Background: Studies using Smovey and Vibration foam rollers are mostly conducted with normal adults, breast cancer patients, and athletes. However, there are not many studies applied to stroke patients to date. Objectives: The purpose of this study is to investigate the effect of vibration exercise on the range of motion of the shoulder and knee joints in stroke patients. Design: A randomized controlled trial. Methods: A total of 36 stroke patients, with 12 in the Smovey and Vibration foam roller group (SVG), 12 in the Smovey and Non-Vibration foam roller group (SNVG), and 12 in the control group (CG) were randomly assigned to exercise three times a week for 6 weeks. The range of motion of the shoulder and knee joints was measured for each group before and after 6 weeks of exercise. For joint range of motion, shoulder flexion and extension and knee flexion and extension were measured using BPMpro. Results: In terms of the difference in time, the flexion and extension of the shoulder and the flexion and extension of the knee on the paretic side were significant in the SVG and SNVG. The CG was not significant. Shoulder flexion and extension and knee flexion and extension on the unaffected side were all insignificant. The differences between each group were significant between the SVG and the CG and the SNVG and the CG. SVG and SNVG were not significant. Conclusion: It was found that vibration exercise had a positive effect on the range of motion of the shoulder and knee joints. Therefore, it is thought that vibration exercise can be provided as a clinical intervention method for shoulder and knee range of motion.

Background: Bird dog exercise (BDE) is one of the lumbar stabilization exercises that rehabilitate low back pain by co-contraction of the local and global muscles. Previous studies have reported the effect of various type of BDEs (for example, practicing the exercises on various surfaces and changing the limb movement) for muscle co-contraction. Objects: This study aimed to investigate the effect of knee joint flexion position of the raised lower limb on abdominal and back muscle activity during BDE in patients with chronic low back pain (CLBP). Methods: Thirteen males participated in this study (age: 32.54 ± 4.48 years, height: 177.38 ± 7.17 cm). Surface electromyographic (SEMG) data of the internal abdominal oblique (IO), external abdominal oblique (EO), lumbar multifidus (MF), and thoracic part of the iliocostalis lumborum (ICLT) were collected in two knee joint flexion positions (90° flexion versus 0° flexion) during BDE. The SEMG data were expressed as a percentage of root mean square mean values obtained in the maximal voluntary isometric contraction. Results: Greater muscle activity of the IO (p = 0.001), MF (p = 0.009), and ICLT (p = 0.021) of the raised lower limb side and the EO (p = 0.001) and MF (p = 0.009) of the contralateral side were demonstrated in the knee joint flexion position compared to the knee joint extension position. Greater local/global activity ratios of the abdominal muscle (i.e., IO and EO) of the raised lower limb (p = 0.002) and the back muscle (i.e., MF and ICLT) of the contralateral side (p = 0.028) were also noted in the knee joint flexion position. Conclusion: BDE with a knee joint flexion position might be recommended as an alternative lumbar stabilization exercise to enhance muscle activity in both the raised lower limb and the contralateral sides of the trunk for individuals with CLBP

Background: Individuals with scapular winging may have proprioceptive dysfunction which is important for motor control and causes shoulder instability. Reduced serratus anterior (SA) and lower trapezius (LT) muscle activity accompanied by over-active upper trapezius (UT), and pectoralis major (PM) may be contributing factors. Flexi-bar (FB) exercise may be used to increase joint position sense (JPS) and alter the target muscle activities. Objects: This study aimed to investigate the immediate effects of flexi-bar exercise prior to knee push-up plus (FPK) versus knee push-up plus (KPP) on JPS and muscle activity of SA, LT, UT, and PM in subjects with scapular winging. Methods: Eighteen subjects with scapular winging were recruited. JPS was investigated at baseline, after KPP and after FPK. Passive and active JPS errors were calculated by isokinetic equipment. Surface electromyography was used to record muscle activities during KPP and FPK. One-way repeated-measures analysis of variance and post hoc analyses were used to analyze the JPS error measured at baseline, after KPP and after FPK. Paired t-tests were used to compare muscle activities between KPP and FPK. Results: Passive JPS error was significantly decreased after KPP (p = 0.005) and after FPK (p = 0.003) compared to the baseline. Active JPS error was also significantly decreased after KPP (p = 0.016) and after FPK (p = 0.012) compared to the baseline. There was no significant difference in the passive and active JPS errors between KPP and FPK. SA activity during FPK was significantly increased (p = 0.024), and LT activity during FPK was significantly increased (p = 0.006). There were no significant differences in the UT and PM activity. Conclusion: FB might be recommended to immediately improve passive and active JPS and to selectively increase SA and LT muscle activities during KPP in individuals with scapular winging.

