Background: Visual and somatosensory integration processing is needed to reduce pusher behavior (PB) and improve postural control in hemiplegic patients with acute stroke. Objects: This study aimed to investigate the effects of game-based postural vertical training (GPVT) on PB, postural control, and activity daily living (ADL) in acute stroke patients. Methods: Fourteen participants with acute stroke (<2 months post-stroke) who had PB according to the Burke lateropulsion scale (BLS) (score>2) were randomly divided into the GPVT group (n1=7) and conventional postural vertical training (CPVT) group (n2=7). The GPVT group performed game-based postural vertical training using a whole-body tilt apparatus. while the CPVT group performed conventional postural vertical training to reduce PB (30 minutes/session, 2 times/day, 5 days/week for 3 consecutive weeks). The BLS was evaluated to assess the severity of PB. And each subject’s postural control ability and ADL level were assessed using the postural assessment scale for stroke (PASS), balance posture ratio (BPR), and Korean-modified Barthel index (K-MBI). Outcomes were measured preand post-intervention. Results: Comparison of the pre- and post-intervention assessment results showed that both interventions led to the following significant changes: decreased severity of PB scores and increased PASS, BPR, and K-MBI scores (p<.05). In particular, statistical analysis between the two groups, the BLS score was significantly decreased in the GPVT group (p<.05). And PASS, BPR, and K-MBI scores were significantly improved in the GPVT group than in the CPVT group (p<.01, respectively). Conclusion: This study demonstrated that GPVT lessened PB severity and improved postural control ability and ADL levels in acute stroke patients.

Background: After stroke, in order to improve gait function, it is necessary to increase the muscle strength and to enhance the propriocetive function of the lower extremity. Objects: This study aimed to compare the effects of open kinetic chain (OKC) versus closed kinetic chain (CKC) isokinetic exercise of the hemiparetic knee using the isokinetic equipment on lower extremity sensorimotor function and gait ability in patients with chronic stroke. Methods: Thirty participants with chronic hemiplegia (> 6 months post-stroke) were randomly divided into 2 equal groups: CKC group and OKC group. Patients from both groups attended conventional physiotherapy sessions 3 times a week for 6 weeks. Additionally, subjects from the CKC group performed isokinetic exercise using the CKC attachment, while those from the OKC group performed isokinetic exercise using the OKC attachment. The isokinetic knee and ankle muscles strength, position sense of the knee joint, and spatiotemporal gait parameters were measured before and after interventions. Results: The knee muscles peak torque/body weight (PT/BW) and hamstring/quadriceps (H/Q) ratio significantly increased in both groups (p<.01). In particular, ankle plantarflexors PT/BW, position sense of the knee, gait velocity, and spatial gait symmetry significantly improved in the CKC group (p<.01, p<.05, p<.01, and p<.01, respectively). Conclusion: CKC isokinetic exercise can be an effective therapeutic intervention for the improvement of sensorimotor function of the lower extremity and gait functions, such as gait velocity and symmetry. CKC position in isokinetic strength training is effective to improve functional ability in patients with chronic stroke.

Background: It is very difficult for hemiplegic patients to effectively perform the sit-to-stand (STS) movements independently because of several factors. Moreover, the analysis of STS motion in hemiplegic patients has been thus far confined to only muscle strength evaluation with little information available on structural and environmental factors of varying chair height and foot conditions. Objects: This study aimed to analyze the change in biomechanical factors (ground reaction force, center of mass displacement, and the angle and moment of joints) of the joints in the lower extremities with varying chair height and foot conditions in hemiplegic patients while they performed the STS movements. Methods: Nine hemiplegic patients voluntarily participated in this study. Their STS movements was analyzed in a total of nine sessions (one set of three consecutive sessions) with varying chair height and foot conditions. The biomechanical factors of the joints in the lower extremities were measured during the movements. Ground reaction force was measured using a force plate; and the other abovementioned parameters were measured using an infra-red camera. Two-way repeated analysis of variance was performed to determine the changes in biomechanical factors in the lower extremities with varying chair height and foot conditions. Results: No interaction was found between chair height and foot conditions (p>.05). All measured variables with varying chair height showed a significant difference (p<.05). Maximum joint flexion angle, maximum joint moment, and the displacement of the center of mass in foot conditions showed a significant difference (p<.05); however the maximum ground reaction force did not show a significant difference (p>.05). Conclusion: The findings suggest that hemiplegic patients can more stably and efficiently perform the STS movement with increased chair height and while they are bare-foot.

