Usefulness of one-arm motorized gait device for chronic hemiplegic stroke survivors.

BACKGROUND: After stroke, gait training is a key component of rehabilitation, and most individuals use a variety of walking aids depending on their physical condition and environment. OBJECTIVE: This study aimed to investigate the potential effect of a one-arm motorized gait device for gait assist of chronic hemiplegic stroke survivors through comparison with traditional gait devices (parallel bar and hemi-walker). METHODS: This study was conducted on 14 chronic hemiplegic stroke survivors. The participants were asked to walk under three conditions using different gait devices, and their gait parameters during walking were collected and analyzed. The first condition involved walking on parallel bars; second condition, walking using hemi-walkers; and third condition, walking using one-arm motorized gait devices. With the use of a gait analysis system, the spatio-temporal gait parameters in each condition were collected, such as gait velocity, cadence, step length, stride length, single support time, and double support time. RESULTS: In the results by repeated-measures ANOVA or the Friedman test, a significant difference was found in the gait parameters among all three conditions (p< 0.05). The post-hoc test showed a significant change in the spatio-temporal gait parameters (especially, velocity, cadence and affected side single and double support time) when one-arm motorized gait device were used compared with parallel bars and hemi-walkers (p< 0.05). CONCLUSION: The results of this study suggest that one-arm motorized gait devices developed for hemiplegic stroke survivors may be more effective potentially than parallel bars and hemi-walkers in gait assistance of chronic hemiplegic stroke survivors.

Gender differences in pulmonary function, physical activity, and quality of life of patients with COPD based on data from the Korea National Health and Nutrition Examination Survey 2015 to 2019 from the Perspective of Pulmonary Rehabilitation.

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide, with the fourth highest mortality rate. This study aims to analyze pulmonary function, physical activity, and quality of life (QoL) between genders from the perspective of pulmonary rehabilitation in Korean patients with COPD. This study investigated raw data from the Korea National Health and Nutrition Examination Survey from 2015 to 2019 and included 151 COPD patients (men: 66.55 ±â€…10.07 years, women: 65.21 ±â€…11.73) out of 39,759 participants. Pulmonary function, such as forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), and frequency of physical activities (e.g., physical activity for work and leisure, strengthening exercise, and sitting time a day) and QoL by using EQ-5D-3L, were compared between genders in patients with COPD. Smoking status differed in health-related characteristics between genders (P < .001). In pulmonary function, the FVC (men: 3.48 ±â€…0.98ℓ, women: 2.53 ±â€…0.56ℓ, P < .05), FEV1 (men: 2.13 ±â€…0.93 ℓ, women: 1.88 ±â€…0.53 ℓ, P < .001), FEV6 (men: 3.16 ±â€…1.00ℓ, women: 2.46 ±â€…1.56ℓ, P < .001) and peak expiratory flow (men: 5.61 ±â€…2.44ℓ/s, women: 4.68 ±â€…1.53ℓ/s, P < .05) was higher in men, however, predicted FEV1 (men: 66.03% ±â€…23.13%, women: 79.95% ±â€…18.45%, P < .05) and predicted FEV1/FVC ratio (men: 59.67% ±â€…15.02%, women: 74.10% ±â€…10.49%, P < .001) in women. The frequency of strengthening exercise was higher in men (P < .05). QoL of patients with COPD was not significantly different between genders. To provide correct interventions and pulmonary rehabilitation to patients with COPD, gender differences, including physiological and psychological differences, must be considered.

Fully Immersive Virtual Reality Game-Based Training for an Adolescent with Spastic Diplegic Cerebral Palsy: A Case Report.

