Immediate Effects of Ankle Mobilization on Range of Motion, Balance, and Muscle Activity in Elderly Individuals with Chronic Ankle Instability: A Pre-Post Intervention Study.

BACKGROUND This study aimed to identify the immediate effect of applying ankle mobilization to the elderly with chronic ankle instability on the range of joint motion, balance, and lower extremity muscle activity. MATERIAL AND METHODS This study, the Cumberland Ankle Instability Tool (CAIT) was used to evaluate chronic ankle instability, and as a result, 65-year-olds with a score of 24 or less were conducted. In this study, the grade III of Maitland mobilization was used to increase the range of joint motion in older people with chronic ankle instability. And four joint mobilizations were administered for a total of 40 minutes, 10 minutes per run. In the pre-examination, the range of motion of ankle joints, balance, and lower extremity muscle activity in the Limit of Stability (LOS) position prior to ankle mobilization. The reexamination was taken a right after the intervention to see the immediate effect of applying joint mobilization. This study was conducted after receiving the approval of the Institutional Review Board of the Korea National University of Transportation. RESULTS The study results show that, as a result of applying the ankle mobilization intervention, the range of dorsi flexor and plantar flexor motion increased, resulting in the improvement of balance and an immediate effect on the lower extremity muscle activity when measuring the Limit of Stability. CONCLUSIONS The conclusion of this study is ankle mobilization may be a useful intervention method in preventing falls and improving balance in older adults with chronic ankle instability.

Effects of Task-Specific Training after Cognitive Sensorimotor Exercise on Proprioception, Spasticity, and Gait Speed in Stroke Patients: A Randomized Controlled Study.

Background and objectives: Common problems in stroke patients include loss of proprioception, spasticity, and impaired gait. The purpose of this study was to examine the effects of task-specific training (TST) combined with cognitive sensorimotor exercise (CSE) on proprioception, spasticity and gait speed in stroke patients. Materials andMethods: Thirty-seven subjects were randomly divided into three groups; (1) the TST after CSE group (Experimental I, n = 13); (2) the TST group (Experimental II, n = 12), and (3) a conventional physical therapy training group (control group, n = 12). Evaluations were performed before the commencement of training and again eight weeks after training was initiated. An electrogoniometer was used to evaluate proprioception variation. The composite spasticity score (CSS) and MyotonePRO were used to evaluate spasticity. In addition, 10 m walk test was used to assess gait speed. Results: After training, the Experimental I group showed significant improvement in proprioception compared to the Experimental II and control group (p < 0.05). In CSS, gastrocnemius muscle tone (GMT) and gait speed among three groups, Experimental I group differed significantly after eight weeks of training compared to the control group (p < 0.05). Conclusions: These findings suggest that the TST combined with CSE provided significant improvements in proprioception, spasticity, and gait speed.

The reliability and validity of the Korean version of the Japanese orthopaedic association back pain evaluation questionnaire.

[Purpose] The purpose of this study was to establish the reliability and validity of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) translated into Korean for use with patients' low back pain. [Subjects and Methods] Sixty-two subjects with low back pain, 28 men and 34 women, participated in the study. Reliability was determined by using the intra class correlation coefficient and Cronbach's alpha for internal consistency. Validity was examined by correlating the JOABPEQ scores with the 36 item short form health survey (SF 36). [Results] Test-retest reliability was 0.75-0.83. The criterion-related validity was established by comparison with the Korean version of the SF 36. [Conclusion] The Korean version of the JOABPEQ was shown to be a reliable and valid instrument for assessing low back pain.

Effect of thoracic and cervical joint mobilization on pulmonary function in stroke patients.

[Purpose] This study aimed to conduct thoracic and cervical mobilization in stroke patients and determine its effects on respiratory function. [Subjects and Methods] Twenty-one stroke patients were studied. Subjects were divided into a control group (control group, n=11) who did not undergo thoracic and cervical joint mobilization, and an experimental group (thoracic and cervical mobilization group, n=10) who underwent thoracic and cervical joint mobilization. Forced vital capacity and forced expiratory volume in the first second, well-known indicators of respiratory capabilities, were measured. Peak cough flow was measured as an indicator of cough capability. [Results] After the exercise, respiratory function in the thoracic and cervical mobilization group showed statistically significant improvements demonstrated by increases in forced vital capacity, forced expiratory volume in the first second, and peak cough flow. [Conclusion] The findings indicate that thoracic and cervical mobilization can improve the thoracic movements of stroke patients resulting in improved pulmonary function.

Effects of an upper-limb exercise program for improving muscular strength and range of movement on respiratory function of stroke patients.