목 적 : 수술 전 종양의 위치 확인, 뇌종양 수술의 성과 및 계획을 향상시키기 위해 Neuronavigation 시스템을 이용하고 있다. 본 연구에서는 수술 전 시행되는 Navigation MRI의 정확성 향상을 위해 기존의 2D Axial(이하 AXL) 영상을 보완한 3D Sagittal(이하 SAG) 영상을 적용함으로써 그 유용성을 평가하고자 한다. 대상 및 방법 : 뇌종양 제거 수술을 위해 본원에 입원한 환자 중 수술 전 Navigation 검사를 시행한 환자 20명을 대상으로 하였다. 검사 장비는 3.0T MRI System(Intera Achieva, Philips medical system, Netherlands), 신호수집코일은 32Channel SENSE Head coil을 사용하였다. 사용된 Parameter는 기존의 2D T1 AXL은 FOV 240mm, TR/TE 514ms/10ms, Matrix 256×256, Thickness/gap 2mm/0mm, NSA 1, Scan time 11m 5s이고, 2D T2 FLAIR AXL은 FOV 240mm, TR/TI/TE 11000ms/2800ms/125ms, Matrix 256×256, Thickness/gap 2mm/0mm, NSA 1, Scan time 8m 15s이다. 그리고 새롭게 적용된 3D T1 SAG은 FOV 240mm, TR/TE 9.8ms/4.6ms, Matrix 240×240, NSA 1, Scan time 6m 17s이고, 3D T2 FLAIR SAG은 FOV 240mm, TR/TI/TE 4800ms/1650ms/340ms, Matrix 256×256, NSA 2, Scan time 6m 9s이다. 각각의 3D SAG 영상은 AXL(1mm/No gap) 영상으로 재구성하였다. 평가 방법은 조영제 주입 전 2D T2 FLAIR AXL 영상과 3D FLAIR SAG 영상을 얻고, 조영제 주입 후 2D T1 AXL 영상과 3D T1 SAG 영상을 획득하여 각 AXL 영상의 SNR과 CNR을 비교하였다. 또한 정성적 분석을 위해 신경외과전문의 2명과 방사선사 5명이 각 영상의 평가항목(1.해상도 2.대조도 3.Artifact 감소 4.병변의 경계부위 묘사 5.병변의 명확도 6.조영증강 효과)에 대해 리커트(Likert) 5점 척도로 분석하였다. 분석 방법은 각 2D AXL 영상을 3점 기준으로 3D AXL 영상을 비교 평가하였다. 통계적 분석은 SPSS(Ver.20)을 이용하여 paired t-test 방법으로 분석하였다. 결 과 : 정량적 분석 결과 2D T2 FLAIR AXL 영상의 평균 SNR은 62.5, 3D T2 FLAIR AXL 영상은 191.7로 3D기법이 약 3.1배 높았고, 2D T1 AXL CE 영상의 평균 SNR은 62.9, 3D T1 AXL CE 영상은 144.5로 3D 기법이 약 2.3배 높았다. 또한 3D T2 FLAIR AXL 영상의 평균 CNR은 211.1로 2D AXL 영상의 62.0에 비해 약 3.4배 높았고, 3D T1 AXL CE 영상의 평균 CNR도 101.4로 2D AXL CE 영상의 53.9에 비해 약 1.9배 높았다. 그리고 2D AXL 영상을 3점 기준으로 비교 평가한 정성적 분석 결과는 3D FLAIR AXL 영상의 평균값이 3.88(±1.00), 3D T1 AXL CE 영상의 평균값은 4.57(±0.73)점으로 나타났다. 정량적 및 정성적 분석 결과값은 paired t-test 통계 분석 결과 각각의 평가 항목에서 모두 p<0.05로 유의한 결과를 나타냈다. 결 론 : 기존의 2D AXL 영상보다 3D SAG 영상을 획득하여 AXL로 재구성한 영상이 SNR과 CNR 모두 더 높은 결과를 나타냈고, 정성적 분석 결과 또한 3D 기법을 적용한 영상이 더 높은 점수를 얻었다. 그리고 종양의 위치에 따라 COR 영상이 필요할 경우가 있는데, 3D 영상을 획득하면 AXL 영상뿐만 아니라 COR 영상까지 추가적인 스캔 없이 재구성할 수 있어 더 효율적이었다. 시간적인 측면에서도 더 나은 영상을 더 빠른 시간 안에 획득할 수 있어 실용적이고, 이는 환자의 Motion Artifact 발생 가능성도 줄일 수 있었다. 그리고 기존의 2D AXL 영상은 2mm 두께로 영상을 획득하지만 3D 영상은 1mm로 재구성할 수 있어 종양의 위치를 더 정확하게 판단할 수 있었다. 이러한 장점은 수술 전 Navigation MRI 검사를 통해 수술 부위를 판단하는 의료진의 입장에서 더 나은 수술 결과를 도출 할 수 있고 나아가 결국 의료의 질을 높이는 계기가 될 것이라 사료된다.

