The effect of a novel core stabilization technique on managing patients with chronic low back pain: a randomized, controlled, experimenter-blinded study.

OBJECTIVE: To identify the effect of a novel augmented core stabilization exercise technique on physical function, pain and core stability in patients with chronic low back pain. DESIGN: A block randomized controlled trial with two groups. SETTING: A sports rehabilitation clinic. PARTICIPANTS: Forty patients with low back pain (20 experimental, mean (SD) age 50.35 (9.26) years and 20 control, 51.30 (7.01)), 19 men and 21 women. INTERVENTIONS: In the experimental group ankle dorsiflexion was used in addition to drawing in the abdominal wall; the control group involved drawing in the abdominal wall alone. Both groups received the same conventional physical therapy training three days a week for eight weeks. MAIN OUTCOME MEASURES: Physical disability instruments; Oswestry Disability Index and Roland Morris Disability Questionnaire; pain intensity assessments; visual analogue scale, Pain Disability Index, and a pain rating scale; and core stability measures, such as the active straight leg raise, were determined at pretest, posttest and two-month follow-up. RESULTS: After the intervention, the experimental group showed significant greater improvement at two months compared with the control group. Physical disability results included Oswestry Disability Index (P = 0.001, from 24.25 (7.08) to 13.35 (4.17)) and Roland Morris Disability Questionnaire (P = 0.001, from 15.55 (1.99) to 8.15 (1.69)), pain intensity including visual analogue scale (P = 0.001, from 6.30 (1.03) to 3.35 (0.59)), Pain Disability Index (P = 0.001, 31.25 (5.44) to 19.00 (3.58)) and pain rating scale (P = 0.001, from 72.25 (18.73) to 50.10 (15.47)), and the core stability test such as active straight leg raise (P = 0.001, from 7.40 (0.75) to 2.15 (0.49)). CONCLUSIONS: This study provides the clinical evidence that adding ankle dorsiflexion to drawing in the abdominal wall gave increased benefit in terms of physical disability, pain and core stability in patients with chronic low back pain.

Accuracy of the detection of infratentorial stroke lesions using perfusion CT: an experimenter-blinded study.

INTRODUCTION: Although perfusion CT (PCT) for the detection of supratentorial stroke is well established, there is a dearth of evidence of its effectiveness in the detection of infratentorial stroke. Hence, this study compared sensitivity, specificity, and accuracy of PCT maps between infratentorial and supratentorial stroke lesions. METHODS: One hundred patients with acute stroke who had successfully undergone near whole-brain PCT with the toggling table technique and follow-up MRI were included. Wilcoxon Mann-Whitney test was performed at P<0.01. RESULTS: There was no significant statistical difference in the accuracy (91.79% vs. 93.23% in regional cerebral blood volume; 92.26% vs. 95.31% in regional cerebral blood flow; 89.17% vs. 92.71% in mean transit time; 89.76% vs. 92.19% in time to peak; P>0.01 in all PCT maps) between supratentorial and infratentorial stroke. Also, there was no remarkable difference in both sensitivity and specificity of PCT maps. CONCLUSION: This was the first study to investigate the accuracy of PCT with the toggling table technique in detection of infratentorial stroke lesions. Clinically, PCT is highly reliable and accurate in detecting infratentorial stroke lesions.

Neuroplastic effects of end-effector robotic gait training for hemiparetic stroke: a randomised controlled trial.