[Purpose] This study aims to investigate the effects of upper-limb exercises on the respiratory functions of stroke patients. [Subjects and Methods] This study was performed with 25 stroke patients. The subjects were divided into the control group (n=12) which did not perform upper arm training and the experimental group (n=13) which conducted upper arm training. Forced vital capacity and forced expiratory volume in the first second, both of which are used in this study, are well-known indicators of respiratory capabilities. Peak cough flow is used to indicate cough capability. [Results] Concerning changes in forced vital capacity, forced expiratory volume in the first second and the peak cough flow of each group after the exercise, while the control group did not show significant differences, the experimental group showed statistically significant increases. [Conclusion] The results of the study indicate that exercise programs that increase the mobility of upper limbs and increase muscular strength have the effect of normalizing vertebral alignment for stroke patients, and thus can provide effective interventions for improving respiratory function.

Nerve growth factor expression in stroke induced rats after shock wave.

[Purpose] This study investigates effects of extracorporeal shock wave therapy on nerve growth factor expression in stroke in rats. [Subjects and Methods] Sixteen eight-week-old Sprague-Dawley rats were used and randomly divided into two groups: an experimental group, a control group. The experimental group received extracorporeal shock wave therapy after the stroke. The spinal cord encompassing the lumbar 4-lumbar 5 level was then removed for Western blot analysis. [Results] There was a significant difference in nerve growth factor expression between the groups after the impairment. [Conclusion] Application of extracorporeal shock wave therapy increased the expression of nerve growth factor and nerve growth factor postulated to promote nerve growth factor upregulation through formation of a microenvironment at the spinal cord level related to the injured area.

Effects of treadmill speed on the knee angle and stance time of white rats with knee osteoarthritis according to the treadmill speed.

[Purpose] The purpose of this study was to identify whether walking on a treadmill at an adjusted speed is suitable for humans by examining the effects of exercise on the joint functions of white rats with induced knee osteoarthritis. [Subjects and Methods] The subjects were 20 Sprague-Dawley white rats, aged eight weeks, weighing 250 to 300 g. The moderate-speed exercise group performed their exercise at a gradient of 0% and a speed of 15 m/min, and the high-speed exercise group performed their exercise at a gradient of 0% and a speed of 26 m/min. [Results] Statistically significant changes were elicited by the moderate-speed and high-speed exercises. [Conclusion] In conclusion, the results of the present study present the importance of walking exercise. In particular, they demonstrate that changes in knee ROM and stance time are elicited by changes in walking speed.

Effects of physical exercise on the functional recovery of rat hindlimbs with impairments of the sciatic nerve as assessed by 2D video analysis.

[Purpose] The purpose of this study was to investigate the effects of treadmill training on functional recovery by analyzing the ankle joint as well as the knee and hip joints with 2D video analysis during gait by rats with sciatic nerve injury. [Subjects and Methods] Twenty-four male Sprague-Dawley rats were used in this study. The sham group (SG) received only a sham operation without any sciatic injury; the training group (TG) performed treadmill training for 4 weeks after sciatic injury; and the control group (CG) wasn't provided with any therapeutic intervention after sciatic injury. [Results] The ankle, knee, and hip ROM of TG and CG during the initial, mid stance, and toe-off phases of gait at post-test were significantly different from SG. [Conclusion] Physical exercise, like treadmill training, is beneficial for the improvement of the ankle, knee and hip joints of rats with crushed sciatic nerve injury.

The effects of stabilization exercise with an oral assistive device on pain and functionality of low back pain patients.

[Purpose] This study examined low back pain patients' decrease in pain and improvement in functionality after performance of a lumbar stabilization exercise using an oral assistive device, which can replace a lumbar assistive device. [Subjects and Methods] The experimental group (n=12) conducted a stabilization exercise using an oral assistive device after conventional physical therapy. The control group (n=12) received conventional physical therapy. In order to objectively measure pain in this study, a visual analogue scale (VAS) was used. In order to evaluate the subjects' functional aspects while living with low back pain, the Oswestry Disability Index (ODI) was used. [Results] There were statistically significant improvements in the comparison of the VAS and ODI of the experimental group and the control group. The experimental group's VAS and ODI significantly improved after the intervention compared to the control group. [Conclusion] The stabilization exercise using the assistive device after conventional physical therapy in the rehabilitation of low back pain patients reduced subjects' pain and increased their functional activities.

The influence of an ankle foot orthosis on the percentage of weight loading during standing tasks in stroke patients.

