Background: Gait problems appear in most stroke patients. Commonly, stroke patients show the typical abnormal gait patterns, such as circumduction, genu recurvatum, and spastic paretic stiff-legged gait. An inclined treadmill gait exercise is good for gait problems of stroke patients. In addition, the backward walking training has been recommended in order to improve the component of the movement for the forward walking. Objects: The purpose of this study to investigated the effects of backward walking with inclined treadmill training on the gait in chronic stroke patients. Methods: A total of 30 volunteers were randomly allocated to two groups that walked on an inclined treadmill: the experimental group (n1=15), which walked backward, and the control group (n2=15), which walked forward. To measure the improvement of the patients’ gait, a Figure of Eight Walking Test (F8W), Four Square Step Test (FSST), and Functional Gait Assessment (FGA) were performed. We also measured spatio-temporal gait variables, including gait speed, cadence, stride length, and single limb support using a three-axial wireless accelerometer. The measurements were taken before and after the experiment. The Wilcoxon signed-rank test was used to compare both groups before and after the interventions. The Mann-Whitney U test was used for the comparisons after the interventions. The statistical significance was set at α=.05. Results: Before and after experiment, all dependent variables were significantly different between the two groups (p<.05). As compared to the control group, the experimental group showed more significant improvements in F8W, FSST, speed, cadence, stride length, and single limb support (p<.05); however, FGA in this group was not significantly different from the control (p>.05). Conclusion: Our results suggest that backward walking on an inclined treadmill is more effective for improving the gait of stroke patients than forward walking.

Background: In the stroke patients with the characteristics of hemiplegic gait, turning direction of the affected and unaffected side influences turning time. Therefore, it is important to investigate the walking response to turning directions in stroke patients. Objects: This study aimed to measure the walking time while turning direction in hemiplegic patients depending on balance ability measured by Berg Balance Scale. Methods: A group of forty-five subjects with stroke (Berg Balance Scale score≥46 were twenty-eight, Berg Balance Scale score≤45 were seventeen) were enrolled in this study. Subjects were asked to perform the Timed Up and Go test. Testing indications included two directions for turning in each subject. These indications were for turning toward the affected and unaffected side in stroke patients. The duration of total analysis duration, sit to stand phase, stand to sit phase, mid-turning phase, and end turning phase were recorded. The obtained data were analyzed by using paired t-test and Wilcoxon signed rank test in the group that are below and above 45 points of Berg Balance Scale score. The significance level was set at ɑ=.05. Results: There were significant increase time in the analysis duration and end turning phase duration while subjects were turned the unaffected side in stroke patients that presented a Berg Balance Scale score≤45 (p<.05). However, the comparison between the affected side and the unaffected side in the stroke patients with Berg Balance Scale score≥46, revealed no significant differences of the measured parameters. Conclusion: This finding should be suggested in the specific definition of turning direction for evaluation with Timed Up and Go test in the Berg Balance Scale score≤45, and other intervention for hemiplegic patients need to be suggested the direction of turning during walking training program.

This study aimed to evaluate the surface area and velocity of center of pressure (COP) during one leg standing by stimulating the sensory system in normal adults. Thirty subjects were enrolled in this study. Subjects were asked to stand on one leg during testing conditions. Testing conditions included 6 different sensory stimulations as follows: eyes opened, eyes closed, eyes opened with vibrator, eyes opened with head-mounted display (HMD), eyes opened with vibrator and HMD, and eyes closed with vibrator. During each testing condition, the surface area and velocity of center of pressure were measured. There were significant differences in the mean surface area and the mean velocity of COP between the “eyes opened” condition and the other five testing conditions (p<.05). However, in the comparison between the “eyes closed” and “eyes opened with HMD” conditions, there were no significant differences in the tested parameters. This study shows that closing eyes or keeping eyes opened while using HMD to experience virtual reality has the same effect on one leg standing balance. This finding should be considered in the evaluation or intervention of balance, especially one leg standing balance and balance while standing with a small base of support.

