The purpose of this study was to examine the differentiation of proprioception, invertor and evertor muscle strength, and time to peak torque at a velocity of 300 °/sec of the ankle joint in people with or without functional ankle instability (FAI). Nineteen subjects with a history of ankle sprain participated. All subjects were divided into FAI group (n1=9, Cumberland ankle instability tool (CAIT)≤24) and a control group (n2=10) based on their CAIT scores. Isokinetic dynamometer was used to measure the sense of active joint position of the ankle at mid-range and end-range of an inversion motion and invertor as well as the evertor muscle strength and time to peak torque at 300 °/s. The FAI group showed a statistically reduction in invertor and evertor muscle strength and time to peak torque when compared to the control group (p<.05). Muscle strength and time to peak torque of the invertor and evertor, as well as the sense of active joint position at end-range were also lower in the FAI group than in the control (p<.05). Correlations between CAIT score and position sense at end-range (r=-.577) and invertor muscle strength (r=.554) were statistically significant (p<.05). Individuals with FAI showed reduction in invertor and evertor muscle strength and recruitment time as well as in proprioception of the ankle joint. Thus, proprioception and invertor and evertor muscle strength of the ankle joint at fast angular velocity may be investigated when examining and planning care for individuals with FAI.

The aim of the current study was to assess the effectiveness of backward gait training on the treadmill in patients with spastic diplegic cerebral palsy (CP). Twelve patients with spastic diplegic CP participated in the study. An 8-week course of backward gait training was administered to the subjects for 3 days per week. Pre-intervention and post-intervention assessments of temporal-spatial gait parameters, the symmetry of the bilateral lower extremity weight bearing, and gross motor function were analyzed using motion analysis system, force plate, and Gross Motor Function Measurement (GMFM). There were significant improvements (p<.05) in the measures of both step length and right stance phase time. Joint kinematics showed increase in right hip abduction in initial contact and terminal swing, right hip external rotation and knee flexion in mid-swing, left ankle dorsiflexion in initial contact and terminal swing (p<.05). The symmetry of the bilateral lower extremity weight bearing and GMFM also significantly increased (p<.05). These findings indicate that backward gait training using a treadmill is beneficial for patients with spastic diplegic CP.

The purpose of this study was to identify the factors determining the participation restriction of chronic stroke patients based on international classification of functioning, disability, and health (ICF) model. Sixty-eight stroke patients participated. The participants were assessed participation restriction using the Korean version of London handicap scale (K-LHS), modified Barthel index (K-MBI) to measure activities of daily living, Berg balance scale (K-BBS) to assess balance, and the center for epidemiologic studies depression (K-CES-D) to gauge depression. Also, 3 minutes walking test (3MWT), gait velocity, asymmetric posture, and family support were assessed. A stepwise multiple regression analysis was used to explore the factors determining participation restriction. There were no significant different in the K-LHS and K-MBI results by gender (p>.05). Correlations between the K-LHS and K-MBI (r=-.656), K-BBS (r=-.543), K-CES-D (r=.266), 3MWT (r=-.363), gait velocity (r=.348), and family support (r=-.389) were significant (p<.05). Also, the K-MBI and family support were the factors that determined participation restriction (p<.05) and that 40.2% of the variation in the K-LHS can be explained. Therefore, it is suggested that evaluation and intervention of patient's activity level and extent of family support is necessary to reduce participation restriction of chronic stroke patients.

The purpose of this study was to investigate the effects of a task-oriented approach on weight-bearing distribution and muscular activities of the paretic leg during sit-to-stand movement in 18 chronic stroke patients. Both groups were received neurodevelopmental treatment for 30 min/day and then the experimental group (=9) followed additional a task-oriented approach (sit-to stand training with controlled environment) and the control group (=9) followed a passive range of motion exercise for 15 min/day, five days/week, for four weeks. Weight-bearing distribution and muscular activities of the paretic leg during sit-to-stand movement were measured before and after four weeks of training. There was significantly improved weight-bearing distribution of the paretic leg during sit-to-stand movement in the experimental group compared with that of the control group after four weeks of training (p<.05). But electromyographic activities of the quadriceps and the tibialis anterior of the paretic leg were not significantly different (p>.05). Thus, it is necessary to apply a task-oriented approach to improve the weight-bearing distribution of the paretic leg during sit-to-stand movement in chronic stroke patients.