[Purpose] The aim of this study was to investigate the effects of an ankle foot orthosis on weight-bearing abilities of stroke patients by comparing weight loading during performance of tasks in various standing positions on the affected side. [Subjects and Methods] This study was performed with 16 stroke patients. To measure the weight loading value and percentage of weight loading in affected lower extremities, 5 standing tasks were performed with and without an ankle foot orthosis in random order. [Results] In the rising from a chair, maintaining a standing position, and forward weight shifting tasks, the affected lower extremities showed a significantly higher percentage of weight loading with an ankle foot orthosis. In the tasks requiring weight shifting to one leg, weight shifting to the lateral side showed the best weight-bearing ability with or without an ankle foot orthosis, followed by the forward and backward weight shifting, respectively. There were statistically significant correlations in all 5 tasks with or without an ankle foot orthosis. [Conclusion] An ankle foot orthosis improves the weight-bearing ability, especially when shifting weight forward, resulting in increased weight-bearing ability in activities of daily living tasks such as quiet standing and rising from a chair. The 5 tasks in this study would be a fine assessment tool under clinical conditions to investigate the postural stability of the affected side with or without application of an ankle foot orthosis.

Efficacy of pulmonary rehabilitation using cervical range of motion exercise in stroke patients with tracheostomy tubes.

[Purpose] In this study, stroke patients who were intubated with tracheostomy tubes performed cervical range of motion exercises, and changes in their pulmonary and coughing functions were examined. [Subjects and Methods] Twelve stroke patients who were intubated with tracheostomy tubes participated in the study. The subjects were randomly assigned to either the control group (n=6), which did not perform cervical range of motion exercises, or the experimental group (n=6), which did perform exercises. [Results] With regards to forced vital capacity, forced expiratory volume at one second, and peak cough flow rate before and after the exercises, the control group did not show any significant differences while the experimental group showed statistically significant increases in all three parameters. [Conclusion] The results indicate that cervical range of motion exercises can effectively improve the pulmonary function and coughing ability of stroke patients intubated with tracheostomy tubes, and that cervical range of motion exercises can help in the removal of tracheostomy tubes.

Single fiber curvature for muscle impairment assessment: Phase contrast imaging of stroke-induced animals.

There are technical challenges in imaging studies that can three-dimensionally (3D) analyze a single fiber (SF) to observe the functionality of the entire muscle after stroke. This study proposes a 3D assessment technique that only segments the SF of the right stroke-induced soleus muscle of a gerbil using synchrotron radiation x-ray microcomputed tomography (SR-µCT), which is capable of muscle structure analysis. Curvature damage in the SF of the left soleus muscle (impaired) progressed at 7-day intervals after the stroke in the control; particularly on the 7 days (1 week) and 14 days (2 weeks), as observed through visualization analysis. At 2 weeks, the SF volume was significantly reduced in the control impaired group (p = .033), and was significantly less than that in the non-impaired group (p = .009). We expect that animal post-stroke studies will improve the basic field of rehabilitation therapy by diagnosing the degree of SF curvature. RESEARCH HIGHLIGHTS: Muscle evaluation after ischemic stroke using synchrotron radiation x-ray microcomputed tomography (SR-µCT). Curvature is measured by segmenting a single fiber (SF) in the muscle. Structural changes in the SF of impaired gerbils at 7-day intervals were assessed.

Simultaneous visualization of micro-damage in cortical bone, trabecular bone, and intracortical vasculature for diagnosing osteoporosis: An animal model synchrotron imaging.

Osteoporosis (OP) is difficult to diagnose through the three-dimensional visualization of micro-damage. In this study, aimed to make an objective diagnosis by visualizing micro-damage caused by OP using synchrotron radiation-based µCT (SR-µCT). Female mice (n = 12) were randomly divided into an ovariectomized group (OVX, n = 6) in which both ovaries were excised and OP occurred, and a sham-operated group (SHAM, n = 6). After six weeks, all femurs (left and right) were excised from both groups (n = 12 per group). Thereafter, femurs were randomly divided into SR-µCT (OVX group, n = 6; SHAM group, n = 6) and µCT (OVX group, n = 6; SHAM group, n = 6) groups. In the SR-µCT group, micro-damage was visualized by manually segmenting the cortical bone, trabecular bone, and intracortical vasculature using a water-shedding algorithm. In addition, trabecular bone was obtained by automatic segmentation using µCT. Cortical bone volume/total volume was greater (p = .015), and cortical thickness was greater in the SHAM group than in the OVX group (p = .007). Among the trabecular bone parameters, the bone volume/total volume (TV) in OVX was significantly lower than that in the SHAM group (p = .012). The canal volume was greater (p = .021) and lacuna volume was greater (p < .001) in the SHAM group than in the OVX group. We expect that it will be possible to analyze damage and recovery mechanisms in the field of rehabilitation. SR-µCT has been proposed as an objective method for OP diagnosis as it allows the visualization of microstructures. RESEARCH HIGHLIGHTS: Damage mechanism for diagnosis and evaluation in an osteoporosis model. Synchrotron radiation can objectively diagnose osteoporosis. Visualization is possible by segmenting microdamage caused by osteoporosis.

