Background: Neuromuscular electrical stimulation (NMES) is used for muscle strengthening. While voluntary muscle contraction follows Henneman et al.’s size principle, the NMES-induced muscle training disrespects the neurophysiology, which may lead to unwanted changes (i.e., declined balance ability). Objects: We examined how the balance was affected by abdominal muscle training with the NMES. Methods: Fifteen young adults (10 males and 5 females) aged between 21 and 30 received abdominal muscle strengthening with NMES for 23 minutes. Before and after the training, participants’ balance was measured through one leg standing on a force plate with eyes open or closed. Outcome variables included mean distance (MDIST), root mean square distance (RDIST), total excursion (TOTEX), mean velocity (MVELO), and 95% confidence circle area (AREA) of center of pressure data. Two-way repeated measures analysis of variance was used to test if these outcome variables were associated with time (pre and post) and vision. Results: All outcome variables were not associated with time (p > 0.05). However, all outcome variables were associated with vision (p = 0.0001), and MVELO and TOTEX were 52.4% (45.5 mm/s versus 95.6 mm/s) and 52.4% (364.1 mm versus 764.5 mm) smaller, respectively, in eyes open than eyes closed (F = 55.8, p = 0.0005; F = 55.8, p = 0.0005). Furthermore, there was no interaction between time and vision (F = 0.024, p = 0.877). Conclusion: Despite the different neurophysiology of muscle contraction, abdominal muscle strengthening with NMES did not affect balance.

Background: Neuromuscular electrical stimulation (NMES) is a physical modality used to activate skeletal muscles for strengthening. While voluntary muscle contraction (VMC) follows the progressive recruitment of motor units in order of size from small to large, NMES-induced muscle contraction occurs in a nonselective and synchronous pattern. Therefore, the outcome of muscle strengthening training using NMES-induced versus voluntary contraction might be different, which might affect balance performance. Objects: We examined how the NMES training affected balance and proprioception. Methods: Forty-four young adults were randomly assigned to NMES and VMC group. All participants performed one-leg standing on a force plate and sat on the Biodex (Biodex R Corp.) to measure balance and ankle proprioception, respectively. All measures were conducted before and after a training session. In NMES group, electric pads were placed on the tibialis anterior, gastrocnemius, and soleus muscles for 20 minutes. In VMC group, co-contraction of the three muscles was conducted. Outcome variables included mean distance, root mean square distance, total excursion, mean velocity, 95% confidence circle area acquired from the center of pressure data, and absolute error of dorsi/plantarflexion. Results: None of outcome variables were associated with group (p > 0.35). However, all but plantarflexion error was associated with time (p < 0.02), and the area and mean velocity were 37.0% and 18.6% lower in post than pre in NMES group, respectively, and 48.9% and 16.7% lower in post than pre in VMC group, respectively. Conclusion: Despite different physiology underlying the NMES-induced versus VMC, both training methods improved balance and ankle joint proprioception.

Background: Stroke patients require arm movement exercising for various stimulations in standing position for various stimulations rather than in a sitting position because they require integrated skillful movements, such as stretching, holding, and controlling. Objective: This study was conducted to provide foundational clinical data about lower limb global synkinesis in stroke patients using arm movements in a standing position. Design: Randomized controlled trial. Methods: The subjects were divided into a control group (n = 10) and an experimental group (n = 10), and a pre-test was conducted to evaluate leg global synkinesis (GS) and balance. Intervention method is stretching an arm to hold a ball, repeating supination and pronation of the hand only while maintaining the arm extended as much as possible, repeating shoulder abduction and adduction while holding the pegboard. This was followed by a three-week intervention during which re-measurement was conducted in the same way as was done for the pre-test. Results: The control group showed a significant difference in GS and balance during plantar flexion (p<.05), and the experimental group showed a significant difference in GS and balance during all movements (p<.05, p<.01, respectively). There was a significant difference in GS and balance between the two groups during dorsiflexion (p<.05, p<.01, respectively). Conclusion: The findings demonstrate that human arm movements in a standing position can reduce GS in the affected limb, and balance can be improved by stimulating the surrounding tissues of the affected limb and changing them positively.

