The aim of this study is to compare measurements of abdominal muscle thickness using ultrasonography imaging (USI) to those using a special transducer head device, during five different trunk stabilization exercises, ultimately to determine which exercise led to the greatest muscle thickness. Thirty eight healthy subjects participated in this cross-sectional study. The five types of trunk stabilization - i.e., a sit-up on the supine, an upper and lower extremity raise with quadruped on the prone, a leg raise in sitting on the ball, trunk rolling on the ball, and balance using sling on the prone position - were each performed with an abdominal draw. The thickness of the abdominal muscle - including the transverse abdominal (TrA), internal oblique (IO), and external oblique (EO) - was measured by USI with a special transducer head device, at rest and then at contraction in each position. Data were analyzed using one-way repeated ANOVA with the level of significance set at =.05. The results were as follows: 1) the TrA thickness was statistically significant (p<.05), whereas the IO and EO thicknesses were not (p>.05); 2) among the five types of trunk stabilization, TrA thickness significantly increased with the balance using a sling in the prone position, (p<.05), whereas no significant difference was noted for the four types of trunk stabilization (p>.05); 3) reliability data showed that there was a high degree of consistency among the measurements taken using the special transducer head device (ICC=.92). In conclusion, the balance using a sling in the prone position was more effective than any of the four other types of trunk stabilization in increasing TrA thickness in healthy subjects.
This study aimed to investigate whether isometric lower limb exercise can activate contralateral trunk muscles and whether the magnitude of muscle activation is related to lower limb movement in sitting. This study included 25 healthy young subjects (20 males and 5 females). The magnitude of trunk muscle activation was measured using surface electromyography (EMG) during hip flexion, extension, adduction, and abduction, and a significant difference was observed in the activation levels of trunk muscles among the tests (p<.01). The EMG activity of the multifidus (MF) and erector spinae (ES) muscles on the contralateral side were significantly greater during hip extension. However, the activation levels of the contralateral internal oblique (IO) and rectus abdominis (RA) muscles were greatest during hip flexion. The MF : ES EMG ratio was significantly greater during hip isometric during hip isometric flexion and abduction compared to hip extension and adduction. There was no significantly difference in the IO : RA ratio during the isometric contractions toward different directions. These findings indicate that isometric lower limb exercise can elicit trunk muscle contraction on the contralateral side and may therefore be helped for developing contralateral trunk muscle strength in individuals undergoing rehabilitation.
The purpose of this study was to determine the effect of ankle joint mobilization with movement (MWM) on the range of motion (ROM) in the ankle, on the muscle strength of lower extremities, and on spatiotemporal gait parameters in chronic hemiplegic patients. Fifteen subjects with chronic stroke were divided into two groups: an experimental group (8 subjects) and a control group (7 subjects). Both groups attended two or three sessions of physical therapy each week. The experimental group also attended additional MWM training sessions three times a week for five weeks. For both groups, the ROM of the ankle, the muscle strength of the lower extremities, and the spatiotemporal gait parameters in paretic limbs were evaluated before and after the training period. The results showed that the experimental group experienced more significant increases than did the control group in terms of passive (6.10%) and active (21.96%) ROM of the ankle, gait velocity (12.96%), and peak torque, of the knee flexor (81.39%), the knee extensor (24.88%), and the ankle plantar flexor (41.75%)(p<.05). These results suggest that MWM training in patients with chronic stroke may be beneficial in increasing ROM in the ankle, muscle strength in the lower extremities, and gait speed.
The lower trapezius muscle is an important stabilizer and primary mover of the scapula. The potential use of ultrasound imaging to evaluate scapular muscle function warrants investigation. The purpose of this study is to use ultrasound imaging for determining the effectiveness of 4 different isometric exercises for maximally activating the lower trapezius muscles in healthy subjects. Twenty-eight (14 men and 14 women) volunteers were recruited for this study. Thickness measurements of the lower trapezius muscles were recorded during 4 exercises: latissimus pulldown (LP), prone V-raise (PV), prone row (PR), and modified prone cobra (MP). Lower trapezius muscle thickness was measured 3 times by 2 investigators at a point 3 cm lateral to the lateral edge of the T8 spinous process. The order of 4 exercise execution was randomized for each participant. To identify statistical significance, one-way ANOVA with repeated measures was used with the significance level of .05. Intraclass correlation coefficient (ICC) for intra-reliability was .86~.98 and inter-rater reliability .83~.96 for the lower trapezius, respectively (p<.01). Thickness changes in the lower trapezius muscles between the relaxed and contracted states in men were as follows: LP (, 182%), MP (, 167%), PV (, 149%), and PR (, 133%). In women the values were as follows: LP (, 163%), MP (, 131%), PV (, 129%), and PR ( mm, 100%). Thickness of the lower trapezius muscles significantly differed between exercises in both the gender (p<.01). The LP was the most effective exercise for increasing the activation of the lower trapezius muscle in both the gender. We recommend performing the LP exercise for strengthening the lower trapezius muscles.