The purposes of this study were to develop a new orthosis controlling ankle and knee joint motion during the gait cycle and to identify the effects of the newly designed orthosis on gait kinematics and tempospatial parameters, including coordination of the extremities in stroke patients. Fifteen individuals who had sustained a stroke, onset was 16 months, participated in this study. Before application of the measurement equipment the subjects were accustomed to walking on the ankle-foot orthosis (AFO) or stance control knee with knee flexion assisted-oil damper ankle-foot orthosis (SCKAFO) for 5 minutes. Fifteen patients were investigated for 45 days with a 3-day interval between sessions. Measurements were walking in fifteen stroke with hemiparesis on the 3D motion analysis system. Comparison of AFO and SCKAFO are gait pattern. The difference between the AFO and SCKAFO conditions was significant in the gait velocity, step length of the right affected side, stance time of both legs, step-length asymmetry ratio, single-support-time asymmetry ratio, -thigh angle and -shank angle in the mid swing (p<.001). Using a SCKAFO in stroke patients has shown similar to normal walking speeds can be attained for walking efficiency and is therefore desirable. In this study, the support time of the affected leg with the SCKAFO was longer than with the AFO and the asymmetry ratio of single support time decreased by more than with the AFO. This indicates that the SCKAFO was effective for improving gait symmetry, single-support-time symmetry. This may be due to the decrease of gait asymmetry. Thus, the newly designed SCKAFO may be useful for promoting gait performance by improving the coordination of the extremity and decreasing gait asymmetry in chronic stroke patients.

This study used an unstable platform to change the support surface type and position of both lower limbs in order to determine changes in weight distribution and muscle including the vastus medialis, tibialis anterior, lateral hamstring, and lateral gastrocnemius of both lower limbs were evaluated during knee joint flexing and extending in a semi-squat movement in 32 hemiplegic patients. The support surface conditions applied to the lower limbs were divided into four categories: condition 1 had a stable platform for both lower limbs; condition 2 had an unstable platform for the non-hemiplegic side and a stable platform for the hemiplegic side; condition 3 had a stable platform for the non-hemiplegic side and an unstable platform for the hemiplegic side; and condition 4 had an unstable platform for both sides. The normalized EMG activity levels of muscles and weight bearing ratio of both sides in the four surface conditions were compared using repeated measures ANOVA. A significant increase was found in the weight support distribution for the hemiplegic side in flexing and extending sessions in condition 2 compared to the other conditions (p<.05). A statistically significant decrease in significant decrease in asymmetrical weight bearing in flexing and extending sessions was observed for condition 2 compared to the other conditions (p<.05). A similar significant decrease was found in differences in muscular activity for both lower limbs in condition 2 (p<.05). The muscular activity of the hemiplegic side, based on the support surface for each muscle showed a significantly greater increase in condition 2 (p<.05). An unstable platform for the non-hemiplegic side and a stable platform for the hemiplegic side therefore increased symmetry in terms of the weight support distribution rate and muscle activity of lower limbs in hemiplegic patients. The problem of postural control due to asymmetry in hemiplegic patients should be further studied with the aim of developing continuous effects of functional training based on the type and position of the support surfaces and functional improvement.

