Comparison of the Effects of Isometric Horizontal Abduction on Shoulder Muscle Activity During Wall Push-Up Plus and Wall Slide in Individuals With Scapular Winging.

CONTEXT: Wall push-up plus (WPP) and wall slide (WS) are commonly prescribed in early rehabilitation to increase serratus anterior (SA) muscle activity. For individuals with scapular winging (SW), synergistic muscles such as upper trapezius (UT) and pectoralis major (PM) may compensate for weak SA during scapular movement. However, no studies have applied isometric horizontal abduction (IHA) during WS in individuals with SW nor have compared it with WPP with IHA. OBJECTIVES: This study compared the effects of IHA on shoulder muscle activity during WPP and WS exercises in individuals with SW. DESIGN: Cross-sectional study; 2-way repeated-measures analysis of variance was used to assess the statistical significance of observed differences in SA, UT, PM, lower trapezius (LT), and infraspinatus (IS) muscle activities. SETTING: Research laboratory. PATIENTS: We recruited 30 individuals with SW comprising 20 men and 10 women. INTERVENTIONS: The individuals performed WPP and WS exercises with and without IHA using Thera-Band. MAIN OUTCOME MEASURES: Surface electromyography was used to measure muscle activity of the SA, UT, PM, LT, and IS during the isometric phase of WPP and WS. Maximal voluntary isometric contractions were recorded to normalize electromyographic data. RESULTS: There was no significant interaction between IHA application and exercise type for any of the shoulder muscles. IHA application increased SA (P = .008), UT (P = .001), LT (P = .009), and IS (P = .000) activities and decreased PM (P = .001) activity compared with those without IHA. WS exercises elicited higher PM (P = .017) and LT (P = .011) activities than WPP. CONCLUSION: WPP and WS with IHA may be effective in increasing the muscle activities of shoulder stabilizers and preventing overactivation of PM activity. WPP may be recommended for individuals with overactivated PM, whereas WS may be used to increase LT activity.

Altered muscle recruitment patterns during isometric shoulder abduction in individuals with chronic upper trapezius pain: a cross sectional study.

BACKGROUND: Upper trapezius (UT) pain with myofascial trigger points (MTrPs) can affect movement at the glenohumeral joint as well as at the scapulothoracic joint. The investigation of muscle recruitment patterns can discern motor control strategies. The purpose of this study was to compare shoulder muscle recruitment patterns and muscle activity according to various loads between individuals with and without chronic UT pain. METHODS: In this cross-sectional study, twenty-four participants that had UT pain with MTrPs and sex, age, body weight matched 24 controls with no UT pain were recruited. Surface EMG electrodes were attached to the UT, the serratus anterior (SA), the lower trapezius (LT) and the middle deltoid (MD). All participants performed isometric shoulder abduction with a load of 25%, 50%, or 75% of the maximum strength at 60° of shoulder abduction. The EMG activity, the activity ratio (SA/UT, LT/UT, MD/UT), and the relative contribution of each muscle activity were calculated. RESULTS: MD activity was significantly decreased in the UT pain group compared to that in the control group (p < 0.05). The EMG activity ratio of SA/UT (p < 0.025) and the relative contribution of SA activity to shoulder abduction (p < 0.05) were significantly greater in the UT pain group than in the control group in the 25% loading condition. CONCLUSION: The results of present study showed that UT pain with MTrPs may increase the relative contribution of SA activity and decrease MD activity at low loads. Altered recruitment patterns of scapular upward rotators can be altered in the proper scapular position, which results in decreased MD activity. Clinicians should consider altered recruitment patterns when managing UT pain. TRIAL REGISTRATION: Clinical Research Information Service: Clinical Research Information Service (KCT0007370; 08/06/2022).

Electromyographic Analysis of Hip and Trunk Muscle Activity During Side Bridge Exercises in Subjects With Gluteus Medius Weakness.