The purpose of this study was to investigate the effect of visual feedback on the postural control of stroke patients, by systematically varying conditions of visual feedback [eye-open condition (EO) vs. eye-closed condition (EC)], and base-support (both-side support, affected-side support, and unaffected-side support). In this study, we allocated 41 stroke patients with no damage in the cerebellum and visual cortex who can walk at least 10 meters independently, and 35 normal adults who have no experience of stroke to the control group. Both groups were asked to perform a "sit-to-stand" task three to five times, and their postural control ability was measured and compared in terms of asymmetric dependence (AD) instead of the traditional symmetric index (SI) in the literature. The results showed that although both subject groups maintained better postural control in the EO condition than in the EC condition, the patient group appeared to be more stable in EC than in EO when they were required to perform the task of the support condition given on the affected side. These results implied that visual feedback can impair stroke patients' postural control when it is combined with a specific support condition.
This study aimed to determine the usefulness of classifying patients with neck pain on the basis of the results of passive scapular elevation test. We classified 21 patients with neck pain into positive (n=12) and negative (n=9) groups on the basis of passive scapular elevation test; the 2 groups then equally performed scapular stabilization exercise program for 30 min, 3 times a week, for 4 weeks. Visual analogue scale (VAS), neck disability index (NDI), and range of motion (ROM) were recorded both before and after the intervention for both groups. Paired t-test was used to determine that there were significant changes between before and after the intervention, and independent t-test was used for analyzing changes between two groups of dependent variables. After 4 weeks of training, we observed significant decrease in pain and disability (p<.05) and a significant increase in rotation, flexion, extension, and side-bending ROM (p<.05) in both groups. Further, between pre- and post-intervention evaluations, we observed a significant decrease in pain and disability and a significant increase in rotation and flexion ROM in the positive group than in the negative group (p<.05). These results indicate that passive scapular elevation test may be used to identify mechanical disorders of the cervicoscapular muscle in patients with neck pain. Therefore, we recommend the use of passive scapular elevation test to determine appropriate treatment intervention when treating patients with neck pain.
In daily activities, people often perform two or more tasks simultaneously. This is referred to as dual-tasking or multi-tasking. The purpose of this study was to examine the effects of performing dual tasks while using a mobile phone on static and dynamic postural stability. Twenty-four subjects were asked to stand on a force plate and then instructed to perform a balance task only (BT), a balance task while listening to music (BTL), a balance task while talking on the mobile phone (BTT), and a balance task while sending text messages (BTS). We used the BioRescue to measure postural sway and limit of stability for static and dynamic postural stability. Also the star excursion balance test (SEBT) was used to measure dynamic postural stability. A one-way ANOVA with repeated measures was used to compare the effects of the BT, BTL, BTT, and BTS. The Bonferroni's post hoc test was used to determine the differences among four tasks. Carrying out the BTS significantly decreased the limit of stability compared with carrying out the BT, BTL, and BTT (p<.05). In limit of stability, total surface area of BTT was more significantly decreased than that of BT and total surface area of BTS was more decreased than that of BT, BTL and BTT (p<.05). In the SEBT, the BTS displayed significantly smaller reach distance values compared with the BT or BTL (p<.05). These findings suggest that performing the balance task while sending text message on the mobile phone decreases dynamic postural stability, whereas performing the same task while listening to music using the mobile phone does not. Therefore, it requires more attention to maintain dynamic balance while sending text messages.
