Pressure ulcers are serious complications of tissue damage that can develop in patients with diminished pain sensation and diminished mobility. Pressure ulcers can result in irreversible tissue damage caused by ischemia resulting from external loading. There are many intrinsic and extrinsic contributors to the problem, including interface tissue pressure, shear, temperature, moisture, hygiene, nutrition, tissue tolerance, sensory and motor dysfunction, disease and infection, posture, and body support systems. The purposes of this study were to investigate the relationship between buttock interface pressure and seating position, wheelchair propulsion speed. Seated-interface pressure was measured using the Force Sensing Array pressure mapping system. Twenty subjects propelled wheelchair handrim on a motor-driven treadmill at different velocities (40, 60, 80 m/min) and seating position used recline (, , ) with a wheelchair simulator. Interface pressure consists of average (mean of the pressure sensor values) and maximum pressure (highest individual sensor value). The results of this study were as follows; No significant correlation in maximum/average pressure was found between a static position and a 40 m/min wheelchair propulsion (p>.05). However, a significant increase in maximum/average pressure were identified between conditions of a static position and 60 m/min, and 80 m/min wheelchair propulsion (p<.05). No significant correlation in maximum pressure were found between a recline (neutral position) and a , , or recline of the wheelchair back (p>.05). No significant difference in average pressure was found between conditions of a recline and both a and recline of wheelchair back. However, a significant reduction in average pressure was identified between conditions of a and recline of wheelchair back (p<.05). This study has shown some interesting results that reclining the seat by reduced average interface pressure, including the reduction or prevention in edema. And interface pressure was greater during dynamic wheelchair propulsion compared with static seating. Therefore, the optimal seating position and seating system ought to provide postural control and pressure relief. We need an education on optimal seating position and a suitable propulsion speeds for wheelchair users.
Patellofemoral pain syndrome (PFPS) is often attributed to malalignment and maltracking of patella within the patellofemoral joint. Most exercise for PFPS has focused on selectively strengthening the vastus medialis oblique muscle (VMO). This study was designed to identify the effect of medial, lateral wedge and difference of Quadriceps angle (Q-angle) on vastus medialis oblique/vastus lateralis muscle (VL) activity ratios. The subjects were twenty young adult males who had not experienced any knee injury. They were asked to perform isometric contraction exercises in three postures using medial and lateral wedge. The EMG activity of the VL and VMO were recorded in three postures by surface electrodes and normalized by %MVC values derived from seated, isometric knee extensions. The normalized EMG activity levels (%MVC) of the VL and VMO for the three postures of the lower extremities were compared using 2-way repeated measures ANOVA with 1 between-subject factor (group), and 1 within-subject factor (wedge). Results of repeated measures of ANOVA's revealed that the medial wedge isometric contraction exercise produced significantly greater EMG activity of VMO/VL ratios in Group I (Q-angle or less) (p<.05). But, the medial wedge isometric contraction exercise was no significant difference of VMO/VL ratios in Group II (Q-angle or more) (p>.05). These results have important implications for selective VMO muscle strengthening exercises in PFPS patients.
Osteoporosis is characterized by low bone mass and the microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. It has been suggested that speed of sound (SOS) and broadband ultrasound attenuation (BUA) of quantitative ultrasound sonography (QUS) may provide information about not only bone density but also the microarchitecture and elastic properties of bone. Physical inactivity reduced mechanical usage and it made process to the bone changes. This study aimed to association between the physical activity and the QUS parameters in 1305 (593 men, 712 women) aged 20 years over in a rural population. Two QUS parameters, BUA (p=.23) and SOS(p=.73) were measured at the right calcaneus of postmenopausal women, no significant associations were observed between sports index and SOS and BUA. These results suggest that work, non-sports leisure physical activity (p<.01) have a significant influence on QUS parameters in a rural population. Physical activity are meaningful predictor of QUS parameters of the calcaneus in a rural population.
The purpose of this study was to investigate the effects of the increasing ankle range motion program on ambulation and balance for the elderly with balance disorder. Eighteen elderly subjects were administered with a timed test twice; approximately 4 weeks apart. The exercise group participated in a fall prevention exercise class at the Y.S. Senior Welfare Center of the Seoul Metropolitan Government. The session consisted of a stationary cycle, static stretching ankle joints, balance boards, and progressive resistive exercises using the Thera-band. The results were as follows: Firstly, the increasing ankle range of motion program was effective on the exercise group. Gait-speed was improved (p<.005). Secondly, balance was significantly improved (p<.000). Thirdly, increasing ankle range of motion program was effective in ankle dorsiflexion which was the major risk factor for falls among the elderly. Differences in gait and balance between the groups were examined using a paired t-test (p<.05). The exercise group demonstrated significantly higher values of gait-speed, ankle range of motion, and balance when compared with the non-exercise group. The results of this study suggest that the increasing ankle range of motion program is an effective intervention for the elderly with balance disorder.
