Background: Stroke patients experience multiple dysfunctions that include motor and sensory impairments. Therefore, new intervention methods require a gradational approach depending on functional levels of a stroke patient’s activity and should include cognition treatment to allow for a patient’s active participation in rehabilitation. Objects: This study investigates the effect of integrated revision of electrical sensory stimulation, which stimulates somatosensory and action observation training, which is synchronized cognition intervention method on stroke patients’ functions. Methods: Twenty-one stroke patients were randomized into two groups. The two groups underwent twenty minutes of intervention five times a week for three weeks. This study used an electromyogram to evaluate symmetric muscle activation of lower extremities and muscle onset time when performing sit to stand before and after intervention. A weight-bearing ratio was used to evaluate the weight-bearing of the affected side in a sit to standing. To evaluate sit to stand performance ability, this study performed five timed sit to stand tests. Results: The two groups both showed statistically significant improvement in muscle onset time of lower extremity, static balance ability in a standing position, and sit to stand performance after the intervention (p < 0.05). In addition, the action observation and synchronized electrical sensory stimulation group showed significant improvement in symmetric muscle activation of lower extremities and weight–bearing ratio of the affected side (p < 0.05). Conclusion: action observation and synchronized electrical sensory stimulation (AOT with ESS) can have positive effects on a stroke patient’s sit to stand performance, and the intervention method that provides integrated AOT with ESS can be used as new nervous system intervention program.

Background: Flat-footed persons with collapsed medial longitudinal arch lose flexibility after skeletal maturity, resulting in several deformities and soft tissue injuries. Although arch support taping is usually applied in the clinic to support the collapsed arch, research on the use of different types of tape for more efficient arch support in flat-footed persons is lacking. Objects: The purpose of this study was to examine three conditions (barefoot, kinesio tape, and dynamic tape) and compare their effects on static and dynamic balance in persons with asymptomatic flexible flatfoot. Methods: Twenty-two subjects (9 females and 13 males) with asymptomatic flexible flatfoot participated in this study. The subjects performed the Y-balance test to measure the composite reach score. The subjects also performed a 30-second standing test to measure the center of pressure (COP) path length and a walking test to measure anteroposterior and lateral variability using the Zebris FDM system. One-way repeated-measures analysis of variance compared the three conditions applied to the subjects’ feet for each balance variable. Results: The composite reach score significantly increased following the application of dynamic tape compared with barefoot and that of kinesio tape compared with barefoot. There was no significant difference in the COP path length during standing among the three conditions. Anteroposterior and lateral variability during walking significantly with dynamic tape application compared with barefoot. Conclusion: The results of this study suggest that, in persons with asymptomatic flexible flatfoot, application of kinesio tape and dynamic tape may be effective in increasing the composite reach score in Y-balance test, whereas application of dynamic tape may be effective in reducing anteroposterior and lateral variability during walking.

Background: Shoulder function is achieved by the coordinated movements of the scapula, humerus, and thoracic spine, and shoulder disorders can be associated with altered scapular kinematics. The trunk plays an important role as the kinematic chain during arm elevation. Objects: The purpose of this study was to determine the effects of thoracic hyperkyphosis on scapular orientation and trunk motion. Methods: Thirty-one subjects (15 in the ideal thorax group and 16 in the thoracic hyperkyphosis group) performed right-arm abduction and adduction movements in an unconstrained plane. The scapular orientation and trunk motion were recorded using a motion analysis system. Results: Those subjects with thoracic hyperkyphosis displayed greater scapular posterior tilting at a 120˚ shoulder elevation, greater scapular internal rotation throughout the arm raising phase, and greater trunk axial rotation at the upper ranges of the shoulder elevation, compared to those subjects with an ideal thorax (p<.05). Conclusion: Thoracic hyperkyphosis can cause scapular instability, greater trunk rotation and greater scapular posterior tilting, and may contribute to preventing the achievement of a full range of humeral abductions in an unconstrained plane.