Comparison of expression of inflammatory cytokines in the spinal cord between young adult and aged beagle dogs.

Aging is an inevitable process that occurs in the whole body system accompanying with many functional and morphological changes. Inflammation is known as one of age-related factors, and inflammatory changes could enhance mortality risk. In this study, we compared immunoreactivities of inflammatory cytokines, such as interleukin (IL)-2 (a pro-inflammatory cytokine), its receptor (IL-2R), IL-4 (an anti-inflammatory cytokine), and its receptor (IL-4R) in the cervical and lumbar spinal cord of young adult (2-3 years old) and aged (10-12 years old) beagle dogs using immunohistochemistry and western blotting. IL-2 and IL-2R-immunoreactive nerve cells were found throughout the gray matter of the cervical and lumbar spinal cord of young adult and aged dogs. In the spinal cord neurons of the aged dog, immunoreactivity and protein levels were apparently increased compared with those in the young adult dog. Change patterns of IL-4- and IL-4R-immunoreactive cells and their protein levels were also similar to those in IL-2 and IL-2R; however, IL-4 and IL-4R immunoreactivity in the periphery of the neuronal cytoplasm in the aged dog was much stronger than that in the young adult dog. These results indicate that the increase of inflammatory cytokines and their receptors in the aged spinal cord might be related to maintaining a balance of inflammatory reaction in the spinal cord during normal aging.

The effect of a trunk stabilization exercise program using weight loads on balance and gait in stroke patients: A randomized controlled study.

BACKGROUND: The effects of trunk stabilization exercise programs and exercises applying weight loads for stroke patients are well presented. However, there is not enough objective research to prove the effects of trunk stabilization exercise programs using weight loads for stroke patients. OBJECTIVE: In this study, a trunk stabilization exercise program using weight loads was performed to investigate its impact on the balance and gait ability of stroke patients. METHODS: Thirty patients with stroke were randomly divided into three groups. Experiment group 1 followed a trunk stabilization exercise program using weight loads, experiment group 2 followed a trunk stabilization exercise program, and the control group followed general physiotherapy. Patients' balance ability was assessed using balance measurement equipment BT-4 (postural sway area (PSA), postural sway length (PSL), limit of stability (LOS)), Berg Balance Scale (BBS), and Time Up and Go test (TUG). Gait speed was measured to examine gait ability. RESULT: After the intervention, the PSA, PFSL in experimental groups 1 and 2 decreased but that of the control group increased. BBS, TUG, and LOS scores of experimental group 1 were significantly improved compared to experimental group 2 and the control group. Also, gait speed was significantly improved in experimental group 1 compared to experimental group 2 and the control group. CONCULSION: This study may be used as a basic material for an effective trunk stabilization exercise method for stroke patients and might be of significance as an intervention method for stroke patients requiring long-term treatment.

Analysis of type I osteoporosis animal models using synchrotron radiation.

Preclinical experiments to analyze the trabecular space of spongy bones using small animals are required for the evaluation and treatment of patients with osteoporosis (OP). We performed ovariectomy to create OP models. A total of four mice were used. Ovariectomized group (OVX, n = 2) in which both ovaries were resected at random, and the sham operated group (SHAM, n = 2) performed surgery without resecting the ovaries. We propose a study that enables OP analysis by analyzing tibia microstructures of OVX and SHAM using synchrotron radiation (SR). SR imaging is a technology capable of irradiating an extremely small object in the order of several tens of nanometers using a nondestructive method at the microscopic level. Unlike previous imaging diagnoses (staining, micro-CT [Computed Tomography]) it was possible to preserve the real shape and analyze bone microstructures in real-time and analyze and evaluate spongy bones to secure data and increase the reliability of OP analysis. We were able to confirm the possibility of OP diagnosis through experimental animals for spongy bone damage related to bone mineral density. Therefore, we aimed to provide a rehabilitation and medicine therapy intervention method through basic research on the evaluation of OP diagnosis through human-based segmentation of challenging spongy bones while supplementing the limitations of existing imaging methods. RESEARCH HIGHLIGHTS: We present an analysis of osteoporosis through spongy bone using phase-contrast X-ray source. Unlike existing methods, it is possible to analyze the internal microstructure of the tibia with this method. This is an objective mechanism for OP and a basis for rehabilitation.

