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.

목적 : 본 연구는 일어서기에 어려움을 가진 고령자를 비롯한 모든 사람들의 신체적 부담을 줄여주고 독립 적인 일상생활을 성취하기 위해 일어서기 능력이 저하된 고령자에게 사용이 쉽고 편리하고 안전한 일어서기 보조기기를 개발하고 사용에 대한 평가를 실시함으로써 사회적 참여능력을 증진시키기 위한 도구로서의 역할을 제시하는 것이 목적이다. 연구 방법 : 본 연구에서는 기존 일어서기 보조기기의 문제점인 큰 부피, 무거운 중량 그리고 높은 가격 등을 최소화한 일어서기 보조기기를 개발하여 연구도구로 활용하였다. 개발된 일어서기 보조기기에 대한 평가를 위해 65세 이상의 노인 90명을 대상으로 Rapid Entire Body Assessment(REBA), 일어서기 단계별 수행도 및 운동기술능력 분석, Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)를 평가도구로 활용하였다. 결과 : 개발한 보조기기 적용 전·후에 따른 일어서기 자세분석 결과 목, 몸통, 위팔, 아래팔 그리고 REBA 총점에서 통계적으로 유의미한 차이를 보였다(p<.05). 보조기기의 적용 전·후에 따른 일어서기 단계별 수행도 분석 결과 1단계에서 6단계와 전체 단계 평균값에서 통계적으로 유의한 차이를 보였고(p<.05), 운동기술능력에서는 유연성, 지속하기, 속도처리 모두 통계적으로 유의미한 차이를 보였다(p<.05). QUEST를 활용한 사용성 평가 결과 모든 항목에서 ‘만족한다’이상의 긍정적인 결과가 나타났다. 결론 : 본 연구결과를 통해 개발한 일어서기 보조기기가 근골격계 위험성이 높은 고령자에게 수행도 및 운 동기술의 향상뿐만 아니라 만족스러운 보조도구로써의 역할의 가능성을 확인하였다. 추후 고령자뿐만 아니라 일어서기에 어려움을 겪고 있는 다양한 사람들에게 보조기기를 적용함으로써 일상생활에서 겪을 수 있는 불편함을 해소하고 작업치료의 중재적 적용범위를 보다 확장할 수 있는 계기가 되길 기대한다.

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.

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 purpose of this study was to determine the effect of the pelvic compression belt (PCB) on the electromyography (EMG) activities of trunk muscles during sit-to-stand (SitTS), and stand-to-sit (StandTS) tasks. Twenty healthy subjects (7 men and 13 women) were recruited for this study. The subjects performed SitTS, and StandTS tasks, with and without a PCB. Surface EMG was used to record activity of the internal oblique (IO), external oblique (EO), rectus abdominis (RA), erector spinae (ES), and multifidus (MF) of the dominant limb. EMG activity significantly decreased in the RA (without the PCB, %maximal voluntary isometric contraction [%MVIC]; with the PCB, %MVIC), EO (without the PCB, %MVIC; with the PCB, %MVIC), MF (without the PCB, %MVIC; with the PCB, %MVIC), and ES (without the PCB, %MVIC; with the PCB, %MVIC) during the SitTS task and in the IO (without the PCB, %MVIC; with the PCB, %MVIlC), RA (without the PCB, %MVIC; with the PCB, %MVIC), EO (without the PCB, %MVIC; with the PCB, %MVIC), MF (without the PCB, %MVIC; with the PCB, %MVIC), and ES (without the PCB, %MVIC; with the PCB, %MVIC) during the StandTS task when a PCB was used (p<.05). In men the EMG activity of the MF significantly decreased during the SitTS task when a PCB was used (p<.05): in women, the EMG activity of the RA, EO, MF, and ES during the SitTS task and that of the EO, MF, and ES during the SitTS task significantly decreased when a PCB was used (p<.05). In addition, the rates of change in the EMG activity of each muscle differed significantly during the SitTS and StandTS tasks before and after the use of the PCB. However, the EMG activity did not significantly differ between the male and female subjects. These findings suggest that the PCB may contribute to the modification of activation patterns of the trunk muscles during SitTS, and StandTS tasks.