The purpose of this study was to investigate the effects of smartphone use on muscle fatigue and tenderness in the cervical erector spinae (CES) and the upper trapezius (UT) and on the cervical range of motion among subjects with and without neck muscle pain. The subjects were 30 smartphone users in their 20 s who -were assigned to either an experimental group with neck muscle pain or a control group without neck muscle pain. Muscle fatigue and tenderness in the CES and the UT as well as the subjects’ cervical range of motion were measured before and after 20-min smartphone sessions in a sitting position. In a between-group comparison of muscle fatigue, the experimental group showed a significantly greater decrease in median frequency in the CES and the right UT after smartphone use (p<.05). Regarding the assessment of muscle tenderness after smartphone use, the experimental group showed a statistically significant decrease in the pressure-pain threshold (PPT) in all muscles (p<.05), whereas the control group showed a significantly decreased PPT in the right CES and the UT (p<.05). The assessment of the cervical range of motion revealed a statistically significant reduction in the cervical flexion-extension and left lateral flexion in the experimental group (p<.05) after smartphone use. However, there was no significant change in the cervical range of motion in the control group (p>.05) after smartphone use. When compared with the control group, the experimental group demonstrated greater changes in cervical extension, lateral flexion, and rotation, except for cervical flexion (p<.05). In conclusion, when smartphone users have pre-existing neck muscle pain, the use of a smartphone further increased muscle fatigue and tenderness in the neck and reduced PPT and the cervical range of motion.

The purpose of this study was to determine the effectiveness of sit-to-stand training on unstable surfaces in individuals with stroke. Nineteen subjects with chronic stroke were divided into two groups: an experimental group (10 subjects) and a control group (9 subjects). They received 30 minutes of Neuro-developmental therapy (NDT) treatment, and sit-to-stand exercise for 15 minutes three times a week for four weeks. During the sit-to-stand training, the experimental group performed on an unstable AIREX balance pad, but the control group performed on a stable surface. Balance ability and weight-bearing distribution during quiet standing were measured before and after training period using the 7-item Berg balance scale-3P (BBS-3P) and the Five-times-sit-to-stand test (FTSST). In addition, the muscle strength of the knee extensor was evaluated before and after the training period. The results were as follows: 1) The weight-bearing distribution forward of the affected leg, increased significantly in the experimental group after the four-week intervention (p<.05), 2) The 7-item BBS-3P and FTSST increased significantly in the experimental group after the four-week intervention (p<.05), 3) The knee extensor muscle strength in both groups increased significantly after the four-week intervention (p<.05). In conclusion, the results of this study did not show that the sit-to-stand training on an unstable surface was more effective than on a stable surface. However, the results suggested that sit-to-stand training is effective in the balance training of stroke patients.

The purpose of this study was to compare spatio-temporal parameters during walking between patients with idiopathic Parkinson's disease and a control group matched for age, height, and weight. Thirty-three subjects were included in this study. Fifteen normal subjects (age, 63.3±5.8 yrs; height, 164.1±8.7 cm; weight, 60.7±17.5 kg) and eighteen patients (age, 64.0±7.7 yrs; height, 164.7±7.3 cm; weight, 63.6±7.7 kg) participated in the study. The Vicon 512 Motion analysis system was used for gait analysis in each group during walking, with and without an obstacle. The measured spatio-temporal parameters were cadence, walking speed, stride time, step time, single limb support time, double limb support time, stride length, and step length. Results in stride length and step length, when walking without an obstacle, showed a significantly greater decrease in the patient group compared to the control group. During walking with an obstacle, the patient group showed a significantly greater decrease in the step length as compared to the control group. For the control group, there were significant decreases in parameters of cadence and walking speed and increases in parameters of stride time, step time, and single limb support time when walking with an obstacle. The patient group had lower cadence and walking speed and higher stride time, step time, and single limb support time during walking with an obstacle than in walking without an obstacle. These results suggest that patients with Parkinson's disease who walk over an obstacle can decrease cadence, stride length, and step length. Further study is needed, performed with more obstacles and combined with other external cues, such as visual or acoustic guides.

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.

This study was designed to examine the effects of temporary immobilization of the ankle and knee joints on standing in healthy young adults with the use of a postural control mechanism. The subjects were twenty-four college students (12 males and 12 females, aged between 20 and 28). A Biodex balance system SD 950-302 and its software were used to measure indirect balance parameters in standing. Each subject underwent postural stability tests in 4-different joint conditions: free joints, ankle immobilization only, knee immobilization only, and ankle and knee immobilization. In addition, the postural stability test was conducted once with the subject's eyes open and once with the eyes closed conditions. For data analysis of the postural stability tests, the overall stability index, antero-posterior stability index, and medio-lateral stability index were recorded. The overall stability index (p=.000) and medial-lateral index (p=.003) were significantly greater different conditions with eyes closed in postural stability. Therefore, the eyes closed condition is expected to be used as an effective postural stability training for treatment planning in patients with unstable postures. In addition, training based on the dynamic multi-segment model can improve postural stability and is available to therapeutic programs, helping people with unstable balance to reduce their risk of falling.