Effects of Cognitive Sensory Motor Training on Lower Extremity Muscle Strength and Balance in Post Stroke Patients: A Randomized Controlled Study.

BACKGROUND: Sensory motor impairment, the most common neuromuscular condition in stroke patients, often contributes to muscle weakness and imbalance. OBJECTIVE: The purpose of this research was to investigate the effects of cognitive sensory-motor training (CSMT) on the muscle strength and balance ability in post-stroke patients. METHODS: Thirty-five participants after stroke were randomly assigned to the CSMT (n = 17) or control group (n = 18). All participants received 30 min of training each time, five times per week, for six weeks. Lower extremity muscle strength of tibialis anterior (LEMTA) was evaluated using a digital muscular dynamometer. The Medical Research Council (MRC) scale was used to evaluate muscle strengths of the hip joint, knee joint, and ankle joint. For balance ability test, the center of pressure (COP) movement distance and limited of stability (LOS) were measured using BioRescue. RESULTS: LEMTA, MRC scale, balance ability were significantly more improved in the CSMT group than in the control group (p < 0.05). CONCLUSIONS: Our findings indicate that CSMT is beneficial and effective for improving muscle strength of the lower extremity and balance ability of post-stroke patients.

Effects of Mirror Therapy Combined with EMG-Triggered Functional Electrical Stimulation to Improve on Standing Balance and Gait Ability in Patient with Chronic Stroke.

This study was performed to evaluate the effects of EMG-triggered functional electrical stimulation on balance and gait ability on patient with Chronic Stroke. A total of 60 chronic stroke patients were divided into mirror treatment and functional electrical (MT-EF) Group, MT group, CON group. Each group performed 60 min a day five times a week for eight weeks. MT-FE group was performed 30 min five times a week for eight weeks in mirror therapy process with EMG-FES. MT group performed 30 min five times a week for eight weeks in mirror therapy process. CON group was performed 30 min five times a week for eight weeks in conservative treatment. To measure the balance ability, Biorescue (COP, LOS), Berg balance scale (BBS) and FRT, and the gait ability test was performed by 10 m walk test. MT-FE group revealed significant differences in COP, LOS, BBS, FRT and 10 m walk test as compared to the MT and CON groups (p < 0.05). Our results showed that MT-FE was more effective on COP, LOS, BBS, FRT and 10 m walk test in patients with chronic stroke. Our results also showed that MT-EF group was more effective on balance and gait ability in patients with chronic stroke. We suggest that this study can be used for intervention data for recovering balance and gait ability in chronic stroke patients.

Micro- and nano-tomography analysis of mouse soleus muscle using radiation.

In this study, we analyze radiation images of muscle structure of mice soleus muscles using radiation source-based microtomography and nanotomography. Soleus muscle samples were collected for analysis from 8-week-old male Institute of Cancer Research mice. First, phase-contrast X-ray microtomography was employed in these experiments. Then to obtain images with excellent contrast, imaging was performed using monochromatic light with excellent transmission power. To analyze additional muscle structures in higher magnification images than these images, nanotomography was performed, which facilitated obtaining high-magnification and high-resolution images. Muscle tissue microstructures were confirmed through three-dimensional images obtained from phase-contrast X-ray microtomography. Thus, the muscle tissue's overall shape at microscopic level can be captured. Additionally, a single muscle fiber was examined using hard X-ray nano-imaging, through which we could observe the alignment of countless myofibrils, that is, actin and myosin filaments in the muscle fibers. Thus, the methodology adopted here proved to be advantageous in analyzing the muscle tissue's overall structure with microtomography and in observing the myofibrils in detail using nanotomography.

Three-dimensional analysis of injury conditions of single muscle fibers in small animals using phase-contrast X-ray imaging.

Muscle damage can reduces the biological functions and lead to ultimately a disease state. For the reason, it is important to accurately check the state of an injury such as atrophy, and it is required to identify the state of fibers constituting the muscle. This study describes a novel method of analyzing single muscle fibers with injury conditions in three-dimensions. The muscle fibers of the mice were visualized using phase-contrast X-ray projection the microstructure. In additions, it was possible to confirm the status by quantitatively analyzing the injury severity of muscle fibers. Significantly, the muscle conditions of multiple individuals were individually determined. This study could contributes to areas where it is very important to identify microdetailed and quantitative changes of state, such as new drug development.