Background: Various methods are used for recovery of knee flexion range of motion (ROM) due to a tightened rectus femoris muscle (RFM) or limited inferior glide of the patella. Stretching methods are common interventions for restoring the tightened RFM length. Also patellar inferior gliding (PIG) technique can recover tightened RFM length too. However, effect of applying the PIG to passive knee flexion (PKF) has not been studied.
Objects: The purpose of this study was to investigate the effect of combining PIG with RFM stretching for improving knee flexion ROM in subjects with RFM tightness.
Methods: Twenty-six subjects with RFM tightness were recruited. Two different methods of knee stretching were tested: 1) PKF during modified Thomas test (MTT) and 2) PKF with PIG during MTT. The passive stretching forces was controlled by hand-held dynamometer. The knee flexion ROM angle was measured by a MTT with ImageJ software. Differences between the conditions with and without PIG were identified with a paired t-test.
Results: The knee flexion ROM was significantly greater for PKF with PIG (114.44±9.33) than for PKF alone (108.97±9.42) (p<.001).
Conclusion: A combination of passive knee flexion exercise and PIG can be more effective than PKF in increasing knee flexion ROM in individuals with RFM tightness.
Background: Squatting is one of the best functional exercises to strengthen the quadriceps muscle in independent gait and activities of daily living. Although the use of a gym ball during squat exercise is the most common way of strengthening the vastus medialis oblique (VMO) muscle, published data on this subject are limited.
Objects: The purpose of this study was to compare the sequential muscle activation of the VMO and vastus lateralis (VL) muscles during squat exercise using a gym ball at different knee flexion angles.
Methods: Forty healthy adults were randomly divided into experimental (squat exercise using a gym ball) and control (squat exercise alone) groups, in which squats were performed at 45° and 90° knee flexion. Electromyographic (EMG) activity data were collected over 10 seconds under the 2 angles of knee flexion (45° and 90°).
Results: There was significant group and time interaction effect for VMO and VL muscle activation at 45° knee flexion. This was similarly demonstrated at 90° knee flexion. No significant group main effect and time main effect for VMO and VL muscle activation were noted at 45° knee flexion, respectively. In contrast, there was significant group main effect and time main effect for VMO and VL muscle activation at 90° knee flexion. These significant differences were demonstrated through two-way analysis of variance over repeated measurements, suggesting that the EMG activity of the VMO muscle during squatting with a gym ball showed remarkable improvement compared to that of the VL muscle.
Conclusion: This research suggests that squat exercise using a gym ball may be more beneficial in improving the activity of VMO than of the VL muscle at both 45° and 90° of knee flexion, respectively. We highly recommend squat exercises with a gym ball for selective strengthening of the VMO muscle in knee rehabilitation.
Background: Deficiencies in the ability to maintain balance are common in elderly. Augmented feedback such as knowledge of results (KR) can accelerate learning and mastering a motor skill in older people.
Objects: We designed this study to examine whether one session of Wii-Fit game with self-regulated KR is effective for elderly people, and to compare the effect of two different timings of self-regulated KR conditions.
Methods: Thirty-nine community-dwelling elders, not living in hospice care or a nursing home, participated in this study. During acquisition, two groups of volunteers were trained in 10 blocks of a dynamic balancing task under the following 2 conditions, respectively: (a) a pre-trial self-regulated KR (n1=18), or (b) a post-trial self-regulated KR (n2=21). Immediate retention tests and delayed retention tests of balancing performance were administered in 15 minutes and 24 hours following acquisition period, respectively.
Results: In both groups, significant improvements of balancing performances scores were observed during the acquisition period. Regardless of the group, mean of balancing performance scores on retention tests were well-maintained from the final session. There were no significant differences between groups in balancing performance scores during the acquisition period (p>.05); however, the post-trial self-regulated KR group exhibited significantly higher balancing performance scores in both the immediate retention test and delayed retention test than that of the pre-trial self-regulated KR group (p<.05).
Conclusion: Therefore, subjects who regulated their feedback after a dynamic balancing task, during the acquisition period, experienced more efficient motor learning during the retention period than did subjects who regulated their feedback before a dynamic balancing task. Accordingly, in case of presenting the KR of motor learning in clinical settings to elders who reduced dynamic balance abilities, the requesting time of KR is imperative according to self-estimation processes as well as types of KR and practice.