Background: Compared to healthy people, patients with chronic lower back pain have reduced balance abilities which may cause proprioception problems, patients with chronic lower back pain avoid physical activities due to pain, and reduced activity levels lead to muscle weakening, which can further exacerbate pain. Recently, there have been many studies on the use of sensory stimulation; and among these studies, interventions that use vibrational stimulation have shown functional improvements in the patients. Objects: This study examined the effects of a stabilization exercise with vibration stimulation on the balance ability and disability in patients with chronic back pain. Methods: The subjects of the study were 30 persons who were randomly assigned to the experimental group and the control group, with 15 subjects in each. The subjects were evaluated before and after intervention via a balance ability test, the Korean Oswestry disability index (KODI) test, a pain test, and a proprioceptive sensory test. Both groups received general physical therapy. The experimental group performed the stabilization exercise with vibration stimulation, and the control group performed a general stabilization exercise, three times a week for six weeks. Results: After the intervention, both groups showed significant improvements in the balance ability test, the KODI test, the pain test, and the proprioceptive sensory test. The experimental group showed statistically significant, higher improvements than the control group in the balance ability test, the KODI test, and the proprioceptive sensory test. Conclusions: The stabilization exercise with vibration stimulation for patients with chronic back pain has been reported to provide greater functional improvements than the conventional intervention method. Therefore, the stabilization exercise in a vibration stimulation environment could be a useful intervention for patients with chronic back pain.

Background: The continuous co-contraction of the trunk muscles through trunk stabilization exercises is important to patients with lumbar spinal stenosis (LSS). However, intentional abdominal muscle contraction (IAMC) for trunk stabilization has been used only for specific training in the treatment room. Objects: The purpose of this study was to provide feedback to adults with LSS to enable IAMC during activities of daily living (ADLs). Methods: The participants with spinal stenosis were divided into an experimental group of 15 adults and a control group of 16 adults. Electromyographic signals were measured while the subjects kept their both hands held up at 90°. The measured muscles were the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES). Pelvic tilt was measured using a digital pelvic inclinometer. The degree of pain was measured using the visual analogue scale (VAS) and functional capacity was measured using the Korean version of the Oswestry disability index (KODI). Results: While the experimental group showed statistically significantly higher activities in the RA, EO, and IO after the intervention compared with the control group. Pelvic tilt was significantly decreased only in the experimental group. Both the experimental and control groups exhibited statistically significant declines in the VAS and KODI (p<.01). In terms of the levels of changes, the experimental group exhibited a statistically significant larger decline only in the VAS and the pelvic tilt when compared with the control group (p<.05). Conclusions: The subjects could stabilize their trunks, and relieve their pain and dysfunctions and reduce pelvic tilt by learning abdominal muscle contraction during ADLs.

Background: In previous studies regarding flexible pes planus, Foot orthosis, special shoes have been used as interventions for correcting malalignment and intrinsic muscles strengthening exercise have been regarded as interventions for foot function and supporting medial longitudinal arch during walking. However, some recent studies reported that strengthening extrinsic muscles as well as intrinsic muscles is more effective and active intervention for flexible pes planus. In particular, the tibialis posterior muscle of foot extrinsic muscles plays essential roles in maintaining the medial longitudinal arch during dynamic weight bearing and balance. In addition this muscle acts longer than other supination muscles during the stance phase in the gait cycle. Objects: This study aimed to investigate the effect of foot intrinsic muscle and tibialis posterior muscle strengthening exercise for plantar pressure and dynamic balance in adults with flexible pes planus. Methods: 16 young flexible pes planus adults (7 males, 9 females) were recruited and were randomized into two groups. The experimental group performed foot intrinsic muscle and tibialis posterior muscle strengthening training, the control group performed only foot intrinsic muscle strengthening training. All groups received strengthening training for 30 minutes five times a week for six weeks. Results: The experimental group had significantly lower plantar pressure of medial heel area than the control group in stand (p<.05). The experimental group had significantly higher dynamic balance ability than control group (p<.05). Conclusion: The results of this study provide evidence to suggest that foot intrinsic muscle and tibialis posterior muscle of extrinsic muscle strengthening exercises may improve plantar pressure distribution and dynamic balance ability in adults with flexible pes planus.