The purpose of this study was to investigate the effect of visual feedback on the postural control of stroke patients, by systematically varying conditions of visual feedback [eye-open condition (EO) vs. eye-closed condition (EC)], and base-support (both-side support, affected-side support, and unaffected-side support). In this study, we allocated 41 stroke patients with no damage in the cerebellum and visual cortex who can walk at least 10 meters independently, and 35 normal adults who have no experience of stroke to the control group. Both groups were asked to perform a "sit-to-stand" task three to five times, and their postural control ability was measured and compared in terms of asymmetric dependence (AD) instead of the traditional symmetric index (SI) in the literature. The results showed that although both subject groups maintained better postural control in the EO condition than in the EC condition, the patient group appeared to be more stable in EC than in EO when they were required to perform the task of the support condition given on the affected side. These results implied that visual feedback can impair stroke patients' postural control when it is combined with a specific support condition.

This study aimed to identify the asymmetry observed in the electromyography (EMG) activity patterns of selected trunk and thigh muscles between the affected and unaffected sides during the sit-to-stand movement in ambulatory patients with post-stroke hemiparesis. This study included 20 patients with post-stroke hemiparesis. The differences between stroke fast walkers (, 11 subjects) and stroke slow walkers (<8 m/s, 9 subjects) were compared. The activation magnitude and onset time of the multifidus, lumbar erector spinae, hamstrings, and quadriceps during the sit-to-stand movement were recorded through surface EMG. Moreover, the EMG activation magnitude and onset time ratios of each bilateral corresponding muscle from the trunk and leg were measured by dividing the relevant values of the unaffected side by those of the affected side. In all the subjects, the activation magnitudes of the multifidus, hamstring, and quadriceps on the affected side significantly decreased compared to those on the unaffected side (p<.05). The onset time of muscle activity in the affected side was markedly delayed for the multifidus and quadriceps during the task (p<.05). The activation magnitude ratios of the quadriceps were markedly decreased in the stroke slow walkers as compared to those in the stroke fast walkers. These findings indicate that the asymmetry in the multifidus, hamstring, and quadriceps muscle activation patterns in patients with post-stroke hemiparesis may be due to the excessive muscle activation in the unaffected side to compensate for the weakened muscle activity in the affected side. Our findings may provide researchers and clinicians with information that can be useful in rehabilitation therapy.

Although there have been various studies related to the body's movement from a sitting to a standing position (sit-to-stand task), there is limited information on the kinematic changes on the frontal and transverse planes. The purpose of this study was to ascertain how pelvic tilt affects kinematic changes in the frontal and transverse planes in the hip and knee joints during a sit-to-stand task. For this study, 33 healthy participants (13 female) were recruited. Each participant rose from a sitting to a standing posture at his or her preferred speed for each of three different pelvic tilt trials (anterior, posterior, and neutral), and the measured angles were analyzed using a 3-D motion analysis system. A one-way repeated measure analysis of variance was performed with Bonferroni's post hoc test. In addition, an independent t-test was carried out to determine the sex differences in hip and knee joint kinematic changes during the sit-to-stand tasks. The results were as follows: 1) The hip and knee joint angle in the frontal and transverse planes showed a significant difference between the different pelvic tilt postures during sitting in the pre-buttock lift-off phase (pre-LO) (p<.05). Compared to the posterior pelvic tilt posture, the anterior pelvic tilt posture involved significantly greater hip joint adduction and internal rotation, knee joint adduction, and reduced internal rotation of the knee joint. 2) Sex differences were found with significant differences for males in the initial and maximal angles in the frontal plane of the hip and knee joint (p<.05). Females had a significantly smaller initial abduction angle of the hip joint and a significantly greater maximal angle of the hip adduction joint. These results suggest that selecting a sit-to-stand exercise for pelvic tilt posture should be considered to control abnormal movement in the lower extremities.