CONTEXT: Side bridge exercises strengthen the hip, trunk, and abdominal muscles and challenge the trunk muscles without the high lumbar compression associated with trunk extension or curls. Previous research using electromyography (EMG) reports that performance of the side bridge exercise highly activates the gluteus medius (Gmed). However, to the best of our knowledge, no previous research has investigated EMG amplitude in the hip and trunk muscles during side bridge exercise in subjects with Gmed weakness. OBJECTIVE: The purpose of this study was to examine the EMG activity of the hip and trunk muscles during 3 variations of the side bridge exercise (side bridge, side bridge with knee flexion, and side bridge with knee flexion and hip abduction of the top leg) in subjects with Gmed weakness. DESIGN: Repeated-measures experimental design. SETTING: Research laboratory. PATIENTS: Thirty subjects (15 females and 15 males) with Gmed weakness participated in this study. INTERVENTION: Each subject performed 3 variations of the side bridge exercise in random order. MAIN OUTCOME MEASURES: Surface EMG was used to measure the muscle activities of the rectus abdominis, external oblique, longissimus thoracis, multifidus, Gmed, gluteus maximus, and tensor fasciae latae (TFL), and Gmed/TFL muscle activity ratio during 3 variations of the side bridge exercise. RESULTS: There were significant differences in Gmed (F2,56 = 110.054, P < .001), gluteus maximus (F2,56 = 36.416, P < .001), and TFL (F2,56 = 108.342, P < .001) muscles among the 3 side bridge exercises. There were significant differences in the Gmed/TFL muscle ratio (F2,56 = 20.738, P < .001). CONCLUSION: Among 3 side bridge exercises, the side bridge with knee flexion may be effective for the individuals with Gmed weakness among 3 side bridge exercises to strengthen the gluteal muscles, considering the difficulty of the exercise and relative contribution of Gmed and TFL.

Effects of sitting posture and bolus volume on activation of swallowing-related muscles.

BACKGROUND: The pharyngeal phase is a particularly important clinical factor related to swallowing dysfunctions. Head and neck posture, as well as bolus volume, are important factors affecting the pharyngeal stages of normal swallowing. OBJECTIVE: The aim of our study was to identify the effects of sitting posture and bolus volume on the activation of swallowing-related muscles. MATERIALS AND METHODS: Twenty-four subjects participated in the study. The subjects were positioned in three sitting postures-slump sitting (SS), lumbo-pelvic upright sitting (LUS), and thoracic upright sitting (TUS). While sitting in the chair, the subject was instructed to swallow 10 and 20 mL of water. Surface electromyography (EMG) was used to measure the muscle activity of the supra-hyoid (SH) and infra-hyoid (IH) muscles. Also, sitting posture alignment (head, cervical and shoulder angle) was also performed. Data were analysed with a repeated measures analysis of variance (RMANOVA) using a generalised linear model. RESULTS: There was no significant difference in terms of the head angle (P = .395). However, significant differences were found in relation to the cervical angle (P < .001) and shoulder angle (P < .001). The TUS produced the lowest SH EMG activity (P = .001), in comparison to SS and LUS. The bolus volume for 20 mL showed greater SH and IH EMG activity (P < .001) than did the bolus volume for 10 mL. CONCLUSIONS: Correcting sitting posture from SS to TUS may better assist swallowing-related muscles with less effort, irrespective of the bolus volume.

Effect of Isometric Hip Abduction on Foot and Ankle Muscle Activity and Medial Longitudinal Arch During Short-Foot Exercise in Individuals With Pes Planus.