The purpose of the present study was to investigate the effects of familiar exercise and novel exercise on motor function after intracerebral hemorrhage (ICH) in rats. The rats were subjected to a unilateral striatal ICH via collagenase infusion. The rats were randomly divided into the following three groups: the CON (control group; rested one week post-ICH), the FE (familiar exercise group; familiar exercise was performed two weeks after one-week post-ICH period), and NE (novel exercise group; novel exercise was performed two weeks after one-week post-ICH period). We measured neurological behavior using a ladder rung walking test and a beam walking test; we measured the level of nerve growth factor (NGF) using immunohistochemistry and western blot analysis. We performed a one-way ANOVA test to analyze the scores obtained from the neurological behavior tests and the differences of NGF protein levels among the three groups. In the present study, the FE group and the NE group showed significant improvement during the neurological behavior tests and in their expression of NGF protein level, as compared to the CON group. Especially, NE group more increase than FE group in neurological behavior tests, the expression of NGF on motor cortex. In conclusion, these results suggest that, after ICH, familiar exercise and novel exercise enhance motor function and, novel exercise is more effective than familiar exercise.
The aim of the current study was to assess the effectiveness of backward gait training on the treadmill in patients with spastic diplegic cerebral palsy (CP). Twelve patients with spastic diplegic CP participated in the study. An 8-week course of backward gait training was administered to the subjects for 3 days per week. Pre-intervention and post-intervention assessments of temporal-spatial gait parameters, the symmetry of the bilateral lower extremity weight bearing, and gross motor function were analyzed using motion analysis system, force plate, and Gross Motor Function Measurement (GMFM). There were significant improvements (p<.05) in the measures of both step length and right stance phase time. Joint kinematics showed increase in right hip abduction in initial contact and terminal swing, right hip external rotation and knee flexion in mid-swing, left ankle dorsiflexion in initial contact and terminal swing (p<.05). The symmetry of the bilateral lower extremity weight bearing and GMFM also significantly increased (p<.05). These findings indicate that backward gait training using a treadmill is beneficial for patients with spastic diplegic CP.
The primary aim of this study was to compare responsiveness of self-report by worker and therapist-scored functional capacity instrument. Self-report and therapist-scored interval-level person measures and item difficulties were compared at admission and discharge. Therapist and worker ratings were collected on 230 clients from 27 rehabilitation sites using the newly developed Occupational Rehabilitation Data Base (ORDB) functional capacity instrument. ORDB comprises several subscales measuring relevant variables of "a return-to-work model" in work-related rehabilitation clinics. The functional capacity scale deals with 10 DOT job factors. The rating scale categories were 1-severely impaired, 2-moderately impaired, 3-mildly impaired, and 4-not impaired. Only data from clients with low back pain (n=98) with complete data (both admission and discharge scores) were used for the present study. Therapists and workers completed the functional capacity instrument at admission and discharge. Rasch analysis [1-parameter item response theory model (IRT)] was applied to calibrate item difficulty and person ability measure of therapist and workers ratings. Effect sizes for therapist and self-report ratings were slightly different, .69 and .30, respectively. Therapist and worker ratings were more consistent at discharge (r=.54) than at admission (r=.32). Workers have a tendency to be more severe in their ratings (show higher item difficulties) than therapists at admission and discharge. Therapists and workers report similar magnitudes of improvement following treatment program. These findings challenge the belief that injured workers may unreliable source for monitoring therapeutic outcomes. Self-report measures have the advantage of conserving therapist time for treatment (versus evaluation). While the therapist and self-report ratings are comparable at discharge, there is less consistency at admission. Comparable therapist-worker ratings may be achieved by controlling for rating severity using IRT methodologies.
The aim of this study was to examine the effects of repeated passive movement (RPM) of different velocities on the improvement of knee joint position sense (JPS) in post-stroke patients with hemiplegia, thereby investigate the possibility of clinical application in the initial stage of rehabilitation for patients with post-stroke hemiplegia. Thirteen hemiplegic patients participated in this study. For the subjects' knee JPS tests, a passive angle reproduction test and an active angle reproduction test were performed prior to and after the intervention, which involved 30 repetitions of passive full-range-of-motion flexion and extension exercise of the knee joints at randomized degrees of , , and . Paired t-test analysis was done in order to compare changes in the pre- and post-intervention knee JPS. One-way repeated analysis of variance was used in order to compare changes in JPS after intervention at three different movement velocities. The level of significance was set at .05. The result was that the subjects' post-intervention knee JPS significantly improved after the RPM exercise at a and a relative to the RPM exercise (p<.05). JPS changes with RPM intervention at the rapid velocity of were most increased, suggesting the most effective enhancement in knee JPS is with intervention at the velocity (p<.05). Therefore, RPM intervention at a half or higher velocity improved stroke patients' knee JPS. During the initial stage of rehabilitation for patients with post-stroke hemiplegia, the efficient application of the RPM exercise at a half or higher velocity will be possible.