The purpose of this study was to propose a task-related circuits program for stroke patients and to test the difference in functional improvements between patients undergoing conventional physical therapy and those participating in a task-related circuits exercise program. The subjects were 10 stroke in-patients of the Korea National Rehabilitation Center in Seoul. We measured the following variables: Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Tone Assessment Scale (TAS), speed of gait, rate of step, physiological costs index, age, weight, height, site of lesion, onset day and whether the subject participated in an exercise program. Collected data were statistically analyzed by SPSS 10.0/PC using descriptive statistics, Mann-Whitney U test, Wilcoxon rank sum test and Spearman's correlation. The results of the experiment were as follows: (1) In the pre-test and post-test for function, there was not a statistical significance between the group partaking in a task-related circuits program and the group of conventional physical therapy (p>.05). (2) In the MAS, BBS and speed of gait test, the group undergoing conventional physical therapy showed a statistical significance (p<.05). (3) In the MAS, BBS, speed of gait, PCI, TAS (passive, associated reaction, TAS total score), the group of task-related circuits program showed a statistical significance (p<.05). As a result, the group participating in a task-related circuits program had a more functional improvement than the group participating in conventional physical therapy. Therefore, an intervention recommended for a stroke patient would be a task-related circuits program consisting of a longer session of each task for a more improved functional recovery.

The purpose of this study was to investigate the correlation and characteristics between electromyographic (EMG) activities of lower leg muscles and the posturographic assessment of static balance control in normal adults. Twenty-four young, healthy adults(12 males, 12 females) participated in the study. Center of pressure (COP) parameters were obtained using force platform as total path distance, total sway area, X mean frequency and Y mean frequency for 20 seconds in the following conditions: (1) comfortable standing with eyes opened or closed, (2) uncomfortable standing (feet together) with eyes opened or closed, (3) virtual moving surround delivered using Head mount display (HMD) with four different moving patterns. The virtual moving patterns consisted of close-far, superior-inferior tilting (pitch), right-left tilting (roll), and horizontal rotation (yaw) movements. Surface electromyographic activites were recorded on the tibialis anterior, peroneus longus, medial and lateral heads of gastrocnemius muscles under each condition. Correlation between the posturographic measures and EMG activities were evaluated. Total path distance and total sway area of COP were significantly increased during uncomfortable standing. EMG activity of tibialis anterior was significantly more during uncomfortable standing and virtual moving surround stimulation than during comfortable standing. Total path distance and sway area of COP during comfortable standing with closed eyes showed significant positive correlation with the EMG activities of the lateral head of gastrocnemius muscle. Total path distances and total sway area of COP during muscle. Total path distances and total sway area of COP during presentation of virtual moving surround also had significant positive correlations with EMG activities of the lateral head of gastrocnemius muscle under close-far movement.

The purpose of this study was to assess the effect of visual block (eyes open or closed), mental task type, and participation in an exercise program on static balance in the elderly. The subjects were 34 elderly (>65 years old) residents of a social welfare institute in Gyeonggi-do. We measured the following variables. Berg balance scale, mini mental state examination, balance performance monitor (sway area, path, and maximal sway velocity), age, weight, height and whether the subject participated in an exercise program. Scores for the Berg balance scale and mini mental state examination were evaluated to assess static balance ability either alone (single task paradigm) or while performing a mental task (dual task paradigm). Static balance variables that were measured included sway area, path, and maximal sway velocity. Each test was repeated three times. Multiple regressions analysis was used to examine the effect of each variable on static balance ability. For the dual task paradigm, static balance was affected by whether the subject participated in an exercise program. The Berg balance scale score for subjects with their eyes open was affected by whether they participated in an exercise program, while this variable in addition to the height and weight of subjects were determining variables in subjects with their eyes closed. As a result, whether subjects participated in an exercise program affected their static balance irrespective of whether their eyes open or closed. Therefore, regular exercise is recommended for elderly people and further research is needed to examine the relationship between static and dynamic balance while performing mental tasks such as cognition and attention.

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.