BACKGROUND: Recently, virtual reality-based training (VR-based training) is receiving attention as greater emphasis is placed on the importance of interest and motivation in participation. However, studies investigating the effects of fully immersive VR-based training are insufficient. CASE PRESENTATION: We report a case of using a fully immersive VR game-based training in a patient with cerebral palsy. A 15-year-old girl was diagnosed with spastic diplegia cerebral palsy Gross Motor Function Classification System level II. A six-week intervention (18 sessions) phase was performed with one fully immersive VR game using PlayStation®VR in three sessions per week. After 18 sessions of training, the scores on the gross motor function measure-88 (Gross Motor Function Measure-88-GMFM-88), pediatric balance scale (PBS), timed up and go test (TUG), functional gait assessment (FGA), and 10 m walking test (10MWT) were improved: GMFM-88, 91.56 points (9.31 points increase); PBS, 45 points (6 points increase); TUG, 8.23 s (6.9 s decrease); FGA, 11 points (3 points increase); the 10 MWT, 5.27 s (6.59 s decrease). CONCLUSIONS: This study found that a fully immersive VR game-based training using PlayStation®VR may be an effective intervention for GMFCS level II adolescent, leading to some improvement of motor function, balance and gait skills in adolescents with cerebral palsy.

Effects of Upper-Body Flexibility Exercise on Golf Performance of Amateur Female Golfer: A Case Report.

BACKGROUND We investigated the effects of the upper-body flexibility exercises on the golf performance of a female amateur golfer. CASE REPORT The participant was a 43-year-old woman who performed a general golf swing exercise (30 min) and an upper-body flexibility exercise (20 min) 3 times a week, for a total of 6 times in 2 weeks. The maximum rotation angle of the upper body was measured using a goniometer. To measure the X-factor, the numerical value was measured after subtracting the rotation angle of the lower-body from the rotation angle of the upper body when the participant stopped making a back-swing top motion. A camera measuring instrument was used to measure the clubhead speed and carry distance of the golf ball when she hit the ball with a no. 7 iron club. After the exercises, the maximum rotation angle of the participant's upper body increased from 40° to 69°, and the X-factor increased from 10° to 24°. The clubhead speed increased from 29.4 m/s to 34.4 m/s, and the carry distance increased from 84 m to 106 m. CONCLUSIONS The participant responded positively to the upper-body flexibility exercises, and there was improved upper-body mobility, X-factor, clubhead speed, and carry distance. Our results showed that upper-body flexibility exercises with a general golf swing exercise for female amateur golfers may improve golf performance.

Knee Muscles Strength Can be Improved by Using an Elastic Band as an Assistive Device for Knee-Ankle Complex.

BACKGROUND There are various tools and methods used for strength exercise. Elastic bands, one of the resistance exercise tools, have been used for various purposes, including muscle strengthening; however, there is very little evidence supporting their efficacy. The study was performed to investigate the effect of knee-ankle elastic bands on knee muscle strength-related parameters according to sex in healthy adults. MATERIAL AND METHODS This was a cross-sectional study. Twenty-one participants (11 female and 10 male) were studied using a cross-over design. Isokinetic concentric knee extension and flexion strength was measured at 60°/s and 180°/s with and without application of a therapeutic elastic band in the shape of an "8", with knee flexion and ankle dorsiflexion. The variables related to muscle power automatically calculated in the protocol of the isokinetic system were compared according to sex and angular velocity. RESULTS Peak moment (PM), PM/body weight, average power, total work, and the agonist/antagonist ratio, demonstrated significant improvement (P<0.05) at both 60°/s and 180°/s "with" compared to "without" the elastic band according to sex. CONCLUSIONS The use of therapeutic elastic bands in the shape of a figure 8 with knee flexion and ankle dorsiflexion may be used as assistive devices for improving strength in muscles supporting the knee. Further high-quality studies are needed to assess the potential of elastic bands as assistive devices and not merely as exercise tools. Therapeutic elastic bands in the shape of an "8" with knee flexion and ankle dorsiflexion may be useful in sports activities.

Analysis of trunk muscles activity during horseback riding machine exercise in children with spastic cerebral palsy.

