Background: Floor sit-to-stand (FSTS) places a higher load on the knees than chair sit-to-stand (CSTS). It is difficult to experimentally measure the maximum knee joint force during sit-to-stand motion. Objectives: This study's objectives were twofold: firstly, to quantify the differences in knee joint force between FSTS and CSTS, and secondly, to identify the angles at which the maximum knee joint force occurs during these motions. Design: Computer simulation study. Method: This study was conducted on 4 adult male subjects in their 20s. The FSTS and CSTS motion trajectories of the subjects were acquired using 3- dimensional motion analysis equipment. Using these, the human body mass model of the program was modified according to the subject, and the knee joint force was calculated. Also, the knee angle at which the maximum knee joint force occurs was found. Results: When the subjects performed the FSTS motion, a knee joint force that was up to about 160% higher than that of the CSTS motion occurred, and the angle at which the maximum knee joint force occurred was different between the sitting sequence(FSTS motion: 56~58 degree, CSTS motion: 78~82 degree) and the standing sequence(FSTS motion: 98~100 degree, CSTS motion: 70~74 degree). Conclusion: By comparing FSTS motion with CSTS motion, it is expected that it can be used as a quantitative guide for the effect of motion similar to FSTS motion on the knee when prescribing exercise for the elderly or patients with knee-related lesions.

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.

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.

Background: Light touch cue is a sensory input that could potentially help in the control of posture. The immediate stimulatory effect of light touch cues using a cane during gait is associated with postural stability. This strategy can help post-stroke individuals regain their ability to perform the sit-to-stand (STS) transfer safely. Objects: The effects of light grip on postural control during the STS transfer in post-stroke subjects were investigated. Methods: Eleven participants (6 men, 5 women) with hemiplegia due to stroke were recruited in the study. The subjects with hemiparesis performed STS transfer in three randomly assigned conditions (1) without a cane (2) light grip with a cane (3) strong grip with a cane. Results: The difference in weight-bearing distribution between the left and right feet, when the subjects were instructed to stand up, was 52.73±2.13% without a cane, 42.75±3.26% with a strong grip, and 43.00±2.55% with a light grip (p<.05). The rate of rise in force indicates the peak power provided by subjects during their STS transfers. The rate of rise in force was statistically significantly lower without a cane than that with a light grip or a strong grip (p<.05). The subjects’ centers of pressure sway on the mediolateral side during STS transfers statistically significantly declined with a light grip or a strong grip when compared to those without a cane (p<.05). Conclusion: When the subjects with hemiparesis used a cane during STS transfers, their duration, center of pressure sway, and difference in weight-bearing distribution were all reduced. The subjects also exhibited similar results during STS transfers with a cane gripped lightly. This result may provide guidelines for the use of assistive devices when patients with hemiparesis practice STS transfers in clinical settings.

Background: Assessments of Sit-to-Stand (STS) and gait functions are essential procedures in evaluating level of independence for the patients after stroke. In a previous study, we developed the software to analyze center of pressure (COP) in standing position on Wii Balance Board (WBB). Objects: This purpose of this study is to measure test-retest reliability of ground reaction forces, COP and time using WBB on STS and gait in healthy adults. Methods: Fifteen healthy participants performed three trials of STS and gait on WBB. The time (s), vertical peak (%) and COP path-length (㎝) were measured on both tasks. Additionally, counter (%), different peak (%), symmetry ratio, COP x-range and COP y-range were analyzed on STS, 1st peak (%), 2nd peak (%) of weight were analyzed on gait. Intra-class correlation coefficient (ICC), standard error measurement (SEM) and smallest real difference (SRD) were analyzed for test-retest reliability. Results: ICC of all variables except COP path-length appeared to .676∼.946 on STS, and to .723∼.901 on gait. SEM and SRD of all variables excepting COP path-length appeared .227∼8.886, .033∼24.575 on STS. SEM and SRD excepting COP path-length appeared about .019∼3.933, .054∼11.879 on gait. Conclusion: WBB is not only cheaper than force plate, but also easier to use clinically. WBB is considered as an adequate equipment for measuring changes of weight bearing during balance, STS and gait test which are normally used for functional assessment in patients with neurological problems and elderly. The further study is needed concurrent validity on neurological patients, elderly patients using force plate and WBB.

Excessive lumbar flexion during sit-to-stand (STS) is a risk factor for lower back pain. Postural taping can prevent unwanted flexion of the lumbar spine. This study aimed to demonstrate the effect of taping the lower back on the lumbopelvic region and hip joint kinematics during STS. Sixteen healthy subjects participated. All subjects performed the STS with and without taping of the lower back. A three-dimensional motion analysis system was used to measure the kinematics of the lumbar spine, pelvis, and hip joint during STS. The angle of the peak lumbar flexion, pelvic anterior tilting, and hip flexion and angular displacement of the lumbar spine between starting position and maximal lumbar flexion were collected. Paired t-tests, or Wilcoxon's rank-sum test for non-parametric distribution, were used to assess differences in the measurements with and without taping. A p-value ＜.05 was taken to indicate a significant difference. Significant differences were observed in the angle of the peak lumbar flexion, pelvic anterior tilting, hip flexion and angular displacement of the lumbar spine (p＜.05). Taping was associated with a significant decrease in the angle of peak lumbar flexion and angular displacement of the lumbar spine between the starting position and maximal lumbar spine flexion. In addition, the peak angle of pelvic anterior tilting and hip flexion were significantly increased with taping. The findings of this study suggest that taping the lower back can decrease excessive lumbar flexion, and increase the pelvic anterior tilting and hip flexion motion during STS.

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 sit-to-stand ativities and to suggest a new therapeutic approach for movement reeducation in patients who have difficulty with sit-to-stand activities. The three different 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 analyze the kinematic component of STS, a motion analysis system (Zebris) was applied to the ankle, knee, hip joint, and thigh-off area. Also, to determine the onset time of muscle contraction, surface electrodes were placed to the rectus femoris muscle (RF), the vastus lateralis muscle (VL), the biceps femoris muscle (BF), the tibialis anterior muscle (TA), the gastrocnemius muscle (GCM), and the soleus muscle (SOL). One-way repeated ANOVA was used for the statistical analysis. First, significant differences were found in kinematic variables for the hip, knee, ankle joint, and thigh-off among the three activities. Second, there was significant difference in muscle activation pattern in TA. VL. and BF among three activities. In conclusion, the findings of this study suggest the following evaluative and therapeutic approach for STS activity: (1) Changes in knee and ankle joints should be prioritized and recruitment order differences in VL and RF can be generated to accomplish abnormal STS activity. (2) APT STS can be introduced for movement efficiency and functional advantage when abnormal STS is treated.

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.

연구의 배경 앉은 자세에서 일어서기는 일상생활동작중 흔한 동작중의 하나이다. 노인들을 포함한 많은 환자들은 앉은 자세에서 일어서기에 어려움이 있고 속도가 감소한다. 이 연구의 목적은 다른 두 속도로 앉은 자세에서 일어서는 동작을 실행할 때 최대 지면반발력의 세개의 요소를 비교하는 것이다. 대상자 22명의 건강한 성인 (20-36세)을 대상으로 하였다. 실험방법 앉은 자세에서 일어서기동작 수행중 최대 지면반발력을 측정하기 위하여 힘판을 사용하였다. 대상자

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.