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.

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.

Progressive Respiratory Muscle Training for Improving Trunk Stability in Chronic Stroke Survivors: A Pilot Randomized Controlled Trial.

BACKGROUND: Stroke weakens the respiratory muscles, which in turn may influence the trunk stability; it is unclear whether the progressive respiratory muscle training (RMT) is effective in improving the trunk stability. The aim of this study was to investigate the effects of progressive RMT with trunk stabilization exercise (TSE) on respiratory muscles thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors. METHODS: This is a pilot randomized controlled trial. Chronic stroke survivors (n = 33) who were able to sit independently participated in the tstudy. The participants were allocated into the RMP with TSE group or the TSE group. The respiratory muscle thickness during resting and contraction were measured. Maximal expiratory pressure (MEP), peak expiratory flow (PEF), and forceful expiratory volume at 1 sec (FEV1) for forced expiratory muscle function and maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), and vital capacity (VC) for inspiratory muscle function were examined. Trunk stability was estimated by maximal velocity and path length of the center of pressure (COP) by using a balance board with sitting posture. RESULTS: The respiratory muscle thickness was significantly increased on the affected side in the RMT group than in the TSE group. The MEP, PEF, MIP, and PIF were significantly increased in the RMT group than in the TSE group; however, FEV1 and VC showed no significant differences between the 2 groups. Trunk stability for the maximal velocity of COP of extension and affected side bending was significantly increased in the RMT group than in the TSE group. In addition, the maximal path length of COP of flexion, extension, affected/less affected side bending was significantly increased in the RMT group than in the TSE group. CONCLUSIONS: RMT combined with TSE can be suggested as an effective method to improve the respiratory muscle thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors as opposed to TSE only.

Decreased Respiratory Muscle Function Is Associated with Impaired Trunk Balance among Chronic Stroke Patients: A Cross-sectional Study.

The abdominal muscles play a role in trunk balance. Abdominal muscle thickness is asymmetrical in stroke survivors, who also have decreased respiratory muscle function. We compared the thickness of the abdominal muscles between the affected and less affected sides in stroke survivors. In addition, the relationship between respiratory muscle function and trunk balance was evaluated. Chronic stroke patients (18 men, 15 women; mean age, 58.94 ± 12.30 years; Mini-Mental Status Examination score ≥ 24) who could sit without assist were enrolled. Abdominal muscle thickness during rest and contraction was measured with ultrasonography, and the thickening ratio was calculated. Respiratory muscle function assessment included maximum respiratory pressure, peak flow, and air volume. Trunk function was evaluated using the Trunk Impairment Scale, and trunk balance was estimated based on the center of pressure velocity and path length within the limit of stability in sitting posture. Abdominal muscles were significantly thinner on the affected side, and the thickening ratio was lower in the affected side (P < 0.05). In addition, the higher thickening ratio of the affected side showed significant relationship with higher trunk function. Moreover, higher respiratory muscle function was significantly correlated with higher level of trunk function and balance in stroke patients (P < 0.05). Thus, chronic stroke survivors have decreased abdominal muscle thickness on the affected side, and respiratory muscle function has positive correlation with trunk function and balance. We propose that respiratory muscle training should be included as part of trunk balance training in chronic stroke patients.

The Effects of Double Oscillation Exercise Combined with Elastic Band Exercise on Scapular Stabilizing Muscle Strength and Thickness in Healthy Young Individuals: A Randomized Controlled Pilot Trial.