The purpose of this study was to investigate the short-term effects of lumbar rotational mobilization under the single-leg standing (SLS) position. Fifteen healthy individuals were recruited, and randomized to agroup of trunk rotational exercise (TRE) and lumbar rotational mobilization (LRM). Trunk twist rotational exercise was performed to the TRE group, and mobilization was applied to the LRM group on the lumbar spine. Velocity of the center of pressure (VCOP) and center of pressure (COP) for each participant were measured through SLS. COPs were not significantly increased or decreased after treatment in both groups. VCOPs also did not change considerably except on the right side when the eye was closed. There was no significant difference between COPs and VCOPs in two groups. This study suggests that trunk rotation exercise and lumbar rotation mobilization would have similar effects on balance ability.

Background: At present time, smartphones have become very popular and powerful devices, and smartphone applications with the good validity have been designed to assess human balance ability. Objects: The purpose of this study is to evaluate the feasibility of smartphone acceleration in the assessment of postural control ability for six different conditions. Methods: Twenty healthy college-aged individuals volunteered. Static balance ability was measured twice with one-day interval using smartphone application and 3D motion capture system under the six different conditions. Results: Dominant frequencies for each test condition did not show significant differences except for two conditions. The intra-rater correlation coefficient between the first and second tests showed high correlations in six conditions(r>.70, p<.05). Smartphone acceleration and the acceleration calculated from the 3D marker position data showed high correlation coefficient(r>.80, p<.001). Conclusion: Acceleration recorded from a smartphone could be useful assessment variables for balance test in the clinical field.

Background: South Korea is one of fastest aging countries in the world. Poor balance and falls of the elderly are main health issues. Objects: The goal of this study was to understand the association between the socioeconomical factors and the standing balance of elderly living in the rural and urban area. Methods: One hundred sixty-six elderly participants who were older than 65 and were able to walk without an assistive device were recruited in the city of Gwangju and in the rural area of Jeonnam, South Korea. All participants performed the static and dynamic standing balance tests. Static standing balance was measured with chronometer in seconds while standing on one leg. Dynamic balance was tested with the timed up and go test (TUG), measured in seconds while getting up from a chair and walking 3 meters and back to sit. The static and dynamic standing balance was analyzed using analysis of variance and the Fisher’s Least Significant Difference post hoc test. Results: Male participants from both areas had no difference in one leg standing and TUG. The female elderly living in rural area took shorter in TUG than females living in urban area. Age decreased the one leg standing time in both areas while did not affect the TUG significantly. As the monthly income increased, both of one leg standing and TUG increased in urban area, while the medium monthly income showed best performance (it was not statistically significant) in both of one leg standing and TUG in rural area. Conclusion: Socioeconomical factors affects differently the standing balance of the elderly living in rural and urban South Korea. Female living alone in urban area with low monthly income demonstrated worst standing balance in this study.

The purpose of this study was to test the effect of Gastrocnemius and Low Back-muscle isotonic exercise on static•dynamic standing balance during the period of 4 weeks. This study was two groups pretest-posttest design. Nineteen subjects who were over 22 years old were randomly assigned to either the experimental group that received the Gastrocnemius muscle exercise(n=9) or the low back muscle exercise(n=10) : The former group performed isotonic exercise(plantar flexion), the latter group performed isotonic exercise(trunk extension) a total of 18 times for three times per week for four weeks. Two groups also performed static and dynamic balance before the exercise and 4weeks after the exercise. The data were analyzed by using the paired t-test and independent t-test. The results were as follows: As compared with change of dynamic balance performance capacity at two groups, a significant difference was shown in the test(p<.05), but not in static balance(p>.05). Also, a significant difference of balance between groups was not shown in the test. In this study indicated that gastrocnemius and low back muscle isotonic exercise will have positive impact on standing balance.

Multi-sensory systems, including the visual, somatosensory, and vestibular ones, are involved in maintaining standing balance. The organization of these sensory systems is as important as the efficiency of each individual system in maintaining optimal balance. The purpose of the present experiment was to investigate the developmental changes in static standing balance and sensory organization under altered sensory conditions. This study involved 64 children (from 4 to 15 years of age) and 17 young adults. The children were divided into four age groups: 4~6, 7~9, 10~12, and 13~15 years. Static standing balance was assessed with the one-leg standing test under four different sensory conditions: the children stood on a firm surface with (1) eyes open or (2) closed, and they stood on a foam surface with eyes (3) open or (4) closed. In balancing ability, the age groups exhibited significant differences. The function of sensory organization for balance control was poorer for the children than for the young adults. The functional efficiency of the somatosensory system of the children aged 7~9 years was at the young adults' level, and the visual function of the children aged 10~12 years had also reached the young adults' level. However, the functional efficiency of the vestibular system of children was significantly lower than that of the young adults, even at the age of 15 years. This may indicate that sensory organization and standing balance are still developing after the age of 15 years.

