT) muscles, the LT/UT and SA/UT EMG activity ratios, and the scapular upward rotation angle during scapular posterior tilting exercise (SPTE). Twenty-four subjects with round-shoulder posture participated in this study. The EMG activities of the LT, SA, and UT were collected during SPTE both without and with visual EMG biofeedback. The scapular upward rotation angle was measured at the baseline, after SPTE without visual EMG biofeedback, and after SPTE with visual EMG biofeedback. The LT, SA, and UT EMG activities, and the LT/UT and SA/UT EMG activity ratios were analyzed by paired t-test. The scapular upward rotation angle was statistically analyzed using one-way repeated analysis of variance. If a significant difference was found, a Bonferroni correction was performed (p=.05/3=.017). The EMG activities of LT and SA significantly increased, and the EMG activity of UT significantly decreased during SPTE with visual EMG biofeedback compared to SPTE without visual EMG biofeedback (p<.05). In addition, the LT/UT and SA/UT EMG activity ratios significantly increased during SPTE with visual EMG biofeedback compared to SPTE without visual EMG biofeedback (p<.05). Significant increases were found in the scapular upward rotation angle after SPTE without and with visual EMG biofeedback compared to baseline (p<.017), and no significant differences were observed in the scapular upward rotation angle between SPTE without and with visual EMG biofeedback. In conclusion, SPTE using visual EMG biofeedback may be an effective method for increasing LT and SA activities while reducing UT activity.
The purpose of this study was to find which spatiotemporal gait parameters gained from stroke patients could be predictive factors for the gait part of Tinetti Performance-Oriented Mobility Assessment (POMA-G). Two hundred forty-six stroke patients were recruited for this study. They participated in two assessments, the POMA-G and computerized spatiotemporal gait analysis. To analyze the relationship between the POMA-G and spatiotemporal parameters, we used Pearson’s correlation coefficients. In addition, multiple linear regression analyses (stepwise method) were used to predict the spatiotemporal gait parameters that correlated most with the POMA-G. The results show that the gait velocity (r=.67, p<.01), cadence (r=.66, p<.01), step length of the affected side (r=.49, p<.01), step length of the non-affected side (r=.53, p<.01), swing percentage of the non-affected side (r=.47, p<.01), and single support percentage of the affected side (r=.53, p<.01) as well as the double support percentage of the non-affected side (r=-.42, p<.01) and the step-length asymmetry (r=-.64, p<.01) correlated with POMA-G. The gait velocity, step-length asymmetry, cadence, and single support percentage of the affected side explained 67%, 2%, 2%, and 1% of the variance in the POMA-G, respectively. In conclusion, gait velocity would be the most predictive factor for the POMA-G.
The purpose of this study was to compare the effects of underwater treadmill gait training (UTGT) and overground treadmill gait training (OTGT) on the gait, balance ability and pulmonary function of stroke patients. Twenty subjects were recruited for this study. The subjects were randomly assigned to two groups: UTGT (n1=10) and OTGT (n2=10). The 10 m walk test (10 MWT), Berg Balance Scale, Timed Up and Go (TUG) test, center of pressure, pulmonary function of forced vital capacity (FVC), forced expiratory volume after 1 sec (FEV1) and FEV1/FVC were measured before and after 4 weeks of training. Both groups undertook the gait training for 30 min a day, 3 times a week, for 4 weeks, and rating of perceived exertion of the groups were measured and compared. All the studied variables were significantly improved in both groups (p<.05) at the end of the study, except in the FEV1 of OTGT (p>.05). There was significant between-group difference in all of the variables, except in the 10 MWT (p>.05). These findings suggest that UTGT is more effective than OTGT in improving the balance and pulmonary functions of stroke patients.
This study compared the effects of the initial head position (i.e., a HHP versus a relaxed head position) of subjects with and without a FHP on the thickness of the deep and superficial neck flexor muscles during CCF. The study recruited 6 subjects with a FHP and 10 subjects without a FHP. The subjects performed CCF in two different head positions: a HHP, with the head aligned so that the forehead and chin formed a horizontal line, and a relaxed head position (RHP), with the head aligned in a self-selected comfortable position. During the CCF exercise, the thickness of the longus colli (LCo) and the thickness of the sternocleidomastoid (SCM) were recorded using ultrasonography. The thickness of each muscle was measured by Image J software. The statistical analysis was performed with a two-way mixed-model analysis of variance. The thickness of the SCM differed significantly (p<.05) between the subjects with and without FHP. According to a post hoc independent t-test, the change in thickness of the SCM increased significantly during CCF in the subjects with FHP while adopting a HHP compared to that in the subjects without FHP. The change in thickness of the SCM was not significantly different between the two positions in subjects without FHP, and there was no significant change in thickness of the LCo muscle during the CCF exercise according to the initial position in both subjects with and without FHP. The results suggest that CCF should be performed in RHP to minimize contraction of the SCM in subjects with a FHP.