Detecting neuroplastic changes during locomotor neurorehabilitation is crucial for independent primal motor behaviours. However, long-term locomotor training-related neuroplasticity remains unexplored. We compared the effects of end-effector robot-assisted gait training (E-RAGT) and bodyweight-supported treadmill training (BWST) on cortical activation in individuals with hemiparetic stroke. Twenty-three men and five women aged 53.2 ± 11.2 years were recruited and randomly assigned to participate in E-RAGT (n = 14) or BWST (n = 14) for 30 min/day, 5 days/week, for 4 weeks. Cortical activity, lower limb motor function, and gait speed were evaluated before and after training. Activation of the primary sensorimotor cortex, supplementary motor area, and premotor cortex in the affected hemisphere significantly increased only in the E-RAGT group, although there were no significant between-group differences. Clinical outcomes, including the Fugl-Meyer assessment (FMA), timed up and go test, and 10-m walk test scores, improved after training in both groups, with significantly better FMA scores in the E-RAGT group than in the BWST group. These findings suggest that E-RAGT effectively improves neuroplastic outcomes in hemiparetic stroke, although its superiority over conventional training remains unclear. This may have clinical implications and provides insight for clinicians interested in locomotor neurorehabilitation after hemiparetic stroke.Trial Registration: ClinicalTrials.gov Identifier NCT04054739 (12/08/2019).

Use of a combination of ankle pressure and SENSERite system to treat older adults with impaired ankle proprioception: a single-blind experimental study.

OBJECTIVE: To investigate the effects of a combination of visual biofeedback and ankle pressure on ankle position sense in elderly adults with and without impaired ankle joint position sense (JPS). DESIGN: Independent 2 x 3 factorial design with an experimenter-blind study. SETTING: University motion laboratory. PARTICIPANTS: Older adults (N=40) were recruited from local community centers. Among them, 21 elderly subjects had relatively normative score, whereas 19 subjects had impaired ankle position sense. INTERVENTION: Both the normative and impaired elderly subjects underwent either ankle JPS visual feedback training alone or a combination of ankle JPS visual feedback training and circumferential ankle pressure for one 30-minute training session. MAIN OUTCOME MEASURES: The outcome measures included ankle JPS errors measured in absolute constant error (ACE) and variable error (VE) during standing at pretest, posttest, and 1-week follow-up test. A separate repeated measures analyses of variance was performed to evaluate the differential training effects on ACE and VE, respectively. The Pearson chi-square test and Bonferroni test were performed. Significance was assigned at P less than .05 for all analyses. RESULTS: Regardless of intervention conditions, older adults with and without ankle position sense impairment showed immediate treatment benefits, which relatively remained stable even at the follow-up test. These effects were reflected in significant improvements of JPS accuracy and consistency (P<.05). CONCLUSIONS: Our findings may suggest that both interventions were equally effective in increasing ankle JPS accuracy and consistency in older adults with and without impairments, and therapeutic effects lasted for a week, reflecting long-term effect.

The validity and reliability of the motor point detection system: a preliminary investigation of motor points of the triceps surae muscles.

OBJECTIVE: To investigate the validity and reliability of the motor point detection system in cadavers and healthy young adults. DESIGN: Correlation statistics. SETTING: University research laboratory. PARTICIPANTS: Sixty-two lower limbs of 31 healthy young adults (mean age, 22.3+/-1.8) and 10 size-matched lower limbs from cadavers were used. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The validity of the motor point detection system's motor point measure was determined by comparing the motor point locations of the lower-leg muscles obtained from the motor point detection system with the established anatomic motor point locations from our previous cadaveric dissection study. The anatomic motor points were determined by tracing the terminal motor nerve branches on soleus, medial, and lateral gastrocnemius muscles through the dissection of adult cadavers. The test-retest reliability was determined by repeatedly measuring the locations of motor points in healthy young adults on 2 separate occasions, approximately 24 hours apart. The intraclass correlation coefficient (ICC) was computed to determine correlation, and an independent t test was used to determine the difference between the demographic and clinical variables at the significance level (P<.05). RESULTS: Correlation analysis revealed relatively high validity between the motor point detection system and cadaver-dissected motor point location measurements (ICC(2,1)=.71-.92, P<.05). The test-retest reliability showed excellent correlation between the repeated measures (range, ICC(1,2)=.90-.95 at P<.05). CONCLUSIONS: Our results showed that the motor point detection system was accurate and consistent in the measurement of motor point locations of the lower-leg muscles. This system can be considered as an alternative device to localize motor points in clinical settings. Our motor point detection system warrants further investigation in pathologic population.

Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: a preliminary investigation.