This study aimed to investigate the effect of double oscillation exercise combined with elastic band exercise on the strength and thickness ratio of the scapular stabilizing muscles in healthy young individuals. A total of 30 subjects (17 male, 13 female) were randomly assigned to an elastic band exercise group (EBG) (n = 15) or an elastic band plus double oscillation exercise group (EB-DOG) (n = 15). A total of 28 subjects completed the experiment and evaluation. Patients in the EBG performed the elastic band exercise for shoulder flexion, extension, abduction, adduction, horizontal abduction/adduction, and internal/external rotation for 30 minutes/session, five times/week, for four weeks. Patients in the EB-DOG performed the elastic band exercise for 15 minutes and the double oscillation exercise in three planes of motion (frontal, sagittal, and transverse), using a Bodyblade® for 15 minutes/session, five times/week, for four weeks. Shoulder muscle strength was assessed using a manual muscle test device during maximal voluntary isometric contraction (MVIC), while the thicknesses of the scapular stabilizing muscles were assessed using rehabilitative ultrasound imaging both at rest and during MVIC. Both groups had significant effects on shoulder muscle strength, however, there was no significant difference between the two groups for change value of shoulder muscle strength (Bonferroni correction p < 0.005). Significant differences were observed in the group × time interactions for horizontal abduction, external rotation, and protraction. There was a statistically significant improvement in thickness ratio of LT and SA in the EB-DOG and no significant difference was founded in EBG (Bonferroni correction p < 0.006). In comparison between the two groups, EB-DOG showed a significant change in the thickness ratio of LT compared to EBG. In addition, significant differences were observed for the group × time interactions for the thickness ratio of the LT (F = 12.177, P = 0.002; Bonferroni correction p < 0.006). The double oscillation exercise combined with elastic band exercise more effectively increased the thickness of the shoulder stabilizing muscles compared with the resistance exercise alone.

Comparison of postural sway depending on balance pad type.

[Purpose] The purpose of the present study was to compare the postural sway of healthy adults standing on different types of balance pads. [Subjects and Methods] Nine healthy adults participated in this study. Postural body sway was measured while participants were standing on four different types of balance pads: Balance-pad Elite (BE), Aero-Step XL (AS), Dynair Ballkissen Senso (DBS), and Dynair Ballkissen XXL Meditation and Yoga (DBMY). A Wii Balance Board interfaced with Balancia software was used to measure postural body sway. [Results] In the sway velocity, sway path length, and sway area, no significant differences were found between baseline conditions (participants were standing on the floor with no balance pad) and the use of the BE or AS. However, significant increases in all parameters were found comparing baseline conditions to the use of either Dynair balance pad. Furthermore, the use of either Dynair balance pad significantly increased postural sway compared to both the BE and the AS. [Conclusion] These findings suggest that the DBS and DBMY balance pads may serve as superior tools for providing unstable condition for balance training than the BE and the AS balance pads.

Diaphragm Thickness and Inspiratory Muscle Functions in Chronic Stroke Patients.

BACKGROUND The aims of this study are to investigate the difference between the diaphragm thickness at end expiration and the thickness at total lung capacity (TLC), and to examine differences in inspiratory muscle function between stroke patients and healthy individuals. MATERIAL AND METHODS Forty-five stroke patients and 49 healthy volunteers were included in this study. Diaphragm thickness was measured at end expiration and at TLC by ultrasonography. The maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), vital capacity (VC), and inspiratory muscle endurance (IME) were assess to evaluate inspiratory muscle function. RESULTS In stroke patients, the diaphragm was significantly thinner on the affected side than the less affected side at end expiration and at TLC. The change between the thickness at end expiration and at TLC were also significant on both sides. Between groups, the difference in diaphragm thickness at end expiration was not significant, but at TLC, the diaphragms were significantly thicker in healthy individuals than on either side in stroke patients, and the change in diaphragm thickness was significantly greater for healthy individuals. Inspiratory muscle functions were also significantly greater in healthy individuals. MIP, PIF, and VC were positively correlated with the change in thickness in healthy individuals, and MIP was positively correlated with the change in thickness and IME in stroke patients. CONCLUSIONS Stroke patients showed decreases in the thickening ability of the diaphragm at TLC and in inspiratory muscle function. The change between the diaphragm thickness at end expiration and at TLC was positively correlated with MIP, PIF, and VC.

Effects of Virtual Reality Training using Xbox Kinect on Motor Function in Stroke Survivors: A Preliminary Study.

