This study compared the effect of therapeutic exercise with conservative treatment in women with chronic neck pain. Subjects were allocated to control, neck isometric exercise, and cervical stabilization exercise groups consisting of 29, 32, and 31 patients, respectively. The conservative treatment for the control group consisted of hot packs, ultrasound, interferential current therapy, and intermittent cervical traction. The neck isometric exercise group performed a neck isometric exercise and the cervical stabilization exercise group performed a cervical stabilization exercise. To compare the three groups, the levels of perceived pain, neck disability, and psychological depression were assessed on admission, at discharge, and one month after discharge. On admission and at discharge, the pain and neck disability scores did not differ significantly among the groups. However, one month after discharge, both the neck isometric and cervical stabilization exercise groups had significantly improved perceived pain levels as compared to control (p<.05). The improvement in the degree of neck disability was most significant in the cervical stabilization exercise group (p<.05). On comparing the changes in the variables at the three assessments for each group, there was a significant difference between the control and cervical stabilization exercise groups (p<.05). The findings indicate that therapeutic exercises, especially cervical stabilization exercises, are more effective for improving pain and neck disability than conservative treatment.
Studies of attentional focus effects, have shown that the performer's attentional focus plays an important role in the performance and learning of motor tasks. We examined the influence of attentional focus on the performance of dual tasks (a postural task and a suprapostural task) and used electromyography (EMG) to examine whether the differences between external and internal focus were also manifest at the neuromuscular level. The subjects (n=40) stood on a balance board (postural task) and held a bar horizontally (suprapostural task). All of the subjects performed under different attentional focus conditions: external (balancer on balance board) or internal (feet) focus on the postural task, and external (balancer on bar) or internal (hand) focus on the suprapostural task. The mean displacement velocity of the bar and the percent reference voluntary contraction (%RVC) of the biceps brachii were reduced when the subjects adopted an external focus on the suprapostural task (p<.05). In addition, the mean displacement velocity of the balance board and %RVC of the tibialis anterior were reduced when the subjects adopted an external focus on the postural task (p<.05). When the subjects adopted an external focus on the suprapostural task, the mean displacement velocity of the balance board and %RVC of the tibialis anterior were also reduced (p<.05). When the subjects' attentional focus was on the postural task, there were no differences in the mean displacement and %RVC of the biceps brachii between attentional focuses. The performance of each task was enhanced when subjects focused on the respective task. The suprapostural task goals had a stronger influence on postural control than vice versa. These results reflect the propensity of the motor system to optimize control processes based on the environmental outcome, or movement effect, that the performer wants to achieve.
The purpose of this study was to examine the validity and reliability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-VA3.0 in patients with hip and knee osteoarthritis (OA). The sample consisted of 301 patients who had received treatments at the physical therapy units of 5 medical institutions in Andong City in june 2006. Questionnaires on the WOMAC were recruited by 12 physical therapists. The internal structure and reliability of the scales were evaluated by means of item-internal consistency (Cronbach's alpha coefficient: ), item-discriminant validity, and Pearson's relation coefficient. To explore construct validity, we conducted a principal component factor analysis with varimax rotation analysis. The criterion for factor extraction was an eigenvalue >1.0. The average age of the patients was 62.1 years. All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficients of .81, .91, and .80, respectively. The internal consistency reliability of item-each scale were also internally consistent with Cronbach's coefficient of .89 (Pearson's correlation coefficient: .71~.84), .93 (.89~.91), and .96 (.67~.91), respectively. However, high correlation was found among 3 items (.66~.83, .66~.67, and .67~.83), so the item-discriminant validity was low ( coefficient: .81, .91, .80, respectively). The construct validity by factor analysis was low because it was not consistent With WOMAC-VA3.0. In conclusion, the results reported here confirm the reliability of the WOMAC in patients with OA of the hip and knee. The collection of information on the hip and knee osteoarthritis using this instrument was acceptable to patients. A further prospective multi-center study will be necessary to prove the construct validity.