CONTEXT: The improvement of hip joint stability can significantly impact knee and rearfoot mechanics. Individuals with pes planus have a weak abductor hallucis (AbdH), and the tibialis anterior (TA) may activate to compensate for this. As yet, no studies have applied isometric hip abduction (IHA) for hip stability during short-foot exercise (SFE). OBJECTIVE: To compare the effects of IHA on the muscle activity of the AbdH, TA, peroneus longus (PL), and gluteus medius (Gmed), as well as the medial longitudinal arch (MLA) angle during sitting and standing SFE. DESIGN: Two-way repeated analyses of variance were used to determine the statistical significance of AbdH, TA, PL, and Gmed electromyography activity, as well as the change in MLA angle. SETTING: University research laboratory. PARTICIPANTS: Thirty-two participants with pes planus. INTERVENTION(S): The participants performed SFE with and without isometric hip abduction in sitting and standing positions. MAIN OUTCOME MEASURES: Surface electromyography was used to measure the activity of the AbdH, TA, PL, and Gmed muscles, and Image J was used to measure the MLA angle. RESULTS: Significant interactions between exercise type and position were observed in terms of the PL muscle activity and in the change in MLA angle only, while other muscles showed significant main effects. The IHA during SFE significantly increased the AbdH muscle activity, while the TA muscle activity was significantly lower. The muscle activity of Gmed and PL was significantly increased in the standing position compared with sitting, but there was no significant difference with or without IHA. The change in the MLA angle was significantly greater in SFE with IHA in a standing position than in the other SFE conditions. CONCLUSIONS: IHA may be an effective method for reducing compensatory TA activity and increasing AbdH muscle activity during SFE for individuals with pes planus.

Effects of a Collaborative Intervention Process on Parent-Therapist Interaction: A Randomized Controlled Trial.

Aim: To determine whether a collaborative intervention process facilitates parent-therapist interactions. Methods: Participants were 18 children with physical disabilities, their mothers, and 16 physical therapists. Therapists randomized to the experimental group were instructed in strategies for collaboration (working together) with parents in goal setting, planning, and implementing interventions. Family-therapist dyads participated in 6 weekly sessions. Four sessions were videotaped and combined (1st and 2nd for goal-setting/planning, 3rd and 5th for implementation) to code behaviors using Response Class Matrix. Multivariate analysis of variance was used to compare therapist and parent behaviors between groups. Results: Therapists in the experimental group demonstrated a higher frequency of "seeking information" (p < 0.01), "giving information" (p < 0.05), "positive behavior" (p < 0.01) and lower frequency of "child-related behavior" (p < 0.001) than therapists in the comparison group during goal-setting/planning and implementation. Parents in the experimental group demonstrated a higher frequency of "giving information" than parents in the comparison group (p < 0.01) during goal-setting/planning and implementation. Conclusion: Parents and therapists in the experimental group interacted more with each other, whereas those in the comparison group focused more on the child. The collaborative strategies appear to have increased parent participation in the intervention process, which has been a challenge for physical and occupational therapists.

Effects of a Collaborative Intervention Process on Parent Empowerment and Child Performance: A Randomized Controlled Trial.

AIMS: To examine the effects of a four-step collaborative intervention process on parent and child outcomes and describe parents' and therapists' experiences. METHODS: Eighteen children with physical disabilities, their mothers, and 16 physical therapists participated. Therapists randomized to the experimental group were instructed in the collaborative intervention process. All family-therapist dyads participated in six weekly sessions. Outcomes included the adapted Family Empowerment Scale (FES) and Canadian Occupational Performance Measure (COPM). A questionnaire was completed by parents and therapists to rate and describe their experiences. RESULTS: Mean scores on the FES (p <.05) and COPM (p <.001) increased after intervention but there were no group differences (p >.05). Effect size for change in child performance (.73) and parent satisfaction (1.08) on the COPM favored the experimental group. Parents in the experimental group were more confident in carrying out activities during daily routines (p =.01) and worked together with therapists to a greater extent (p =.01) than parents in the comparison group. Therapists in the experimental group perceived that they provided information/instruction (p <.01) and worked together with parents (p =.02) to a greater extent than therapists in the comparison group. CONCLUSIONS: Findings support the importance of shared goal setting for children's activities. Further research is recommended.

Comparative Effects of 4 Single-Leg Squat Exercises in Subjects With Gluteus Medius Weakness.