The purpose of this study was to compare the effects of underwater treadmill gait training (UTGT) and overground treadmill gait training (OTGT) on the gait, balance ability and pulmonary function of stroke patients. Twenty subjects were recruited for this study. The subjects were randomly assigned to two groups: UTGT (n1=10) and OTGT (n2=10). The 10 m walk test (10 MWT), Berg Balance Scale, Timed Up and Go (TUG) test, center of pressure, pulmonary function of forced vital capacity (FVC), forced expiratory volume after 1 sec (FEV1) and FEV1/FVC were measured before and after 4 weeks of training. Both groups undertook the gait training for 30 min a day, 3 times a week, for 4 weeks, and rating of perceived exertion of the groups were measured and compared. All the studied variables were significantly improved in both groups (p<.05) at the end of the study, except in the FEV1 of OTGT (p>.05). There was significant between-group difference in all of the variables, except in the 10 MWT (p>.05). These findings suggest that UTGT is more effective than OTGT in improving the balance and pulmonary functions of stroke patients.

The purpose of this study was to investigate the effect of multi joint-joint position sense (MJ-JPS) training on joint position sense, balance, and gait ability in stroke patients. A total of 18 stroke patients participated in the study. The subjects were allocated randomly into two groups: an experimental group and a control group. Participants in the experimental group received MJ-JPS training (10 min) and conventional treatment (20 min), but participants in the control group only received conventional treatment (30 min). Both groups received training for five times per week for six weeks. MJ-JPS is a training method used to increase proprioception in the lower extremities; as such, it is used, to position the lower extremities in a given space. MJ-JPS measurement was captured via video using a Image J program to calculate the error distance. Balance ability was measured using Timed Up and Go (TUG) and the Berg Balance Scale (BBS). Gait ability was measured with a 10 m walking test (10MWT) and by climbing four flights of stairs. The Shapiro-Wilk test was used to assess normalization. Within-group differences were analyzed using the paired t-test. Between-group differences were analyzed using the independent t-test. The experimental group showed a significant decrease in error distance (MJ-JPS) compared to the control group (p<.05). Both groups showed a significant difference in their BBS and 10MWT results (p<.05). The experimental group showed a significant decrease in their TUG and climbing results (p<.05), but the control group results for those two tasks were not found to be significant (p>.05). There was significant difference in MJ-JPS and by climbing four flights of stairs on variation of pre and post test in between groups (p<.05), but TUG and BBS and 10MWT was no significantly (p>.05). We suggest that the MJ-JPS training proposed in this study be used as an intervention to help improve the functional activity of the lower extremities in stroke patients.

The purpose of this study was to determine the effect of gait initiation training on gait and center of pressure (CoP) during gait initiation in stroke patients. Twenty-three subjects were randomly assigned to either an experimental group (EG) or a control group (CG). The EG received gait initiation training with increased CoP posterior distances the maximum the rear on gait training. The CG received general gait training. Both groups received training three times a week over a period of four consecutive weeks. The figures for CoP distances the maximum the rear, CoP distances time the mover the maximum the rear, the Tinetti Performance-Oriented Mobility Assessment (POMA), and gait velocity were recorded both before and after the training sessions for both groups. The EG’s results for CoP distances the maximum the rear, CoP distances time the mover the maximum the rear, and POMA improved after training (p<.05). In terms of the rate of change of CoP distances the maximum the rear, the EG demonstrated a significantly higher increase (p<.05) than did the CG. The results of this study suggest that increased CoP distances the maximum the rear affect the gait initiation and gait performance of stroke patients. Further studies with a larger sample size are necessary to verify the accuracy of the results of this study.

The purpose of this study was to investigate the effects of active and passive postural perturbation on ankle dorsiflexor responses in stroke patients. The subjects consisted of 13 stroke patients. Using wireless electromyography, the patients’ ankle dorsiflexor muscle responses were measured under the following conditions: active dorsiflexion (AD), active perturbation (AP), and passive perturbation (PP). Tibialis anterior muscle activity increased most significantly during PP of the affected side (118.64±56.28). The most significant increase for the non-affected side was in AD (72.64±24.56). Tibialis anterior muscle activity was compared under each condition. The affected side showed significant differences between PP and AD and between PP and AP (p<.05). The non-affected side showed not significant differences between each condition. The ratios of tibialis anterior muscle activity under AP to that under AD were 1.00 on the affected side and .75 on the non-affected side and the difference was not significant (p>.05). The ratios of tibialis anterior muscle activity under PP to that under AD were 3.30 on the affected side and 1.14 on the non-affected side and the difference was significant (p<.05). Passive perturbation improved tibialis anterior muscle activity on the affected side, and training based on this approach may have the potential to improve the ankle dorsiflexion of people with stroke.

