Background: The Nordic hamstring exercise is a closed-chain exercise that effectively activates all lower extremity muscles, but there is a lack of consideration of ankle joint which affects exercise effectiveness. One of the major advantages of the Nordic exercise have been known as strengthening lower extremity extensors. This manifests the exercise increases activities of the ankle plantar flexors as well as hip extensors. Objectives: To investigated the impacts of changes in ankle position on the lower extremity musculature and subjective difficulties during the Nordic hip extension exercise. Design: Cross-sectional study. Methods: Twenty the healthy male participants participated in this study. Participants perform three variations of the Nordic exercises including three ankle positions. Each Nordic exercise was defined as ankle position (neutral, dorsiflexion and plantar flexion). During the Nordic exercise, erector spine (ES), gluteus maximus (GM), biceps femoris (BF), gastrocnemius (GCM) activities and subjective difficulties (Borg RPE score) were measured. Results: Muscular activities of the biceps femoris and gastrocnemius were significantly different among the three ankle conditions, which showed controversial results (P<.05). The biceps femoris activity was significantly higher with the dorsiflexion condition, compared to the others (P<.05). On the other hand, activity of the gastrocnemius was significantly higher with the plantarflexion position compared to the others (P<.05). Conclusion: Present study suggests the ankle positional changes could affect lower muscular activities during the Nordic exercise. Although it is difficult to affirm the causes due to limited data, selective activation of the biceps femoris might accomplish with ankle dorsi flexion and that of the gastrocnemius might accomplish with the ankle plantarflexion during the Nordic exercises.

목적 : 본 연구는 상지근력 저하로 인해 일상생활 활동 수행이 제한되는 근육병 장애인을 대상으로 Arm Support 사용에 따른 작업 부하의 변화와 심리·사회적 영향을 알아보고자 하였다. 연구방법 : 연구 대상자는 지역사회에 거주하는 근육병 장애인 3명으로, 모두 척수성 근위축증을 진단받았다. 대상자는 능 동형 Arm Support 적용 전·후에 식사, 마스크 착용, 머리 빗기 활동을 수행하였다. 이후, NASA-TLX를 통해 능동형 Arm Support 적용 전·후 활동의 작업 부하를 측정 및 비교하였으며, 한국판 보조공학기기 심리·사회적 영향 척도 (K-PIADS)를 활용하여 Arm Support의 심리·사회적 영향력을 측정하였다. 마지막으로, 인터뷰를 통해 기기 사용 후 느낀 주관적인 감정 등에 대해 알아보았다. 결과 : 작업 부하 변화는 Arm Support 적용 후에 모든 항목의 평균 점수가 감소하였으며, 신체적 요구도 항목의 평균 점수가 가장 많이 감소하였다. 심리·사회적 영향 측정 결과는 하위 영역인 자기욕구 실현능력 2.08점(‘긍정적인 영향 ~ 매우 긍정적인 영향’), 적응성 2.06점(‘긍정적인 영향 ~ 매우 긍정적인 영향), 자존감 1.71점(’다소 긍정적인 영향 ~ 긍정 적인 영향‘)이었다. 인터뷰를 통해, 대상자는 Arm Support 사용함으로써 활동 수행 시 자신감, 만족감, 편안함 등을 느 꼈지만, Arm Support 구조가 정확하게 고정되지 않거나 휠체어 구조물의 간섭으로 인해 불편함 또한 느낀 것을 확인하 였다. 결론 : 본 연구를 통해 Arm Support가 근육병 장애인의 작업 부하를 낮추며, 긍정적인 심리·사회적 영향을 미치는 점 을 알 수 있었다. 추후에는 다양한 유형의 근육병 장애인을 대상으로 실생활 기반의 연구가 진행되어야 할 것이며, 체계 적인 평가를 통해 맞춤형의 서비스가 이루어져야 할 것이다. 본 연구의 결과가 Arm Support를 중재 전략으로 활용하는 연구와 서비스에 기초자료로 활용되기를 기대한다.