The purposes of this study were to examine the reliability and validity of Korean translation of Pediatric Evaluation of Disability Inventory (PEDI-K) in school-aged children with cerebral palsy (CP). The PEDI-K, Functional Independence Measure for Children (WeeFIM) and Gross Motor Function Classification System (GMIFCS) were completed in 104 school-aged children with CP by therapists. The internal consistency of the PEDI-K was calculated by Cronbach's alpha () for assessing reliability. Concurrent validity was evaluated by correlation with the subsets of WeeFIM. Discriminant validity was assessed by comparing GMFCS levels with tests of the PEDI-K. The results showed that internal consistency was good (Cronbach's ranged from .97~.98). Concurrent validity was demonstrated. The correlation with WeeFIM was high in the Functional Skills (self-care, r=.74~.94; mobility, r=.59~.91; social function, r=.65~.93) and in the Caregiver Assistance (self-care, r=.75~.94; mobility, r=.63~.90; social function, r=.78~.96). Discriminant validity was demonstrated on significant decreases in domain scores with increasing GMFCS levels. Reliability and validity have been demonstrated on the PEDI-K. This study extends usage of PEDI-K in clinical activities and research.

The purposes of this study were to examine inter-rater reliability of the Manual Ability Classification System (MACS) by children's age and to identify the correlation between the MACS and the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP). Twenty-six children with CP older than two years participated. Children with CP were classified according to the MACS and the GMFCS by two physical therapists. Inter-rater reliability was analyzed using the Intraclass Correlation Coefficients (ICCs). The results showed that the reliability of the MACS for children aged 2~3 years was .88 and for children aged above 4 years was .98 (p<.05). Children with quadriplegia had a higher level of MACS than children with spastic hemiplegia and diplegia. A moderate relationship between the MACS and the GMFCS was found in all children (rater 1, r=.631; rater 2, r=.438). The MACS will be used for classification of children with CP according to the manual abilities. Thus, it offers a reliable method for communicating between therapists about the manual ability of children with CP who are older than 2 years.

The purpose of this study was to investigate the effects of a repetitive lifting task on the level of activation and median frequency of the paraspinal muscles, and to provide basic data of the maximal acceptable duration of the lifting task to avoid muscle fatigue. Ten healthy male subjects were recruited as participants and they repetitively (12 lifts/min) lifted a box (46 ㎝ × 30 ㎝ × 30 ㎝, 15 kg) for 10 minutes. Electromyographic data (muscle activation and median frequency), heart rate, and Borg CR10 score were recorded at 1, 3, 5, 7, and 9 minutes after the lifting task. Electromyographic data was recorded from the elector spinalis, mutifidus, external oblique abdominis, and rectus abdominis for 1 minute. The results showed that as the repetitive lifting task progressed, the heart rate and Borg CR10 score significantly increased. In addition, activation of the muscles increased. The median frequency significantly decreased over time in the elector spinalis, mutifidus, and external oblique abdominis (right side), except for the external oblique abdominis (left side) and rectus abdominis. It is suggested that the median frequency recorded from a dynamic task is used to monitor muscle fatigue. Furthermore, the repetitive lifting task (15 kg, 12 lifts/min) should not continue for more than 3 minutes in order to avoid muscle fatigue.

This study investigated the irradiation pattern of muscles on the affected side in stroke patients after application of diagonal 2 extension (D2 ex) proprioceptive neuromuscular facilitation in the unaffected upper extremity. Seven stroke patients participated. Electromyographic activities were recorded in the iliopsoas, biceps brachii, and triceps brachii were recorded by surface electrodes at rest, D2 ex with knee extension, and D2 ex with knee 90 flexion, normalized by maximal voluntary isometric contraction (MVIC) values. The medial frequencies of biceps brachii in both sides were also measured to compare muscle type recruited. %MVIC of biceps brachii and triceps brachii were significantly higher in D2 ex than at rest (p<.05). There was no difference in median frequency of biceps brachii between the affected and unaffected side (p>.05). This suggests that proprioceptive neuromuscular facilitation using D2 ex may improve muscle activities of the paretic side and that the irritation pattern of the affected side may respond to maintain body equilibrium according to movement of the sound side.

The purpose of this study was to develop a checklist of risk factors for quantitative assessment of musculoskeletal complaints in shipbuilding workers. A key point was to develop comprehensive a checklist including the worker's physical ability, as ergonomic and workload factors. ln the first, through correlation analysis between musculoskeletal complaints and physical abilities in shipbuilding workers, risk factors related to physical abilities were selected. In the second, after the development of a checklist was composed of physical, ergonomic and workload factors, factor analysis was used to test the validity of the developed checklist. Each factors selected finally showed that physical factors were hand grip strength, spinal curvature, and flexibility (sit to reach), ergonomic factors were posture, total exposed time, duration, and force of working, and workload factors were physical and psychological workload perceived by worker. The results showed that musculoskeletal complaints was associated with physical abilities (p<.05). The developed checklist had a reliability of .761 (Cronbach=.761) and a validity and explanation of 54.9%. The criterion of management was classified in 4 stages by relative weights of each factor. It is suggested that active intervention is needed to reduce musculoskeletal complaints in workers with more than a 14.31 score.