The purpose of this study was to examine the effects of static stretching and Evjenth-Hamberg stretching the on range of motion (ROM) of the knee joint. The subjects were composed of twenty healthy males without weight-training experience. The ROM of the knee joint was measured by using an En-Knee. Three tests (performed on the 1st week, 4th week, and 8th week) were conducted to examine the change of each variable. Data were analyzed with a analysis of variance (grouptest) for repeated measures on last factor through SPSS 10.0. The data analysis revealed the change in the ROM was dependent on the stretching method. The results were as follows: The ROM was improved in both methods by each time, but the E-HS was more improved than the SS. In conclusion, this study indicated that the E-HS is more efficient than the SS on the ROM of the knee joint.
The objectives of this study were to examine the relative efficacy of three active exercise programs for work-related, chronic low back pain, and to observe to what extent the programs affected the mechanical stability of the lumbar region. The subjects were 64 employees who were randomly divided into three groups to match the three active exercise programs which were performed 3 times a week for 6 months. All subjects were assessed with the same measurements at a pre-study examination, and then were reassessed at 2 weeks, 3months and 6 months after the study. The pain intensity didn't show any significant difference among the three groups. However, the Oswestry Disability Index showed significant differences among the three groups at 6 months and the lumbar and thoracic exercise groups showed significant decreases compared to the general physiotherapy group (p<.05). Maximal stretching with both hands in the overhead direction showed a significant difference among the three groups at 3 months and 6 months, and the thoracic exercise group at 6 months showed a significant increase in overhead stretching compared to the lumbar exercise and general physiotherapy groups (p<.05). The group that performed maximal stretching with both hands in the overhead direction showed the most significant among the 3 months and 6 months. At 6 months, the thoracic exercise group showed a significant increase in overhead stretching compared to the lumbar exercise and general physiotherapy groups (p<.05). The lumbar region angle of inclination showed significant differences among the three groups at 2 weeks 3 months, and 6 months, with the thoracic exercise group being decreased more significantly at 6 months than the lumbar exercise and general physiotherapy groups (p<.05). Exercise aimed at increasing thoracic mobility has an effect on lumbar stability. Furthermore, it is far more effective for lumbar stabilization than general physiotherapy and deep muscle strengthening lumbar exercise.
The purposes of this study were to determine the effects of rehabilitation programs on functional performance of the lower extremities and whether additional therapeutic exercise with routine rehabilitative therapy improves functional performance more than just routine rehabilitative therapy by it self for inpatients who have suffered a stroke with below moderate severity within 3 to 6 months after the onset of the stroke. Fifty-eight subjects were divided into two groups. Group I was given routine rehabilitative therapy and group II was given additional therapeutic exercise along with the routine rehabilitative therapy. Each group received 6 weeks of rehabilitation. The timed get-up and go test (TUG), the Fugl-Meyer score (FMS), functional independence measure (FIM), functional reach (FR), gait velocity (GV), and the strength of knee extensor and flexor were selected to measure effect of rehabilitation programs. The main results were measured and analysed at baseline, 3 weeks, and 6 weeks after the start of the rehabilitation programs. The results revealed that all of functional performance of the lower extremities in 3 weeks after the start of the rehabilitation programs were significantly improved compared with before the rehabilitation programs in both groups. In 6 weeks, TUG, FIM, FR, GV, and the strength of knee extensor in group I, TUG, FMS, FIM, FR, GV, and the strength of knee extensor and flexor in group II were significantly improved compared with the results after 3 weeks. At 3 weeks after rehabilitation programs, group II made significantly greater gains in TUG, FR, GV, and the strength of the knee flexor compared to the group I. At 6 weeks, group II made significantly greater gains in TUG, FR, GV, and the strength of the knee extensor and flexor compared to the group I. In conclusion, rehabilitation programs for stroke patients within 3 to 6 months after stroke onset significantly contributed to improve functional performance of the lower extremities. It is desirable for improvement of functional performance of the lower extremities to perform additional exercise with routine rehabilitative therapy.
We investigated the activation of the cerebral cortex during active movement, passive movement, and functional electrical stimulation (FES), which was provided on wrist extensor muscles. A functional magnetic resonance imaging study was performed on 5 healthy volunteers. Tasks were the extension of right wrist by active movement, passive movement, and FES at the rate of .5 Hz. The regions of interest were measured in primary motor cortex (M1), primary somatosensory cortex (SI), secondary somatosensory cortex (SII), and supplementary motor area (SMA). We found that the contralateral SI and SII were significantly activated by all of three tasks. The additional activation was shown in the areas of ipsilateral S1 (n=2), and contralateral (n=1) or ipsilateral (n=2) SII, and bilateral SMA (n=3) by FES. Ipsilateral M1 (n=1), and contralateral (n=1) or ipsilateral SII (n=1), and contralateral SMA (n=1) were activated by active movement. Also, Contralateral SMA (n=3) was activated by passive movement. The number of activated pixels on SM1 by FES ( pixels) was smaller than that by active movement ( pixels) and nearly the same as that by passive movement ( pixels). Findings reveal that active movement, passive movement, and FES had a direct effect on cerebral cortex. It suggests that above modalities may have the potential to facilitate brain plasticity, if applied with the refined-specific therapeutic intervention for brain-injured patients.
