Efficacy of Wheelchair Skills Training Program in Enhancing Sitting Balance and Pulmonary Function in Chronic Tetraplegic Patients: A Randomized Controlled Study.

Background and Objectives: This study aimed to evaluate the effectiveness of a wheelchair skills training program (WSTP) in improving sitting balance and pulmonary function in patients with chronic tetraplegia resulting from cervical spinal cord injury (cSCI). Materials and Methods: Twenty-four patients were randomly divided into WSTP and control groups. The WSTP group participated in the WSTP for eight weeks, while the control group underwent conventional physical therapy for the same eight-week period. Sitting balance was evaluated using the activity-based balance level evaluation (ABLE) scale, and pulmonary function was evaluated using forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF). Results: The WSTP group showed significant improvements in both sitting balance and pulmonary function during the intervention period (p < 0.05), whereas the control group did not show any significant changes. A strong positive correlation was found between ABLE scores and all three pulmonary function parameters across all time points. Conclusions: Our results suggest that the WSTP significantly improves sitting balance and specific aspects of lung function in patients with tetraplegia.

Comparative study of vestibular projection pathway connectivity in cerebellar injury patients and healthy adults.

OBJECTIVE: Cerebellar injury can not only cause gait and postural instability, nystagmus, and vertigo but also affect the vestibular system. However, changes in connectivity regarding the vestibular projection pathway after cerebellar injury have not yet been reported. Therefore, in the current study, we investigated differences in the connectivity of the vestibular projection pathway after cerebellar injury using diffusion tensor imaging (DTI) tractography. METHODS: We recruited four stroke patients with cerebellar injury. Neural connectivity in the vestibular nucleus (VN) of the pons and medulla oblongata in patients with cerebellar injury was measured using DTI. Connectivity was defined as the incidence of connection between the VN on the pons and medulla oblongata and target brain regions such as the cerebellum, thalamus, parieto-insular vestibular cortex (PIVC), and parietal lobe. RESULTS: At thresholds of 10 and 30, there was lower connectivity in the ipsilateral hemisphere between the VN at the medullar level and thalamus in the patients than in healthy adults. At a threshold of 1 and 10, the patient group showed lower VN connectivity with the PIVC than healthy adults. At a threshold of 1, VN connectivity with the parietal lobe in the contralateral hemisphere was lower in the patients than in healthy adults. Additionally, at a threshold of 30, VN connectivity at the pons level with the cerebellum was lower in healthy adults than in the patients. CONCLUSION: Cerebellar injury seems to be associated with decreased vestibular projection pathway connectivity, especially in the ipsilateral thalamus, PIVC, and contralateral parietal lobe.

Breathing Exercise Called the Maximal Abdominal Contraction Maneuver.

Background and objectives: The maximal abdominal contraction maneuver (MACM) was designed as an effective and efficient breathing exercise to increase the stability of the spinal joint. However, it has not been determined whether MACM is more effective and efficient than the maximal expiration method. Thus, the present study was undertaken to investigate whole abdominal muscle thickness changes after MACM. Materials and Methods: Thirty healthy subjects (17 males and 13 females) participated in this study. An experimental comparison between MACM and the maximal expiration task was conducted by measuring the change of abdominal muscle thickness such as the transverse abdominis (TrA), internal oblique (IO), external oblique (EO) and rectus abdominis (RA) using ultrasound images. Results: The results indicated that MACM resulted in significantly greater muscle thickness increases of the TrA and RA than the maximal expiration exercise (p < 0.05). Conclusion: MACM provided better exercise than the maximal expiration exercise in terms of increasing spine stability, at least from a co-contraction perspective.

Wheelchair Skills Training for Functional Activity in Adults with Cervical Spinal Cord Injury.

Wheelchair skills training can improve independent wheeled mobility for daily living activities as well as functional and social participation of adults with cervical spinal cord injury (C-SCI). The objective of this study was to examine the effectiveness of wheelchair skills training in improving both wheelchair skills and upper arm skilled performance in adults with C-SCI. In a randomized controlled study, 24 adults with tetraplegia were randomized and allocated to training group (n=13) or control group (n=11). The training group attended wheelchair skills training sessions, whereas the control group attended conventional exercise sessions. All interventions lasted 8 weeks, with a frequency of 3 days per week. All individuals were tested with the Wheelchair Skills Test (WST) and the Van Lieshout Test (VLT). The test was repeated at pre- and post-training (after 4 weeks and 8 weeks). For WST, univariate analysis demonstrated significant main effects in between-group, within-group, and group-by-time interaction (p<0.05). VLT showed no significant effect in between-group comparison (p>0.05), whereas within-group comparison of test times and group-by-time interaction showed significant main effects (p<0.05). Thus, wheelchair skills training is more beneficial for adults with C-SCI than conventional exercise.