The purpose of this study was to investigate the effect of attentional focus and distance of external focus on the performance of balance task of upper extremity. Subjects (N=30) held a stick (2 m) and maintained it horizontally. All of the subjects performed balance task of upper extremity under four different attentional focus conditions: focus on hand (internal focus), marker at 10 cm inside of hand (external focus 1), marker at 10 cm outside of hand (external focus 2), marker at 20 cm outside of hand (external focus 3). The mean velocity of the bar (mm/s) and the muscle activity of biceps brachii (%RVC) were measured. They were decreased when the subjects focused on external focuses compared to internal focus and decreased as distance of attentional focus from body increased (p<.05). There were significant differences between groups (p<.05); internal focus-external focus 1, internal focus-external focus 2, internal focus-external focus 3, external focus 2-external focus 3. These results showed that external focus is more effective than internal focus in enhancing motor performance and focusing on more distant attentional focus results in enhanced motor performance promoting the utilization of more automatic control mechanisms.

The aim of this study was to investigate the effect of supporting surface instability to trunk and lower extremity muscle activities during bridging exercise combined with core-stabilization exercise. Thirty young healthy adults (15 males and 15 females) voluntarily participated in this study. Each subject was asked to perform bridging exercise combined with core-stabilization exercise on three different supporting surfaces (stable ground surface, the wooden balancing board, and the air cushion). The muscle activities were measured using surface electromyography (EMG) during performing exercise. To test statistical significance, one-way ANOVA with repeated measures was used with the significance level of .05. The findings of this study are summarized as follows. (1) There were significant differences in muscle activities on internal oblique, external oblique, gluteus medius, semitendinosus, biceps femoris, medial gastrocnemius and lateral gastrocnemius during exercise (p<.05). (2) The biceps femoris and lateral gastrocnemius showed significantly higher muscle activity on the wooden balancing board rather than on the ground, and semitendinosus, biceps femoris, medial gastrocnemius and lateral gastrocnemius showed significantly higher muscle activity on the air cushion rather than on the ground (p<.05). Therefore, it is concluded that muscle activities in the trunk and the lower limbs during bridging exercise combined with core-stabilization exercise was affected with instability of supporting surface. Further researches are needed to investigate the long term effect of bridging exercise on muscle activity with patient group.

In order to prevent upper extremity musculoskeletal disorders, effective keyboard selection is an important consideration. The aim of this study was to compare upper extremity muscle activity according to transverse plane angle changes during vertical keyboard typing. Sixteen healthy men were recruited. All subjects had a similar typing ability (rate of more than 300 keystrokes per minute) and biacromion and forearm-fingertip lengths. Four different types of keyboard (vertical keyboard with a transverse plane angle of 60˚, 90˚, or 120˚, and a standard keyboard) were used with a wrist support. The test order was selected randomly for each subject. Surface electromyography (EMG) was used to measure upper extremity muscle activity during a keyboard typing task. The collected EMG data were normalized using the reference contraction and expressed as a percentage of the reference voluntary contraction (%RVC). In order to analyze the differences in EMG data, a repeated one-way analysis of variance, with a significance level of .05, was used. Bonferroni correction was used for multiple comparisons. There were significant differences in the EMG amplitude of all seven muscles (upper trapezius, middle deltoid, anterior deltoid, extensor carpi radialis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris) assessed during the keyboard typing task. The mean activity of each muscle had a tendency to increase as the transverse plane angle increased. The mean activity recorded during all vertical keyboard typing was lower than that recorded during standard keyboard typing. There was no significant difference in accuracy and error scores; however, there was a significant difference between transverse plane angles of 60˚ and 120˚ with regard to comfort. In conclusion, a vertical keyboard with a transverse plane angle of 60˚ would be effective in reducing muscle activity compared with vertical keyboards with other transverse plane angles.