Appropriate trunk muscle activity is needed to perform functional activities in cerebral palsy, this study analyzed the activity of trunk muscles during horseback riding machine exercise in children with spastic cerebral palsy. 10 children with spastic cerebral palsy were participated, the activity of the trunk muscles, including both sides of the rectus abdominis, external oblique, latissimus dorsi, and erector spinae in sitting posture and during horseback riding machine exercise were evaluated using a surface electromyography. The activity of bilateral rectus abdominis, external oblique, latissimus dorsi, and erector spinae increased during horseback riding machine exercise than quiet sitting posture. Moreover, there were significant differences in activities of the trunk muscles between the sitting posture and horseback riding machine exercise, with the exception of the left external oblique and the left latissimus dorsi. Horseback riding machine exercise provides more opportunities to use the trunk muscles for children with spastic cerebral palsy than general sitting posture. In future, it will be of use to investigate the effect of horseback riding machine exercise in patients with cerebral palsy.

The relationship between sitting balance, trunk control and mobility with predictive for current mobility level in survivors of sub-acute stroke.

OBJECTIVE: To investigate the relationship between sitting balance, trunk control, and mobility, as well as whether the sitting balance and trunk control can predict mobility level in sub-acute stroke survivors. METHODS: This is a observational and cross-sectional study. Fifty-five hemiplegic stroke survivors were participated in this study. The Timed Up and Go Test (TUG) was used to estimate mobility, and the Sitting Balance Scale (SBS) was used to examining sitting balance. The Trunk Impairment Scale (TIS), Trunk Control Test (TCT), and Postural Assessment Scale for Stroke-trunk control (PASS-TC) were used for examining the trunk control. Spearman's correlation was used to analyze the relationship between TUG, SBS, TIS, TCT, and PASS-TC. RESULTS: The TUG is significantly correlated with SBS (r = -0.78), TIS (r = -0.76), TCT (r = -0.65), and PASS-TC (r = -0.67). In addition, the receiver operation characteristic (ROC) curve showed as cut-off value of SBS as >28.5, TIS > 16.5, TCT >82, and PASS-TC >10.5. The area under the ROC curve in each of the four tests is moderately accurate for predicting the mobility of sub-acute stroke survivors (0.84 ~0.90) (0.7 < AUC ≤ 9 (moderate informative)). IMPLICATIONS: The SBS showed the highest correlation for mobility using TUG in the hemiplegic stroke survivors. Also, SBS was revealed as the most dominant examination tool predicting the mobility by TUG, it can be explained the sitting postural balance is the variable predicting the mobility in survivors of sub-acute stroke.

Feasibility of full immersive virtual reality video game on balance and cybersickness of healthy adolescents.

Various virtual reality (VR) games with head-mounted displays (HMDs) can provide immersive experiences, but are often accompanied by negative experiences. We investigated the feasibility of immersive virtual reality game on balance and cybersickness in healthy adolescents. This is cross-over design. This study included 11 healthy adolescents. Balance and cybersickness were measured in the following three conditions. First, as a baseline, only balance was measured while no immersive virtual reality game was being played. Second, balance and cybersickness were measured while the participants played an immersive virtual reality game with a fixed background. Third, balance and cybersickness were measured while the participants played an immersive virtual reality game with a moving background. A force plate was used to measure balance, while the Questionnaire (VRSQ) and Simulator Sickness Questionnaire (SSQ) were used to measure cybersickness. Sway velocity and length significantly increased during the game with a moving background compared to baseline and a fixed background game (p < 0.05). VRSQ and SSQ scores significantly increased during the game with a fixed and moving background compared to baseline (p < 0.05) and were significantly higher with use of the moving versus fixed background (p < 0.05). This study demonstrated that playing an immersive virtual reality game with a moving background could negatively affect balance and cybersickness. These results will help to select game contents that can reduce side effects when applying VR HMD to various fields in the future.

Development of a sit-to-stand assistive device with pressure sensor for elderly and disabled: a feasibility test.