CONTEXT: Of the weight-bearing exercises, single-leg squats (SLSs) represent one of the most commonly used hip-strengthening exercises that require more gluteus medius (GMED) activity. To date, no studies have investigated how the 4 SLS exercises affect muscle imbalance of GMED, tensor fasciae latae (TFL), and adductor longus (AL), and kinematics of hip. OBJECTIVE: To investigate the hip muscle activities, onset time, and kinematics during 4 different SLS exercises (unilateral squat, unilateral wall-squat [UWS], lateral step-down, and front step-down) in subjects with GMED weakness. DESIGN: Repeated-measures experimental design. SETTING: Research laboratory. PARTICIPANTS: Twenty-two subjects (11 males and 11 females) participated in this study and were compared using 1-way repeated-measures analysis of variance. MAIN OUTCOME MEASURES: Surface electromyography was used to measure the muscle activities and onset time of the GMED, TFL, and AL, and 3-dimensional motion tracking system was used to measure the hip adduction and internal/external rotation angles during SLS exercises. One-way repeated-measures analysis of variance was used at a significance level of P < .05. RESULTS: The UWS produced higher GMED/TFL activity ratio and lower GMED/TFL onset time ratio than in the other 3 exercises (P < .05). No difference in GMED/AL activity ratio and GMED/AL onset time ratio was observed. The hip adduction angle was greater in UWS than in the other 3 exercises (P < .05). As for the hip internal/external rotation, lateral step-down exhibited higher hip internal rotation angle than front step-down (P < .05). CONCLUSION: The UWS may be recommended as an effective exercise for the subjects with GMED weakness, but they should take care to avoid excessive hip adduction during the exercise.

Effects of Motor Control Exercise Vs Muscle Stretching Exercise on Reducing Compensatory Lumbopelvic Motions and Low Back Pain: A Randomized Trial.

OBJECTIVES: The purpose of this study was to investigate the effectiveness of a 6-week motor control exercise (MCE) vs stretching exercise (SE) on reducing compensatory pelvic motion during active prone knee flexion (APKF) and intensity of low back pain. METHODS: Thirty-six people in the lumbar-rotation-extension subgroup were randomly assigned equally into 2 exercise groups (18 people in each an MCE or SE group). A 3-dimensional motion-analysis system was used to measure the range and onset time of pelvic motion and knee flexion during APKF. Surface electromyography was used to measure the muscle activity and onset time of the erector spinae and the hamstrings during APKF. The level of subjective low back pain was measured using a visual analog scale. RESULTS: The MCE group had more significant decreases in and delay of anterior pelvic tilt, pelvic rotation, and erector spinae muscle activity during APKF, as well as reduced intensity of low back pain compared with the SE group (P < .05). CONCLUSIONS: For rehabilitation in patients in the lumbar-rotation-extension subgroup, MCE was more effective than SE in reducing compensatory pelvic motion and muscle activity during APKF and minimizing low back pain.

Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus.

[Purpose] This study investigated whether the toe-spread-out exercise affects the hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction. [Subjects and Methods] Twenty-four subjects with hallux valgus were randomly assigned to orthosis and orthosis plus toe-spread-out exercise groups. The orthosis group wore the orthosis for 8 weeks, while the orthosis plus toe-spread-out group also performed the toe-spread-out exercise. The hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction were measured initially and after 8 weeks by radiography and ultrasonography. [Results] While there were no significant changes in the three parameters in the orthosis group, there were significant differences in the orthosis plus toe-spread-out exercise group after 8 weeks. In addition there were significant differences in the three measures between the two groups. [Conclusion] The toe-spread-out exercise reduces the hallux valgus angle and hallux valgus angle during active abduction, and increases the cross-sectional area of the abductor hallucis muscle. The toe-spread-out exercise is recommended for patients with mild to moderate hallux valgus.

Lumbopelvic motion during seated hip flexion in subjects with low-back pain accompanying limited hip flexion.