This study was conducted in order to examine whether abdominal draw-in maneuver (ADIM) with isometric shoulder flexion, extension, adduction, and abduction selectively contracted deep abdominal muscles. This study's subjects were 13 males 17 females. In order to evaluate the comparison of effects of ADIM and ADIM with isometric shoulder flexion, extension, adduction and abduction, measurements were made on transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) using a real-time ultrasonic diagnostic imaging system. Each position was repetitively measured three times with a real-time ultrasonic diagnostic imaging system and their mean values were used for analysis. The ADIM with isometric shoulder flexion, extension, adduction and abduction significantly increased the thickness of TrA relative to the ADIM only (p<.05). The ADIM with isometric shoulder abduction significantly increased the thickness of IO compared to the ADIM only (p<.05). The ADIM with isometric shoulder extension and abduction significantly decreased the thickness of EO compared to the ADIM only and the ADIM with isometric shoulder extension significantly decreased the thickness of EO relative to the ADIM with isometric shoulder adduction (p<.05). ADIM with isometric shoulder abduction is an effective method to selectively strengthen deep abdominal muscles and therefore may be employed as an intervention for trunk stabilization.

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.

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 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 effects of weight shift training with joint mobilization on the ankle joint passive range of motion (PROM), balance capacity and gait velocity in hemiplegic patients. Fourteen subjects were randomly assigned to either the experimental group (EG) or the control group (CG), with seven subjects in each group. The EG received weight shift training with joint mobilization in the paretic leg's subtalar joint in order to increase ankle dorsiflexion. The CG received general physical therapy training. Both groups received training five times a week over a period of two consecutive weeks. The figures for PROM of ankle dorsiflexion on the paretic leg, the functional reach test (FRT), the timed up and go (TUG) test, and gait velocity were recorded both before and after the training sessions for both groups. The EG's results in gait velocity, the FRT and the TUG test improved after training (p<.05). The PROM of ankle dorsiflexion improved both in the EG and the CG (p<.05), the EG demonstrated a significantly higher increase (p<.05) than that of the CG. The results of this study suggest that increased joint mobilization positively affects balance and gait velocity of hemiplegic patients. Further studies with a greater sample size are necessary in order further prove the accuracy of the results of this study.

The aim of this study was to investigate the effects of respiratory muscle training (RMT) with abdominal drawing-in maneuver (ADIM) on pulmonary function. Twenty-two subjects with restrictive breathing participated in this study. All the subjects were randomly assigned to three groups (7 subjects in RMT group, 7 subjects in RMT with ADIM group, 8 subjects in control group). The first group performed the RMT by using incentive respiratory spirometer (IRS). The second group performed the RMT by using IRS and the ADIM by using a Stabilizer. The exercises were conducted over four days. The pulmonary function was evaluated using the spirometer to measure the force exploratory volume in 1 second () and forced vital capacity (FVC). Measurements were conducted on the first day and the last day. A paired-t test was used for pre-post changes and the change rates in FVC and among each group were investigated by a one-way ANOVA. The findings of the the study were as follows: 1) There were significant differences of FVC and between pre and post in the two training groups (p<.05) 2) There was no significant difference of the change ratio the FVC and between the RMT group and RMT with ADIM group. Therefore, it is concluded that respiratory muscle and ADIM training, combined with two methods of treatment would suggest positive evidence for improving pulmonary function.