BACKGROUND: Although the Kinect gaming system (Microsoft Corp, Redmond, WA) has been shown to be of therapeutic benefit in rehabilitation, the applicability of Kinect-based virtual reality (VR) training to improve motor function following a stroke has not been investigated. This study aimed to investigate the effects of VR training, using the Xbox Kinect-based game system, on the motor recovery of patients with chronic hemiplegic stroke. METHODS: This was a randomized controlled trial. Twenty patients with hemiplegic stroke were randomly assigned to either the intervention group or the control group. Participants in the intervention group (n = 10) received 30 minutes of conventional physical therapy plus 30 minutes of VR training using Xbox Kinect-based games, and those in the control group (n = 10) received 30 minutes of conventional physical therapy only. All interventions consisted of daily sessions for a 6-week period. All measurements using Fugl-Meyer Assessment (FMA-LE), the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the 10-meter Walk Test (10mWT) were performed at baseline and at the end of the 6 weeks. RESULTS: The scores on the FMA-LE, BBS, TUG, and 10mWT improved significantly from baseline to post intervention in both the intervention and the control groups after training. The pre-to-post difference scores on BBS, TUG, and 10mWT for the intervention group were significantly more improved than those for the control group (P <.05). CONCLUSIONS: Evidence from the present study supports the use of additional VR training with the Xbox Kinect gaming system as an effective therapeutic approach for improving motor function during stroke rehabilitation.

Reliability of an Electronic Inspiratory Loading Device for Assessing Pulmonary Function in Post-Stroke Patients.

BACKGROUND: The purpose of this study was to examine the inter- and intra-rater reliability of an electronic inspiratory loading device for the assessment of pulmonary functions: maximum inspiratory pressure, peak inspiratory flow, and vital capacity. MATERIAL/METHODS: Subjects were 50 patient volunteers in a rehabilitation hospital who had experienced their first episode of unilateral stroke with hemiparesis during the previous 6 months (26 men, 24 women; mean age [±SD], 55.96 [±12.81] years), with no use of medications that could induce drowsiness, evidence of restrictive lung disease, history of asthma, use of psychotropic drugs, or alcohol consumption habit. Maximum inspiratory pressure, peak inspiratory flow, and vital capacity for pulmonary functions were assessed using an electronic inspiratory loading device (PowerBreathe, K5, 2010) by 2 examiners, with patients in an unassisted sitting position, and 1 examiner re-assessed with same patients at the same time of a day after 1 week. Intra-class correlation coefficients were used to assess reliability. RESULTS: Intra-rater reliability ranged from intra-class correlation coefficients (ICCs)=0.959 to 0.986 in variables. For the inter-rater reliability between 2 examiners, the ICCs ranged from 0.933 to 0.985. Intra-rater and inter-rater reliability were good in variables (maximal inspiratory pressure, peak inspiratory flow, and vital capacity). CONCLUSIONS: The intra- and inter-examiner reliability of the pulmonary function measurements, maximum inspiratory pressure, peak inspiratory flow, and vital capacity, for the post-stroke patients was very high. The results suggest that the electronic inspiratory loading device would be useful for clinical rehabilitative assessment of pulmonary function.

Effects of a multifactorial fall prevention program on balance, gait, and fear of falling in post-stroke inpatients.

[Purpose] This study investigated the effects of a multifactorial fall prevention program on balance, gait, and fear of falling in stroke patients. [Subjects] Twenty-five stroke patients were divided randomly into multifactorial fall prevention program group (n=15) and control treadmill group (n=10). [Methods] All interventions were applied for 30 min, five times per week, for five weeks. The fall prevention program included interventions based on the "Step Up to Stop Falls" initiative and educational interventions based on the Department of Health guidelines. For those in the treadmill group, the speed was increased gradually. The Korean falls efficacy scale and Korean activities-specific balance confidence scale were used to assess fear of falling. To assess balance and walking ability, the Korean performance-oriented mobility assessment scale and the 10-m and 6-minute walk tests were used. [Results] The fall prevention program interventions were found to be very effective at improving gait, balance, and fear of falling compared with the treadmill intervention and therefore seem appropriate for stroke patients. [Conclusion] A multifactorial fall prevention program is effective at improving balance, gait ability, and fear of falling. It is a more specific and broad intervention for reducing falls among inpatients in facilities and hospitals.

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.

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.

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.

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.

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.

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.

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.

Development of a wheeled walker braking device using the four-bar mechanism.

