The purpose of this study was to identify the differences of the static and the dynamic balance reactions in the flexion syndrome (FS) and the extension syndrome (ES) group of the patients with chronic lowback pain (LBP) and healthy subjects. Twenty subjects were included in each group. By using EquiTest 5.02, the static balance was measured by the equilibrium score and the strategy score of sensory organization test (SOT), while the dynamic balance was measured by the latency of motor control test (MCT) and the sway energy of adaptation test (ADT). Oswestry Disability Index (OSI) was used to measure level of the disability in patients with chronic LBP. The equilibrium scores, the strategies of SOT, and thelatencies of MCT of three groups were compared with one way ANOVA, while the sway energy of ADT was compared with repeated measures one way ANOVA. The results of this study showed that the equilibrium scores and the strategy scores of SOT were significantly lower in patients with chronic LBP than in healthy subjects. The equilibrium scores and the strategy scores of SOT were significantly differences between the FS and ES groups in condition 5 (support surface was sway-referenced and visual information waseliminated by eye closure), and 6 (support surface was sway-referenced and visual information was altered by sway-referencing). The FS group showed delayed average reaction time at large posterior translation, however, the ES group showed delayed average reaction time at large anterior translation, Even though the sway energy of the patients with chronic LBP were greater than that of healthy subjects during the toe down (plantar flexion rotation), the values between the FS and ES groups didn't show any significant difference. The disability level showed highly correlation with the equilibrium score of the condition 5. As the results, the FS and ES groups divided by the their symptoms and signs in patients with chronic LBP showed different balance reaction. Therefore, more accurate evaluation and balance treatments are needed to focus on their symptoms and signs in patients with chronic LBP.
The purpose of this paper is to provide the reader with a pertinent information and research trends of biomechanics in wheelchair propulsion. Biomechanical studies for wheelchair propulsion mainly focus on the most suitable propulsion performance and methods for preventing upper extremity injuries. Recent issues have concentrated on wheelchair propulsion style and cycle mainly because of the high prevalence of repetitive strain injuries in the upper extremely such as shoulder impingement and carpel tunnel syndrome. Optimizing wheelchair propulsion performances as well as medical reflections are presented throughout the review. Information on the underlying musculoskeletal mechanisms of wheelchair propulsion has been introduced through a combination of data collection under experimental conditions and a more fundamental mathematical modelling approach. Through a synchronized analysis of the movement pattern and muscular activity pattern, insight has been gained in the wheelchair propulsion dynamics of people with a different level of disability (various level of physical activity and functional potential). Through mathematical modelling simulation, and optimization (minimizing injury and maximizing performance), underlying musculoskeletal mechanisms during Wheelchair propulsion is investigated.
The purpose of this study was to compare the onset times of muscle activities and the order of muscle firing in hamstring gluteus maximus, and lumbar erector spinae muscle during active hip extension between subjects with low back pain (LBP) and healthy subjects. Thirty subjects, 15 with LBP and 15 healthy subjects, participated in this study. Electromyographic activity was recorded during active hip extension in prone and standing position. Relative onset times of these muscle activities were determined. Similar muscle firing order in hamstring, gluteus maximus, and lumbar erector spinae muscle showed in both groups and positions. However, the onset time of gluteus maximus was significantly later in prone and standing active hip extension in subjects with LBP than in healthy subjects. The onset time of lumber erector spinae muscle activity was significantly delayed in subjects with LBP in standing active hip extension, The delayed onset times of gluteus maximus and lumbar erector spinae muscles' activities were probably related to LBP. Further studies are needed to identify whether the delayed onset times of gluteus maximus and lumbar erector spinae muscle activities are the contributing factors to LBP.
This study was designed to identify the effects of walking conditions (normal walking vs. toe-walking) on electromyographic (EMG) activity of gastrocnemius, tibialis anterior, and soleus muscle. Seven healthy adult males participated in this study. The exclusion criteria were orthopedic or neurologic disease, congenital anomaly or acquired deformity, or pain in low back or lower extremities. The maximal voluntary isometric contraction for each muscle was used for the reference contraction, and EMG activity of each muscle during normal walking and toe-walking was expressed as a percentage of reference contraction. The gait cycle was determined with two foot switches, and gait was normalized as 100% gait cycle for each condition. The maximal values of EMG activity in terminal stance (30~50% of gait cycle) of each condition were compared for data analysis. No significant differences were found in EMG activity of the tibialis anterior and soleus (p>.05), whereas significant decrement was found in EMG activity of gastrocnemius during toe-walking compared to normal walking (p<.05). There is a limitation to generalize the results of this study, because small number of subjects participated for this study and only EMG was used for data collection. The treatment methods should be developed to improve gait efficiency by substituting the weakened muscles secondary to upper motor neuron, or by strengthening the distal muscles in lower extremity.