본 연구는 퇴행성 무릎 관절염을 가진 노인여성을 대상으로 12주간의 노르딕 워킹을 통해 신체 기능과 관절염 통증 정도의 개선에 어떠한 효과를 미치는지 규명하는데 목적이 있다. 본 연구의 대상자는 퇴행성관절염으로 진단받은 노인여성 16명(나이: 73.00±3.70year, 신장: 154.30±4.07cm)을 대상으로 무선배정 된 노르딕 워킹 운동그룹(n=9)과 통제그룹(n=7)으로 나누었다. 운동 그룹은 노르딕 스틱을 이용하여 12주간 주 3회, 1회 30분 노르딕 워킹 운동을 실시하였고, 운동 강도는 HRR의 40-60%로 설정하였다. 통제그룹은 동일한 기간 동안 일상생활을 유지하도록 하였다. 종속변인으로 신체조성(체중, 체지방률, 근골격량)과 근력과 유연성(상·하지 근력, 상·하지 유연성), 균형능력(정적균 형, 동적균형) 및 통증정도를 측정하였다. 이러한 지표들의 측정은 운동프로그램을 진행하기 전과 후로 나누어 2번 측정하였다. 자료처리는 SPSS-PC version 25.0을 이용하여 실험집단과 통계집단간의 생리학적 특성 비교를 위해 독립표본 t-test를 사용하였으며, 노르딕 워킹 운동그룹과 통제그룹의 그룹 간, 시기간의 변화를 알아보기 위해 2x2 반복측정 이원배치분산분석을 사용하였다. 연구 결과는 첫째, 12주간의 노르딕 워킹을 통해 신체조성 기능에서 체지방률은 운동 처치 후에 감소하는 결과가 나타났으며(p=.004), 집단 간과 시기 간의 상호작용에서도 감소하는 결과가 나타났다(p=.003). 골격근량은 운동처치 후에 증가하는 결과가 나타났으며(p=.018), 집단 간과 시기 간의 상호작용에서도 증가하는 결과가 나타났다(p=.005). 둘째, 근력과 유연성은 상지근력과 하지유연성에서 집단 간과 시기 간 상호작용에서 증가하는 결과가 나타났으며(p=.009)(p=036), 하지근력에서는 운동집단과 통제집단 간 개선 효과가 나타났다(p=.006). 또한, 상지유연성은 운동처치 후에 증가하는 결과가 나타났다(p=.020). 셋째, 균형능력 요인은 정적균형에서 운동처치 후 개선 효과가 나타났으며(p=.016), 동적균형에서는 차이가 나타나지 않았다(p>.05). 넷째, 통증정도는 운동처치 후 개선 효과가 나타났으며(p=.022), 운동집단과 통제집단 간에 개선 효과도 나타났다(p=.013). 결론적으로 12주간의 노르딕 워킹은 퇴행성 무릎 관절염을 가진 노인여성의 신체조성과 근력과 유연성 에 긍정적인 영향을 미치는 것으로 나타났다. 따라서 노르딕 워킹은 퇴행성 무릎 관절염을 가진 노인여성 에게 신체조성과 안정성, 균형성을 높여 주였으며, 무릎 관절의 통증을 낮춰주어 재활 운동 기능 개선에 효과적인 운동방법이라고 사료된다.