An abdominal drawing-in maneuver (ADIM) with a pressure biofeedback unit can be used to prevent excessive lumbar lordosis during bridging exercise. Therefore, in this research, the effects of an ADIM on lumbar lordosis and lower extremity muscle activity during bridging exercise were investigated in thirty healthy adults. Surface electromyography (EMG) and VICON system were used to collect kinematic data and muscle activity, respectively. A paired t-test was used to determine a statistical significance. The results showed as follows: (1) When performing bridging exercise with an ADIM, the height of the anterior superior iliac spine and greater trochanter decreased significantly (p<.05). (2) When performing bridging exercise with an ADIM, the trunk extension angle and pelvic angle increased significantly (p<.05). (3) When performing bridging exercise with an ADIM, the EMG signal amplitude increased significantly in the rectus abdominis, internal oblique abdominis, external oblique abdominis, medial hamstring, and lateral hamstring (p<.05). (4) When performing bridging exercise with an ADIM, the EMG signal amplitude decreased significantly in the erector spinae (p<.05). From the result of this research, an ADIM trained with pressure biofeedback unit during bridging exercise is effective to prevent excessive contraction of erector spinae, to limit excessive motion of pelvis from sagittal plane and to increase muscle activity of abdominal muscles and hamstring muscle.

The purpose of this study was to compare the effectiveness of modified vertical roll sling and conventional Bobath roll sling in reducing hemiplegic shoulder subluxation. Radiography of anterior oblique radiographic view' were taken, before and immediately after wearing each sling in 13 hemiplegic patients. The vertical distance. horizontal distance. and joint distance were measured. Analysis of radiographically measured distances showed that both modified vertical roll sling and Bobath roll sling decreased vertical, horizontal. and joint distances. Reduction in vertical and joint distances were significantly greater in modified vertical roll sling compared to Bobath roll sling. while horizontal distance showed no significant difference between the two slings. Therefore it can be concluded that modified vertical roll sling is an effective orthosis in reducing hemiplegic shoulder subluxation.

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.

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.

This study examined the effects of socket flexion angle in trans-tibial prosthesis on stump/socket interface pressure. Ten trans-tibial amputees voluntarily participated in this study. F-socket system was used to measure static and dynamic pressure in stump/socket interface. The pressure was measured at anterior area (proximal, middle, and distal) and posterior area (proximal, middle, and distal) in different socket flexion angles (5°, 0°, and 10°). Paired t-test was used to compare pressure differences in conventional socket flexion angle of 5° with pressures in socket flexion angles of 0° and 10° (α=.05). Mean pressure during standing in socket flexion angle of 10° decreased significantly in anterior middle area (19.7%), posterior proximal area (10.4%), and posterior distal area (16.3%) compared with socket flexion angle of 5°. Mean pressure during stance phase in socket flexion angle of 0° increased significantly in anterior proximal area (19.3%) and decreased significantly in anterior distal area (19.7%) compared with socket flexion angle of 5°. Mean pressure during stance phase in socket flexion angle of 10° decreased significantly in anterior proximal area (19.6%) and increased significantly in anterior distal area (8.2%) compared with socket flexion angle of 5°. Peak pressure during gait in socket flexion angle of 0° increased significantly in anterior proximal area (23.0%) compared with socket flexion angle of 5° and peak pressure during gait in socket flexion angle of 10° decreased significantly in anterior proximal area (22.7%) compared with socket flexion angle of 5°. Mean pressure over 80% of peak pressure (MP80+) during gait in socket flexion angle of 0° increased significantly in anterior proximal area (23.9%) and decreased significantly in anterior distal area (22.5%) compared with socket flexion angle of 5°. MP80+ during gait in socket flexion angle of 10° decreased significantly in anterior distal area (34.1%) compared with socket flexion angle of 5°. Asymmetrical pressure change patterns in socket flexion angle of 0° and 10° were revealed in anterior proximal and distal region compared with socket flexion angle of 5°. To provide comfortable and safe socket for trans-tibial amputee, socket flexion angle must be considered.

The purpose of this study was to assess the influence of spine orthosis and sit-to-stand motor strategies on ground reaction force (GRF) and lower extremity muscle activity. Twenty healthy adult men participated, and subjects randomly performed sit-to-stand motions in three different conditions: Momentum-transfer strategy (MTS); MTS with spine orthosis; and zero-momentum strategy (ZMS) with spine orthosis. GRF data, onset time, and muscle activity were determined and compared using force plate and electromyography. Data were statistically analyzed by the SPSS version 13.0. One-way repeated analysis of variance (ANOVA) was used to determine the statistical significance, and least significant difference was used as a post hoc test. The level of significance was .05. The results of this study were as follows: 1. Peak GRF and relative time to peak GRF were not significantly different in the three different conditions (p>.05). 2. Onset time of four muscles, tibialis anterior, gastrocnemius, biceps femoris and rectus femoris, in the three different conditions were significantly different (p<.05). 3. The tibialis anterior and rectus femoris muscle activity before hip-off and tibialis anterior, gastrocnemius, and rectus fermoris muscle activity after hip-off were significantly different in the three different conditions (p<.05).