Changes of kinematic parameters of lower extremities with gait speed: a 3D motion analysis study.

[Purpose] The purpose of this study was to investigate the changes in hip, knee and ankle kinematic variables of the lower extremities at different gait speeds. [Subjects and Methods] Forty healthy subjects who had no previous history of neurological, musculo-skeletal or other medical conditions that could affect gait were recruited. The subjects were asked to walk 10 m down a walkway at three different gait speeds: normal gait speed, and self-selected fast, and slow speeds. The experimental order was randomly chosen across these gaits. The hip, knee and ankle kinematic data were evaluated using a VICON 3D motion analysis system and force plates. [Results] The flexion peak and external rotation peak of the knee joint significantly increased with the increase of gait speed. The plantarflexion peaks of the ankle joint significantly increased with increase of gait speed. However, none of the kinematic data of the hip joint were significantly dependent on increase of gait speed. [Conclusion] The relationship of the knee and ankle joint can be described as coupling motion which is dependent on gait speed. Our present findings suggest that coupling motion of the knee joint and plantarflexion of the ankle joint significantly increase with increase of gait speed. These results will provide important insight into gait mechanisms for the evaluation of pathological populations.

Effectiveness of motor sequential learning according to practice schedules in healthy adults; distributed practice versus massed practice.

[Purpose] The purpose of the current study was to compare the effectiveness of motor sequential learning according to two different types of practice schedules, distributed practice schedule (two 12-hour inter-trial intervals) and massed practice schedule (two 10-minute inter-trial intervals) using a serial reaction time (SRT) task. [Subjects and Methods] Thirty healthy subjects were recruited and then randomly and evenly assigned to either the distributed practice group or the massed practice group. All subjects performed three consecutive sessions of the SRT task following one of the two different types of practice schedules. Distributed practice was scheduled for two 12-hour inter-session intervals including sleeping time, whereas massed practice was administered for two 10-minute inter-session intervals. Response time (RT) and response accuracy (RA) were measured in at pre-test, mid-test, and post-test. [Results] For RT, univariate analysis demonstrated significant main effects in the within-group comparison of the three tests as well as the interaction effect of two groups × three tests, whereas the between-group comparison showed no significant effect. The results for RA showed no significant differences in neither the between-group comparison nor the interaction effect of two groups × three tests, whereas the within-group comparison of the three tests showed a significant main effect. [Conclusion] Distributed practice led to enhancement of motor skill acquisition at the first inter-session interval as well as at the second inter-interval the following day, compared to massed practice. Consequentially, the results of this study suggest that a distributed practice schedule can enhance the effectiveness of motor sequential learning in 1-day learning as well as for two days learning formats compared to massed practice.

Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders.

[Purpose] This study investigated upper-extremity muscle activities in natural, ideal, and corrected head positions. [Subjects and Methods] Forty subjects with a forward head posture and rounded shoulder were recruited and randomly assigned to the natural head position group (n = 13), ideal head position group (n = 14), or corrected head position group (n = 13). Muscle activities were measured using a four-channel surface electromyography system at the sternocleidomastoideus, upper and lower trapezius, and serratus anterior muscles on the right side during an overhead reaching task. [Results] The muscle activities of the upper trapezius and serratus anterior differed significantly among head positions. Post hoc tests revealed significant differences between natural and ideal head positions, and natural and ideal head positions for both the upper trapezius and serratus anterior. [Conclusion] Recovery of normal upper trapezius and serratus anterior muscle functions plays an important role in correcting forward head posture and rounded shoulders.

Effect of constrained weight shift on the static balance and muscle activation of stroke patients.

[Purpose] The purpose of this study was to evaluate the effects of constrained weight shift induced by shoe lift beneath the unaffected lower extremity, on balance functions and electromyography of the affected lower extremity of stroke patients. [Subjects and Methods] Twelve patients with unilateral stroke were recruited as volunteers for this study. The subjects were repeatedly measured in a randomized order under three conditions: no-shoe lift, and shoe lifts of 5 mm and 10 mm heights beneath the unaffected lower extremity. [Results] Standing with a 10 mm shoe lift for the unaffected lower extremity decreased the mean velocity of mediolateral sway compared to no-shoe lift. Regarding the velocity of anteroposterior sway, standing with 5 mm and 10 mm shoe lifts decreased the mean velocity of anteroposterior sway. The muscle activation of the affected lower extremity was not significantly different among the no-shoe lift, 5 mm shoe lift and 10 mm shoe lift conditions; however, the muscle activities of the rectus femoris, biceps femoris, tibialis anterior, and medial gastrocnemius of the affected lower extremity progressively improved with increasing height of the shoe lift. [Conclusion] A constrained weight shift to the affected side elicited by a shoe insole of 10 mm height on the unaffected side can improve the static standing balance of stroke patients, and it resulted in 14-24% increases in the muscle activities of the affected leg.