Elderly patients face difficulty in performing the sit-to-stand motion; hence, their dependency on assistive devices for activities of daily living is increasing. However, the existing devices do not provide support according to the individual's characteristics. This study aimed to develop a sit-to-stand motion assistive chair that detects the user's weight using a load sensor and assists them to stand up by adjusting the speed themselves as per their weight and preference. Additionally, we investigated the feasibility of the developed device. A device for assisting patients in the sit-to-stand motion in rising up from the chair by electrical motorization was developed. This device senses the load on the seat plate using the load sensor and transmits it to the display through which the users can control the speed themselves using the speed control device. To test its feasibility, the electromyographic muscle activation was analyzed for the erector spinae, quadriceps, tibialis anterior, and gastrocnemius muscles in the sit-to-stand motion using this device in five healthy adults. When compared with the non-use of the device, the use of the developed assistive chair device significantly decreased the muscle activation of the erector spinae, quadriceps, tibialis anterior, and gastrocnemius by 37.27%, 20.44%, 14.50%, and 10.56% on the left and by 17.98%, 24.48%, 32.61%, and 6.05% on the right, respectively. The assistive device with a pressure sensor can effectively assist elderly patients with reduced muscle strength and balance in performing the sit-to-stand motion.

Effects of Kinect Video Game Training on Lower Extremity Motor Function, Balance, and Gait in Adolescents with Spastic Diplegia Cerebral Palsy: A Pilot Randomized Controlled Trial.

The Kinect video game (KVG) has received attention as an intervention method for cerebral palsy (CP). However, evidence remains limited. PURPOSE: To investigate the effects of training using Xbox Kinect on lower extremity motor function, balance, and gait in adolescents with spastic diplegia CP. METHODS: This study was a pilot randomized controlled trial. Ten participants were randomly allocated to either the KVG training group (n = 5) or the conventional training (CT) group (n = 5). The Selective Control Assessment of the Lower Extremity (SCALE) tool, Pediatric Balance Scale (PBS), and GAITRite were used for the outcome measurements. RESULTS: In the comparison between the groups, the KVG group showed significant improvements in all the items in the SCALE (except for right hip abduction) and PBS score as compared with the CT group. CONCLUSIONS: KVG training might be an effective intervention for the rehabilitation of adolescents with spastic diplegia CP.

Feasibility of training using full immersion virtual reality video game in young stroke survivor: A case report.

BACKGROUND: With the recent developments in science, full-immersion virtual reality devices have been developed, which may have feasibility for stroke rehabilitation. OBJECTIVE: This case report investigated the feasibility of training using a full-immersion virtual reality video game for improving motor function, balance, and gait in a young stroke survivor. METHOD: The case was a 27-year-old woman with stroke. A training using full-immersion virtual reality video game (Sony PlayStation®VR) was performed for 30 minutes per session, 3 sessions per week, for 6 weeks, with a total of 18 sessions. Before training and at each training for 6 weeks, with a total of 19 times, the motor function, balance, and gait were assessed using the Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and Tinetti Balance Assessment, 10 Meter Walk Test (10MWT), Tinetti Gait Assessment, and Dynamic Gait Index (DGI). RESULTS: During the training, there were no adverse events reported. The case achieved 14 points higher than the pre-assessment with 34 points on the MAS, 16 points higher than the pre-assessment with 48 points on BBS, 6.85 sec lower than the pre-assessment, with 13.58 sec on TUG, 5 points higher than the pre-assessment with 13 points on the Tinetti Balance Assessment, 5.36 sec lower than the pre-assessment, with 8.15 sec on the 10MWT, 4 points higher than the pre-assessment with 10 points on the Tinetti Gait Assessment, and 10 points higher than the pre-assessment with 21 points on the DGI. CONCLUSION: This case report suggests that training using a full-immersion virtual reality video game may be a safe and effective method to improve motor function, balance, and gait in a young stroke survivor.

Impaired Cognitive Function is Associated with Motor Function and Activities of Daily Living in Mild to Moderate Alzheimer's Dementia.