Background: The bridge exercise targets the gluteus maximus (Gmax) and gluteus medius (Gmed). However, there is also a risk of dominant hamstring (HAM) and erector spinae (ES) muscles. Objects: To analyze the muscle activity the of Gmax, Gmed, HAM and ES during the bridge exercise with and without hip external rotation in different degrees of knee flexion. Methods: Twenty-three subjects were participated. The electormyography (EMG) activity of the Gmax, Gmed, HAM and ES muscles was recorded during the exercise. The subjects performed the bridge exercise under four different conditions: (a) with 90˚ knee flexion, without hip external rotation (b) with 90˚ knee flexion, with hip external rotation (c) with 135˚ knee flexion, without hip external rotation (d) with 135˚ knee flexion, with hip external rotation. Results: There was no significant interaction effect between the degree of knee flexion and hip external rotation. There was a significant main effect for degree of knee flexion in Gmax, HAM muscles activity. Gmax muscle activity was significantly greater in the 135˚ knee flexion position than in the 90˚ knee flexion position (p<.001). While HAM muscle activity was significantly less in 135˚ knee flexion position than in the 90˚ knee flexion position (p<.001). ES muscle activity was significantly less in the 135˚ knee flexion position than in the 90˚ knee flexion position (p=.002). The activity of both the Gmax and Gmed muscles was significantly greater with hip external rotation (p<.001 and p=.005, respectively). Conclusion: For patients performing the bridge exercise, positioning the knee in 135° of flexion with hip external rotation is effective for improving Gmax and Gmed muscle activity while decreasing HAM, and ES muscle activity.

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: Squatting is one of the best functional exercises to strengthen the quadriceps muscle in independent gait and activities of daily living. Although the use of a gym ball during squat exercise is the most common way of strengthening the vastus medialis oblique (VMO) muscle, published data on this subject are limited. Objects: The purpose of this study was to compare the sequential muscle activation of the VMO and vastus lateralis (VL) muscles during squat exercise using a gym ball at different knee flexion angles. Methods: Forty healthy adults were randomly divided into experimental (squat exercise using a gym ball) and control (squat exercise alone) groups, in which squats were performed at 45° and 90° knee flexion. Electromyographic (EMG) activity data were collected over 10 seconds under the 2 angles of knee flexion (45° and 90°). Results: There was significant group and time interaction effect for VMO and VL muscle activation at 45° knee flexion. This was similarly demonstrated at 90° knee flexion. No significant group main effect and time main effect for VMO and VL muscle activation were noted at 45° knee flexion, respectively. In contrast, there was significant group main effect and time main effect for VMO and VL muscle activation at 90° knee flexion. These significant differences were demonstrated through two-way analysis of variance over repeated measurements, suggesting that the EMG activity of the VMO muscle during squatting with a gym ball showed remarkable improvement compared to that of the VL muscle. Conclusion: This research suggests that squat exercise using a gym ball may be more beneficial in improving the activity of VMO than of the VL muscle at both 45° and 90° of knee flexion, respectively. We highly recommend squat exercises with a gym ball for selective strengthening of the VMO muscle in knee rehabilitation.