PURPOSE: Limited hip flexion may lead to a poor lumbopelvic motion during seated active hip flexion in people with low-back pain (LBP). The purpose of this study was to compare lumbopelvic motion during seated hip flexion between subjects with and without LBP accompanying limited hip flexion. METHODS: Fifteen patients with LBP accompanying limited hip flexion and 16 healthy subjects were recruited. The subjects performed seated hip flexion with the dominant leg three times. A three-dimensional motion-analysis system was used to measure lumbopelvic motion during seated hip flexion. RESULTS: During seated active hip flexion, the angle of hip flexion was significantly lower in patients with LBP accompanying limited hip flexion (17.4 ± 4.4 in the LBP group, 20.8 ± 2.6 in the healthy group; t = 2.63, p = 0.014). The angle of the lumbar flexion (4.8 ± 2.2 in the LBP group, 2.6 ± 2.0 in the healthy group; t = -2.96, p = 0.006) and posterior pelvic tilting (5.0 ± 2.6 in the LBP group, 2.9 ± 2.0 in the healthy group; t = 2.48 p = 0.019), however, were significantly greater in patients with this condition. CONCLUSIONS: The results of this study suggest that limited hip flexion in LBP can contribute to excessive lumbar flexion and posterior pelvic tilting during hip flexion in the sitting position. Further studies are required to confirm whether improving the hip flexion range of motion can reduce excessive lumbar flexion in patients with LBP accompanying limited hip flexion.

Comparison of pectoralis major and serratus anterior muscle activities during different push-up plus exercises in subjects with and without scapular winging.

To examine the differences between men with and without scapular winging in the electromyographic (EMG) amplitude and activity ratio between the pectoralis major (PM) and serratus anterior (SA) during 3 push-up plus exercises: (a) the standard push-up plus (SPP), (b) the knee push-up plus (KPP), and (c) the wall push-up plus (WPP), and to determine which exercise induced the lowest PM/SA ratio in each group. Twenty-eight men participated in this study (13 scapular winging group: age, 21.8 ± 2.1 years; 15 control group: age, 23.3 ± 2.0 years). Surface EMG of the PM, SA, and activity ratio between the PM and SA were collected during 3 push-up plus exercises, and the EMG data were expressed as a percentage of the reference voluntary contraction (%RVC). The normalized PM activity for subjects in the scapular winging group was significantly greater than that in the control group (79.16 ± 6.65 %RVC vs. 39.66 ± 6.19 %RVC, p ≤ 0.05). The normalized SA activity was significantly lower in the scapular winging group compared with the control group (39.80 ± 4.09 %RVC vs. 56.28 ± 3.81 %RVC, p ≤ 0.05) and was significantly decreased in the following order: SPP > KPP > WPP; 77.09 ± 5.12 %RVC > 39.48 ± 3.38 %RVC > 27.55 ± 3.07 %RVC, p < 0.016). The PM/SA EMG ratio was significantly greater in the scapular winging group compared with that in the control group across all exercises and was significantly lower during SPP than that during KPP and WPP in both groups (1.13 ± 0.58 vs. 0.53 ± 0.25 for SPP, 3.50 ± 2.07 vs. 0.92 ± 0.63 for KPP, 4.04 ± 3.13 vs. 1.19 ± 0.66 for WPP, p < 0.016). Greater PM activity was found in the scapular winging group, and the SPP is an optimal exercise for subjects with scapular winging, where maximum SA activation with minimal PM activation is desired.

Factors affecting upper limb functional recovery after mastectomy with immediate breast reconstruction: a prospective study.