본 연구의 목적은 해부학적 근거로 제작한 5가지의 EMS 요추 복압 벨트가 요추 안정화에 미치는 영향을 연구하는 것이다. 본 연구는 요방형근, 척추세움근, 내복사근, 외복사근, 대요근으로 총 5가지의 코어 근육을 선정하여 이에 맞는 근육 모양과 통증 유발점인 압통점을 고려해 전도성 원단으로 패턴을 설계하여 복압 벨트에 결합했다. 총 4가지 동작으로 실험을 진행하여 각각 다른 EMS복압 벨트가 요추 안정화에 미치는 영향을 알아보았다. 건강한 신체의 20대 남성 5명을 대상으로 진행하였고 선정 조건은 최근 3개월 동안 요통 과거력이 없고 사전 검사를 통해 제한되는 동작이 없고, 체간의 근력이 정상등급에 속한 대상이다. 실험 동작의 순서는 하지직거상 검사, 좌전굴, 체전굴, 배근력으로 다음 동작에 제한되지 않게 선정하였다. 동작 간의 휴식은 2분으로 진행하였고, EMS복압 벨트를 착용 후 실험을 진행할 때는 혈류량 증가와 근 활성화를 위해 전기자극을 10분씩 적용하고 진행하였다. 실험 결과의 통계는 비모수 검정으로 윌콕슨 검정과 프리드만 검정을 실시함으로 구체적인 차이를 분석하였다. 본 연구의 결과 5가지의 패턴 중 5,4,3,1,2 순으로 Type별 순위 결과를 확인할 수 있었으며 각 근육의 움직임과 연관성이 있는 실험 동작에 조금 더 유의미한 결과를 확인할 수 있었다. 본 연구의 결론은 해부학적 근거로 제작된 패턴으로 인해 각 근육에 각기 다른 모양으로 전기자극을 전달하였을 때 구분되는 효과를 확인할 수 있었으며 일반인 대상으로 일상생활이나 트레이닝에 있어 요추 안정화를 향상할 수 있을 것으로 기대된다.

Background: The spinal nerves, which start at the lumbar level, are connected to the nerve innervation in the knees. Currently, there is a lack of research on the treatment of knee pain through lumbar mobilization. Objectives: To investigate the effects of lumbar joint mobilization (LJM) and transcutaneous electronic nerve stimulation (TENS) on proprioception and muscular strength in volleyball players with chronic knee pain. Design: Two group pre-posttest. Methods: A total of 26 professional volleyball players with chronic knee pain were allocated to the LJM (n=13) and TENS (n=13) groups. In the LJM group, grade III - IV amplitude was applied 3 times for 1 minute (80 times per minute) at the affected lumbar (L2-3) facet joint in the prone position. In the TENS group, the TENS treatment device was used to directly apply or 15 minutes to the area of chronic knee pain (100 Hz, 150 ㎲). Proprioception was measured by knee flexion and extension angles, and muscle strength was evaluated using an isokinetic test. Measurements were taken before and after interventions. Results: In the eye opened conditiond, proprioception significantly increased during both knee extension and flexion after LJM, while only knee extension was significantly increased in the TENS group. There was also a significant difference in knee extension between the two groups. In the eye close conditiond, proprioception was significantly improved only during knee extension in the LJM group, and the difference in knee extension between the groups was also significant (P<.05). The maximum torque of the affected knee joint was significantly improved at 60°/sec in both groups (P<.05); however, there was no difference between the two groups. There was no significant difference in the maximum flexion torque within or between the groups. Conclusion: This study suggests that LJM improved proprioception and muscular strength in volleyball players with chronic knee pain.

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.

In the present study, the general characteristics, job stress, working conditions, and aspects of pain of some industrial workers working in Changwon-si, Gyeongsangnam-do, were surveyed. In analyzing the relationship between job stress and the existence of pain, the variables “working speed” and“ opportunities to develop abilities” were shown to have statistically significant relationships with the existence of pain (p≤.05). Regarding the relationship between working conditions and the existence of pain, the variables“ amount of work per hour,“” amount of work per day,“” number of parts handled during work,“” work production per person,” and“ inconvenient postures or motions during work” were shown to have statistically significant relationships with the existence of pain(P≤.05). Regarding aspects of pain“, within 1~3 years” was the most common answer to time of occurrence of symptoms, with a percentage of 27.6%“; appear almost always” was the most common answer to frequency of symptoms, with a percentage of 37.1%;“ slight pain” was the most common answer to degree of pain, with a percentage of 50.5%; and“ moderate” was the most common answer to encumbrance caused by pain to living and work, with a percentage of 41.2%. The aim of the present study was to determine the factors that affect pain due to musculoskeletal diseases in industrial workers and to define the aspects of pain in order to provide basic data for the preparation of measures to prevent musculoskeletal diseases. To control pain due to musculoskeletal diseases, factors that affect pain, as well as the aspects of pain, should be recognized early, and efforts should be made to supplement and improve systems for preventing recurrence.

