Background: Deep learning related research works on website medical images have been actively conducted in the field of health care, however, articles related to the musculoskeletal system have been introduced insufficiently, deep learning-based studies on classifying orthopedic manual therapy images would also just be entered. Objectives: To create a deep learning model that categorizes cervical mobilization images and establish a web application to find out its clinical utility. Design: Research and development. Methods: Three types of cervical mobilization images (central posteroanterior (CPA) mobilization, unilateral posteroanterior (UPA) mobilization, and anteroposterior (AP) mobilization) were obtained using functions of ‘Download All Images’ and a web crawler. Unnecessary images were filtered from 'Auslogics Duplicate File Finder' to obtain the final 144 data (CPA=62, UPA=46, AP=36). Training classified into 3 classes was conducted in Teachable Machine. The next procedures, the trained model source was uploaded to the web application cloud integrated development environment (https://ide.goorm.io/) and the frame was built. The trained model was tested in three environments: Teachable Machine File Upload (TMFU), Teachable Machine Webcam (TMW), and Web Service webcam (WSW). Results: In three environments (TMFU, TMW, WSW), the accuracy of CPA mobilization images was 81-96%. The accuracy of the UPA mobilization image was 43~94%, and the accuracy deviation was greater than that of CPA. The accuracy of the AP mobilization image was 65-75%, and the deviation was not large compared to the other groups. In the three environments, the average accuracy of CPA was 92%, and the accuracy of UPA and AP was similar up to 70%. Conclusion: This study suggests that training of images of orthopedic manual therapy using machine learning open software is possible, and that web applications made using this training model can be used clinically.

Background: The effect of mobilization on lumbar back pain has been fully described in several clinical aspects, but evidence for muscle strength would be still less clear. Objective: To assess the effect of lumbar mobilization on lower limb strength in healthy individuals. Methods and Analysis: Healthy people aged 18-65 will be included regardless of race or sex. Original peer-reviewed primary reporting randomized controlled trials (RCTs) will be included. Electronic databases, such as MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Pedro, CINAHL, ClinicalTrials.gov will be searched from inception until July 30. Only studies published in English will be included in this review. Two reviewers will complete the screening for eligibility independently, and the other two reviewers will also complete the risks of data extraction and bias assessment independently. Lower Limb strength will be assessed as primary outcome, and particular intervention or participant characteristics will be assessed as the secondary outcomes. Meta-analysis will be conducted using Review Manager 5.3.3, and evidence level will be assessed using the method for Grading of Recommendations Assessment, Development and Evaluation. Outcomes will be presented as the weighted mean difference or standardized mean difference with 95% CI. If I2 ≤ 50%, P>.1, the fixed effect model will be used, otherwise, random-effects model will be used. Ethics and dissemination: This review might not be necessary ethical approval because it does not require individual patient’s data; these findings will be published in conference presentations or peer-reviewed journal articles. PROSPERO registration number: CRD42020150144.

Background: Spinal Mobilization is one of the manual therapy technique that clinicians have used to treat pain, however, there is still a lack of research on changes in strength in healthy people. Objectives: To investigate the effect of posterior-anterior lumbar mobilization on lower limb strength in healthy individuals. Design: Two-group pretest-posttest design. Methods: In this study, 23 healthy subjects aged 20 years were assigned to 12 lumbar mobilization group (LMG) and 12 sham group (SG) to perform intervention and measurement through pre- and post-design. Intervention was performed in LMG with grade III~IV on L3-5 of the lumbar spine, and lumbar mobilization was performed for each segment. After intervention, knee flexion and extension strength were measured. To measure the main effect on muscle strength, a comparative analysis was conducted using paired t-test and independent t-test. Results: In LMG, knee flexor and extensor strength were increased significantly at 60°/s (P<.05). In addition, the extensors of LMG and SG were significantly different only at 60°/s, and the flexors were significantly different between groups at both 60°/s and 180°/s (P<.05). Conclusion: In healthy individuals, lumbar mobilization results in improvement of strength of knee flexor and extensor, and additional experiments on the effect of mobilization on the lumbar spine on functional changes in the lower limbs will be needed.

Background: Previous robot-mediated gait training has been proven several limitations such as pointless repeated motion training, decreased presence, etc. In this research, adult stroke patients were participated in robot-mediated gait training accompanied with or without virtual reality program. Objectives: Exploring whether the results indicated virtual reality system has contribution to muscle strength and balance ability. Design: A case series research, cross-over trial. Methods: Eleven participants (male 4, female 7) with adults diagnosed as stroke from medical doctor ware engaged. The participants received 2 treatment sessions of identical duration, robot-assisted gait training with virtual reality and robot-assisted gait training with screen-off randomly crossed over include 1-day for each person of wash-out period. The parameter was muscle activity, the researchers assessed sEMG (surface electromyography). Results: The result showed less muscle activities during training in robotassisted gait training with virtual reality circumstances, and these indicated muscles were gluteus medius muscle, vastus medialis muscle, vastus intermedius and vastus lateralis muscle, semimembranosus muscle, gastrocnemius- lateral head, and soleus muscle (P<.05). Conclusion: In this study, we analyzed the outcome of muscle activity for clinical inference of robot-assisted gait training with virtual reality (VR). Less muscle activity was measured in the treatment accompanied by VR, therefore, a more systematic, in-depth and well-founded level of follow-up research is needed.