Background: In previous studies regarding flexible pes planus, Foot orthosis, special shoes have been used as interventions for correcting malalignment and intrinsic muscles strengthening exercise have been regarded as interventions for foot function and supporting medial longitudinal arch during walking. However, some recent studies reported that strengthening extrinsic muscles as well as intrinsic muscles is more effective and active intervention for flexible pes planus. In particular, the tibialis posterior muscle of foot extrinsic muscles plays essential roles in maintaining the medial longitudinal arch during dynamic weight bearing and balance. In addition this muscle acts longer than other supination muscles during the stance phase in the gait cycle.
Objects: This study aimed to investigate the effect of foot intrinsic muscle and tibialis posterior muscle strengthening exercise for plantar pressure and dynamic balance in adults with flexible pes planus.
Methods: 16 young flexible pes planus adults (7 males, 9 females) were recruited and were randomized into two groups. The experimental group performed foot intrinsic muscle and tibialis posterior muscle strengthening training, the control group performed only foot intrinsic muscle strengthening training. All groups received strengthening training for 30 minutes five times a week for six weeks.
Results: The experimental group had significantly lower plantar pressure of medial heel area than the control group in stand (p<.05). The experimental group had significantly higher dynamic balance ability than control group (p<.05).
Conclusion: The results of this study provide evidence to suggest that foot intrinsic muscle and tibialis posterior muscle of extrinsic muscle strengthening exercises may improve plantar pressure distribution and dynamic balance ability in adults with flexible pes planus.
Background: Shoulder stabilization commonly involves two components: the glenohumeral stabilization exercise (GSE) and scapular stabilization exercise (SSE). Despite the fact that the shoulder stabilization has advantageous merit, to our knowledge, only a few studies have compared the superior of the GSE and the SSE.
Objects: The purpose of this study was to assess the effects of GSE in patients with nonspecific shoulder pain.
Methods: Thirty subjects with nonspecific shoulder pain were randomly divided into an experimental group and control group, each with 15 patients. The experimental group used an GSE, whereas the control group did SSE. All subjects were measured in shoulder stability, scapular symmetric alignment, pain, muscle power, and range of motion before and after the intervention.
Results: GSE resulted in significantly better shoulder stability (p=.046, from 8.67±7.54 score to 13.93±9.40) in the experimental group compared with SSE in the control group. However, no significant effects were observed for scapular symmetric alignment including the angles of inferior scapular distance (p=.829) and inferior scapular height difference (p=.735), pain (p=.113), muscle power including shoulder flexion (p=.723) and abduction (p=.897) and range of motion including shoulder flexion (p=.853) and abduction (p=.472).
Conclusion: These findings suggest that GSE may be more effective in increasing the shoulder stability than the SSE in patients with nonspecific shoulder pain, probably through a centralization effect on the shoulder mechanism.
Background: Losing balance during locomotive actions becomes an increasing threat to both the community-dwelling elderly and elderly with Parkinson disease (PD). Those with PD may be at a high risk of fall due to particular characteristics during the turn. Turning around during locomotive actions may be one of problematic factors causing losing balance.
Objects: This study is part of a larger study, which in part aims to identify turning strategies, to compare the strategies in the elderly with and without idiopathic PD aged 51 years and older and to distinguish whether the turning strategies can predict the elderly at risk of falls.
Methods: A total of 22 community-dwelling elderlies (10 elderlies with idiopathic PD and 12 healthy elderlies) were investigated for the turning strategies during the timed up and go test.
Results: There were some significant differences between the two groups during turning (p<.05). The idiopathic PD group had a tendency of challenging on taking more number of steps, more time to accomplish and staggering more for the turn relative to the control group.
Conclusion: Taking more number of steps and more time to turn may be useful for distinguishing the characteristics of PD from that of the healthy elderly in turning strategy.