The present study highlights the effects of the dual-task cognitive-gait intervention (CGI) on working memory and gait functions in older adults with a history of falls. Thirteen older adults with a history of falls were recruited from local community centers and randomly stratified into either the control (n = 5) or experimental (n = 8) group. The experimental group received the dual-task cognitive-motor intervention involving simultaneous motor (walking) and cognitive (memory recall) task whereas the control group received a placebo treatment (walking with simple music). The intervention was provided 30 minutes per session, over a 6-week period. Memory measures included a combination of word recall and arithmetic task. Gait function measures included velocity and center of pressure (COP) stability. Non-parametric tests were used at p < 0.05. The experimental group showed a greater memory performance than the control (p < 0.05). However, no significant intervention-related changes in gait velocity and stability were observed. Our findings provide the first evidence in literature to demonstrate that the long-term dual-task cognitive-motor intervention improved memory of older adults with a history of falls under the dual cognitive motor task condition.

Comprehensive Hand Repetitive Intensive Strengthening Training (CHRIST)-induced morphological changes in muscle size and associated motor improvement in a child with cerebral palsy: an experimenter-blind study.

PURPOSE: This case study was conducted to determine Comprehensive Hand Repetitive Intensive Strengthening Training (CHRIST)-induced morphological changes in the commonly affected extensor carpi radialis (ECR) and triceps brachii (TRI) muscle and associated muscle strength and motor performance in a child with hemiparetic cerebral palsy (CP) using standardized clinical tests and ultrasound imaging. DESIGN: A single case study with pre-/post-test. SUBJECT: A 4.9-year-old female, diagnosed with hemiparetic CP. METHOD: The child received a 5-week course of CHRIST course, comprising of 60-minute periods a day, five times a week. A real-time ultrasound imaging was performed to determine the CHRIST-induced changes in cross-sectional area (CSA) of the ECR and TRI. Clinical tests including the modified Wolf Motor function test (WMFT), the modified Jebsen-taylor hand function test (Jebsen hand) and the modified Pediatric Motor Activity Log (PMAL) questionnaire were used to compare the intervention-related changes in motor performance in upper extremity. RESULTS: Ultrasound imaging data showed that the CSAs of both ECR and TRI muscles of the affected upper limb at relaxation and contraction states were enhanced and these therapy-induced morphological changes were associated with enhanced muscle strength and gross motor performance in reaching and grasping skills. CONCLUSIONS: Our results suggest that the CHRIST is effective in treating muscle weakness and motor function in a child with hemiparetic CP. This is the first evidence in literature that might shed light on the therapeutic efficacy of our novel intervention on muscle size, associated muscle strength and motor improvement.

Comparison of isometric cervical flexor and isometric cervical extensor system exercises on patients with neuromuscular imbalance and cervical crossed syndrome associated forward head posture.

BACKGROUND: Isometric cervical flexor system exercise (ICF) and isometric cervical extensor system exercise (ICE) are cervical stabilization techniques that have been used to restore cervical crossed syndrome (CCS)-associated forward head posture. However, the therapeutic effects and underlying motor control mechanisms remain elusive. PURPOSE: The purpose of present study was investigating the concurrent therapeutic effects of ICF and ICE on muscle size, muscle imbalance ratio, and muscle recruitment sequence using ultrasound imaging and electromyography. METHODS: A total of 18 participants (7 females; age=24±4.0 years) with CCS associated with forward head posture underwent ICF and ICE. Paired t-test analysis was used for statistical analysis. RESULTS: Paired t-test analysis showed that sternocleidomastoid thickness was greater during ICF than ICE. Similarly, cross-sectional area and horizontal thickness of the longus colli were greater during ICE than ICF. The upper trapezius/lower trapezius muscle imbalance ratio and the pectoralis major/lower trapezius muscle imbalance ratio were significantly decreased during the application of ICE compared to ICF. CONCLUSIONS: These results provide compelling, mechanistic evidence as to how ICE is more beneficial for the restoration of neuromuscular imbalance than ICF in individuals with CCS.