Anticipatory postural adjustments are pre-planned by the central nervous system (CNS) before the activation of agonist muscles in the limbs, and minimize postural sway. Most previous studies on this topic have focused on upper-limb movement, and little research has been conducted on lower-limb movement. The purpose of this study was to investigate the recruitment order of left and right trunk muscles during limb movement. Fifteen healthy subjects (10 male, 5 female) were enrolled. Electro-myographic signals were recorded on the muscles of: (1) deltoid, lumbar erector spinae, latissimus dorsi and internal oblique during shoulder flexion, (2) rectus femoris, rectus abdominis, external oblique and internal oblique during hip flexion. During right upper limb flexion, the onset of left erector spinae muscle and left internal oblique muscle activity preceded the onset of right deltoid by 8.09 ms and 19.83 ms, respectively. But these differences were not significant (p>.05). A similar sequence of activation occurred with lower limb flexion. The onset of left internal oblique muscle activity preceded the onset of right rectus femoris muscle by 28.29 ms (p<.05). The onset of right internal oblique muscle activity preceded the onset of left rectus femoris muscles by 23.24 ms (p<.05). The internal oblique muscle was the first activated during limb movement. Our study established the recruitment order of trunk muscles during limb movement, and explained the postural control strategy of the trunk muscles in healthy people. We expect that this study will be used to evaluate patients with an asymmetric recruitment order of muscle activation due to impaired CNS.
To reduce winging scapula, various exercise protocols have been widely used by clinicians. Selective serratus anterior strengthening, and restoring balanced function, are especially recommended to reduce winging scapula. The purpose of this study was to investigate visual biofeedback using a real time video camera display system for monitoring scapular winging during arm lowering. For this study, 13 males with winging scapular were recruited during arm lowering. Electromyography (EMG) activity was recorded from the serratus anterior (SA) and upper trapezius (UT) of the right side and compared with normal EMG activity using a paired t-test. The study showed, through visual biofeedback, that EMG activity significantly increased in the SA and significantly decreased in the UT (p<.05). These results suggest that visual biofeedback can be recommended as an effective method for scapular eccentric control, to prevent scapular winging during arm lowering.
The purpose of this preliminary study was to develop a measurement for assessing risk factors for falling in community-dwelling elderly persons. Rasch analysis and principal component analysis were performed to examine whether items on the Activities-Specific Balance Confidence (ABC), assessing self-efficacy, and items on the Berg Balance Scale (BBS), assessing balance function, contribute jointly to a unidimensional construct in the elderly. A total of 35 elderly persons (4 men, 31 women) participated. In this study, each item of ABC (16 items) and BBS (14 items) was scored on a 5-point ordinal rating scale from 0 to 4. The initial Rasch and principal component analysis indicated that 3 of the ABC items and 2 of the BBS items were misfit for this study. These 5 items were excluded from further study. After combining ABC and BBS, Rasch and principal component analyses were examined and finally 23 items selected; 12 items from ABC, 11 items from BBS. The 23 combined ABC-BBC items were arranged in order of difficulty. The hardest item was 'walk outside on icy sidewalks' and the easiest item was 'pivot transfer'. Although structural calibration of each 5 rating scale categories was not ordered, the other three essential criteria of Linacre's optimal rating scale were satisfied. Overall, the ABC-BBS showed sound item psychometric properties. Each of the 5 rating scale categories appeared to distinctly identify subjects at different ability levels. The findings of this study support that the new ABC-BBS scale measure balance function and self-efficacy. It will be a clinically useful assessment of risk factors for falling in the elderly. However, the number of subjects was too small to generalize our results. Further study is needed to develop a new assessment considering more risk factors of falling in elderly.