Effect of handrail use while performing treadmill walking on the gait of stroke patients.

[Purpose] The purpose of this study was to investigate how the use of handrails during treadmill walking affects the gait parameters of stroke patients. [Subjects and Methods] The participants, 30 hemiplegic stroke patients, were randomly allocated to one of three groups: the NHG group (No Handrail group, n=10), the FHG group (Front handrail group, n=10), and BHG group (Bilateral Handrail group, n=10). All the subjects' performed treadmill walking for 30 min, five days a week, for a period of eight weeks. Gait parameters were evaluated using the RS-scan system. [Results] A statistically significant difference in the HM (heel-medial) area of plantar foot pressure was observed between BHG and NHG. Statistically significant difference in the HL (heel-lateral) area of plantar foot pressure was observed between BHG and NHG, and between FHG and NHG. A statistically significant difference in contact area of the rear foot was observed between BHG and NHG. [Conclusion] The results of this study show that holding handrails during treadmill training may enhance the improvement in the quality of patients' gait (plantar foot pressure, contact area of foot).

Prevalence and determinants of pain in the ipsilateral upper limb of stroke patients.

This study investigated the prevalence of pain in the ipsilateral upper-limb in stroke patients. 229 stroke patients (133 men, 96 women; M age = 59.0 yr., SD = 12.4) were assessed with the Pain Behaviors Scales and their motor weakness was measured with the Motricity Index. Results indicated that over 27% of patients experienced pain in at least one joint of the ipsilateral upper limb. Shoulder pain was the most common. Further analysis indicated that the occurrence of pain in the ipsilateral upper limb was higher among women, among patients who used a cane, and among patients with a greater weakness of the affected lower limb.

A DNA vaccine against GII.4 human norovirus VP1 induces blocking antibody production and T cell responses.

Human noroviruses (HuNoVs) are highly contagious and a leading cause of epidemics of acute gastroenteritis worldwide. Among the various HuNoV genotypes, GII.4 is the most prevalent cause of outbreaks. However, no vaccines have been approved for HuNoVs to date. DNA vaccines are proposed to serve as an ideal platform against HuNoV since they can be easily produced and customized to express target proteins. In this study, we constructed a CMV/R vector expressing a major structural protein, VP1, of GII.4 HuNoV (CMV/R-GII.4 HuNoV VP1). Transfection of CMV/R-GII.4 HuNoV VP1 into human embryonic kidney 293T (HEK293T) cells resulted in successful expression of VP1 proteins in vitro. Intramuscular or intradermal immunization of mice with the CMV/R-GII.4 HuNoV VP1 construct elicited the production of blocking antibodies and activation of T cell responses against GII.4 HuNoV VP1. Our collective data support the utility of CMV/R-GII.4 HuNoV VP1 as a promising DNA vaccine candidate against GII.4 HuNoV.

Cycloastragenol inhibits adipogenesis and fat accumulation in vitro and in vivo through activating Hedgehog signaling.

In this study, we investigated the effect of cycloastragenol (CAG), a triterpenoid isolated from Astragalus membranaceus roots, on regulating the adipogenesis and fat accumulation in vitro and in vivo. During the adipogenesis of 3T3-L1 cells, CAG inhibited lipid accumulation and the expression of key adipogenic factors, proliferator-activated receptor γ (PPARγ) and CCAAT enhancer binding protein α (C/EBPα) and increased the expression of Gli1, a key mediator in Hedgehog (Hh) signaling. In HFD-induced animal experiment, CAG significantly reduced body weight gain without affecting brown fat weight. In addition, CAG regulated the expression of PPARγ, C/EBPα, and Gli1 in visceral white adipose tissue (vWAT). We also confirmed the inhibitory effect of CAG on specifically targeting white adipose tissue (WAT) formation in stromal vascular fraction (SVF) cell differentiation. Taken together, these results suggest that CAG may be a potent phytochemical preventing adipogenesis and obesity via Hh signaling. Supplementary Information: The online version contains supplementary material available at 10.1007/s10068-023-01403-0.

Curcumol metabolized by rat liver S9 fraction and orally administered in mouse suppressed the proliferation of colon cancer in vitro and in vivo.