The purpose of this study is to examine the activity ratios of global trunk muscles and local trunk muscles in relation to adjustments in the level of task difficulty while performing stability exercises in easily applied bridging lumbar stabilization exercise. Twenty healthy subjects performed bridging lumbar stabilization exercise while the level of task difficulty was plate was used in the same posture for all the exercises. EMG was used to examine the activity ratios of the global muscles and multifidus in relation to the level of task difficulty. Moreover, the activity ratios of the multifidus muscle, the erector spinae and the gluteus maximus muscle were measured. A one-way ANOVA with repeated measures was used, and a Bonferroni correction was conducted (=.05). When the bridging lumbar stabilization exercise were performed at different difficulty levels, the activity of the multifidus muscle, which is a local muscle, was high in all three exercises. Also, compared to low intensity and intermediate intensity exercises, high intensity exercises showed more significant differences (=.05). Among all the muscles, the multifidus showed the highest activity at intermediate intensity. Based on these results, we suggest that in the case of bridging lumbar stabilization exercise, low intensity or intermediate intensity exercises are more suitable and efficient for local muscle stabilization.

The purpose of this study was to investigate intra-rater reliability and determine the validity of electromyography (EMG) measurements to represent muscle activity and ultrasonography (US) to represent muscle thickness during manual muscle testing (MMT) to external abdominal oblique (EO) and lumbar multifidus (MF). Twenty healthy subjects were recruited for this study and asked to perform MMT at differing levels. The subjects' muscle activity using EMG was measured by a ratio to maximum voluntary contraction (MVC) and root mean square (RMS) methods. The subjects' muscle thickness using US was measured by raw muscle thickness and change ratio of thickness to maximum (MVC) or resting condition. In three trials, measurements were performed on each subject by one examiner. The intra-rater reliability of measurements of EMG and US to EO and MF was calculated using intra-class coefficients. The intra-rater reliability of all measurements was excellent (ICC=.75~.98) in EMG and US. The conduct validity was calculated by one-way ANOVA with repeated measurements to compare whether the EMG and US measurements were different between MMT at different levels. There was only a significant difference between all grades at %MVC thickness measurement of US. These results suggest that a %MVC thickness measurement of US was a more sensitive and discriminate in all manual muscle testing grades. This information will be useful for the selection of US measurement and analysis methods in clinics.

The purpose of this study was to examine the acute effects of nerve mobilization, static stretching, and hold-relax on the flexibility of hamstring muscles and their surface electromyographic (EMG) responses to passive stretches in poststroke hemiparesis. This study was a randomized cross-over trial. Fourteen subjects received three treatment sessions in random order with each consisting of ten repetitions. The treatment sessions included nerve mobilization, static stretching, and hold-relax. The treatment sessions were held at least 24 hours apart to minimize any carryover effect. The outcome was measured by the distance between the greater trochanter and lateral malleolus and hamstring EMG activity during passive knee extension stretching. Repeated-measures analysis of variance showed significant changes in hamstring flexibility and EMG activity in main effect of time pre, post and followup (p<.05). However, no significant differences occurred among the three stretching techniques. No technique was consistently found to be superior. The three stretching techniques in this study make it difficult to determine the most effective technique. Therefore, clinicians use nerve mobilization of effective stretching techniques with other stretching techniques.

The purpose of this study was to investigate the most effective and comprehensible method for the assessment of resting scapular position (RSP) and pain level (PL) in unilateral shoulder pain (USP). Fifty volunteers with USP were involved in the study. Resting scapular assessments of the patients' pain sides (PS) and non-pain sides (NPS) were evaluated. The assessment tools for RSP are: 1) sternal notch (SN) to coracoid process (CP) distance 2) 3rd thoracic spinous process (T3S) to posterolateral angle of acromion (PLA) distance 3) scapular index 4) 8th thoracic spinous process (T8S) to inferior angle of scapular (IAS) distance 5) supine measurement of pectoralis minor (PM) distance 6) standing PM distance 7) PM index (PMI) and 8) PM pain. The paired t-test was used to compare PS and NPS in RSP. Pearson correlation analysis was used to confer a relationship between the PL and RSP. The results of this study indicated that: 1) all the variables between the PS and NPS for RSP were statistically significant(p<.05) and 2) the PMI showed the strongest relationship in the correlation analysis between RSP and PL(p<.05, r=.37). Therefore, it can be concluded that there is a relationship between PMI and PL and it is suggested that an assessment tool using PMI to diagnose shoulder pain would be clinically effective.