The purpose of this study was to investigate the effects of vibration on Golgi tendon organ(GTO) and Hold-Relax of PNF in muscular activity and gait factors on Delayed Onset Muscle Soreness(DOMS). This study was conducted on 20 subjects. they were divided into two groups; Hold-Relax of PNF(n=10), Vibration on GTO(n=10). Both of the group was performed interventions 1 times a day for 3 days. The data was analyzed by the repeated-ANOVA for comparing before, after 24h and after 48h changes of factors in each group and the Independent t-test for comparing the between groups. The results are as follows. There was statistically significant difference of before, after 24h and after 48h vibration on GTO group and Hold-Relax of PNF group in muscular activity and gait factors on DOMS.(p<0.05). There was no statistically significant difference of between vibration on GTO group, but there was statistically significant difference Hold-Relax of PNF group in EMG, step width, step length, stride length(p>0.05). As a results of this study, Hold-Relax of PNF group are effective in improving muscular activity and gait factors

Muscular dystrophy is a hereditary musculoskeletal disorder caused by a mutation in the dystrophin gene. Duchenne muscular dystrophy (DMD) is one of the most common, and progresses relatively faster than other muscular dystrophies. It is characterized by progressive myofiber degeneration, muscle weakness and ultimately ambulatory loss. Since it is an X-linked recessive inheritance, DMD is mostly expressed in males and rarely expressed or less severe in females. The most effective measurement tool for DMD is magnetic resonance imaging (MRI), which allows non-invasive examination of longitudinal measurement. It can detect progressive decline of skeletal muscle size by measuring a maximal cross-sectional area of skeletal muscle. Additionally, other techniques in MRI, like T2-weighted imaging, assess muscle damage, including inflammation, by detecting changes in T2 relaxation time. Current MRI techniques even allow quantification of metabolic differences between affected and non-affected muscles in DMD. There is no current cure, but physical therapist can improve their quality of life by maintaining muscle strength and function, especially if treatment (and other forms of medical intervention) begins in the early stages of the disease.

The spinal cord is highly complex, consisting of a specialized neural network that comprised both neuronal and non-neuronal cells. Any kind of injury and/or insult to the spinal cord leads to a series of damaging events resulting in motor and/or sensory deficits below the level of injury. As a result, muscle paralysis (or paresis) leading to muscle atrophy or shrinking of the muscle along with changes in muscle fiber type, and contractile properties have been observed. Traditionally, histology had been used as a gold standard to characterize spinal cord injury (SCI)-induced adaptation in spinal cord and skeletal muscle. However, histology measurements is invasive and cannot be used for longitudinal analysis. Therefore, the use of conventional magnetic resonance imaging (MRI) is promoted to be used as an alternative non-invasive method, which allows the repeated measurements over time and secures the safety against radiation by using radiofrequency pulse. Currently, many of pathological changes and adaptations occurring after SCI can be measured by MRI methods, specifically 3-dimensional MRI with the advanced diffusion tensor imaging technique. Both techniques have shown to be sensitive in measuring morphological and structural changes in skeletal muscle and the spinal cord.

The present study purposed to examine the effects of transcutaneous electrical nerve stimulation, self-stretching and functional massage on the recovery of muscle contraction force for muscle fatigue caused by sustained isotonic contraction. The subjects of this study were 45 healthy students. They were divided into transcutaneous electrical nerve stimulation group(n=15), self-stretching group(n=15) and functional massage group(n=15), and using Primus RS. We observed the pattern of changes in maximal voluntary isometric contraction force(MVIC) after causing muscle fatigue in quadriceps femoris muscle through sustained isotonic contraction. Maximal voluntary isometric contraction force(MVIC) were greatly increased after transcutaneous electrical nerve stimulation, self-stretching and functional massage. In the comparison of recovery rate of muscle contraction force for muscle fatigue caused by sustained isotonic contraction among the treatment groups, it did not show any significant differences. However, it showed that each treatment may be effective in recovery of muscle fatigue caused by sustained isotonic contraction.