Body weight support treadmill training is a new and promising therapy in gait rehabilitation of patients with hemiplegia. The purpose of this study was to identify the effects of body weight support treadmill training on gait and standing balance in patients with hemiplegia. Eighteen patients with hemiplegia participated in the study. A 10 m-timed walk test, measurements of step length and standing balance score were administered. Intervention consisted of body weight support treadmill training five times a week for 2 weeks. The data were analyzed by paired t-test. Body weight support treadmill training scoring of standing balance, step length and 10 m-timed walk test showed a definite improvement. Body weight support treadmill training offers the advantages of task-oriented training with numerous repetitions of a supervised gait pattern. The outcomes suggest that patients with hemiplegia can improve their gait ability and standing balance through body weight support treadmill training.

이 연구는 성인 편마비 환자를 대상으로 PLS (Posterior Leaf Spring) 착용이 기립 균형에 미치는 영향을 알아보는 것이었다. 신발만 착용하였을 때의 기립조건과 신발과 PLS를 동시에 착용한 기립조건의 평균평형지수가 맨발로 서 있을 때의 기립조건에 비하여 높았다. 그러나 신발만 착용한 기립조건과 신발과 PLS를 함께 착용한 기립조건하에서의 평균평형지수의 차이는 없었다. 따라서 편마비 환자의 기립균형과 관련하여 PLS만을 착용한 효과와 신

The purpose of this study was to investigate the effect of functional strengthening exercise on static and dynamic standing balance in a child with cerebral palsy. The subject was a 7 year old boy with diplegia whose Gross Motor Function Measure (GMFM) score was 80% along with G1 of the lower extremities in Modified Ashworth Scale. The subject was ambulatory with some degree of limitation and demonstrated muscle weakness and strength asymmetry in the lower extremities. A changing criterion design for a single-subject research was used for this study. The functional strengthening exercise consisted of lower extremity ergometer exercise and knee exercise with grading movement in standing position, each for 20 minutes, which lasted 18 sessions for 6 weeks. A knee extensor strength test on both extremities and standing balance test were conducted after each functional strengthening exercise. Two types of standing balance were tested: one leg stance test and functional reach test. One leg stance test was to evaluate static standing balance, and functional reach test was to evaluate dynamic standing balance. The results showed that the functional strengthening exercise had some positive effects on improvement of both static and dynamic standing balance, and there was a positive correlation between the knee strength and standing balance.

The purpose of this study was to investigate whether the standing balance could be influenced by the different foot positions. Seventeen patients with hemiplegia were tested for the static and dynamic balance under the different foot positions. In the balance test, subject stood by bearing weight on one foot, and the other foot was positioned in three different positions (symmetric, anterolateral, and anterior position). This study used the Kinesthetic ability trainer (KAT2000) to measure the standing balance. The results were as follows: 1) There were significant differences in the static standing balance in different foot positions with both weight-bearing on the paretic limb and on the nonparetic limb (p<.05). 2) There were also significant differences in the dynamic standing balance in different foot positions with both weight-bearing on the paretic limb and on the nonparetic limb (p<.05). 3) There was a significant difference when the paretic weight-bearing and the nonparetic weight-bearing were compared (p<.01). 4) when the paretic weight-bearing and the nonparetic weight-bearing were compared, anterior foot position showed a significant difference in the dynamic standing balance (p<.05), but anterolateral foot position did not show a significant difference (p>.05). In this study, the standing balance showed a significant difference according to different foot positions in hemiparetic patients, and standing balance was better when they stood by bearing weight on the nonparetic limb. These results indicate that it is a necessary to consider both weight-bearing limb and foot position not only in the rehabilitation program but also in achieving the stability in the independent life.