Background: Mobilization and cranio-cervical flexion exercise has been reported in reducing pain from cervical part and improving its motor function; also, has been represented that alleviate of neck pain and recover of neck muscles improve the normal gait performance. However, few studies have identified the effects of mobilization and exercise on pain and gait parameters with preceding issues. Objective: To examine the effects or changes of pressure pain threshold (PPT) and gait parameters in patients with chronic neck pain. Design: Cross-Sectional Clinical Trials Methods: Twenty patients with the history of neck pain (>3 months) performed the cervical mobilization and cranio-cervical flexion exercise. Gait parameters were assessed with wireless device and collected data were transmitted to the personal computer via Bluetooth. The PPT was measured posteroanterior direction at the prone position and the mean of subsequent three PPT measurements was used for the final analysis. Results: Both cervical central posteroanterior mobilization (CCPAM) (p<.000) and sling-based cranio-cervical flexion exercise (SBCCFE) (p<.000) group showed a significant increase in the PPT and the gait parameters, cadence (p<.023), was significantly increased in the CCPAM group, however slightly increased in the SBCCFE group. The comparison between the CCPAM and the SBCCFE groups after treatment did not show significant differences for the score on the PPT and gait parameters. Conclusions: This study suggests that CCPAM and SBCCFE increase PPT, cadence, and gait speed.

Background: Because of the lack of accurate values for applied forces in manual therapy, manual therapists relies on the magnitude of the individual’s perception during applying the force. However, excessive loading maneuvers carry risks for patients. Objective: To establish the relationship between the maximal force applied to swine skin with the specific region, sex, and baseline parameters of the subject. Design: Ex-vivo Study and laboratory Experimental research Methods: 3.5 kg of Korean pork sirloin that is a piece of swine was handled and it was set 3 dimensions; #A; #B; #C. Forty-seven participants who has no experience in physical therapy randomly carried out the experiment, indicated to push each place of the pressure spots with same posture and process under supervision from the instructor who has over 15 years of manual therapy, and we measured the pressure force in each time. Results: The biggest pressure force was recorded in spot #A, and #B was represented after #C. Pressure on #A showed certain statistic relation with height (r=.317, p<.05) and weight (r=.434, p<.01); pressure on #B showed certain relation which has statistical meaning with only height (r=.401, p<.01); pressure on #C emerged to have statistic relationship with height (r=.308, p< .05)and weight (r=.428, p<.01). The age aspect revealed relation with pressure on #A, #B and #C, but that was not statistically significant. Conclusions: It can be inferred that there is the most loss of pressure in the area where cartilage is like an island in the middle.

Background: Cervical mobilization has been applied mainly for the improvement of arm and neck movements and pain reduction, and little research has been done to improve the executive function. Since this kind of so-called mechanical neck pain is one of most common symptoms, there are controversial issues about this with spine alignment. Posteroanterior (PA) mobilization from the Maitland concept is a process of examination, assessment, and treatment of neuromusculoskeletal disorder by manipulative physical therapy. Objective: To examine the short-term benefits of mobilization for patients with non-specific neck pain. Design: Dual-group Pretest-Posttest Design from the Quasi-Experimental research Methods: Fourteen participants (male 8, female 6; 20’s of their age) with nonspecific neck pains which are distributed all the unilateral or bilateral body side were recruited. Participants were categorized to Neck Pain with Movement Coordination Impairments (NPMCI) and Neck Pain with Mobility Deficits (NPMD) groups according to the results of physical examination. Professional physical therapist who has over 15-years-of clinical experience applicated manipulative therapy for the neck pain, an occupational therapist only conducted evaluations; K-NDI (Korean version of the Neck Disability Index), VAS (Visual Analog Scale), BDS-K (Korean version of Behavioral Dyscontrol Scale) for decreasing possible adverse effects; there were no person who reported other symptoms followed 4 weeks from the trial. Results: In the NPMCI group, data analysis indicated statistical differences between the PA mobilization interventions in NDI and BDS-K; even though, pain was reduced in VAS, this is not a significantly differ. In the NPMD group, data analysis represented statistical differences between the PA mobilization interventions in NDI, VAS and BDS-K; the scores were represented to be increased or the pain got relief. Conclusions: PA mobilization techniques according to Maitland concept have beneficial effects in patients with neck pain and other clinical positive effects which included neck disability, pain itself and motor function of upper extremity.