The purpose of this study was to investigate the effect of Modified Constraint-Induced Therapy (MCIT) on the effected upper extremity of children with hemiparesis. Four children with hemiparetic upper extremity caused by brain injuries were trained by MCIT for ten weeks. During the same period, all of the subjects were also involved in thirty-minute regular physical therapy and occupational therapy. During the treatment period, the unaffected upper extremities of the subjects were restrained by a specially designed hand splint or a mitten for five hours a day, five days per week. For two hours out of the five-hour restraint period, the affected upper extremities were intensively trained by performing various functional tasks, which were individually structured to emphasize use of the affected arm. A single-subject design with A-B-A reversal was employed in this study. The affected limb motor ability was evaluated by Melbourne Assessment, measuring the time to grasp and release nine pegs, and measuring grasping power. As a consequence of this study, the affected limb motor test scores of all four subjects in the baseline period were improved during the treatment period. Furthermore, the treatment effect was maintained during a one-month follow-up period. The results of this study support the assumption that MCIT is an effective therapeutic method to improve the sensory and motor abilities of hemiparetic children. It also increases the frequency of functional use of the hemiparetic hands of brain-injured children. Based on the results of this study, it can also be assumed that the modified CIT method is especially beneficial to these children by reducing the negative emotional effects of forceful restraint of the unaffected upper extremity. To optimize the functional recovery of the paretic upper extremity by CIT, the restriction period per day should be decided individually, according to the characteristics of the individual.
By measuring changes in blood lactate and plasma enzyme (CPK, GOT, GPT) with electrical stimulation applied at two duty cycles, this study is intended to look into which type of duty cycle may have more effects on blood lactate and plasma enzyme constituents through animal experiment so as to determine any duty cycle appropriate for electrical treatment. In this study, electrical stimulation was applied to total 20 Korean house rabbits (weight: 3~3.5 kg) by means of an electrical therapeutic apparatus called TS6000 (made in Netherlands) at duty cycle of 50% and 20% respectively for 30 minutes. Here, 5 cc of blood was collected from their carotid artery before stimulation and in 30 minutes after stimulation respectively to carry out biochemical experiment and analysis. As determined through the above experiment, blood lactate rate was increased to 333.07% at 50% duty cycle after experiment and 185.71% at 20% duty cycle after experiment respectively. In both cases, blood lactate rate was significantly increased to higher level after electrical stimulation than before. Moreover, the rate of change in the average of blood lactate rate at both duty cycles also showed significant differences. CPK rate was boosted to 301.82% at 50% duty cycle after experiment and 321.35% at 20% duty cycle after experiment respectively. In both cases, CPK rate was remarkably boosted to higher level after stimulation than before (p<.05). However, there was not any significant difference in the rate of change in average CPK at both duty cycles (p<.05). GOT rate was significantly boosted up to 38.97% at 50% duty cycle after experiment (p<.05), while it was slightly increased to 1.68% at 20% duty cycle after experiment without any significant difference. Rather, GPT rate dropped slightly at both duty cycles after experiment, but there was not any significant difference. Although blood lactate and GOT were relatively less generated at 20% duty cycle after electrical stimulation than at 50% duty cycle, the change of duty cycle didn't have any significant influence on CPK rate. In this regard, this study failed to come any consistent conclusion about the association between change of duty cycle and muscle fatigue. Therefore, it is advisable that follow-up studies seek various ways to a little more effectively apply electrical stimulation to laboratory animals by avoiding their muscle fatigue. GOT rate was significantly boosted up to 38.97% at 50% duty cycle after experiment (p<.05), while it was slightly increased to 1.68% at 20% duty cycle after experiment without any significant difference. Rather, GPT rate dropped slightly at both duty cycles after experiment, but there was not any significant difference. Although blood lactate and GOT were relatively less generated at 20% duty cycle after electrical stimulation than at 50% duty cycle, the change of duty cycle didn't have any significant influence on CPK rate. In this regard, this study failed to come any consistent conclusion about the association between change of duty cycle and muscle fatigue. Therefore, it is advisable that follow-up studies seek various ways to a little more effectively apply electrical stimulation to laboratory animals by avoiding their muscle fatigue.
This study was done to research the general information, causes of stroke, risk factors, complications during admission of geriatric CVA inpatients. We retrospectively studied 208 above 65 years old geriatric CVA inpatients treated in Ajou university hospital from 1994 to 2003 by medical record. These were divided into two groups by following years. We were gathered information about sex, onset age, cause of stroke, number of stroke, complications, housing, family, insurance, smoking, alcohol. Most of incidence of the stroke was noted in the group of young old age (65~74 years old) and old age (75~84 years old). The occurrence rate of male stroke (38.5%) was less than of female stroke (61.5%) and the ratio of male to female was 1:1.6. The occurrence rate of ischemic stroke (72.6%) was higher than of hemorrhagic stroke. The occurrence rate of ischemic stroke increased more and more at the late stage. The most common risk factors for stroke was hypertension and complications during hospitalization were neurogenic bowl and bladder. These results of epidemiologic study may help above 65 years old geriatric CVA early treatment and prevention, rehabilitation and use basic data for multiple prospective study using stroke registry.