A novel spinal kinematic analysis using X-ray imaging and vicon motion analysis: a case study.

This study highlights a novel spinal kinematic analysis method and the feasibility of X-ray imaging measurements to accurately assess thoracic spine motion. The advanced X-ray Nash-Moe method and analysis were used to compute the segmental range of motion in thoracic vertebra pedicles in vivo. This Nash-Moe X-ray imaging method was compared with a standardized method using the Vicon 3-dimensional motion capture system. Linear regression analysis showed an excellent and significant correlation between the two methods (R2 = 0.99, p < 0.05), suggesting that the analysis of spinal segmental range of motion using X-ray imaging measurements was accurate and comparable to the conventional 3-dimensional motion analysis system. Clinically, this novel finding is compelling evidence demonstrating that measurements with X-ray imaging are useful to accurately decipher pathological spinal alignment and movement impairments in idiopathic scoliosis (IS).

Diaphragm breathing movement measurement using ultrasound and radiographic imaging: a concurrent validity.

Recent ultrasound imaging evidence asserts that the diaphragm is an important multifunctional muscle to control breathing as well as stabilize the core and posture in humans. However, the validity and accuracy of ultrasound for the measurement of dynamic diaphragm movements during breathing and functional core activities have not been determined. The specific aim of this study was to validate the accuracy of ultrasound imaging measurements of diaphragm movements by concurrently comparing these measurements to the gold standard of radiographic imaging measurements. A total of 14 asymptomatic adults (9 males, 5 females; mean age =28.4 ± 3.0 years) were recruited to participate in the study. Ultrasound and radiographic images were used concurrently to determine diaphragm movement (inspiration, expiration, and excursion) during tidal breathing. Pearson correlation analysis showed strong correlations, ranging from r=0.78 to r=0.83, between ultrasound and radiographic imaging measurements of the diaphragm during inhalation, exhalation, and excursion. These findings suggest that ultrasound imaging measurement is useful to accurately evaluate diaphragm movements during tidal breathing. Clinically, ultrasound imaging measurements can be used to diagnose and treat diaphragm movement impairments in individuals with neuromuscular disorders including spinal cord injuries, stroke, and multiple sclerosis.

The relationships between intra-abdominal echogenicity, cardiometabolic risk factors and physical performance in obese children.

While the abdominal adipose tissue has been identified as an important pathomarker for the cardiometabolic syndrome in adults, the relationships between the cardiometabolic risk factors and abdominal adipose morphology or physical performance levels have not been examined in children with obesity. Therefore, the specific aim of this study was to investigate the relationships between risk factors (BMI and physical activity levels and abdominal fat layers including subcutaneous, intra-abdominal preperitoneal and mesenteric fat thickness in children with obesity. 30 children with obesity (mean ± SD = 10.0 ± 4.5 yrs; 9 girls; BMI > 20) underwent physical performance (curl-ups, sit and reach, push-ups, and a 400-m run), ultrasound measurement of thickness of fat composition of the abdomen, blood pressure, oxygen consumption. Pearson correlation analysis showed significant correlations, ranging from -0.523- 0.898 between the intra-abdominal adipose tissue thickness, cardiometabolic risk factors (BMI, blood pressure, heart rate), and the curl-up physical performance test. In conclusion, the present study provides a compelling evidence that the intra-abdominal adipose tissue morphological characteristics were associated with BMI, physical performance, and most importantly cardiometabolic risk factors (blood pressure and heart rate), which eventually contribute to the development of cardiometabolic syndrome in adulthood.

Effects of innovative virtual reality game and EMG biofeedback on neuromotor control in cerebral palsy.