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 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 analyze the effects of three different pelvic tilts on a sit-to-stand (STS) and to suggest a new assessment approach based on biomechanical analysis. The three difrent pelvic tilts were: (1) comfortable pelvic tilt sit-to-stand (CPT STS), (2) posterior pelvic tilt sit-to-stand (PPT STS) and (3) anterior pelvic tilt sit-to-stand (APT STS). To determine the onset time of muscle contraction surface electrodes were applied to the rectus femoris muscle (RF), vastus lateralis muscle (VL), biceps femoris muscle (BF), tibialis anterior muscle (TA), gastrocnemius muscle (GCM), and soleus muscle (SOL). The ICC was used for functional linkage analysis. The findings of this study were as follows. First, significant differences were found in kinematic variables and in muscle activation pattern among the three activities. Second, the results of functional integrated analysis revealed that recruited muscle activation patterns changed when the thigh-off was viewed as a reference point. Third, there were independent functional units between the thigh-off and the VL and between the thigh-off and the RF in the functional linkage analysis. The VL and RF acted as prime mover muscles, and more postural adjustment muscle recruitment was required as the demand of postural muscle control increased (PPT STS, APT STS, and CPT STS in order). In conclusion, the findings of this study suggest the following evaluative and therapeutic approach for STS activity. APT STS can be introduced for movement efficiency and functional advantage when abnormal STS is treated. However, excessive APT would change the muscle activation patterns of BF and SOL and require additional postural muscle control to cause abnormal control patterns.

The patients with hemiplegia show different body weight distribution as compared to normal subjects. These patients load their body weight more on sound leg than affected leg. The purpose of this study was to examine the effect of foot placement under three conditions: forward, intermediate, and backward placement, on body weight distribution and time needed to rise while assuming sit-to-stand. Fourteen patients with hemiplegia participated in the study. Their body weight distributions during sit-to-stand under the three different conditions were measured by a limb loader and time needed to rise was measured by a stopwatch. The data were analysed by the repeated measure of one-way ANOVA. Statistical Analysis demonstrated that body weight distribution was less asymmetric in backward foot placement. The difference of body weight bearing rate between sound leg and affected leg was significantly decreased as foot placement moved from forward to backward. These results show that backward foot placement during sit-to-stand make patient with henuplegia distribute their body weight more evenly on the lower extremity.

목적: 본 연구의 목적은 누운 자세에서 일어서기(supine to standing: STS) 과제 수행 시 유아의 운동발달 수준에 따른 움직임 패턴의 차이점을 규명하는 것이다. 연구대상자는 만 4-6세 유아 89명에게 운동발달검사(MABC-2)를 실시한 후 목적적 표집방법을 통해 선정된 20명의 유아들을 운동발달 수준에 따라 각각 운동발달 상(n=9)집단과 하(n=11)집단으로 배정되었다. 연구대상자들은 누운 자세에서 일어서기 과제를 ‘최대한 빨리 일어나세요.’라는지 시어를 듣고 10회 반복하여 수행하였다. 이때 나타난 유아들의 움직임은 VanSant의 움직임 패턴 발달순서 평가 도구를 사용하여 측정하였다. 그 결과, 누운 자세에서 일어서기 과제 수행 시 소요된 시간과 유아가 사용한 움직임 패턴에서 두 집단 간에 유의한 차이가 나타났으며 특히, 상지와 체간에서 더 큰 차이를 보였다. 운동발달상 집단에서는 전체적으로 대칭적인 움직임 패턴이, 하집단에서는 비대칭적인 움직임 패턴이 나타났으며, 이는 운동 발달 상집단이 하집단보다 상위의 움직임 전략을 사용한다는 것을 의미한다. 누운 자세에서 일어서기 과제의 수행시간도 운동발달 상집단보다 하집단에서 더 길게 소요되었다. 또한, 운동발달평가 점수와 움직임 패턴의 상관관계 분석 결과, 운동발달 평가점수와 신체 부분(상지, 체간, 하지) 간에 정적상관관계가 있는 것으로 나타났다. 이러한 연구결과를 토대로 더 세밀한 운동발달 검사가 필요한 아동들을 보다 쉽고 간편하게 선별할 수 있을 것으로 기대한다. 그리고 기존의 운동발달 평가도구들이 가지고 있는 시공간적 제한점을 보완할 수 있다는 측면에서 실제 교육현장이나 운동발달 연구 영역에서 유용하게 적용될 수 있을 것으로 생각한다.