Background: Total knee arthroplasty (TKA) recovers the alignment of the knee joint, but fails to automatically restore the alignment and function of the hip and ankle joints. It may affect the alignment and stability of the knee joint, therefore therapeutic intervention in hip and ankle joint is necessary for the rehabilitation process after TKA. Objects: The aim of this study was to comparison of the effects of the two exercise methods on the coronal plane alignment after TKA. This study conducted an experiment by dividing subjects into a lower extremity isometric co-contraction group (LEIC) and a quadriceps isolated isometric contraction (QIIC) group. Methods: A total of 37 subjects were randomly assigned to the LEIC (n1=19) or the QIIC (n2=18). Exercise was applied to five times per week for three weeks, starting on the eighth day after surgery. Range of motion exercises were performed as a common intervention and then each group performed quadriceps isometric contraction exercises with 10 sets of 5 repetitions. Radiological imaging was performed prior to surgery, one month and six months after surgery. In addition, the hip-knee-ankle angle (HKA) and tibiotalar angle (TTA) were measured. Results: The HKA was close to neutral in the LEIC rather than the QIIC (p<.05). The LEIC showed varus and the QIIC exhibited valgus TTA (p<.05). In a comparison of HKA and TTA over time, there was no significant change in either group (p>.05). According to the comparison of the TTA before surgery, the LEIC showed significant changes in the varus direction (p<.05), while there was no significant change in the QIIC (p>.05). Conclusion: The LEIC method triggered changes in the TTA and brought the HKA close to the neutral. Thus, LEIC is more effective than QIIC in creating stability in the coronal plane alignment of the knee and ankle joints after TKA.

Cross knee curl-up is an ideal variation of abdominal curl up exercise to strengthen abdominal musculature without excessive lumbar flexion which can increase the loads on the disc and ligaments. In addition, slowly forced expiration can facilitate the activation of the abdominal musculature. The purpose of this study was to determine the effects of slowly forced expiration on activity of abdominal muscles, such as rectus abdominis (RA), external oblique (EO), and transverse abdominis/internal oblique (TrA/IO), while cross knee curl-up. Eleven young and healthy subjects (6 males and 5 females) participated. All subjects performed the cross knee curl-up slowly forced expiration and natural breathing. Paired t-test was performed in normalized electromyogram (EMG) muscle activity of the bilateral RA, EO, and TrA/IO to compare the differences between the cross curl-up with slowly forced expiration and natural breathing. Statistical significance was set at .05. There were no significant differences in normalized EMG muscle activity of the bilateral RA, EO, and TrA/IO between the cross curl-up with slowly forced expiration and natural breathing. The finding of this study designates that slowly forced expiration does not induce increasing activity of abdominal muscle in cross knee curl-up; hence, learning step of breathing control might not be necessary to strengthen abdominal muscle in cross knee curl-up.

The purpose of this study is to identify the bridge exercise posture for the efficient exercise by comparing the muscle activity of the lower limbs according to the changes in muscle length because of knee angle in bridge exercise. The subjects of this study were 9 randomly selected males in their 20s living in D city from those who satisfied inclusion criteria. The measured muscles were Vastus medialis oblique, Vastus lateralis, Semitendinosus, Biceps femoris, Gluteus maximus, Gluteus medius, Tensor faciae latae, and Adductor longus. Data were analyzed through paired comparison test. In the result, ST, BF, and TFL muscle activities were high when knee joint flexion angle was 90°Although in most cases higher muscle activity was shown at 90°than 60°there was no statistical significance. Interestingly, it was lower at 90°than 60°in VL. In ST, BF, and TFL, it was significantly higher at 90°han 60°(p<.05). Conclusively, knee angles in bridge exercise may affect the muscle activity, and in particular when the activity of two joint muscles such as semimenbranosus muscle, biceps femoris muscle, and tensor fasciae latae muscle increase as the angle gets higher. Therefore, it is considered that this study will provide helpful tips to develop muscular strength enforcement program for the patients with damages in the lower limbs through bridge exercise in clinical situations.