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.

목적 : 본 연구는 뇌성마비 아동에게 재활승마 프로그램을 적용하여 경련성과 근의 활성도에 재활승마가 미치는 영향을 알아보고자 하였다. 연구방법 : 연구 대상자는 12세 미만의 경련성 뇌성마비 아동 9명이었으며, 8주 동안 16회의 재활승마를 실시하였다. 재활승마 적용전, 2주, 4주, 8주 때에 주관절과 슬관절 굴곡근의 경련성 정도와 근 활성도를 측정하였다. 경련성은 Ashworth 척도, 근 활성도는 무선 표면 근전도를 사용하여 측정하였다. 경련성과 근활성도의 차이를 비교하기 위하여 반복측정 분산분석을 실시하였다. 통계적 유의수준은 .05로 하였다. 결과 : 재활승마 프로그램을 적용한 결과 주관절 굴곡의 경련성은 기간의 증가에 따라 유의하게 감소하는 결과가 나타났고, 슬관절 굴곡의 경련성은 기간의 증가에 따라 유의하게 감소하는 결과를 보였다(p<.05). 상완이두근의 근활성도는 기간의 증가에 따라 유의하게 증가하는 결과가 나타났으며, 대퇴이두근의 근활성도는 기간의 증가에 따라 유의하게 증가하는 결과를 보였다(p<.05). 결론 : 재활승마 후에 뇌성마비 아동의 경련성 감소와 근활성도 증가에 효과가 있는 것으로 나타났다. 따라서, 뇌성마비 아동의 경련성과 근 활성도를 개선을 위해 재활승마는 유용한 방법이라고 할 수 있겠다.

WMSD occurs by accumulating the visible position and movements. Therefore, it is easier to prevent WMSD from occurring than other diseases when each employee is aware of the factors which cause WMSD. Hence, We need to develop exercise remedy, which can be done without using any exercise equipments and regardless places. The exercise prescription for those for LBP was to do the upper body exercise remedy twice in the morning and another twice in the afternoon and the spinal exercise remedy and the lower body exercise remedy once in the morning and once in the afternoon. We measured their maximum muscular strength every second week using a fitness machine so that we could compare the differences of the muscular strength of the test group and the comparison group. Therefore this research presented the fact that the exercise remedy is effective to prevent and cure LBP through a scientific test. And it confirmed that the exercise remedy by the Ergonomic exercise prescriptions is effective on LBP.

This study has been conducted on the subjects of eight undergradu˗ ate students with abdominal obesity and eight undergraduate stu˗ dents with normal weight to find out correlation between substantial fatigue and Ratings of perceived exertion through analysis of their blood components when they took exercises to strengthen their abdominal muscular power. Comparatively analyzing HDL-C, LDL-C and lactic acid before and after they took sit-up at level of RPE 19-20, no statistically significant differences in HDL, LDL, lactic acid meas˗ ures were observed between groups, but a significant difference in RPE was noted between groups(p<0.05) Our findings suggest that control group showed no significant differ˗ ence in increase of fatigue material whereas the obese group showed a lower frequency of sit-up, though both groups took the same abdominal exercise. Additionally, the lower frequency of sit-up in obese group results from relatively higher Ratings of perceived exer˗ tion rather than increase of substantial fatigue material. This study invites future research that examines the effect of a comprehensive obesity exercise program combined with dietetic

The psychosocial stress and musculoskeletal disorders(MSDs) have been one of major health problems for hospital workers. This study tried to understand the relationship between symptoms associated with MSDs and risk factors such as working posture, job stress, psychosocial stress and fatigue. A total number of 655 hospital workers participated in this study. Specifically, REBA was applied for evaluating working posture and a checklist prepared by KOSHA(Korean Occupational Safety and Health Agency) was used for symptom survey. A questionnaire from KOSHA was also used for collecting data associated with job stress, psychosocial stress and fatigue. All these data were formulated and modeled by path analysis which was one of major statistical tools in this study. Specifically, path analysis for the data we collected came up with several major findings. As a result, as for body part(neck), (waist) and (arms) the degree of risk of work posture measured with the use of job stress(KOSS), psycho-social stress(PWI-SF) and REBA is significantly more affected by fatigue than muscular skeletal disease related consciousness symptom. However, regarding bod(wrist), the degree of risk of work posture measured with the use of job stress(KOSS) and REBA is directly affected by muscular skeletal disease related consciousness symptom. This study is meaningful in that the study clarified the causal relations of the degree of risk of work posture, degree of fatigue, and muscular skeletal disease related consciousness symptoms by each body part measured with the use of work stress(KOSS), psycho-social stress(PWI-SF) and REBA.