The elderly population in many countries has been rising rapidly, and falls are a serious event many elderly people experience. Assistive equipment is actively used to reduce falls among elderly people. Popular types of assistive equipment include canes, electric wheelchairs, and wheeled walkers. Wheeled walkers support the body of elderly people, making their gait comfortable as they age or recover from injuries. Wheeled walkers may be equipped with hand brakes; however, frail older people may experience difficulty using such hand brakes, as they require force to operate. Thus, in the present study, a braking method using a wire connected to a user's belt or clothes was designed and implemented; if the tension of the wire connecting the safety device and the user exceeds a critical value, the wheeled walker brakes, which can prevent the rapid motion of walkers. Two feasibility tests of the wheeled walker with the braking device were conducted: one with 10 healthy adults in their 20s and the other with 10 elderly people over 65 years of age; the tests measured the braking time and speed control using a speed measuring device. The results of the first and second feasibility tests demonstrated that the average braking time of participants was 50.3 ms and 50.7 ms, respectively. All participants in the feasibility tests succeeded in the speed control test. Thus, based on the results, the braking device on the wheeled walker worked properly.

Effect of Horizontal Whole-Body Vibration Training on Trunk and Lower-Extremity Muscle Tone and Activation, Balance, and Gait in a Child with Cerebral Palsy.

BACKGROUND The aim of the present study was to investigate the effect of horizontal whole-body vibration (WBV) training on trunk and lower-extremity muscle tone and activation, balance, and gait in a child with spastic diplegia cerebral palsy. CASE REPORT A 10-year-old male with spastic diplegia cerebral palsy received horizontal WBV training followed by conventional physiotherapy (50 min per day, 12 days per month), but only conventional physiotherapy during followup. Muscle tone was assessed using the Modified Ashworth Scale (MAS) and muscle activation with surface electromyography. Balance was assessed using the Timed Up and Go test (TUG) and Pediatric Balance Scale (PBS), and gait parameters were assessed using the GAITRite system. Assessment was performed at 3 points: pre-intervention, post-intervention, and follow-up. Following the intervention, MAS decreased in both the hip extensor and right ankle plantar flexor. Muscle activation increased post-intervention in the bilateral erector spinae (ES), rectus abdominis (RA), rectus femoris (RF), and right tibialis anterior (TA) during standing, and in the left RA, bilateral RF, gastrocnemius (GCM), and left TA during squatting. At follow-up, activation increased in the right ES, left RA, and RF during standing. At post-intervention and follow-up, improvement was observed in PBS score, gait velocity, right step length, and right stride length, with decreased single-leg support time, and double support and toe deviation angle. CONCLUSIONS Horizontal WBV training can safely and effectively maintain and improve physical performance and can be considered for inclusion in rehabilitation programs.

Does virtual reality training using the Xbox Kinect have a positive effect on physical functioning in children with spastic cerebral palsy? A case series.

PURPOSE: The present study investigated the effects of virtual reality (VR) training using the Xbox Kinect on motor function, balance, gait, and functional mobility in children with cerebral palsy (CP). METHOD: This was a case series. Four children with spastic diplegic cerebral palsy were provided VR training using the Xbox Kinect for 12 sessions (three sessions per week for 4 weeks). At baseline and follow-up, physical function was measured using the following: Selective Motor Control (SMC) for motor function, Pediatric Balance Scale (PBS) for balance, Timed Up and Go (TUG) test and Functional Mobility Scale (FMS) for functional mobility, and 6-meter walk test (6WT) for gait. RESULTS: As compared with the baseline scores, SMC, PBS, TUG, FMS, and 6MWT scores after training showed improvements. In participant 1, PBS and TUG scores improved after VR training. In participant 2, SMC (left ankle dorsiflexor, left knee extensor), PBS, TUG, and FMS scores improved after training. In participant 3, SMC (left hip flexor), TUG, FMS, and 6MWT scores improved after training. In participant 4, SMC (right ankle dorsiflexor), PBS, TUG, FMS, and 6MWT scores improved after training. CONCLUSION: The results show that VR training using the Xbox Kinect may improve physical functioning in children with spastic diplegic cerebral palsy. However, its utility in the rehabilitation of children with CP requires further investigation.