BACKGROUND: The deterioration of cognitive and motor functions and activities of daily living is common in Alzheimer's dementia. OBJECTIVES: The purpose of this study was to investigate the correlation and the strength of the relationship between cognitive function and motor function and activities of daily living after a diagnosis of Alzheimer's disease dementia. METHODS: Sixty-three patients with mild to moderate Alzheimer's disease dementia in a community setting of South Korea were examined for cognitive and motor functions, and functional levels. The test or measures used for cognitive function were the Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), and Clinical Dementia Rating (CDR). The 10-meter walking test (10MWT), Berg Balance Scale (BBS), and Timed Up and Go Test (TUG) were used to examine motor function, while the Modified Barthel Index (MBI) and Katz Index (KI) were used to examining activities of daily living. RESULTS: The MMSE had a positive correlation with that from the BBS (r=.338, p<.05), MBI (r=.363, p<.05), and KI (r=.276, p<.05). The GDS was negatively correlated with BBS (r=.319, p<.05). Multivariate regression analysis showed that MMSE was a major explanatory variable for BBS (R2 =.115, ß=.338, p<.05) MBI (R2 =.131, ß=.363, p<.05), and KI (R2 =.076, ß=.276, p<.05). CONCLUSION: The results of the present study show that cognitive function by MMSE is correlated with balance by BBS and activities of daily living by MBI and KI, and MMSE, which are tests or measures for cognitive function, can be explanatory variable to explain variations in the BBS, MBI, and KI in the persons with mild to moderate Alzheimer's dementia. It may mean that a decrease in cognitive function was found to affect motor function and activities of daily living. Based on this study, appropriate intervention approaches including physical exercise, should be considered for caring for persons with mild to moderate Alzheimer's dementia in a community setting.

Full-immersion virtual reality: Adverse effects related to static balance.

The use of virtual reality (VR) is associated with several adverse effects including dizziness, headache, and motion sickness. This study investigates how full-immersion VR games cause changes in static balance with associated adverse effects, and whether a fixed or a changing game background is more likely to contribute to such problems. Static balance and adverse effects (eye fatigue and dizziness) were measured in 15 healthy adults under three conditions: baseline; after a full-immersion virtual reality game (PlayStation 4 Pro and PlayStation® VR headset) with a fixed background (15 min); and after a full-immersion virtual reality game with a unfixed background (15 min). Static balance was measured with an AMTI force plate, while eye fatigue and dizziness were measured with the Virtual Reality Symptom Questionnaire (VRSQ) and the Simulator Sickness Questionnaire (SSQ). It was determined that playing a full-immersion VR game had a negative effect on static balance and produced several adverse effects including eye fatigue and dizziness. Moreover, sway velocity and sway length increased significantly in the game with a moving background compared to both the baseline and the game with a fixed background (p < 0.05); VRSQ and SSQ were also significantly higher in this case. It is thus preferable from the perspective of reducing adverse effects that only fixed-background full-immersion VR games be used in rehabilitative interventions.

Gait analysis in hemiplegic stroke survivors who used the one-arm motorized walker.

OBJECTIVE: A high number of stroke survivors experience limitations in balance and gait abilities. Thus, an improvement in gait ability is an important goal in the rehabilitation of hemiplegic stroke survivors. This study aimed to investigate the effect of using the one-arm motorized walker, a hemi-walker developed to assist hemiplegic stroke survivors in gait training and activities of daily living, on the improvement in gait ability in hemiplegic stroke survivors. METHODS: Eleven hemiplegic stroke survivors who met the inclusion criteria were included. The participants were instructed to walk thrice using traditional walking aids on a gait mat and then to walk thrice using the one-arm motorized walker. During each walk, spatiotemporal gait parameters, including velocity, cadence, step length, stride length, single support time, and double support time, were evaluated using a gait analysis system. RESULTS: Velocity and cadence significantly increased when the participants walked using the one-arm motorized walker compared to those who used traditional walking aids (p< 0.05), whereas double support time significantly decreased for both the more affected and less affected sides (p< 0.05). However, no significant difference was observed in terms of step length and single support time. CONCLUSION: The one-arm motorized walker may have a positive effect on the improvement of gait ability in hemiplegic stroke survivors. It can be an effective walking aid for hemiplegic stroke survivors who experience difficulties in independent walking.

Effects of an Immersive Virtual Reality Environment on Muscle Strength, Proprioception, Balance, and Gait of a Middle-Aged Woman Who Had Total Knee Replacement: A Case Report.