Human physical activity to lead daily life is performed by a variety of muscular activity strategies. These strategies can be influenced by characteristics, difficulty and muscle fatigue of work. Therefore this study examines muscular strengths (grip and back strength) of workers engaged in electronics industry in Korea, compares them to mean value of muscular strength by sex and age, accumulates related data and then aims to develop improvement methods of working environment and prevention/management program.

It is important to find the effective position for cough and sputum clearance in respiratory physical therapy. The purpose of this study was to compare the changes in peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), and peak cough flow (PCF) related to functional level and measurement position in patients with Duchenne muscular dystrophy. Twenty one subjects were classified into three functional levels, and measurements was undertaken in three different measurement positions (upright sitting, 45˚ reclining and supine). Vitalograph PEF/FEV DIARY was used to measure PEF and FEV1, and Ferraris Pocket Peak was used to measure PCF. Mixed two-way analysis of variance and Bonferroni post-hoc test were used for statistical analysis. The results of the study were as follows: 1) Significant main effects for measurement position were found. 2) PEF was the highest in upright sitting, followed by 45˚ reclining, and supine in order. 3)FEV1 in upright sitting and 45˚ reclining were significantly greater compared with that in supine. 4) PCF in upright sitting and 45˚ reclining were significantly greater compared with that in supine. 5) No significant main effects for functional level were found in PEF, FEV1, and PCF. 6) No significant functional level by measurement position interactions were found in PEF, FEV1, and PCF. Therefore, it is concluded that upright sitting and 45˚ degree reclining positions are recommended for effective cough and sputum clearance.

The purpose of this study is to compare the outcomes of manual stretching treatment with those of motor development and positioning physical therapy (MDPPT) for congenital muscular torticollis (CMT). This study was designed to be randomized controlled trials and to evaluate the outcomes of 43 consecutive patients with CMT who were first seen when they were average 26 days old. Before treatments, the patients were unintentionallv classified into two clinical groups along with the treatment methods. Among the 43 patients, 22 were classified to the manual stretching group and 21 to the MDPPT group. By means of independent t-test on the result. the duration of treatment according to methods was not significantly different in two groups (p>.05). The duration of treatment in accordance with head tilt level was not significantly different in two groups (p>.05). There was change of mass diameter, between at the beginning day of treatment and after treatment in manual stretching group with a strong positive linear correlation (p=.000, r=.734), but slightly positive linear correlation in MDPPT group. The result of this study indicates that two therapeutic methods make little difference in effectiveness.

The purpose of this study was to verify the effects on fine motor, muscle strength (hand-grip), explosive muscular strength (vertical jump) and muscular endurance (sit-up) after ingesting coffee. Hence this study targeted a sample group of 38 healthy men in their twenties, without cardiac disorders and muscle disorders and none of them were hypersensitive to caffeine with symptoms such as palpitation and dyspnea. Nineteen of them ingested coffee, whereas the other nineteen men ingested decaffeinated coffee at the same amount. The amount of coffee was controlled by weight so as to regulate intake to 6 mg caffeine per kg. Research material was evaluated through O'Conner's finger dexterity test, hand-grip strength test, vertical jump test and sit-up test. The data were analyzed by means of paired t-test and ANCOVA. The material was then, analyzed by means of two-way ANOVA in order to verify the effect of one or two cups of coffee on fine motor and hand-grip strength. All parameters were measured by an independent observer. The results were as follows: There were no significant differences to fine motor, hand-grip strength, vertical jump, sit-up before and after drinking decaffeinated coffee, but there was a difference to those before and after drinking caffeine coffee. There was no significant difference to hand dexterity and hand-grip strength in one or two cups of coffee. Intake of a certain dosage of caffeine effects activation of muscles working in a short period based on the results. As a consequence, intake of certain dosages of caffeine was beneficial to enhance efficiency of activity during exercises, but it is will be difficult to obtain the desired result with only one or two cups of coffee.