The effect of motor imagery and mirror therapy on upper extremity function according to the level of cognition in stroke patients.

This study was conducted to investigate the effects of motor imagery (MI) and mirror therapy (MT) on upper extremity function according to the level of cognition in stroke patients. Twenty-four participants who were diagnosed with stroke were divided into a mild cognitive group (n = 12) and a severe cognitive group (n = 12). Then, the two groups were again divided into MI group (n = 6) and MT group (n = 6). The participants were evaluated for function of upper extremity using the Box and Block Test (BBT), the Jebsen-Taylor Hand Function Test (JTHFT), and Manual Function Test (MFT). There were significant differences between the two groups of cognitive function of mild level in the post-test of JTHFT (p < 0.05). In the MI group, significant differences were found in the pre- and post-test scores for all variance (p < 0.05). In the MT group, significant differences were found in the pre- and post-test scores for JTHFT and MFT (p < 0.05). There were significant differences between the two groups of cognitive function of severe level in the post-test of all variances (p < 0.05). Furthermore, in the MT group, significant differences were found in the pre- and post-test scores for all variances (P < 0.05). The results of this study suggest that applying MI to the mild cognitive group is effective and that applying MT to the severe cognitive group is effective.

The influence of high heeled shoes on balance ability and walking in healthy women.

[Purpose] The purpose of this study was to investigate the influence of high heeled shoes on balance ability and walking on healthy women. [Subjects and Methods] Thirty healthy female subjects, without orthopedic history of the lower extremity were selected for the present study. The 3 cm, 6 cm, and 9 cm shoes were worn according to the prescribed order to perform a balance and walking test. [Results] Significant difference was shown after the experiment, in comparison of the groups in all variance, and as the result of post hoc test. Time, anterior-posterior length and medial-lateral length of balance variables as well as velocity of walking variables showed a significant increase between 3 cm and 6 cm, 6 cm and 9 cm, 3 cm and 9 cm. In addition, the balance index of the balance variables as well as the step length and single support ratio of the walking variables showed a significant decrease between 3 cm and 6 cm, 6 cm and 9 cm, 3 cm and 9 cm. [Conclusion] It was found that the higher the shoe heel height, the lower the balance and the less the efficiency of walking.

Effects of trunk stabilization exercise on the local muscle activity and balance ability of normal subjects.

[Purpose] The purpose of this study was to investigate the effects of trunk stabilization exercise on the transvers abdominalis (TA) and internal oblique (IO) muscle activity and balance ability of normal subjects. [Subjects and Methods] Forty healthy male subjects without orthopedic history of the lower extremity were selected for the present study. The experimental group received a hollowing exercise, curl-up and bridging exercise. The control group received a pelvic tilting exercise in the sitting position for the same period of time. [Results] Significant differences in the post-training gains in Balance index, TA, IO were observed between the experimental group and the control group. [Conclusion] The trunk stabilization exercise improved the balance ability and increased the activity of the TA and IO muscle.

Effects of manipulation of the thorax and intensity of the pressure biofeedback unit on the superficial cervical flexors muscle during craniocervical flexion exercise.

[Purpose] This study examined the effects of manipulation of the thorax and the intensity of the pressure biofeedback unit on the superficial cervical flexors muscle during craniocervical flexion exercise. [Subjects and Methods] Thirty three subjects participated in the experiment. Thirty three healthy people without any orthopedic history were also selected. The subjects could monitor the pressure applied to cervical vertebra 3 of the craniocervical junction by markings on the pressure biofeedback unit. Craniocervical flexion exercise was performed for 20 seconds per pressure, and two minutes of rest was allowed after exercise to reduce muscle fatigue. [Results] Significant differences in the post-training gains in the sternocleidomastoid and scalene were observed between the thorax fixation group and thorax non-fixation group. The thorax fixation group showed that muscle activation of the sternocleidomastoid and scalene was increased when the pressure biofeedback unit intensity was 40 mmHg than when pressure biofeedback unit intensity was 20 mmHg and 30 mmHg in the post-hoc result. The thorax non-fixation group showed that muscle activation of the sternocleidomastoid and scalene was higher when the pressure biofeedback unit intensity was 40mmHg compared to that when the pressure biofeedback unit intensity was 20mmHg in the post-hoc result. [Conclusion] Craniocervical flexion exercise is a clinically effective method that reduces the superficial neck flexor muscle activation.

Effects of strengthening exercise integrated repetitive transcranial magnetic stimulation on motor function recovery in subacute stroke patients: A randomized controlled trial.