BACKGROUND The purpose of this case study was to apply a training program using virtual reality to a middle-aged woman who had total knee replacement surgery and to investigate its effects on her muscle strength, proprioception, balance, and gait ability. CASE REPORT The subject who participated in this study was a 62-year-old woman, who had been diagnosed with moderate osteoarthritis and had a total knee replacement. Post-operative treatment consisted of virtual reality training along with range of motion exercise of the knee joint, light quadriceps isometric exercise, and conventional physical therapy. This also included thermal and electric therapy for pain control conducted on 10 occasions (5 times a week for 2 weeks). Total treatment time, which included 30 min of conventional physical therapy, was 60 min. Measurement of the subject's lower extremity muscle strength after intervention decreased to 9.43 s, and the error in proprioception decreased to 1.5°. In addition, balance score increased to 56 points, and the time taken to measure gait ability decreased to 9.87 s. CONCLUSIONS The patient responded positively to rehabilitation using virtual reality, and her muscle strength, proprioception, balance, and gait ability improved. These results suggest that the application of rehabilitative training through virtual reality for total knee replacement patients warrants further study and consideration.

The Effects of Viewing Smart Devices on Static Balance, Oculomotor Function, and Dizziness in Healthy Adults.

BACKGROUND The number of people using smart devices such as smartphones (SPs) or virtual reality head-mounted displays (HMDs) is rapidly increasing. This study aimed to investigate the effects of viewing smart devices, including SPs and HMDs, on postural balance and the development of dizziness in healthy individuals. MATERIAL AND METHODS Twenty-six healthy adults underwent static balance measurements at baseline, and after 5, 10, and 20 minutes of viewing the SP and HMD display. Measurements were taken using a force plate and Wii Balance Board (WBB) and included the parameters of postural sway velocity, path length, and postural sway area. A modified Simulator Sickness Questionnaire (SSQ) evaluated oculomotor function and dizziness twice for each device, after 5 and 20 minutes of use. RESULTS Compared with baseline, the use of smart devices for 20 minutes had significantly increased effects on balance, oculomotor function, and dizziness than shorter use for 10 minutes or 5 minutes in healthy adults. Postural sway velocity and path length were significantly increased after 20 minutes of use of the HMD and SP when compared 5-minute use and baseline measurements (p<0.05). Postural sway area after 20-minute use of the HMD was significantly increased compared with the baseline and 5-minute and 10-minute use of the SP and 5-minute use of the HMD (p<0.05). The SSQ showed that dizziness was significantly increased after 20-minute use compared with 5-minute use of the HMD and SP (p<0.05). CONCLUSIONS Longer use of smart devices affected static balance, oculomotor function, and dizziness in healthy adults.

Comparison of Gait Ability of a Child with Cerebral Palsy According to the Difference of Dorsiflexion Angle of Hinged Ankle-Foot Orthosis: A Case Report.

BACKGROUND The purpose of this study was to compare gait abilities in a child with spastic diplegia according to different dorsiflexion angles on hinged ankle-foot orthosis (hinged AFO). CASE REPORT This study is a case report of a child who was diagnosed with spastic diplegia and ambulated independently with the use of a hinged AFO. For gait analysis, the GAITRite® was used under 3 different conditions including barefoot, wearing regular of hinged AFO, and wearing a dorsiflexion 10° hinged AFO. The gait velocity and cadence were collected as temporal parameters, while step length, stride length, and single and double leg support time were collected as temporal spatial parameters. As a result, when a regular hinged AFO was worn on the barefoot, the gait velocity and cadence per minute were increased, whereas the step length and stride length, the single and double leg support time decreased. The gait velocity, cadence, step length, and stride length were significantly increased when dorsiflexion 10° hinged AFO was applied compared to barefoot. The gait velocity, cadence, step length, and stride length increased with dorsiflexion 10° hinged AFO compared to regular hinged AFO. CONCLUSIONS The results of this study demonstrated that wearing a dorsiflexion 10° hinged AFO would have a positive effect on improving gait ability of a child with cerebral palsy rather than wearing a bare foot and a general hinged AFO.

Biological surface electromyographic switch and necklace-type button switch control as an augmentative and alternative communication input device: a feasibility study.