The purpose of this study was to analyze and compare the effect of resistance exercise and balance exercise on proprioception and WOMAC index of patients with degenerative knee osteoarthritis. A total of 40 subjects participated in this study. The subjects were diagnosed with degenerative knee osteoarthritis and all were more than 60 years old. They were divided into three groups. Group Ⅰ(n=8) was trained with resistance exercise, Group Ⅱ(n=6) was trained with balance exercise and GroupⅢ(n=6) was trained with range of motion as a control. The results of this study were as follows. It was significantly indicated that the resistance exercise group and balance exercise group elicited error-reduction on proprioception goal-angle (p<.05). There was a statistically significant difference on proprioception between resistance exercise group and control(range of motion) group. There was a statistically significant reduction on WOMAC index between resistance exercise group and balance exercise group (p<.05) and on the WOMAC index between resistance exercise group and range of motion group(p<.05). In conclusion, resistance exercise and balance exercise are effective on degenerative knee osteoarthritis and resistance exercise is the most effective for improving proprioception and WOMAC index. More research on the intervention according to the degree of degenerative knee osteoarthritis is needed.

The purpose of this study is to investigate the effects of closed and open kinetic chain exercise for increasing knee joint function on the knee position sense in the normal adults. Thirty normal adults(male 15, female 15; mean age: 22.13±2.58 years) were participated in this study into two groups, each with 15 people. The group I was trained that closed kinetic chain exercise on the knee joint and the group II was trained that open kinetic chain exercise on the knee joint. Exercise programs performed for 4 weeks, 3 times a week were using Shuttle 2000-1 closed kinetic chain exercise and Knee Extensor open kinetic chain exercise(HUR, Filand). The results of this study were as follows: 1) There were statistically significant decreasing of measuring error degree in 0-20。were found between before and after training in closed kinetic chain exercise(p<.05). 2) There were statistically significant decreasing of measuring error degree in 21-40。were found between before and after training in closed kinetic chain exercise(p<.05). 3) There were statistically significant decreasing of measuring error degree in 41-60。were found between before and after training in closed kinetic chain exercise(p<.05). 4) There were statistically significant decreasing of measuring error degree in 0- 20。were found between before and after training in open kinetic chain exercise(p<.05). 5) There were statistically significant decreasing of measuring error degree in 21-40。were found between before and after training in open kinetic chain exercise(p<.05). 6) There were statistically significant decreasing of measuring error degree in 41- 60。were found between before and after training in open kinetic chain exercise(p<.05). In conclusion, these results suggest that closed and open kinetic chain exercise has increased in the knee joint proprioception between before and after training. Especially, closed kinetic chain exercise could be more useful intervention than open kinetic chain exercise for increasing proprioceptive sense.

The purpose of this study was to suppose basis data the influence of different chair type and pelvic control on quadriceps muscle activity and strength during knee joint extension isometric exercise in hemiplegic patients. This research were investigated in ten healthy adults and tens hemipelgic patients. Surface electromyography (EMG) and Biodex system were used to collect kinematic data and muscle activity, respectively. Independent t-test, paired t-test and one-way repeated ANOVA were used to determine a statistical significance. The results showed as follows: (1) Posterior pelvic angles in healthy group and hemiplegic group were significantly different on isokinetic equipment (p<.05). (2) Different chair type and pelvic control on quadriceps muscle activity and strength were significantly different in hemiplegic patients (p<.05). From the result of this research, posterior pelvic angle control during knee joint extension isometric exercise in hemiplegic patients on isokinetic equipment is necessary to increase quadriceps muscle strength in hemiplegic patients.

This study was designed to identify the effect of various decline boards and postures of lower extremities on surface electromyographic (EMG) activity of knee muscles during isometric single-leg decline squat exercises. The subjects were twenty young male adults who had not experienced any knee injury and their Q-angles were within a normal range. They were asked to perform single-leg decline squat exercises in five various conditions. The EMG activities of the gluteus maximus (GM), vastus lateralis (VL), vastus medialis (VMO), tibialis anterior (TA), and gastrocnemius (GCM) muscles were recorded in five various single-leg decline squat exercises by surface electrodes and normalized by maximal voluntary isometric contraction (MVIC) values. The normalized EMG activity levels were compared using one-way ANOVA with repeated measures. The results of this study were as follows: 1) Exercises 2 and 4 produced significantly greater EMG activity of VMO than did exercise 1 (<.05/10), 2) The VMO/VL ratio of EMG activity of exercise 4 was the highest, producing a significantly greater ratio than exercise 1 (<.05/10). These results show that single-leg lateral oblique decline squat exercise is the best exercise for selective strengthening of VMO, and the posture of the contralateral leg does also affect strengthening of VMO, but we'll need to research patellofemoral joint compression for clinical application of single-leg lateral oblique decline squat exercises.