The purpose of this study was to investigate the effects of hip extension velocity (7.5 degree/second, 30 degree/second) on the relative onset time of the gluteus maximus in relation to the hamstring during hip extension in prone position. Thirteen healthy male subjects (mean age=22.6 years [SD=1.8], mean weight=73.4 kg [SD=10.3], mean height=176.1 cm [SD=6.3]) voluntarily participated in this study. Electromyographic data was collected on the gluteus maximus and hamstring to determine onset time. Statistical analyses were performed with the paired t-test. The results showed that the onset time of the hamstring was significantly faster than that of the gluteus maximus in both fast and slow hip extension velocity. The gluteus maximus began contraction .079 seconds later following the contraction of the hamstring. The onset time of the hamstring was significantly faster in fast hip extension velocity compared with slow hip extension velocity. In conclusion, it was determined that the onset time of the gluteus maximus was faster with fast hip extension velocity compared with slow hip extension velocity. There was a statistically significant difference between the onset times of the gluteus maximus and hamstring in relation to the two velocities (p<.05). Further study is needed to examine whether the velocity of hip extension can influence the onset time in a similar fashion in patients with low back pain.

The walker provides stability for walking for people whose lower extremities are disabled. It is important to measure and determine the appropriate height of a walker to conserve energy and to improve function. The purposes of this study were to examine effects of walker height and gait velocity on triceps, latissimus dorsi muscle activation, and energy expenditure index (EEI) during ambulation with a walker. Fifteen healthy subjects participated in this study. Each subject was assigned a walker with one of three heights (high, standard, lower height) and of two gait velocities (comfortable gait velocity or fast gait velocity). Electromyographic data were collected from triceps and latissimus dorsi, and EEI was determined from each condition. Two-way repeated analysis of variance (ANOVA) was used to determine the statistical significance. Post hoc comparison was performed with the Bonferroni test. The results of this study were summarized as follows: 1. There was a significant difference in the %MVIC of triceps among different walker height factors. Post hoc comparison revealed that %MVIC of dominant triceps brachii was more significantly increased in patients who used the higher walker than those who used the lower walker (p<.05). 2. There were significant differences in the %MVIC of the latissimus dorsi among different walker height factors and gait velocity factors. Post hoc comparison revealed that the %MVIC of dominant latissimus dorsi was also more significantly increased in patients who used the higher walker than those who used the lower walker (p<.05) and in those who used the faster gait velocity than those who used the slower gait velocity (p<.05). 3. There were significant differences in the EEI among different walker height factors and gait velocity factors. Post hoc comparison revealed that the EEI was significantly increased among those who used higher and lower walkers compared with the standard walker. The EEI was also more significantly increased among those who used the fast gait velocity than those who used the slower gait velocity (p<.05). It has been concluded that increased muscle activation in triceps and latissimus dorsi was required when the walker height increased and that more energy was exp ended when the gait velocity increased. Therefore, from the findings of this study, it is recommended that walker height be adjusted according to the purposes of gait training and that healthy subjects conserve energy when ambulating with standard walkers in a comfortable gait velocity.

The purpose of this study was to evaluate the effect of concurrent and reciprocal isometric contraction and angle of ankle joint on fatigue of concentrically contracting contralateral dorsiflexor and plantar flexor. Seventeen able-bodied subjects participated in the study. Concurrent and reciprocal isometric contraction were performed under three different ankle joint angles (dorsiflexion, neutral position, plantar flexion). During concurrent or reciprocal isometric contraction. fatigue of concentrically contracting contralateral tibialis anterior, gastrocnemius, and soleus was investigated and compared. There was no interaction between different ankle joint angles and direction of isometric contraction (p<.05). No significant differences were found among three different ankle joint angles (p<.05). Contralateral muscle fatigability was lower in reciprocal isometric contraction than that in concurrent isometric contraction (p<.05). Therefore, the findings of this study suggest that reciprocal isometric contraction is more beneficial than concurrent isometric contraction inducing less fatigability during contralateral concentric contraction.