BACKGROUND: Little is known about the differences in postoperative shoulder function following two common approaches for immediate breast reconstruction (IBR): abdominal-based breast reconstruction and implant-based breast reconstruction (ABR and IMBR). It was hypothesized that postoperative upper limb function would differ between the ABR and IMBR due to incomplete detachment of the pectoral muscles. PURPOSE: This study aimed to investigate the factors for shoulder function recovery post-IBR and compare recovery outcomes between ABR and IMBR. METHODS: This single-center prospective follow-up study included 60 patients who underwent IBR for 4 months postoperatively. Patients were invited to complete functional measurements 1 and 4 months postoperatively. The primary outcome was improvement in upper limb disability based on the Q-DASH score. Secondary outcomes were functional shoulder recovery markers: shoulder flexibility, strength, movement accuracy, scapular alignment, body schema accuracy, and neuropathic pain. Repeated-measures analyzes of variance and linear regression were performed. RESULTS: Within-group differences were found for most variables (p < .05) except for neuropathic pain (p = .929). However, there was no overall main group effect (p > .05). Multivariate regression analysis established significant models for ABR and IMBR (R2 = 0.430, p = .002 and R2 = 0.442, p < .001, respectively). However, the variables included in the model showed between-group differences. CONCLUSION: Postoperative shoulder function was comparable between the two IBR approaches. However, different factors were associated with improved upper limb disability between ABR and IMBR. Acute rehabilitation focused on resolving muscle tightness and pain may help mitigate upper limb disabilities following IBR.Trial registration number: KCT 0006501.

Comparison of shoulder functions between assembly workers with and without subacromial pain syndrome.

BACKGROUND: The occurrence of subacromial pain syndrome (SPS) is associated with the frequent handling and lifting of heavy loads and excessive repetitive work. Thus, assembly workers have a high prevalence of SPS. OBJECTIVE: The purpose of this study was to investigate differences in shoulder ROM, muscle strength, asymmetry ratio, function, productivity, and depression between workers with and without SPS. METHODS: Sixty-seven male workers (35 workers with SPS and 32 workers without SPS) participated in this study. Shoulder internal rotation (SIR), shoulder external rotation (SER), shoulder abduction (SAB), shoulder horizontal adduction ROM and SIR, SER, elbow flexion (EF), scapular depression and adduction, scapular protraction strength were measured. The asymmetry ratio was calculated using the asymmetry ratio formula; shoulder functions were measured using the shoulder pain and disability index (SPADI), disabilities of the arm, shoulder, and hand (DASH), and visual analogue scale (VAS); and Endicott work productivity scale (EWPS). RESULTS: The SPADI (p = 0.001), DASH (p = 0.001), and VAS (p = 0.001) values of workers with SPS were higher than those of workers without SPS. Also, workers with SPS had lower SIR (p = 0.001) and SAB (p = 0.002) ROM compared to workers without SPS. In addition, workers with SPS exhibited lower SIR (p = 0.012) strength than workers without SPS. Workers with SPS had higher asymmetry ratio in SIR (p = 0.015), SER (p = 0.005), and EF (p = 0.008) strength than workers without SPS. CONCLUSIONS: The SIR, SAB ROM, SIR strength, and the asymmetry ratio of SIR, SER, EF strengths could provide an important baseline comparison for the workers with SPS.

Long-term effects of deep-learning digital therapeutics on pain, movement control, and preliminary cost-effectiveness in low back pain: A randomized controlled trial.

Objective: The present study aimed to compare the effects of a deep learning-based digital application with digital application physical therapy (DPT) and those of conventional physical therapy (CPT) on back pain intensity, limited functional ability, lower extremity weakness, radicular symptoms, limited range of motion (ROM), functional movement, quality of life, cost-effectiveness, and postintervention questionnaires for perceived transmission risk of COVID-19 and satisfaction results in 100 participants with low back pain (LBP). Methods: One hundred participants with LBP were randomized into either DPT or CPT groups, three times per week over four weeks. Outcome measures included the (1) Oswestry Disability Index, (2) Quebec Back Pain Disability Scale, (3) Roland-Morris Disability Questionnaire (RMDQ), (4) Numeric Pain Rating Scale, (5) functional movement screen (FMS), (6) short form-12, (7) lower extremity strength, (8) ROM of trunk flexion, extension, and bilateral side bending, (9) questionnaires for perceived transmission risk of COVID-19, (10) preliminary cost-effectiveness, and (11) postintervention satisfaction questionnaire results. The analysis of variance was conducted at p < 0.05. Results: Analysis of variance showed that DPT showed superior effects, compared to CPT on RMDQ, hip extensor strength, transmission risk of COVID-19, as well as satisfaction. Both groups showed significant improvement pre- and postintervention, suggesting that DPT is as effective as CPT, and was superior in preliminary cost-effectiveness and transmission risk of COVID-19. Conclusions: Our results provide novel, promising clinical evidence that DPT was as effective as CPT in improving structural and functional impairment, activity limitation, and participation restriction. Our results highlight the successful incorporation of DPT intervention for clinical outcome measures, lower extremity strength, trunk mobility, ADL improvement, QOL improvement, and FMS in LBP.