Sensorimotor control dysfunction or dyskinesia is a hallmark of neuromuscular impairment in children with cerebral palsy (CP), and is often implicated in reaching and grasping deficiencies due to a neuromuscular imbalance between the triceps and biceps. To mitigate such muscle imbalances, an innovative electromyography (EMG)-virtual reality (VR) biofeedback system were designed to provide accurate information about muscle activation and motivation. However, the clinical efficacy of this approach has not yet been determined in children with CP. The purpose of this study was to investigate the effectiveness of a combined EMG biofeedback and VR (EMG-VR biofeedback) intervention system to improve muscle imbalance between triceps and biceps during reaching movements in children with spastic CP. Raw EMG signals were recorded at a sampling rate of 1,000 Hz, band-pass filtered between 20-450 Hz, and notch-filtered at 60 Hz during elbow flexion and extension movements. EMG data were then processed using MyoResearch Master Edition 1.08 XP software. All participants underwent both interventions consisting of the EMG-VR biofeedback combination and EMG biofeedback alone. EMG analysis resulted in improved muscle activation in the underactive triceps while decreasing overactive or hypertonic biceps in the EMG-VR biofeedback compared with EMG biofeedback. The muscle imbalance ratio between the triceps and biceps was consistently improved. The present study is the first clinical trial to provide evidence for the additive benefits of VR intervention for enhancing the upper limb function of children with spastic CP.

Inter-tester and intra-tester reliability of ultrasound imaging measurements of abdominal muscles in adolescents with and without idiopathic scoliosis: a case-controlled study.

The present study established inter-tester and intra-tester reliabilities of ultrasound imaging and diagnostically differentiated muscle imbalances in lateral abdominal muscle sizes between normal adolescents and adolescents with idiopathic scoliosis (AIS). Fifteen adolescents with AIS were age- and gender-matched with 15 normal adolescents. There was no significant difference between bilateral abdominal muscles in normal adolescents, but there was a significant difference between bilateral abdominal muscles in adolescents with AIS (P<0.05). Overall, inter-tester and intra-tester reliabilities in normal and AIS adolescents ranged from 0.801-0.984. This novel study shows that using ultrasound imaging to measure lateral abdominal muscle thickness is: (1) highly reliable between and within the testers; and (2) capable of distinguishing between subjects with and without pathological muscle morphology due to AIS.

Effects of functional movement strength training on strength, muscle size, kinematics, and motor function in cerebral palsy: a 3-month follow-up.

We investigated the long-term effects of comprehensive hand repetitive intensive strengthening training (CHRIST) on strength, morphological muscle size, kinematics, and associated motor functional changes in children with cerebral palsy (CP). Ten children (5 boys, 5 girls; age range, 6-11 years, mean age, 8.6 years) participated in the study. The children were classified according to the Manual Ability Classification System: 5 were Level II, 2 were Level III, and 3 were Level IV. Quantitative biomechanical measurements were performed to determine muscle strength, muscle size, kinematics (normalized jerk score), and motor function using a dynamometer, ultrasound, Vicon motion analysis, and standardized clinical tests (Quality of Upper Extremity Skills Test, Jebsen-Taylor Hand Function Test, Functional Independence Measure, and Pediatric Motor Activity Log), respectively. Muscle strength, muscle size, kinematics, and motor function significantly improved after a 10-week intervention (3 times a week), and the long-term effects remained even at the 3-month follow-up. In conclusion, this is the first study highlighting the long-term efficacy of upper extremity strength training using the novel CHRIST system in children with CP, which will potentially open up new horizons for effective management in pediatric neurorehabilitation.

Cocontraction of ankle dorsiflexors and transversus abdominis function in patients with low back pain.