Following 3R (reduction, refinement, and replacement) principles, we employed the rat liver S9 fraction to mimic liver metabolism of curcumol having high in vitro IC50 on cancer cells. In HCT116 and HT29 colon cancer cells, the metabolites of curcumol by S9 fraction exerted more enhanced activity in inducing cell cycle arrest and apoptosis via regulating the expression of cyclin D1, CDK1, p21, PARP and Bcl-2 than curcumol. In addition, oral administration of curcumol at 4 mg/kg BW significantly suppressed the development of colon tumor induced by azoxymethane/dextran sulfate sodium, and induced cell cycle arrest and apoptosis in tumor tissues. In mass analysis, curcumenol and curzerene were identified as the metabolites of curcumol by S9 fraction metabolism. Taken together, curcumol metabolites showed the enhanced suppressive effect on colon cancer, suggesting that S9 fraction can be considered as simple, fast, and bio-mimicking platform for the screening of chemical libraries on different chronic diseases.

Response Inhibition Induced in the Stop-signal Task by Transcranial Direct Current Stimulation of the Pre-supplementary Motor Area and Primary Sensoriomotor Cortex.

[Purpose] This study examined whether transcranial direct current stimulation (tDCS) of both the pre-supplementary motor area (pre-SMA) and primary sensoriomotor cortex (M1) alters the response time in response inhibition using the stop-signal task (SST). [Methods] Forty healthy subjects were enrolled in this study. The subjects were randomly tested under the three: the pre-SMA tDCS, M1 tDCS, and Sham tDCS conditions. All subjects performed a SST in two consecutive phases: without or after the delivery of anodal tDCS over one of the target sites (pre-SMA or the M1) and under the Sham tDCS condition. [Results] Our findings demonstrated significant reductions in the stop processing times after the anodal tDCS over pre-SMA, and change response times were significantly greater under the pre-SMA tDCS condition compared to both the M1 tDCS condition and the Sham tDCS condition. There was no significant major effect after delivery of the tDCS for the go processing times observed among the three conditions. [Conclusion] Anodal tDCS of the pre-SMA or M1 during performance of the SST resulted in enhancement of the volitional stop movement in inhibitory control. Our results suggest that when concurrently applied with the SST, tDCS might be a useful adjuvant therapeutic modality for modulation of the response inhibition and its related dynamic behavioral changes between motor execution and suppression.

The Intra- and Inter-rater Reliabilities of the Forward Head Posture Assessment of Normal Healthy Subjects.

[Purpose] Assessment of posture is an important goal of physical therapy interventions for preventing the progression of forward head posture (FHP). The purpose of this study was to determine the inter- and intra-rater reliabilities of the assessment of FHP. [Subjects and Methods] We recruited 45 participants (20 male subjects, 25 female subjects) from a university student population. Two physical therapists assessed FHP using images of head extension. FHP is characterized by the measurement of angles and distances between anatomical landmarks. Forward shoulder angle of 54° or less was defined as FHP. Intra- and inter-rater reliabilities were estimated using Kendall's Taub correlation coefficients. [Results] Intra-class correlation of intra-rater measurements indicated an excellent level of reliability (0.91), and intra-class correlation of inter-rater measurements showed a good level of reliability in the assessment of FHP (0.75). [Conclusion] Assessment of FHP is an important component of evaluation and affects the design of the treatment regimen. The assessment of FHP was reliably measured by two physical therapists. It could therefore become a useful method for assessing FHP in the clinical setting. Future studies will be needed to provide more detailed quantitative data for accurate assessment of posture.

The effect of alpha rhythm sleep on EEG activity and individuals' attention.

[Purpose] This study examined whether the alpha rhythm sleep alters the EEG activity and response time in the attention and concentration tasks. [Subjects and Methods] The participants were 30 healthy university students, who were randomly and equally divided into two groups, the experimental and control groups. They were treated using the Happy-sleep device or a sham device, respectively. All participants had a one-week training period. Before and after training sessions, a behavioral task test was performed and EEG alpha waves were measured to confirm the effectiveness of training on cognitive function. [Results] In terms of the behavioral task test, reaction time (RT) variations in the experimental group were significantly larger than in the control group for the attention item. Changes in the EEG alpha power in the experimental group were also significantly larger than those of the control group. [Conclusions] These findings suggest that sleep induced using the Happy-sleep device modestly enhances the ability to pay attention and focus during academic learning.

Effects of progressive resistance training integrated with foot and ankle compression on spatiotemporal gait parameters of individuals with stroke.