Background: The functioning of the serratus anterior (SA) muscle is essential to normal scapulohumeral rhythm during forward flexion (FF) of the shoulder. Also, SA weakness and overuse of the upper trapezius (UT) is observed in patients with shoulder dysfunction and trapezius myalgia. We designed a combination exercise involving FF and scapular protraction with resistance (CFFSP) to activate the SA muscle and to deactivate the UT muscle.
Objects: The purpose of this study was to determine whether or not CFFSP would be more effective in activating the SA muscle than FF alone and FF with scapular protraction (FFP).
Methods: Nineteen subjects (12 men and 7 women) participated in this study and performed FF, FFP, and CFFSP at 120°. Surface electromyography was applied to the SA, UT, and pectoralis major (PM) muscles, as was one-way analysis of variance (ANOVA) with repeated measures. Statistical significance was set at .05. Bonferroni adjustment was used to counteract the problem of multiple comparisons, with a statistical level of significance of .017 (.05/3).
Results: A statistically significant difference was found in relation to the three positions for the SA muscle (p<.001) and the SA/UT ratio (p=.005) using ANOVA. Significantly different results, depending on the position, were also demonstrated using the Bonferroni post-hoc test for the SA muscle (FF=28.27±16.20, FFP=45.66±15.81, and CFFSP=62.4±27.21) and for the SA/UT ratio (FF=3.04±2.14, FFP=3.61±2.38, and CFFSP=5.95±3.01). Significant differences between the three positions was not found regarding the average amplitude of SA/PM muscle ratio (SA/PM: p=.060).
Conclusion: We recommend the use of CFFSP to strengthen the SA muscle at 120°.
Background: The Pediatric Balance Scale (PBS) and the Fullerton Advanced Balance (FAB) scale were used to assess balance function in patients with balance problem. These multidimensional clinical balance scales provide information about potential risk factors for falls.
Objects: The purpose of this study was to investigate and compare the predictive properties of the PBS and FAB scales relative to fall risk in children with cerebral palsy (CP) using a receiver operating characteristic analysis.
Methods: In total, 49 children with CP (boy=21, girl=28) who were diagnosed with level 1 or 2 according to the Gross Motor Function Classification System participated in this study. The PBS and FAB were performed, and verified cut-off score, sensitivity, specificity, and the area of under the curve (AUC).
Results: In this study, the PBS scale was as a predictive measure of fall risk, but the FAB was not significant in children with CP. A cut-off score of 45.5 points provided optimal sensitivity of .90 and specificity of .69 on the PBS, and a cut-off score of 21.5 points provided optimal sensitivity of .90 and specificity of .62 on the FAB. Both scales showed moderately accurate of AUC with .79 and .76, respectively.
Conclusion: The PBS is a useful screening tool for predicting fall risk in children with cerebral palsy, and those who score 45.5 or lower indicate a high risk for falls and are in need of balance intervention.
Background: Functional capacity evaluations (FCEs) are designed to systematically assess the capacity to perform work-related tasks and to determine worker’s ability to return to the previous job following work-related injuries. These evaluations may be rated either by clinician or worker. There has been a lack of consensus between the two scoring methods.
Objects: This study aimed: 1) to confirm if the data are fit to the Rasch rating scale model and 2) to investigate the item-level concordance rate between the ratings of clinician and injured worker of the FCE.
Methods: A cross-sectional study was conducted with a sample (n=124) of a rehabilitation program with the Occupational Rehabilitation Data Base for workers with low back pain. The functional capacity evaluation at admission and discharge was administered to clinicians and workers. The data were analyzed using both classical test theory-based Pearson’s r and intra-class coefficient followed by item-level analysis with Rasch rating scale model.
Results: All items of the FCE, except sitting items rated by clinician at admission and handling items rated by both clinician and worker throughout admission and discharge, were acceptable fit statistics with minor out of ranges for a misfit criterion. This may indicate that the items of the FCE overall fit to the Rasch rating scale model. Few problematic items responding differently to clinician and worker both at admission and discharge were detected with the differential item functioning analysis despite the excellent concordance rate using the two conventional statistics-sitting and handling items at admission and handling item at discharge.
Conclusion: The item-level speculations using Rasch analysis of the FCE demonstrate that the ratings of clinician and self ratings of worker were psychometrically acceptable though there was an apparent discrepancy between the raters both at admission and discharge.