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

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

This study aimed to determine the effects of Rhythmic Auditory Stimulation (RAS) using music and a metronome on the gait of stroke patients. 13 female and 15 male volunteers were randomly allocated to two groups: namely a group to receive RAS using music and a metronome group (the experimental group; n1=14) and a group to receive RAS using a metronome only (the control group; n2=14). The affected side was the left side in 15 subjects and the right side in 13 subjects. The mean age of the subjects was 56.6 years, and the mean onset duration of stroke was 8.6 months. Intervention was applied for 30 minutes per session, once a day, 5 times a week for 4 weeks. To measure the patients’ gait improvement, we measured gait velocity, cadence, stride length, double limb support using GAITRite, body center sway angle using an accelerometer, and Timed Up-and-Go test. Functional Gait Assessment were conducted before and after the experiment. The paired t-test was used for comparisons before and after the interventions in each group. Analysis of covariance was used for comparisons between the groups after the interventions. Statistical significance was set at α=.05. Within each of the two groups, significant differences in all of the dependent variables before and after the experiment (p<.05) were observed. However, in the comparison between the two groups, the experimental group showed more significant improvements in all dependent variables than the control group (p<.05). Our results also suggest that in applying RAS in stroke patients, the combination of music and a metronome is more effective than using a metronome alone in improving patients’ gait.

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

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

The aim of this study was to analyze the relationship between physical impairments and daily activities on the basis of the outcome measurements in stroke patients. Seventy-six stroke patients participated in this study. Two physical therapists evaluated 3 clinical common measurements, i.e., the Fugl-Meyer Assessment (FMA), the Berg Balance Scale (BBS), and the Functional Independence Measure (FIM). Multiple regression analysis was used, as the dependent variables were the BBS and FIM; the independent variables were post-stroke duration, FMA of Upper Extremity (FMU), and FMA of Lower Extremity (FML). In the regression equation of the BBS, the coefficient of determination () was .383, and the FML was found to be the most important variable for determining the BBS score. In the regression equation of the FIM, was .531, and the FML was found to be the most important variable for determining the FIM. These results suggest that there is a need to determine the function of activities on the basis of the physical impairments of stroke patients. More variable measurement tools on the levels of body function and structure, as well as activity limitations are required.

Clinical measures that Quantify falling risk factors are needed for the accurate evaluation of patients and to plan an intervention strategy. The purpose of this study was to examine the test-retest and interrater reliability of the dynamic gait index (DGI) for persons with Parkinson's disease (PD). A total of 22 idiopathic PD patients were recruited from rehabilitation hospital, Korea in this study. The DGI was assessed in two sessions that were, three days apart. We also measured Berg balance test (BBT) and geriatric depression scale (GDS) for concurrent validity with DGI. Intrarater and interrater reliability (.96 and .98 respectively) for DGI were high. indicating good agreement. The DGI was showed a good positive correlation with the BBS (r=.852). but not GDS (r=-.462). Intrarater and interrater reliability of DGI were high in people with PD. The DGI could be a reliable measure to evaluate functional postural control during gait activities in the PD population, and the ability of DGI to detect real change is acceptable in research and clinical settings.

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

The purpose of this study was to examine the validity and reliability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-VA3.0 in patients with hip and knee osteoarthritis (OA). The sample consisted of 301 patients who had received treatments at the physical therapy units of 5 medical institutions in Andong City in june 2006. Questionnaires on the WOMAC were recruited by 12 physical therapists. The internal structure and reliability of the scales were evaluated by means of item-internal consistency (Cronbach's alpha coefficient: ), item-discriminant validity, and Pearson's relation coefficient. To explore construct validity, we conducted a principal component factor analysis with varimax rotation analysis. The criterion for factor extraction was an eigenvalue >1.0. The average age of the patients was 62.1 years. All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficients of .81, .91, and .80, respectively. The internal consistency reliability of item-each scale were also internally consistent with Cronbach's coefficient of .89 (Pearson's correlation coefficient: .71~.84), .93 (.89~.91), and .96 (.67~.91), respectively. However, high correlation was found among 3 items (.66~.83, .66~.67, and .67~.83), so the item-discriminant validity was low ( coefficient: .81, .91, .80, respectively). The construct validity by factor analysis was low because it was not consistent With WOMAC-VA3.0. In conclusion, the results reported here confirm the reliability of the WOMAC in patients with OA of the hip and knee. The collection of information on the hip and knee osteoarthritis using this instrument was acceptable to patients. A further prospective multi-center study will be necessary to prove the construct validity.