The purpose of this study was to find a more effective balance training method. The subjects of this study were 14 children with cerebral palsy (7 males, 7 females) being treated at Seran Pediatric Developmental Research Center in Taegu. Two groups of children with cerebral palsy (everyday trained group, every-other-day trained group) were evaluated with visual & auditory feedback. Evaluation and training device was Balance Performance Monitor (BPM) Dataprint Software Version 5.3. There was statistically significant difference of the balance score between the pre-and the post-training in both group (p<.05), but there was no difference of the balance score between two groups (p<.05). In conclusion, it is likely that the visual and auditory feedback in children with cerebral palsy was effective in improving standing balance, but there was no difference between everyday trained group and every-other-day trained group.

Human balance is maintained through a complex process involving sensory detection of body motions, integration of sensorimotor information within the central nervous system, and execution of appropriate musculoskeletal responses. The basic task of balance is to position the body center of gravity (COG) over some portion of the support base. When the COG extends beyond the base of support, the person has exceeded the limits of stability (LOS). At this point, a step or stumble is required to prevent a fall. Automatic postural responses operate to keep the COG over the base of support. They are a set of functionally organized, long-loop responses that act to keep the body in a state of equilibrium. There are four commonly identified automatic postural responses, or strategies. These are ankle strategy, hip strategy, suspensory (knee) strategy, and stepping strategy. Thus, the purpose of this study was to evaluate the LOS using various knee strategies. Forty subjects participated in this study. The subjects were comprised of 20 males and 20 females who were without neurologic, orthopaedic or balance performance impairments. The LOS was measured with a Balance Performance Monitor (BPM) Dataprint Software Version 5.3. The results of this study were as follows: 1) Knee joint angle which is to increase stability of standing balance with using knee strategy was at mid-range. 2) There were statistically significant differences in anteroposterior LOSs according to the knee strategy. 3) There were no statistically significant differences in mediolateral LOSs according to the knee strategy. 4) There were statistically significant differences of anteroposterior LOSs with using knee strategy according to gender. 5) There were no statistically significant differences in mediolateral LOSs with using knee strategy according to gender.

The Posterior Leaf Spring (PLS) has been used for hemiplegic patients in order to help their walking and to increase their balance function. Past studies have mainly focused on the PLS's influence on patients' walking without taking balance function into consideration. The purpose of this study was to identify the immediate effect of PLS on the standing balance in hemiplegic patients. Fifteen hemiplegic patients participated in this study: 10 men and 5 women, with an average age of 53.8 years. Standing balance was measured using a computerized dynamic posturography device under three conditions namely bare-foot standing, standing in shoes without PLS, and standing in shoes with PLS. The results were as follows: 1) The composite equilibrium scores of patients who stood in shoes only and stood in shoes with PLS were higher than those of patients who stood bare-foot. 2) There were no statistical difference in the composite equilibrium scores between the standing condition of patients who stood bare foot and that of patients who stood in shoes with PLS. In conclusion, it is not clear whether or not the PLS affects the standing balance of hemiplegic patients. Further study is required to determine the precise effect of the PLS on standing balance in hemiplegic patients who are not wearing shoes. This is particularly relevant in Korea culture where custom demands the removal of shoes when entering any house or even many restaurants.

The purpose of this study was to compare the balance ability at different foot angle with KAT 2000 (Breg, Inc., Vista, CA. 1994). Forty-nine (male 24, female 25) normal subjects participated in this study. All subjects were assessed under two conditions. One was eye-opened condition and the other one was eye-closed one in 3 psi surface condition. All subjects were tested at different foot angle that were toe-in , , toe-out and . The subject attempted to keep the platform as stable as possible with eyes closed and with eyes opened for every 20 seconds. The starting position was that subject crossed their arms across chest and flexed knees slightly. The results of each test were showed by a score on screen, which meant balance index. The se collected data were analyzed by using oneway ANOVA, Scheffe test, and t-test. The results of this study were as follows: 1. When the foot angle were changed, balance index was the lowest in toes-out condition and greatest with toes-in with eyes opened and with eyes closed. There were statistically significant difference with eyes opened and with eyes closed (p<0.05). 2. There was statistically significant difference in balance index according to visual condition and the balance index tested with eyes closed was higher than with eyes closed(p<0.05). 3. There was statistically significant difference in balance index by gender(p<0.05).