The purpose of this study was to examine the path analysis of factors related to musculoskeletal diseases of shipbuilding workers by considering related factors synthetically. The survey was completed by 1,536 shipbuilding workers and except for poor responses, 1,532 were analyzed. The survey consisted of questions about lifestyle, duration of service, physical and mental stress, and musculoskeletal diseases. The collected data was analyzed with SPSS/PC+ (a descriptive statistics program) and with AMOS 4.0 (a statistical program for path modeling) to test whether the hypothesized path model fitted the collected data. The results of the correlation analysis showed that musculoskeletal disease was associated with duration of service (r=-.095), physical stress (r=.077), and mental stress (r=.602). The results of the hypothesized path model satisfied the criteria required in relation to fitting the collected data. Musculoskeletal disease was directly affected by mental stress but not by physical stress, duration of service and life style. Thus, it is suggested that reducing mental stress is a strategy for the prevention for musculoskeletal disease.

The aim of the present study was to determine the effect of proprioceptive neuromuscular facilitation (PNF) leg patterns on the muscle activation of neck flexors. Twenty healthy subjects participated in this study. Each subject performed bilateral asymmetrical PNF leg patterns against manual resistance under four conditions: through the full range of motion toward the right side, left side, and the end range in the right side, left side. Electromyographic (EMG) data was collected from the sternocleidomastoid (SCM) muscles as neck flexors. The root mean square (RMS) value of the SCM was measured and normalized from maximal EMG activity of the SCM. The data were analyzed using the paired t-test and repeated analysis of variance (ANOV A) was used to compare the statistical significance. The results of this study are summarized as follows: Firstly, the RMS values of SCM were significantly higher in all four PNF leg patterns than in the resting condition (p<.05). Secondly, there was no significant difference in muscle activation according to the direction of PNF leg patterns (p>.05). Thirdly, there was no significant difference in muscle activation according to the point of range of the motion of leg patterns (p>.05). It is suggested that PNF bilateral asymmetrical leg patterns have a considerable effect on muscle activation of the SCM, regardless of the range of motion and direction of PNF bilateral asymmetrical leg patterns.

The purposes of this study were to provide the basic data and investigate the reliability of functional reach test and identify correlation of Berg balance scale (BBS) and functional reach test (FRT). The subjects were twenty healthy young adults and forty-five over 65 years old in order to compare balance ability. These data were analyzed by independent t-test and Pearson's correlation test using SPSS WIN 10.0. The results were as follows. Intrarater reliability coefficients of FRT was .976 and interrater was .942. FRT was significantly correlated with age, height, and BBS (p<.05). There were no significant differences in FRT and BBS by sex. There was significant difference in reach distance between below 74 elderly and above in FRT. FRT is very reliable test for balance and significantly correlated with BBS. Therefore, it is suggested that FRT is a clinically useful tool to substitute for BBS measuring balance ability in the elderly.

The purpose of this study was to investigate electromyographic activities of the flexor digitorum superficialis (FDS) and the flexor carpi ulnaris (FCU) by the shape of the ultrasound head. Twelve healthy subjects participated and performed ultrasound therapy with a round head and a long handled head during each 5-minute application. Electromyographic activities of the FDS and FCU were recorded by surface electrodes and normalized by maximal voluntary isometric contraction (MVIC) values. There was no difference in the muscular fatigue of FDS and FCU as determined by the shape of the ultrasound head (p>.05). Without the shape of head, the mean power frequency decreased with the time. There also was no difference in %MVIC of the FDS and FCU as determined by the shape of the ultrasound head (p>.05), but the force exerted exceeded 20%MVIC. There was however a significant difference in the amount of cumulative workload of the FDS and FCU as determined by the shape of ultrasound head (p<.05). The workload was however not affected by the shape of the ultrasound head. Constant static grasp of ultrasound transducer head during ultrasound therapy is considered a high risk factor of work-related musculoskeletal disease.

The purpose of this study was to investigate effect of hospital-based physical and occupational therapy on Modified Barthel Index (MBI) score in stroke inpatients at least 3 months after stroke, to predict MBI score at discharge from subscales of MBI, and determine the characteristics of stroke at admission. Forty-five stroke inpatients participated and received physical and occupational therapy for two months. All participants were assessed on MBI at admission and discharge. The collected data was analyzed by dependency level (MBI≤74 and MBI≥75) at admission. The results revealed that the MBI score at discharge was significantly improved compared to the MBI score at admission in the group with more than moderate dependency level (MBI≤74). In particular, personal hygiene, dressing, ambulation, and chair/bed transfer were improved. But only ambulation was improved significantly in the group with a less than mild dependency level (MBI≥75). The chair/bed transfer, dressing, ambulation, and Mini-Mental State Exam-Korea score at admission were important factors in the MBI score at discharge. Eighty-six percent of the variation in MBI score function at discharge can be explained. Therefore, it is suggested that hospital-based physical and occupational therapy in subacute stroke improve independent living status, especially for patients with a more than moderate dependency level.