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

The purpose of this study was to compare the static balance in a sitting position between a group with adolescent idiopathic scoliosis (AIS) and a normal aged-matched group. Forty-nine subjects were included in this study. Thirty-one healthy subjects and eighteen AIS subjects were participated. Each group was tested with the Lumbar Trunk Muscle Endurance Test (LTMET) and Balance Performance Monitor (BPM). The parameters for static balance were sway area, sway path, mean balance, maximum velocity, anterior-posterior angle, and left-right angle of each group with eyes opened and closed. Results from the LTMET showed significantly more increase in the normal group than in the AIS group in the flexor and extensor endurance. The BPM tested showed significantly difference beteen the groups in parameters of sitting balance such as maximum velocity and anterior-posterior sway angle. For the AIS subjects, there were no significant differences in all parameters of sitting balance between eyes opened and eyes closed. In comparisons of the groups with eyes opened there were no significant differences in all parameters of sitting balance. In comparisons of the groups with eyes closed there were significant differences in the sway area, maximum velocity, anterior-posterior sway angle and left-right sway angle. These results suggest that the AIS group relies much more on proprioception than on vision, and develops compensatory passive postures of the spine. Further study is needed to measure many AIS patients with morphologic and electromyographic data for clinical application.

The purpose of this study was to compare the static balance of standing position between adolescent idiopathic scoliosis (AIS) and a normal group that were aged-matched. There were forty subjects included in this study. Twenty-seven healthy subjects (age, 13.9±1.2 yrs; height, 161.9±7.5 ㎝; weight, 52.2±7.7 ㎏) and thirteen AIS subjects (age, 14.2±2.2 yrs; height, 161.5±8.7 ㎝; weight, 48.1±8.1 ㎏) were participated in the study. The thirteen subjects in the AIS group had a major Cobb angle between 20.1° and 49°. Each group was tested with the Balance Performance Monitor (BPM). The parameters for static balance were sway area, sway path, max velocity, mean balance, anterior-posterior angle, and left-right angle of each group with their eyes opened and again with their eyes closed. Both sides of the forward reach test and the lateral reach test were also performed on each group. Results from the BPM tested showed significantly increases in all parameters of static balance with those patients with AIS under the conditions where eyes were opened and closed. In the right and left forward reach test, there was no significant difference between normal and AIS groups. However, in the lateral reach test with right and left direction, there were significant differences between normal and AIS groups. For the normal subjects, there were significant differences in the parameters with sway path and anterior-posterior sway angle between the eyes opened and closed. However, there were no significant differences in the all parameters between eyes opened and closed for the AIS subjects. These results suggest that, balance programs could be used in the rehabilitation setting for intervention of AIS and evaluation of AIS. Further study is needed to measure many patients with AIS and other functional balance scales for clinical application.

The purpose of this study was to investigate the possibility of virtual moving surround (VMS) on static balance in the patients with balance dysfunction. Eighty three subjects who were admitted or treated as an outpatient, or a family member, at the department of rehabilitation unit of university hospital were recruited to participate. Subjects were three groups based on their overall medical status: healthy, diabetic neuropathy and stroke. Each group was tested for static balance with a forceplate during static standing with VMS. The virtual movement was simulated with a head mounted display. The parameters for static balance were total sway path. In this study, the parameters of postural control for patients with diabetic neuropathy and stroke subjects were significantly increased in conditions elicited with the VMS. In the healthy elderly participants, the total sway path was not significantly different under virtual movement conditions. Therefore, VMS could be used in the evaluation and treatment of the patients with balance dysfunction.