The purpose of this study was to determine the effect of intramuscular stimulation (IMS) therapy in older persons with musculoskeletal pain. The subjects were 181 older persons (54 males, 127 females) with musculoskeletal pain. Intramuscular stimulation unit with needles (size mm) was applied for the treatment. The analgesic effects were measured by visual analog scale (VAS). Results showed that the post-treatment VAS score was significantly decreased after IMS therapy for fifteen minutes compared to pre-treatment score. In addition, the post-treatment VAS score was significantly decreased in patients with chronic pain (pain duration of one year after onset) compared to the post-treatment VAS score in patients with subacute pain (pain duration less than three months after onset). There was no significant difference in analgesic effects according to gender and age groups. It is determined from this study that IMS therapy can be beneficial for patients with chronic musculoskeletal pain in clinical setting. Further study is needed to identify whether the IMS therapy can change the pain threshold in patients with neurologic pain.
The purposes of this research were to investigate home care rehabilitation services in rural areas and to collect basic data about disabled persons necessary when for carrying out rehabilitation services. Respondents were selected from six of a total of eight townships (Myon) and one town (Eup) in the Wonju city area. Wonju is in Kangwon Province (Do). Of a total of 338 names provided by the Myon offices, 298 persons were located and included registered and non-registered persons. Conditions included stroke, spinal cord injury, and cerebral palsy in addition to disabilities classified as first, second or third degree, in the case of registered cases. Respondent demographic characteristics, medical characteristics, rehabilitation service needs, willingness to receive rehabilitation service and individual opinions regarding rehabilitation services were analysed by frequency and percentage. The results were as follows: 1) Rehabilitation services received by disabled persons living at home in the rural areas surrounding Wonju city were medical rehabilitation (41.7%), diagnosis (36.5%), rehabilitation assistive devices (7.6%), social assistance (7.1%), rehabilitation counseling (3.0%), vocational rehabilitation (1.8%), educational rehabilitation (1.6%) and housekeeping services (0.5%). The majority of rehabilitation services were medical rehabilitation provided at hospitals and oriental medicine hospitals. 2) Sixty point eight percent of respondents expressed their willingness to receive home care rehabilitation services. Needs expressed were highest for medical rehabilitation (27.0%), followed by social assistance (19.4%), medical examination (12.4%), physician-generated diagnosis in the home setting (11.6%), sociopsychological rehabilitation (9.3%), vocational rehabilitation (7.6%), rehabilitation engineering (6.0%), educational rehabilitation (3.3%), and housekeeping services (3.3%). 3) Rehabilitation service needs were analyzed by severity classification: 65.8% of first degree, 62.7% of second degree and 55.6% of third degree disability classification, and 62.7% of non-registered disabled individuals responded that rehabilitation service was necessary. 4) Rehabilitation service needs were also analyzed by diagnosis: 62.6% of stroke, 85.5% of amputation, 60.0% of spinal cord injury and 52.4% of traumatic brain injury respondents answered positively that they were willing to receive rehabilitation service if it were to be provided. Rehabilitation service utilization data of disabled individuals living at home in rural areas were investigated and their rehabilitation needs analyzed. This critical information can be used when community-based rehabilitation programs for disabled persons living at home are planned for provision out of a public health center or when community-based rehabilitation welfare policy is formulated.
The purpose of this study was to determine the effect of lift to the shoe of the affected limb on gait patterns in subjects with hemiplegia. The subjects of this study were 18 post-stroke hemiplegics. For the study, insole of the paretic side was lifted 10mm higher, and duration of static weight bearing, dynamic weight bearing and stance phase were measured from one cycle of the gait, before and after the lift application. For the measurement of carry-over effect of lift, we got data of those three items prior to and 3 weeks after lift application and 3 days after removal of the lift. Static weight bearing was significantly increased both just after and continuous application of lift for 3 weeks than before. Dynamic weight bearing was significantly decreased in heel contact and footflat phases only when just after application of the lift, without any change after 3 weeks application. In heel-off phase, dynamic weight bearing did not show any significant difference between before and just after application of lift whereas significantly decreased after 3 weeks application. Duration of stance phase was not changed among anytime of application. According to this study, lift applied to the shoe of the peretic limb was effective in inducing static weight bearing in the paretic limb, but did not significantly effect dynamic weight bearing on gait patterns. This study suggests that symmetry, induced by shoe lift applied to the paretic limb, could help correct abnormal posture that would be caused in standing and prevent development of abnormal muscle tone in subjects with hemiplegia caused by unilateral stroke.
The purpose of this study was to investigate the effectiveness of the low-intensity ultrasound (noblelife) treatment on the pain points of upper trapezius muscle. The study recruited 20 patients who had trigger points in one side of the upper trapezius. The effectiveness of the low-intensity ultrasound treatment was assessed with subjective pain intensity using visual analog scale (VAS) and pressure pain threshold (PPT). The PPT was measured by pressure threshold algometer. Before and after the treatment, changes of pain were evaluated. Wilcoxon test for VAS data and paired t-test for PPT data were used for statistical significance. Compared to the pain intensity before the treatment, the pain intensity after treatment was significantly decreased (p<.05). Low-intensity ultrasound could be safely used in clinical application and at home for the treatment of patients with pain in upper trapezius muscle.