CONTEXT: The abdominal draw-in maneuver (ADIM) with cocontraction has been shown to be a more effective method of activating the transversus abdominis (TrA) in healthy adults than the ADIM alone. Whether such an augmented core stabilization exercise is effective in managing low back pain (LBP) remains uncertain. OBJECTIVE: To determine the effect of 2 weeks of ADIM and cocontraction training on abdominal muscle thickness and activation timing and to monitor pain and function in patients with LBP. DESIGN: Case-control study. SETTING: Local orthopaedic clinic and research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty patients with mechanical LBP (age = 27.20 ± 6.46 years, height = 166.25 ± 8.70 cm, mass = 58.10 ± 11.81 kg) and 20 healthy, age-matched people (age = 24.25 ± 1.59 years, height = 168.00 ± 8.89 cm, mass = 60.65 ± 11.99 kg) volunteered for the study. INTERVENTION(S): Both the LBP and control groups received ten 30-minute sessions of ADIM and cocontraction training of the tibialis anterior (TA) and rectus femoris (RF) muscles over a 2-week period. MAIN OUTCOME MEASURE(S): A separate, mixed-model analysis of variance was computed for the thicknesses of the TrA, internal oblique (IO), and external oblique muscles. The differences in mean and peak electromyographic (EMG) amplitudes, onset time, and latency were compared between the groups. The visual analog pain scale, Pain Disability Index, and LBP rating scale were used to assess pain in the LBP group before and after the intervention. RESULTS: We found an interaction between the LBP and control groups and a main effect from pretest to posttest for only TrA muscle thickness change (F1,38 = 6.57, P = .01). Reductions in all pain measures were observed after training (P < .05). Group differences in peak and mean EMG amplitudes and onset time values for TrA/IO and TA were achieved (P < .05). The RF peak (t38 = 3.12, P = .003) and mean (t38 = 4.12, P = .001) EMG amplitudes were different, but no group difference was observed in RF onset time (t38 = 1.63, P = .11) or the cocontracted TrA/IO peak (t38 = 1.90, P = .07) and mean (t38 = 1.81, P = .08). The test-retest reliability for the muscle thickness measure revealed excellent correlations (intraclass correlation coefficient range, 0.95-0.99). CONCLUSIONS: We are the first to demonstrate that a cocontraction of the ankle dorsiflexors with ADIM training might result in a thickness change in the TrA muscle and associated pain management in patients with chronic LBP.

Motor point location index using regression equations for the tibialis anterior muscle.

PURPOSE: The present study highlighted a novel motor point location index (MPLI) for the precise localization of the motor point (MP) of the tibialis anterior (TA) using a regression equation. METHODS: Twenty healthy young adults (female=8; mean age ± SD=18.50 ± 0.32) were volunteered for this study. The regression analysis was performed by correlating the MP locations with anatomical landmarks. The TA muscle's MP location was bilaterally determined by needle electromyography (EMG) measurement. The anatomical landmarks included lower leg length (LLL), tibial tuberosity-intermalleolar line length (TT-ILL), the knee width (KW) and the leg width (LW). RESULTS: The excellent correlation between the TT-ILL and the vertical MP location was obtained, R(2) 0.815. Approximately 82% of the variance of the vertical MP location was accounted for by its linear relationship with the TT-ILL. The high correlation between the LW and the horizontal MP location was observed, R(2)=0.764. Approximately 77% of the variance of the horizontal MP location index was accounted for by its linear relationship with the LW. CONCLUSIONS: These findings indicate that the anatomical landmarks were useful to accurately predict MP locations for the TA muscle. Clinically, this MP location index using regression equations may be alternative for the current method that was not previously affordable.

The Effect of Comprehensive Hand Repetitive Intensive Strength Training (CHRIST) Using Motion Analysis in Children with Cerebral Palsy.

OBJECTIVE: To investigate the effect of Comprehensive Hand Repetitive Intensive Strength Training (CHRIST) on upper limb function in children with cerebral palsy using motion analysis. METHOD: The subjects in this study included 19 children (10 males, 9 females, mean age=8.8 years) with cerebral palsy. The experimental group (n=10) received CHRIST and general rehabilitation therapy. The control group (n=9) received a home program as well as general rehabilitation therapy. Both groups received 30 sessions of CHRIST or home program training for 60 minutes per session 3 times a week during the 10-week period. The reaching movements were captured by a motion analysis system. Kinematic variables including movement time (MT), mean velocity (MV), normalized jerk score (NJS), mean angular velocity (MAV) and normalized jerk score of the shoulder, elbow and wrist joint with comfortable and fast speed were analyzed between groups and the pre-post training group. RESULTS: After pre- and post-training experimental group, MT, MV, NJS, MAV of shoulder, elbow, wrist and NJS of elbow and wrist improved significantlyin reaching movement of both comfortable and fast speed (p<0.05). However, After pre- and post-training control group, MV improved significantlyin reaching movement of only comfortable speed (p<0.05). Between two groups, MT and MAV of the elbow at comfortable speed and NJS of the elbow at fast speed were statisticallysignificant (p<0.05). CONCLUSION: CHRIST proved to be an effective intervention for improving upper limb extremity function of reaching movement in children with cerebral palsy.