Augmentative and alternative communication (AAC) is an approach used to supplement, improve, and support the communication of those with speech or language impairments. We developed an AAC device for diverse approaches, using an electromyographic (EMG) switch and a necklace-type button switch. The EMG switch comprised an EMG signal processor and a switch interface processor. EMG signals were processed using an electrode through the stages of signal acquisition, amplification, filtering, rectification, and smoothing. In the switch interface processor, the microprocessor determined the switch as ON or OFF in response to an input EMG signal and then converted the EMG signal into a keyboard signal, which was transmitted to a smart device via Bluetooth communication. A similar transmission process was used for the necklace-type button switch, and switch signals were input and processed with general-purpose input/output. The first and second feasibility tests for the EMG switch and button switch were conducted in a total of three test sessions. The result of the feasibility test indicated that the major inconvenience and desired improvement associated with the EMG switch were the intricacy of the AAC device settings. The major inconveniences and desired improvements for the necklace-type button switch involved device shifting, volume and weight, and inconvenience in fixing the switch in various directions. Thus, based on the first and second feasibility tests, we developed an additional device. Finally, the EMG switch and necklace-type button switch developed to remedy the inconveniencies had high feasibility.

Effect of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors: a randomized controlled trial.

BACKGROUND: When solely mirror therapy is applied for a long period of time, spatial perception and attention to the damaged side may decrease, and the effect of mirror therapy may be limited. To overcome this limitation, it has recently been suggested that the combination of mirror therapy with mirror treatment is effective. AIM: The aim of this study was to investigate the effects of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors. DESIGN: A randomized controlled trial. SETTING: Rehabilitation center. POPULATION: Thirty stroke survivors were randomly assigned to two groups: the experimental group (N.=15) and the control group (N.=15). METHODS: Participants of the experimental group received afferent electrical stimulation with mirror therapy, and participants of the control group received sham afferent electrical stimulation with sham mirror therapy for 60 minutes per day, 5 days per week, for 4 weeks. Motor function was measured using a handheld dynamometer and the Modified Ashworth Scale, balance was measured using the Berg Balance Scale, and gait was assessed using the GAITRite® (GAITRite, CIR System Inc., Franklin, NJ, USA) pressure-sensitive walkway at baseline and after 4 weeks. RESULTS: The experimental group showed significant differences in muscle strength, Modified Ashworth Scale, and Berg Balance Scale results, and velocity, cadence, step length, stride length, and double support time of their gait (P<0.05) in the pre-post intervention comparison. Significant differences between the two groups in muscle strength, Berg Balance Scale, gait velocity, step length, and stride length (P<0.05) were found. CONLCUSIONS: Mirror therapy with afferent electrical stimulation may effectively improve muscle strength and gait and balance abilities in hemiplegic stroke survivors. CLINICAL REHABILITATION IMPACT: Afferent electrical stimulation combined with mirror therapy can be used as an effective intervention to improve lower limb motor function, balance, and gait in chronic stroke survivors in clinical settings.

Whole-Body Vibration in Horizontal Direction for Stroke Rehabilitation: A Randomized Controlled Trial.

BACKGROUND As most of the existing whole-body vibration (WBV) training programs provide vertical or rotatory vibration, studies on the effects of horizontal vibration have rarely been reported. The present study was conducted to investigate the effect of WBV in the horizontal direction on balance and gait ability in chronic stroke survivors. MATERIAL AND METHODS This study was designed as a randomized controlled trial. Twenty-one stroke survivors were randomly allocated into 2 groups (whole-body vibration group [n=9] and control group [n=12]). In the WBV group, WBV training in the horizontal direction was conducted for 6 weeks, and a conventional rehabilitation for 30 min, 3 days per week for a 6-week period, was conducted in both the WBV and control groups. Outcome variables included the static balance and gait ability measured before training and after 6 weeks. RESULTS On comparing the outcome variables before and after training in the WBV group, significant differences were observed in the cadence and single support time of gait ability. However, there were no significant differences in other variables, including velocity, step length, stride length, and double support time. In addition, after training, no significant differences in all variables were observed between the 2 groups. CONCLUSIONS The results of this study suggest that WBV training in the horizontal direction has few positive effects on balance and gait function in chronic stroke survivors. However, further investigation is needed to confirm this.