This study was designed to examine the effects of electroacupuncture and treadmill exercise on the improvement of muscle atrophy and Brain-Derived Neurotrophic Factor (BDNF) expression in an ischemic stroke model induced by middle cerebral artery occlusion. This study selected 120 Sprangue-Dawley rats, divided them into six groups, and assigned 5 rats to each group. Experiments were conducted for 1, 3 days and 1, 8 weeks, respectively. In each group, changes in weight of muscle and relative muscle of tibialis anterior muscle, histologic observations, and BDNF expression were observed and analyzed. For the changes in muscle weight of unaffected and affected sides of tibialis anterior, muscle atrophy was expressed in an affected side 3 days after ischemic stroke was induced. There was a statistically significant difference in Group VI 1 and 8 weeks after ischemic stroke was induced, compared to Group II (p<.05). For the changes in relative muscle weight of unaffected and affected sides of tibial anterior muscle, there was significant decrease in each group 3 days after ischemic stroke was induced, compared to Group I, while there was a statistically significant increase in Group VI 1 week after ischemic stroke was induced, compared to Group II (p<.05). For neurologic exercise behavior test, Group VI generally had the highest score, compared to other groups. The results of the behavior test suggests that 8 weeks after ischemic stroke was induced, Group VI improved in degeneration and inflammation of muscle fiber and decreased in destruction of nerve cells and cerebral infarction, thus indicating a similar state of muscle fiber and brain tissue in Group I. In immunohistochemical observations, Group 1 week showed increase in BDNF. Based on these results, electroacupuncture and treadmill exercise may improve muscle atrophy and change in BDNF expression of ischemic stroke rats and contribute to the improvement of exercise function.
The objective of this study was to discern the effects of a balance training program on the performance of lower extremities in order to improve strength (muscle power, flexibility, walking power), balance control and walking ability in the elderly. The subjects selected were aged 65 years and over, with no known relevant medical history that may disturb their balance, and have also been visiting the Gimhae Senior Welfare Center. The variable group consisted of 30 subjects, of whom were people who had been participating in balance training programs (One Leg Standing; OLS, Functional Reach; FR, Timed Get Up and Go; TUG) as an intervention for 8 weeks 3 times per a week. They were examined in order to identify their balance control before and after. The control group consisted of thirty subjects who preferred to exercise without any intervention relating to balance training program. The subjects were measured before and after balance training in order to determine the effectiveness of exercise and the effectiveness of exercise combined with the aid of a Balance Performance Monitor. 1. Mean time on OLS test with left and right sided extremities in the experimental group was 35.44 sec, 42.10 sec longer than control group respectively. In FR tests applied to the left and right side, mean reaching distance was increased up to 5.56 cm, 6.73 cm in experimental group respectively. Mean time on TUG test from a chair in experimental group was decreased to 2.33 sec. 2. Mean value of decline in the level balance control, both left and right side, decreased to 2.24% as examined by the Balance Performance Monitor. Mean scores for sway level after balance training decrease to .98% and for balance control both anterior and posterior directions decreased to mean 1.07% and 1.44%, respectively.
The purpose of this study was to evaluate isometric trunk extension strength in hemiplegic patients, and to compare that with normal subjects to find a correlation between trunk extension strength and the functional independent degree in hemiplegic patients. Fifteen hemiplegic male patients (mean age 55.2±10.2 years) and twenty-five healthy male subjects (mean age 54.6±10.3 years) completed isometric trunk extension. Strength was measured at 0, 12, 24, 36, 48, 60, and 72 degrees of trunk flexion. The functional independent degree was assessed by Functional Independence Measure (FIM). Mean isometric trunk extension strength was 91.2 ft-lbs, 120.7 ft-lbs, 142.3 ft-lbs, 156.4 ft-lbs, 173.5 ft-lbs, 184.1 ft-lbs, and 195.3 ft-lbs in the hemiplegic patients group, and 135.6 ft-lbs, 175.6 ft-lbs, 204.4 ft-lbs, 221.9 ft-lbs, 231.2 ft-lbs, 246.8 ft-lbs, and 259.7 ft-lbs in the normal subjects group. The values of isometric trunk extension strength had a descending linear correlation pattern from trunk flexion angle to extension angle. Trunk extension strength in hemiplegic patients was significantly lower than that of normal subjects (p<.05) but did not correlate with the FIM total score (p>.05). Therefore, the isometric trunk extension strength in hemiplegic patients was lower than that of normal subjects and did not correlate with the functional independent degree.