Respiratory Parameters as Predictors of Balance and Gait Ability in Patients with Stroke at Discharge.

Pulmonary complications are frequent in stroke, contributing to both mortality and morbidity rates. Respiratory parameters in such patients encompass both pulmonary function and respiratory muscle strength. Identifying respiratory function variables that influence the balance and gait ability of patients with stroke is crucial for enhancing their recovery in these aspects. However, no study has assessed predictions for a comprehensive array of balance and gait abilities in such patients. We aimed to examine whether initial respiratory muscle strength and pulmonary function can predict balance and gait ability at discharge from a rehabilitation program. Thirty-one patients with stroke were included in this prospective observational study. Multiple regression models with a forward selection procedure were employed to identify respiratory parameters (including peak expiratory flow and maximal expiratory pressure) that contributed to the results of balance assessments and gait evaluations at the time of discharge. The peak expiratory flow (PEF) served as a predictor explaining 42.0% of the variance. Similarly, the maximal expiratory pressure (MEP) was a predictor variable explaining 32.0% of the variance. PEF and MEP assessments at the initial stage as predictive factors for both balance and gait ability are important in stroke management.

Effect of intensive training with a spring-assisted hand orthosis on movement smoothness in upper extremity following stroke: a pilot clinical trial.

BACKGROUND: A commercial splinting system is designed to permit quick training in opening and closing the affected hand in order to overcome the disadvantages of previous approaches. OBJECTIVE: The purpose of this study was to assess the feasibility of intensive training using a spring-assisted hand orthosis on upper extremity in individuals with chronic hemiparetic stroke. DESIGN: Five participants for the experimental group and 5 for the control group were recruited from a local rehabilitation hospital. Subjects in the experimental group participated in 4 weeks of training using a SaeboFlex orthosis for 1 hour per day, 5 times per week. Each subject in the control group wore the same orthosis for 1 hour per day without participating in upper extremity training. Outcome measures included the Fugl-Meyer Assessment, Box and Block Test, and Action Research Arm Test; kinematic parameters were collected using a 3-D motion analysis system. RESULTS: The Fugl-Meyer assessment and the Box and Block Test score were increased significantly in the experimental group after the intervention. The resultant velocity of the wrist joint for the reach-to-grasp task decreased significantly, and the resultant velocity of the shoulder joint while performing a reach-to-grasp task at acromion height decreased significantly in the experimental group. CONCLUSION: A pilot clinical study of spring-assisted dynamic hand orthosis training is feasible in recovering the movement of the hemiparetic upper extremity.

Distorted body schema after mastectomy with immediate breast reconstruction: a 4-month follow up study.