The purpose of this study was to examine the effect of the hip internal rotation on knee extensor and hip abductor electromyographic (EMG) activity during stair up and stair down mobility. Eighteen healthy subjects were recruited. All subjects performed stair up and down movements on a step of 30cm height while maintaining the hip in neutral (condition 1) and hip in internal rotation (condition 2). Surface EMG activity was recorded from five muscles (gluteus maximus, vastus lateralis (VL), vastus medialis oblique (VMO), posterior gluteus medius (Gmed), and tensor fascia latae (TFU)) and hip internal rotation angle was measured using a three dimensional motion analysis system The time period for stair up and down was normalized using the MatLab 6.5 program, and EMG activity was normalized to the value of maximal voluntary isometric contraction (%MVIC). The EMG activities according to the hip rotation (neutral or internal rotation) during the entire time period of stair up and down in each phase were compared using a paired t-test. During the entire period of stair up, the EMG activities of VL and TFL in condition 2 were significantly greater than in condition 1 (p<.05). During the entire period of stair down, the EMG activities of VL and TFL in condition 2 were significantly greater than in condition 1 (p<.05). However, the EMG activities of the other muscles were not significantly different between the conditions (p>.05). These results suggest that the stair up and down maintaining hip internal rotation was could be a contributing factor on patellar lateral tracking.
The purpose of this study was to determine the differences in joint moment in the intact limb of uni-transfemoral amputees and to identify the implications of knee osteoarthritis. As an experimental method, three-dimensional gait analysis was performed on 10 uni-transfemoral amputees and 10 healthy males. Kinematics and kinetics at the hip, knee, and ankle joint were calculated. As a statistical method, independent t-tests were conducted to perform a comparison between the transfemoral amputee group and the control group. The results showed that the external knee adduction moment increased in the transfemoral amputee group (.22 Nm/kg) compared with that of the control group (.13 Nm/kg) at terminal stance (p=.008). External knee flexion moment also increased in the transfemoral amputee group (.24 Nm/kg) but this difference was not statistically significant. External hip flexion moment increased in the transfemoral amputee group (1.35 Nm/kg) compared with that of the control group (.45 Nm/kg) at initial stance, and external hip extension moment decreased in the transfemoral amputee group (-.26 Nm/kg) compared with that of the control group (-.76 Nm/kg) at terminal stance. Although external ankle plantarflexion moment of the transfemoral amputee group increased, it was not found to be statistically significant. The results suggest that the intact limb joint moment of the uni-transfemoral amputees during walking can be different from that of healthy subjects. In conclusion, it was found that there is a link between the increase of external knee adduction moment and the prevalence of knee osteoarthritis in uni-transfemoral amputees. This result is expected to provide some objective data for rehabilitation programs related to knee osteoarthritis in transfemoral amputees.
With the introduction of the video display terminal (VDT), the efficiency and productivity of work has improved. However, VDT syndrome is threatening the health of workers as a side effect of prolonged use of a VDT. Among various VDT syndromes, the musculoskeletal disorder, especially, the cumulative trauma disorder (CTD) is the common research topic related with upper extremities function. The aim of this study was to investigate the effect of the wrist-hand orthosis (WHO) on fatigue in middle deltoid, anterior deltoid, serratus anterior, and upper trapezius during one-hour computer keyboard typing. Twelve healthy subjects participated in this study. Surface electromyography was used to assess the localized muscle fatigue (LMF), and the LMF was calculated at 10 minutes, 20 minutes, 40 minutes, and 60 minutes in each muscle, with and without the WHO. Data were analyzed by paired t-test with a level of significance of .05. The results of this study are as follows: 1) At 10 minutes, the LMF decreased significantly with applied WHO in the middle deltoid, anterior deltoid, and upper trapezius (p=.001, p=.026, p=.019, respectively). 2) As the computer keyboard typing period increased, there were no significant LMF differences, except for the upper trapezius. Therefore, it can be concluded that the WHO can be applied to decrease the LMF for the initial 10 minute period in the middle deltoid, anterior deltoid, and upper trapezius' but that the long term effect of WHO in reducing the LMF was proven only in upper trapezius during continued computer keyboard typing.