The purpose of this study was to investigate the effects of walking aid on hemiplegic gait of chronic stroke patients. Twelve stroke patients participated in this study. Physiological cost index (PCI), gait speed, and climbing stairs with and without walking aid were measured and analyzed. The results showed that walking with walking aid significantly improved gait speed and reduced physiological cost index and time needed to climb stair (height 7 cm) in comparison with a walking without walking aid. In conclusion, walking aid may improve the speed and efficiency of hemiplegic gait in chronic stroke patients.

Muscle weakness in the hemiplegia following stroke is an important factor which determines the quality of life in the future. Therefore, muscle strengthening exercise is essential for functional recovery in hemiplegic patients. Even though the popular conception is that muscle strengthening exercise causes spasticity and associated reaction that hemiplegia patients don't want, and that it disturbs functional recovery, recently there have been many new reports against that opinion. Therefore, the effects of strengthening exercise programs on functional recovery in hemiplegic patients are still controversial. The purpose of this study was to determine the effects of strengthening exercise programs for the knee joint using isokinetic exercise on the associated reaction of the upper extremities. Comparing the muscle activities of biceps brachii and triceps brachii during, before, and immediately after 2 and 5 minute intervals of isokinetic exercise, we examined the increase and decrease of associated reaction. Twenty stroke inpatients participated in this study. Surface electromyography was used to get muscle activity data from biceps brachii and triceps brachii. The major findings of this study were as follows: 1. The flexor and extensor peak torque were significantly higher on the sound side than the affected side (p<.05). 2. Before and after strengthening exercise, there was no significant difference in muscle activities (surface electromyographic root mean square values) between the sound and affected side. 3. Muscle activities were examined during, before, and immediately after 2 and 5 minute intervals of isokinetic exercise. There were significant differences in muscle activities between, before and during the exercises, during exercise and 5 minutes after exercise in the biceps brachii (p<.05), and during exercise and 5 minutes after exercise in the triceps brachii (p<.05). In conclusion, there was no relation between strengthening exercise and associated reaction in the upper extremities. Rather, muscle activities after exercise had a tendency to decrease relative to before the exercise. Thus, it is considered that intensive strengthening exercise contributes to improvement of functional recovery without increase in associated reaction in hemiparetic patients.

The purpose of this study was to investigate the effects of clinical characteristics of chronic stroke patients on physiological cost index (PCI) during walking. Fourteen stroke patients participated in this study. To investigate the clinical characteristics, Fugl-Meyer score (FMS), gait velocity (GV), muscle strength of the knee extensor, modified Ashworth scale (MAS) of ankle plantar flexor, devices, and gait patterns during walking were measured and analyzed. The results were as follows: Firstly, use of devices and high MAS of the ankle plantar flexor significantly increased PCI. Secondly, PCI was significantly correlated with the FMS and MAS of the ankle plantar flexor. In conclusion, inhibition of spasticity of the ankle plantar flexor is considered to reduce PCI during walking for chronic stroke patients.

The purposes of this study were to determine the effects of rehabilitation programs on functional performance of the lower extremities and whether additional therapeutic exercise with routine rehabilitative therapy improves functional performance more than just routine rehabilitative therapy by it self for inpatients who have suffered a stroke with below moderate severity within 3 to 6 months after the onset of the stroke. Fifty-eight subjects were divided into two groups. Group I was given routine rehabilitative therapy and group II was given additional therapeutic exercise along with the routine rehabilitative therapy. Each group received 6 weeks of rehabilitation. The timed get-up and go test (TUG), the Fugl-Meyer score (FMS), functional independence measure (FIM), functional reach (FR), gait velocity (GV), and the strength of knee extensor and flexor were selected to measure effect of rehabilitation programs. The main results were measured and analysed at baseline, 3 weeks, and 6 weeks after the start of the rehabilitation programs. The results revealed that all of functional performance of the lower extremities in 3 weeks after the start of the rehabilitation programs were significantly improved compared with before the rehabilitation programs in both groups. In 6 weeks, TUG, FIM, FR, GV, and the strength of knee extensor in group I, TUG, FMS, FIM, FR, GV, and the strength of knee extensor and flexor in group II were significantly improved compared with the results after 3 weeks. At 3 weeks after rehabilitation programs, group II made significantly greater gains in TUG, FR, GV, and the strength of the knee flexor compared to the group I. At 6 weeks, group II made significantly greater gains in TUG, FR, GV, and the strength of the knee extensor and flexor compared to the group I. In conclusion, rehabilitation programs for stroke patients within 3 to 6 months after stroke onset significantly contributed to improve functional performance of the lower extremities. It is desirable for improvement of functional performance of the lower extremities to perform additional exercise with routine rehabilitative therapy.