Background: After breast cancer, some patients report residual pain-related upper limb disability without physical impairment. Although pain and altered proprioception are known to affect the working body schema (WBS), there is little available evidence investigating the WBS of breast cancer survivors (BrCS). WBS-body representations in the brain-affect the "neuromatrix" that modulates pain sensitivity and the threshold for threatening stimuli. The aim of this study was to investigate whether WBS was disrupted after mastectomy with immediate breast reconstruction (IBR) for breast cancer and whether pain and proprioceptive changes affected WBS. Methods: Thirty-five BrCS participated in the 4-month follow-up study. They were observed at 1 and 4 months postoperatively. The main outcome measures were the left right judgement test (LRJT) results, absolute angle error, pectoralis minor length index (PMI), pain, and Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score. They were measured at each observation, and parametric tests were performed to identify the nature of WBS. Results: Both the reaction time and accuracy of the hand LRJT were poorer than those of the foot and back LRJT (p < 0.001). The hand LRJT reaction time and accuracy were unchanged over the total follow-up period (p = 0.77 and p = 0.47, respectively). There was a weak correlation between the LRJT reaction time and PMI (r = -0.26, p = 0.07), pain severity (r = 0.37, p = 0.02), and Q-DASH score (r = 0.37, p = 0.02). There was also a weak correlation between LRJT accuracy and Q-DASH score (r = -0.31, p = 0.04). The LRJT accuracy of BrCS who underwent surgery on their dominant side was higher than that of BrCS who underwent surgery on their non-dominant side (p = 0.002). Regression analysis found a weak but significant relationship between the early hand LRJT results and late pain severity (adjusted R2 = 0.179, p = 0.007). A similar relationship was found between early hand LRJT results and Q-DASH score (adjusted R2 = 0.099, p = 0.039). Conclusion: To the best of our knowledge, this is the first study providing the nature of WBS after mastectomy with IBR. In this population, it is necessary to postoperatively preserve WBS integrity for pain and upper limb disability.

Comparison of core stabilization techniques on ultrasound imaging of the diaphragm, and core muscle thickness and external abdominal oblique muscle electromyography activity.

BACKGROUND: To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome measures varied and one intervention was not superior over another. OBJECTIVE: The purpose of this study was to compare the differential effects of ADIM, AB, and DNS on diaphragm movement, abdominal muscle thickness difference, and external abdominal oblique (EO) electromyography (EMG) amplitude. METHODS: Forty-one participants with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were utilized to measure core stability, an ultrasound was utilized to measure diaphragm movement and measure abdominal muscles thickness and EMG was utilized to measure EO amplitude. Analysis of variance (ANOVA) was conducted at P< 0.05. RESULTS: Diaphragm descending movement and transverse abdominis (TrA) and internal abdominal oblique (IO) thickness differences were significantly increased in DNS compared to ADIM and AB (P< 0.05). EO amplitude was significantly increased in AB compared to ADIM, and DNS. CONCLUSIONS: DNS was the best technique to provide balanced co-activation of the diaphragm and TrA with relatively less contraction of EO and subsequently producing motor control for efficient core stabilization.

Effect of side-sling plank exercise on trunk and hip muscle activation in subjects with gluteus medius weakness.

BACKGROUND: The effectiveness of side-sling plank (SSP) exercises on trunk and hip muscle activation in subjects with gluteus medius (Gmed) weakness is unclear. OBJECTIVE: To quantify muscle activation of the rectus abdominis (RA), external oblique (EO), erector spinae (ES), lumbar multifidus (LM), Gmed, gluteus maximus (Gmax), and tensor fasciae latae (TFL) during SSP with three different hip rotations compared to side-lying hip abduction (SHA) exercise in subjects with Gmed weakness. METHODS: Twenty-two subjects with Gmed weakness were recruited. SHA and three types of SSP exercises were performed: SSP with neutral hip (SSP-N), hip lateral rotation (SSP-L), and hip medial rotation (SSP-M). Surface electromyography was used to measure the activation of the trunk and hip muscles. RESULTS: The trunk and hip muscles activations were generally significantly higher level during three SSP than SHA. SSP-M showed significantly lower EO activation while significantly higher ES and LM activation than SSP-L. Gmed activation was significantly higher during SSP-M than during SSP-L. TFL activation was significantly lower during SSP-M than during SSP-N and SSP-L. CONCLUSIONS: SSP could be prescribed for patients who have reduced Gmed strength after injuries. Especially, SSP-M could be applied for patients who have Gmed weakness with dominant TFL.