The aim of this study was to identify the effect of suspension unloading (SU) and electrical stimulation upon the development of neonatal muscular system. For this study, the neonatal rats were randomly divided into three groups: a control group, an experimental group I, and an experimental group II. The SU for experimental group I and II was applied from postnatal day (PD) 5 to PD 30. The electrical stimulation for soleus muscle of experimental group IIwas applied from PD 16 to PD 30 using neuromuscular electrical stimulation (NMES), which gave isometric contraction with 10 pps for 30 minutes twice a day. In order to observe the effect of SU and ES, this study observed myocyte enhancer factor 2C (MEF2C) and vascular endothelial growth factor (VEGF) immunoreactivity in the soleus muscles at PD 15 and PD 30. In addition, the motor behavior test was performed through footprint analysis at PD 30. The following is the result. At PD 15, the soleus muscles of experimental group Iand II had significantly lower MEF2C, VEGF immunoreactivity than the control group. It proved that microgravity conditions restricted the development of the skeletal muscle cells at PD 15. At PD 30, soleus muscles of the control group and experimental group II had significantly higher MEF2C, VEGF, immunoreactivity than experimental group I. It proved that the NMES facilitated the development of the skeletal muscle cells. At PD 30, it showed that SU caused the decrease in stride length of parameter of gait analysis and an increase in toe-out angle, and that the NMES decreased these variations. These results suggest that weight bearing during neonatal developmental period is essential for muscular development. They also reveal that NMES can encourage the development of muscular systems by fully supplementing the effect of weight bearing, which is an essential factor in the neonatal developmental process.
This study was designed to examine, applying Rasch analysis based on item response theory, the questionnaires of the Activities-Specific Balance Confidence (ABC) scale for the elderly. The subjects were 99 institutional older adults and clients of social welfare facilities. The subjects (17 men, 72 women) ranged in age from 65 to 94 years (mean age 76.5 yrs). The Winsteps software was used to assess whether the ABC scale fits the Rasch model, to estimate the score and to refine the rating scale. The results are as follows. Twenty-two subjects were excluded as misfit persons. Four items were found to be misfits and the order of difficulty of the remaining 12 items was rearranged. Their balance confidence is indicated by -.64~1.12 logit, and the transformation formula is score=[(logit score+2.76)/(2.76+3.48)]100. The most difficult item was "Walk outside in icy sidewalks" and the easiest item was "Walk around house." In conclusion, the ABC scale for the elderly has been proven reliable and valid. Therefore, it is expected to be used as an effective examination tool for treatment planning and screening for older adults.
The purposes of the present study were to determine the difference of functional outcome, and to identify factors associated with functional difference in patients with stroke. The sample consisted of 56 stroke patients who had received physical therapy at the physical therapy unit of the Dongeui Medical Center in Busan city between January 2000 and June 2002. Stroke patients were evaluated by physical therapists 3 times; The first day in physical therapy (PT) (T1), one month after the first day in PT (T2), and two months after the first day in PT (T3). Functional status was assessed with the Functional Independence Measure (FIM) instrument, a validated instrument for documenting the severity of disability and assessing the outcome of rehabilitation treatment. Functional gain was calculated over T2-T1, T3-T1, and T3-T2. SAS statistical software was used for the analysis. The Student's t-test, paired t-test, analysis of variance (ANOVA/Tukey and Scheffe), and analysis of covariance (ANCOVA) were used to examine the functional difference in variables. Repeated measures ANOVA was also used to analyze the functional difference by time (T1, T2, and T3). Multiple regression analysis was performed to determine the effects of independent variables on the difference of functional outcome as defined by the FIM score. A total of 56 stroke patients were evaluated, their average age±standard deviation was years (range: 40~81 yr). The functional status of patients who received physical therapy for about 2~3 months was significantly improved (mean FIM scores, 20.5±1.8, 28.9±1.9, and 8.41±1.1 points for each time period, respectively) (p<.0001). Diabetes was significantly associated with the FIM score for T2-T1 (p<.05). The type of diagnosis was significantly associated with the FIM score for T3-T1 (p<.05). Gender, smoking, and the FIM score on admission were significantly associated with the FIM score for T3-T2 (p<.05). In conclusion, gender, smoking, diabetes, the type of diagnosis, and the FIM score on admission were significantly associated with improved FIM scores. We recommend that further research should explore the functional outcome by using larger sample sizes, longer follow-up periods, and more sensitive assessment instruments.