This study was conducted to determine the effects of deep breathing exercise and ankle exercise on blood flow velocity in the femoral vein. Sixteen healthy male students were recruited from Yonsei University, at Wonju. The blood flow velocities in the femoral vein were measured under three different conditions: resting, deep breathing, and ankle exercise. All subjects were given a 5-minute relaxing time in supine position prior to the study. Using a doppler ultrasound with a 8 MHz probe, the peak blood flow velocities were collected in a twenty-second-period at each condition. The subjects took a rest in between trials for the blood flow to return to its resting levels. The result showed a significant difference in peak blood flow velocities under those three conditions (p<.001). The peak blood flow velocity was highest in ankle exercise condition. The peak blood velocity was significantly higher in deep breathing condition compared with the resting condition. As a result, it is revealed that not only the muscular contractions but also the deep breathing exercises induced facilitating effects of venous return. Either of the exercise methods can be recommended to prevent blood stasis in patients with risk of deep vein thrombosis after cardiac or lower extremity surgery.ㅂ
Functional electrical stimulation (FES) training of the knee extensors is a useful way to rehabilitate the ability to stand and walk. However, training using FES has not been able to solve the problem of fatigue; clinical application of FES quickly produces muscle fatigue, due to the continuous activation of the muscles of the lower extremity. Therefore, reduction of muscle fatigue is an important factor in increasing the effectiveness of FES training in paraplegia. Intermittent high frequency alternating stimulation is a method that combines the advantages of high frequency (leading to strong muscle contractions) and alternating stimulation (reducing muscle fatigue), thereby continuously strengthening muscles. It is not known whether low frequency simultaneous stimulation results in stronger muscle contraction than high frequency alternating stimulation. This study compared the effectiveness of high frequency alternating stimulation with low frequency synchronized stimulation. Muscle power using FES on the quadriceps of 20 normal subjects were compared. Intermittent high frequency alternating stimulation did not produce more powerful muscle contraction than intermittent low frequency synchronized stimulation, because the muscle characteristics differed individually. Significant individual variation according to muscle characteristics was founded when applying FES. Accordingly, when physical therapists use FES to treat patients, they must be aware of individual variation in muscle characteristics.
The purpose of this study was to establish reliability of the Tone Assessment Scale (TAS) translated into Korean in patients with stroke. The TAS consists of resting posture, response to passive movement, and associated reaction to active effort. Fifteen patients (14 males, 1 female) were examined by two raters. Surface electromyography (EMG) data at elbow flexor muscle and joint excursion were collected from 6 patients. To identify the correlation between muscle activity and angular changes of elbow muscle, Pearson product moment correlation was used. The inter-rater and intra-rater reliability of the TAS ranged from very good to good (K/Kw=.61~1.00 for intra-rater and K/Kw=.73~1.00 for intra-rater comparisons) in the sections of resting posture and associated reaction. However, in the section of response to passive movement, the reliability coefficients ranged from very good to fair (Kw=.29~1.00). In the 11th item, correlation between EMG ratio of elbow flexor and angular changes of elbow joint showed statistically strong positive relationship (r=.94, p<.05). These results indicate that the TAS is selectively reliable in the sections of resting posture and associated reaction.
The objectives of this study were to investigate the effects of thoracic flexibility exercise on chest function and mobility and to provide the information of physical therapy for patients with idiopathic scoliosis. Forty female subjects who were diagnosed with scoliosis participated in this study and were divided into the experimental and control groups. The experimental group consisted of 20 patients who were treated with thoracic flexibility exercise program during the admission (10 days) ad one month after discharge. The control group consisted of 20 patients who were not treated with thoracic flexibility exercise program. Vital capacity was measured using a respirometer. The chest expansion were calculated using differences of chest circumference between maximum inspiration and maximum expiration measured under armpits, at the junction between the sternum and xyphoid process, and at the waist. All subjects were measured two times: before the admission and at one month after discharge. Data were compared by groups using independent t-test, Vital capacity and chest expansion values (the armpit, chest and waist values) were significantly higher for the experimental group compared to those of the control group (p<.05). The findings of this study show that thoracic flexibility exercise program can lead to an increase in vital capacity and chest expansion and has a positive effects in relieving symptoms and restoring thoracic mobility.
The purpose of this study was to investigate the effect of proprioceptive neuromuscular facilitation (PNF) approach on the spasticity of affected side in patients with hemiplegia. Three subjects with hemiplegia participated in this study. In single-subject research design (a multiple baseline across individuals) was employed in this study. The intervention program including PNF to the unaffected side was introduced for 30 minutes each day during each intervention phase. Muscle tone of affected side was measured with Tone Assessment Scale, and active hip abduction distance of affected side was taken with the subject supine. And then the muscle tone and the hip abduction distance were measured again 30 minutes later following the intervention. The results showed that the PNF application had some beneficial effects on both muscle tone and active hip abduction. This result suggest that PNF application to non-paretic limb can be effective in reducing muscle tone and improving hip abduction range on paretic limb in persons with hemiplegia. However, further research is needed to prove the effect of PNF application on functional improvement.