[Purpose] The purpose of this study was to investigate the effect of progressive resistance training (PRT) integrated with foot and ankle compression on the gait ability of post-stroke patients. [Subjects and Methods] Participants were randomly allocated to two groups: the PRT group (n=14) and the control group (n=14). Subjects in the PRT group received training for 30 minutes, five days per week, for a period of six weeks. Gait ability was evaluated using the RsScan system. [Results] Use of PRT integrated with foot and ankle compression resulted in significant improvements in temporal parameters (gait velocity, step time, and double limb support) and spatial parameters (step length, stride length, and heel-to- heel base of support). [Conclusion] Progressive resistance training integrated with foot and ankle compression improved the gait ability of stroke patients. These results suggest the feasibility and suitability of integration of PRT with foot and ankle compression for individuals with stroke.

Influence of Isokinetic Strength Training of Unilateral Ankle on Ipsilateral One-legged Standing Balance of Adults.

[Purpose] The purpose of the current study was to investigate the changes in one-legged standing balance of the ipsilateral lower limb following unilateral isokinetic strength training. [Subjects and Methods] Thirty healthy adult volunteers were randomly assigned to either a training group or a control group, so that each group included 15 subjects. Subjects in the training group performed unilateral ankle isokinetic exercises of the dominant leg using the Biodex 3 PRO System for a period of four weeks. Ipsilateral one-legged standing balance was evaluated before and after the intervention with three stability indexes of balance using the Biodex System: Anterior-Posterior Stability Index (APSI), Medial-Lateral Stability Index (MLSI), and Overall Stability Index (OSI). [Results] Comparison of pre- and post-test data revealed significant improvements in strength values (dorsiflexion, plantarflexion, eversion, and inversion) and stability indexes (APSI, MLSI, OSI). [Conclusion] These results suggest that ankle strengthening exercise can be considered as a form of exercise that may assist individuals with improvement of balance.

Biomechanical Analysis of Unplanned Gait Termination According to a Stop-Signal Task Performance: A Preliminary Study.

There is a correlation between cognitive inhibition and compensatory balance response; however, the correlation between response inhibition and gait termination is not clear. OBJECTIVES: The purpose of this study was to investigate the gait parameters of the lower extremity that occurred during unplanned gait termination (UGT) in two groups classified by the stop-signal reaction time (SSRT). METHODS: Twenty young adults performed a stop-signal task and an unplanned gait termination separately. UGT required subjects to stop on hearing an auditory cue during randomly selected trials. The spatiotemporal and kinematic gait parameters were compared between the groups during UGT. RESULTS: In phase one, the fast group had a significantly greater angle and angular velocity of knee flexion and ankle plantar flexion than the slow group (p < 0.05). Phase two showed that the fast group had a significantly greater angle and angular velocity of knee extension than the slow group (p < 0.05). Concerning the correlation analysis, the angle and angular velocity of knee flexion and ankle plantar flexion showed a negative correlation with the SSRT during UGT in phase one (p < 0.05). Phase two showed that the angle and angular velocity of knee extension was negatively correlated with the SSRT during UGT (p < 0.05). CONCLUSION: The shorter the SSRT, the greater the angle and joint angular velocity of the ankle or knee joint that were prepared and adjusted for gait termination. The correlation between the SSRT and UGT suggests that a participant's capacity to inhibit an incipient finger response is associated with their ability to make a corrective gait pattern in a choice-demanding environment.

The efficacy of sling exercise combined with extracorporeal shock wave on office workers with chronic neck pain.

This study aimed to investigate the effect of extracorporeal shockwave therapy on the anterior surface line of the fascia meridian, including the oblique muscle, combined with sling exercise, on the stability of the spine in the neck disability index (NDI), neck joint range of motion (ROM), craniovertebral angle, neck alignment, and posture control. A total of 20 office workers with chronic neck pain were randomly assigned to an experimental group that combined extracorporeal shock wave therapy and sling exercise (n = 10) and a control group (CG) consisting of sling exercise (n = 10) performed twice weekly for 4 weeks. All subjects were evaluated using the NDI, ROM, neck alignment, and spine stability tests. Following the intervention, there were significant differences in the For example, NDI, craniovertebral angle, Cobb's angle, Centaur data, and ROM. Except for Cobb's angle and Centaur data (-90 degrees), all variables showed significant differences in the CG. Comparing changes before and after the intervention, The For example, showed significantly more significant changes in all variables than the CG. The combination of extracorporeal shockwave therapy and sling exercises improved NDI, ROM, and neck and spine alignment in office workers with chronic neck pain more effectively than the sling exercise alone. This study could be recommended as a new approach to enable individuals with chronic neck pain to perform better.