This study was performed to compare the muscle activity of lumbar stabilizers between stoop and semi-squat lifting techniques at different lifting loads. Twenty healthy subjects (9 males, 11 females) were recruited for this study. Muscle activity of external obliques (EO), internal obliques (IO) and lumbar multifidus (LM) muscle was measured by surface electromyography during stoop and semi-squat lifting at different lifting loads (10%, 20%, and 30% of the subject's body weight). A one-way repeated measure ANOVA was applied. The results showed that EMG activity of EO was significantly increased with a load of 30% of body weight compared to 10% and 20% of body weight in both lifting techniques (p<.05). Muscle activity of LM was significantly increased in 20% compared to 10% and 30% compared to 10% of subject's body weight in stoop lifting and the muscle activity of LM was significantly increased in 20% compared to 10%, 30% compared to 20%, and 30% compared to 10% of the subject's body weight in semi-squat lifting (p<.05). However, there was no significant difference in activity of IO according to lifting loads in both lifting techniques. There were no significant differences in muscle activity of EO, IO, and LM between stoop and semi-squat technique (p>.05). Therefore, the results of this study suggested that the EO can contribute to increase the lumbar stability during stoop and semi-squat lifting at 30% of body weight rather than at lower loads, and the LM seems to act as counteractor to imposed loads during stoop and semi-squat lifting with increasing loads.
It is important to assess foot posture when investigating the relationship between lower extremity dysfunctions and foot types. Although several measurements of static foot posture have been used, there is no consensus regarding clinical measurements for foot posture. The aim of this study is to explore the differences among navicular drift (NDt), foot posture index (FPI), arch index (AI), dorsal arch height ratio (DAHR), normal navicular height truncated (NNHt) and to discover the most effective measurement. After foot types were classified by navicular drop test (NDp), clinical measurements of NDt, FPI, AI, DAHR, and NNHt were performed on 64 subjects' feet. ANOVA analysis was used for the variance of the difference between the NDp and the five kinds of clinical measurements, and the level of significance was set at =.05. The results showed that all five clinical measurements demonstrated significant differences with navicular drop. In post-hoc, FPI and NNHt showed significant differences in all foot types. The five clinical measurements are suitable the classification of foot types through the NDp. Therefore, it could be possible to assess correct and objective foot posture by using FPI and NNHt.
Most conventional instruments measuring disability rely on total score by simply adding individual item responses, which is dependent on the items chosen to represent the underlying construct (test-dependent) and a test statistic, such as coefficient alpha for the estimate of reliability, varying from sample to sample (sample-dependent). By contrast, item response theory (IRT) method focuses on the psychometric properties of the test items instead of the instrument as a whole. By estimating probability that a respondent will select a particular rating for an item, item difficulty and person ability (or disability) can be placed on same linear continuum. These estimates are invariant regardless of the item used (test-free measurement) and the ability of sample applied (sample-free measurement). These advantages of IRT allow the creation of invariantly calibrated large item banks that precisely discriminate the disability levels of individuals. Computer adaptive testing (CAT) method often requiring a testing algorithm promise a means for administering items in a way that is both efficient and precise. This method permits selectively administering items that are closely matched to the ability level of individuals (measurement precision) and measuring the ability without the loss of precision provided by the full item bank (measurement efficiency). These measurement properties can reasonably be achieved using IRT and CAT method. This article aims to investigate comprehensive overview of the existing disability instrument for back pain and to inform physical therapists of an alternative innovative way overcoming the shortcomings of conventional disability instruments. An understanding of IRT and CAT method will equip physical therapist with skills in interpreting the measurement properties of disability instruments developed using the methods.