The purpose of this study were to translate the Fullerton Advanced Balance (FAB) scale into Korean and to verify the content validity by utilizing a back-translation method with a view to assessing balance function and the risk of falling in a clinical research setting. This research was conducted in six steps. First, three Korean physical therapists translated the FAB scale into Korean. Second, two bilingual professors of physical therapy and a physical therapist evaluated translation conformity of Korean-translated FAB scale. In the third and fourth steps, twelve physical therapists evaluated the degree of translation comprehension, and a translator back-translated the Korean FAB scale into the original language. Fifth, a bilingual professor of physical therapy and two native speakers evaluated the technical and conceptual equivalence between the original and translation versions. In this process, inappropriate translated items were revised using recommended substitute words or sentences, and all items were evaluated on the basis of three points or more on a rating scale in terms of translation comprehension, and the technical and conceptual equivalence of the back-translation. In the sixth and last step, the translation verification committee completed the final Korean version. The above process indicated that the content validity of the Korean-translated FAB scale was established by means of systematic translation methods, and it can therefore be used to assess balance function and the risk of falls in a clinical research setting.
The aims of the current study were to assess reliability of range of motion (ROM) measurement of glenohumeral internal rotation (GIR) with a pressure biofeedback stabilization (PBS) method and to compare the reliability between manual stabilization (MS) and the PBS method. In measurement of pure glenohumeral joint motion, scapular stabilization is necessary. The MS method in GIR ROM measurement was used to restrict scapular motion by pressing the palm of the tester’s hand over the subject’s clavicle, coracoid process, and humeral head. The PBS method was devised to maintain consistent pressure for scapular stabilization during GIR ROM measurement by using a pressure biofeedback unit. GIR ROM was measured by 2 different stabilization methods in 32 subjects with GIR deficit using a smartphone clinometer application. Repeated measurements were performed in two test sessions by two testers to confirm inter- and intra-rater reliability. After tester A performed measurements in test session 1, tester B’s measurements were conducted one hour later on the same day to assess the inter-rater reliability and then tester A performed again measurements in test session 2 for confirming the intra-rater reliability. Intra-class correlation coefficient (ICC) (2,1) was applied to assess the inter-rater reliability and ICC (3,1) was applied to determine the intra-rater reliability of the two methods. In the PBS method, the intra-rater reliability was excellent (ICC=.91) and the inter-rater reliability was good (ICC=.84). The inter-rater and intra-rater reliability of the PBS method was higher than in the MS method. The PBS method could regulate manual scapular stabilization pressure in inter- and intra-rater measuring GIR ROM. Results of the current study recommend that the PBS method can provide reliable measurement data on GIR ROM.
Previous studies have investigated stepping over obstacles in treadmill walking training (TWT-OS) and treadmill walking training (TWT) alone for walking capacity not considering real physical activity. As such, we investigated the effects of TWT-OS on physical activity and changes in different levels of physical activity based on community ambulation in stroke patients. Thirty subjects were randomly assigned to either the experimental group or the control group, with 15 and 15 subjects, respectively. However, one subject from the control group was excluded because of inadequate treatment sessions. All subjects underwent routine physical therapy in the form of treadmill walking. The subjects in the experimental group underwent simultaneous training in obstacle-stepping while walking on the treadmill for 30 min/day, five times/week, for four weeks. Subjects were given a three-axis accelerometer to wear at the hip on a belt for one-week pre- and post-training physical activity. Step counts for seven days, average daily step counts, and the average of minutes spent in sedentary, light, and above moderate activity were chosen as outcome measures of physical activity. No significant differences between the groups were found in terms of step counts for seven days, average daily activity, or daily activity spent at sedentary levels after four-week interventions. However, the average daily activity spent at light levels (-42.60 min vs. -6.71 min) was significantly lower in the experimental group than in the controls. Conversely, average daily activity spent at above moderate levels was higher (19.86 min vs. 11.07 min) (p<.05) after adjusting for each baseline value. Significant pre- and post-training differences were found in all variables of the experimental group (p<.05). Thus, TWT-OS could improve physical levels above moderate activity as a community-oriented task more than simple repetitive waking on a treadmill, and it could provide an opportunity for patients ambulatory after stroke to participate in the community again.
This study examined the effects of trunk stabilization exercise on balance and trunk control in children with spastic diplegia. Four children with ambulatory spastic diplegia participated in the trunk stabilization exercise program using a Both Sides Utilized (BOSU) ball, 30 minutes a day, two times a week for eight weeks. Outcome variables included the pediatric balance scale, trunk control movement scale and multifidus thickness using ultrasound image. After trunk stabilization exercise, there was statistically no significant improvement in pediatric balance scale, trunk control movement scale and multifidus thickness. However, individual outcomes were observed with some positive changes. Balance, trunk control movement, and thickness of multifidus were found to be improved. Trunk stabilization exercise using a BOSU ball could improve trunk control and increase the thickness of multifidus in children with spastic diplegia. Further investigation is needed to evaluate subjects according to type of cerebral palsy and to understand the relationship between postural control and gait.