This study was designed to examine the relationship between clinical symptoms, self-efficacy, and performance of women with osteoarthritis. It is a survey study of 60 women who were diagnosed as osteoarthritis and given medical treatments from September, 2005 to October, 2005 in hospital 'H' located in Yongin-si. For clinical symptoms, radiographs of the subjects' knees were taken and evaluated the pathology grade by the Kellgren-Lawrence grade. Pain and stiffness was measured by the measure of WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and functional reach test was measured in order to examine balancing abilities. Self-efficacy was measured by a tool which has revised the ASES (Arthritis Self-Efficacy Scale), and performance was measured by recording the difficulty of the WOMAC measurements themselves, and the time taken for 20 m walking, going up and down 9 stairs, and 5 sit-down and stand-up repetitions. The resulting differences in the other variables according to performance and the relationship between performance with variables are the following. First, an increase in pain in women with osteoarthritis led to decreased functional ability. Second, an increase in stiffness in women with osteoarthritis led to a decrease in functional ability. Third, a decrease in balance in women with osteoarthritis led to a decrease in functional ability. Fourth, a decrease in self-efficacy in women with osteoarthritis led to a decrease in functional ability. Fifth, the variables for estimating the performance by self-report were pain and self-efficacy. The variables for estimating the performance by recording the time taken was balance and self-efficacy. As a result factors such as pain, balance and self-efficacy in women with osteoarthritis were closely related to performance. Based on the results, it seems that physical therapy programs to decrease pain and to increase the balance in women with osteoarthritis, and psychological approaches to increasing self-efficacy are needed. I hope that the results of this study will be useful data for clinical management and intervention for women with osteoarthritis.
The purpose of this study was to find any correlations among Postural Assessment Scale for Stroke (PASS), Modified Barthel Index (MBI), Tone Assessment Scale (TAS), Motor Assessment Scale-Gait (MAS-G), Fugl Meyer-Balance (FM-B), and to predict MBI from subscales of the PASS. The subjects were 41 stroke patients of the Korea National Rehabilitation Center in Seoul. The main outcome measures were postural control (PASS), gait (MAS-G), Balance (FM-B), Tone (TAS), ADL (MBI). The data was analyzed using the Pearson product correlation. PASS scale was used between other clinical and instrumental indexes, multiple stepwise regression analyses were performed to identify prognostic factors for ADL incline, and Cronbach's alpha coefficient was used to identify internal consistency on PASS scale. The results of this study areas follows: 1. The highest level was sitting without support, the lowest level was standing on paretic leg on PASS scale. The highest level was chair/bed transfer, the lowest level was bathing on MBI. 2. All items of the PASS, except postural tone were significantly correlated with Gait, Balance, MBI (p<.01), 3. The Internal Consistency (Cronbach's alpha coefficient=.85) was very high, indicating that the PASS is homogeneous and is likely to produce consistent response. Furthermore, the sums of maintaining position items and of changing-position items were strongly correlated (r=.64, p<.05) and there were significant correlations between sums of PASS, sums of maintaining position items (r=.87, p<.01), and changing-position items (r=.93, p<.01). 4. The standing without support of the PASS items was the strongest variance (R²=.85) of the predicting ADL function. These findings provide strong evidence of the predictive value of the postural control on gait, Balance, ADL function in stroke patients and to can provide a reference for the successful therapeutic program and more improved functional recovery.
The purpose of this study was to investigate effect of hospital-based physical and occupational therapy on Modified Barthel Index (MBI) score in stroke inpatients at least 3 months after stroke, to predict MBI score at discharge from subscales of MBI, and determine the characteristics of stroke at admission. Forty-five stroke inpatients participated and received physical and occupational therapy for two months. All participants were assessed on MBI at admission and discharge. The collected data was analyzed by dependency level (MBI≤74 and MBI≥75) at admission. The results revealed that the MBI score at discharge was significantly improved compared to the MBI score at admission in the group with more than moderate dependency level (MBI≤74). In particular, personal hygiene, dressing, ambulation, and chair/bed transfer were improved. But only ambulation was improved significantly in the group with a less than mild dependency level (MBI≥75). The chair/bed transfer, dressing, ambulation, and Mini-Mental State Exam-Korea score at admission were important factors in the MBI score at discharge. Eighty-six percent of the variation in MBI score function at discharge can be explained. Therefore, it is suggested that hospital-based physical and occupational therapy in subacute stroke improve independent living status, especially for patients with a more than moderate dependency level.
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a valid and widely used instrument for the assessment of osteoarthritis patients. In this study, data was obtained from the out-patients with painful osteoarthritis of the knee. One hundred-three out-patients were interviewed by physical therapists. In an exploratory way, a Korean version of the KWOMAC was analyzed for unidimensionality, item separation, and item difficulty using the Winsteps programs. Ninety-five patients with osteoarthritis of the knee over 65 years were analyzed for Rash analysis. In the analysis several functional items poorly fit to the model. These items included "heavy domestic duties" and "standing". In the pain domain, one item ("at night while in bed") did not fit the model. In the stiffness domain one item ("after sitting, lying, or resting later in the day") did not fit the model. Although 4 items from the 3 domains (pain, stiffness, function domain) do not fit well, the KWOMAC domains were confirmed by Rasch analysis. Thus the KWOMAC needs to be further examined before it can be used to properly determine the health status of the elderly with OA.