Use of the novel myokinetic stretching technique to ameliorate fibrotic mass in congenital muscular torticollis: an experimenter-blinded study with 1-year follow-up.

OBJECTIVE: To investigate the effect of the myokinetic stretching technique (MST) on morphological changes and associated clinical outcomes. METHOD: Infantile torticollis (N=32, 17 males) between 1 and 5 months of age (50.56 +/- 20.74 days) were treated with the MST for approximately 30 minutes per session, 5 times a week at university hospital. Diagnostic real-time ultrasound imaging was used on both unaffected and affected sides before and after the treatment to measure the sternocleidomastoid (SCM) muscle thickness of the involved area. Range of motion, head symmetry, and plagiocephaly with radiographs were determined. Data were analyzed using unpaired and paired t-test at p< 0.05. RESULTS: A significant reduction in SCM muscle thickness was observed after the intervention (p< 0.05). This morphological change was associated with significant improvements in passive cervical range of motion and head symmetry (p< 0.05). The mean intervention duration was 53.59 +/- 25.12 days to completely resolve the mass. These effects continued to exist one year post-intervention. CONCLUSIONS: This was the first clinical evidence that demonstrated the efficacy of MST for improving cervical motion and muscle thickness in infants with congenital muscular torticollis as well as shortening the treatment duration.

Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study.

OBJECTIVE: To examine an additive effect of virtual reality on balance and gait function in patients with chronic hemiparetic stroke. DESIGN: Twenty-four adults with hemiparetic stroke were randomly assigned to either an experimental group (n = 12) or a control group. Both groups underwent conventional physical therapy, 40 mins a day, 4 days a week for 4 wks. The experimental group received an additional 30 mins of virtual reality therapy each session. Balance performance was determined by the Balance Performance Monitor and Berg Balance Scale tests. Gait performance was determined by the 10-m walking test and Modified Motor Assessment Scale, and spatiotemporal parameters were obtained using GAITRite. Analysis of variance and correlation statistics were performed at P < 0.05. RESULTS: In the balance test, the experimental group had improved Berg Balance Scale scores, balance and dynamic balance angles (ability to control weight shifting) compared with the controls (P < 0.05). In the gait performance test, the experimental group showed significant improvements in velocity, Modified Motor Assessment Scale scores, cadence, step time, step length, and stride length (P < 0.05). Improvement in dynamic balance angles was correlated with velocity and cadence (P < 0.01). CONCLUSIONS: This study demonstrates that virtual reality has an augmented effect on balance and associated locomotor recovery in adults with hemiparetic stroke when added to conventional therapy.

The concurrent validity of the body center of mass in accelerometric measurement.

Accurate estimation of the body center of mass (COM) location has important clinical ramifications in locomotion associated with daily activities of living (ADL). This paper compared two computational estimation methods of COM using an accelerometric measurement and a VICON motion analysis system measurement (established or golden standard), respectively. A convenient sample of four healthy subjects participated. The body COM was measured when the subjects walked on the 6-m long walkway at their self-selected speed for 5 trials. VICON and accelerometer COM data signals were computed by VICON Polygon and trapezoidal double integration methods, respectively and compared to determine the concurrent validity of our COM estimation method. Correlation statistics showed excellent relationship between the two methods (r =0.87, P< 0.05), reflecting an acceptable validity. Our results suggest that the COM estimation using the accelerometer method is as accurate as the conventional method and provide clinical insights when designing a portable and inexpensive COM measurement tool for locomotion evaluation.