본 연구의 목적은 운동강도(최대근수축의 10, 30, 50, 70%)에 따라 유발되는 국소적인 근피로가 슬관절의 위치감각 인지에 미치는 영향을 연구함으로써 근력강화의 운동치료적 효과와 운동학습과 관련된 효과를 동시에 만족시키는 최적의 운동강도를 제시하는 것이었다. 대상자는 건강한 성인여자 40명이었다. 청각을 통한 위치감각 정보를 제공하는 장치와 원판 각도계가 부착된 등속성 Cybex를 사용하였다. 근피로의 상태를 확인하기 위해서 근전도를 이용하여 주파

The purpose of this study was to determine the effect of electrical stimulation biofeedback on motor learning of quadriceps muscle isometric exercise in 3 patients who have undergone total knee replacement surgery. A multiple baseline design across subjects was used. The electrical stimulation biofeedback was provided with each patient during quadriceps isometric exercise, which last 10 to 14 sessions with 10 repetitions each sessions. After training patients received 4 retention tests. Maximum muscle activity was measured pre- and post- electrical stimulation biofeedback training and retention test to evaluate the effect of biofeedback training. Maximum isometric muscle activity of quadriceps was increased after electrical stimulation biofeedback training in all subjects. The results indicate that a electrical stimulation biofeedback training is a useful method to improve motor learning of quadriceps isometric exercise in total knee replacement.

It was recently reported that exercise-induced fatigue is related to joint position sense although some controversy remains. The purposes of this study were to examine the effect on the accuracy of reproducing the knee angles after a fatiguing isokinetic quadriceps exercise at four different levels (10%, 30%, 50%, and 70% of maximal force) and to find the optimal exercise level without causing knee joint proprioception impairment. Forty healthy women, ages 19 to 27, were randomly assigned to four experimental groups. Before and after the exercise, accuracy of positioning with respect to auditory feedback for specific angles was estimated by calculating the mean errors between specific angles and reproduction angles. Fatigue was measured by EMG signals displayed by a frequency spectrum analysis during the quadriceps exercise. Results showed that there was no significant difference in accuracy of the knee joint positioning sense following the exercises in group 1, group 2, and group 3 (10%, 30%, and 50% of maximal force, respectively); the exception being group 4 (70%). Fatigue level was significantly increased in group 4 but there were no significant increases of fatigue level in group 1, group 2, or group 3. The results concluded that the optimal exercise level to acquire the therapeutic exercise effectiveness without position sense impairment was at 50% of maximal force. Further studies using large sample size and patient groups with poor knee joint proprioception would be needed to confirm this conclusion and to clarify the possibility of clinical applications.

The purpose of this study was to determine whether the vastus medialis oblique muscle(VMO) had greater electrical activity than the vastus lateralis muscle(VL) when hip adduction and knee extension exercise were performed. Electrical activity of the VMO and VL was measured on 42 healthy subjects (28 men, 14 women) during maximal voluntary isometric contractions of hip adduction and knee extension by an EMG-BIOFEEDBACK. The results showed that the electromyographic activity of the VMO was significantly greater than that of the VL during the hip adduction exercise. Differences noted with knee extension by performing hip adduction exercises. Isometric hip adduction exercises, therefore, may be advisable in the treatment of patients with patellofemoral pain.