OBJECTIVE: To investigate the effects of strengthening exercise integrated repetitive transcranial magnetic stimulation (rTMS) on motor function recovery in subacute stroke patients. SUBJECTS AND METHODS: Thirty subacute stroke patients were randomly assigned to three groups: an ankle strengthening exercise group (group I), ankle strengthening exercise integrated rTMS group (group II), or an rTMS group (control group (CG)). Study subjects received therapy five days per week for eight weeks. Motor-evoked potential testing, peak torque at the ankle joint, and 10 m walk test were performed before and after the eight-week treatment period. RESULTS: Subjects in group II showed significantly higher amplitude of MEP, plantarflexor and dorsiflexor of peak torque, 10 m walk test than groups I and CG (p < 0.05). Subjects in groups I and II differed significantly in the pre- and post-test for all variables, (p < 0.05). In the CG group, the pre- and post-test scores for the amplitude of MEP, dorsiflexor, and 10-walk test differed significantly (p < 0.05). CONCLUSIONS: Strengthening exercise integrated rTMS has positive effects on motor function recovery in subacute stroke patients.

Effects of the Bad Ragaz Ring Method on muscle activation of the lower limbs and balance ability in chronic stroke: A randomised controlled trial.

BACKGROUND: Recovery of balance and walking abilities is important for the rehabilitation of stroke patients. OBJECTIVES: To evaluate the effects of the Bad Ragaz Ring method on functional recovery in chronic stroke patients. METHODS: Twenty-two chronic stroke patients were randomly assigned to two groups: a Bad Ragaz Ring method group (the experimental group) or a control group. Stroke patients in the experimental group underwent Bad Ragaz Ring exercise and comprehensive rehabilitation therapy, whereas patients in the control group underwent comprehensive rehabilitation therapy alone. The participants in both groups received therapy 3 days per week for 6 weeks. Muscle activations, balance indices, and Timed Up and Go test results were assessed before and after the 6-week therapy period. RESULTS: The experimental group showed significant improvements in activations of tibialis anterior and gastrocnemius muscles, balance index, and Timed Up and Go test results as compared with preintervention results (p < 0.05), whereas the control group showed significant improvement in Timed Up and Go test (p < 0.05). Significant differences in posttraining gains in the activations of tibialis anterior and gastrocnemius muscles and in balance index were observed between the experimental and control groups (p < 0.05). Effect sizes for gains in the experimental and control groups were strong for tibialis anterior and gastrocnemius muscles (effect sizes, 1.04 and 1.45 respectively). CONCLUSION: The Bad Ragaz Ring method may be beneficial for improving balance and leg muscle activation of chronic stroke patients.

The effects of sitting with the right leg crossed on the trunk length and pelvic torsion of healthy individuals.

[Purpose] The purpose of this study was to determine the effects on the trunk length and pelvic torsion of healthy individuals that arise from crossing the right leg while sitting. [Subjects and Methods] The subjects in this study were 30 healthy individuals consisting of 18 males and 12 females. The subjects were instructed to sit on a chair, the height of which was adjustable, so that their knee and hip joints were bent at 90°. For the study, they sat stripped to the waist, with the back and hips bare. They were then instructed to perform a one-leg-crossed sitting posture by placing the right leg on the top of the left knee. A spinal posture test was performed to measure the subjects' trunk length and pelvic torsion by using a three-dimensional image-based spinal diagnostic system. [Results] The results of the three-dimensional spine examination showed statistically significant decreases in trunk length and pelvic torsion after the one-leg-crossed sitting posture. [Conclusion] In this study, the right leg-crossed sitting posture led to a decrease in the right trunk length with time and, in terms of pelvic torsion, increased the posterior rotation of the right pelvis when compared with the left pelvis.

The effects of horse riding simulation exercise with blindfolding on healthy subjects' balance and gait.

[Purpose] The study was conducted to determine the effect of horse riding simulation combined with blindfolding on healthy individuals' balance and gait. [Subjects and Methods] Thirty subjects were randomly divided into an experimental group (n=15) and a control group (n=15). The subjects in the experimental group covered their eyes using a blindfold, climbed onto a horse riding simulator, and performed the horse riding simulation exercise. The control group took part in the horse riding exercises without a blindfold. All of the subjects performed the 20 minutes long exercise once a day, five times a week, over a four-week period. [Results] The experimental group showed significant improvement in static balance, dynamic balance, velocity, and cadence compared to pre-intervention measurements. In addition, the control group showed significant improvement in static balance, dynamic balance, single support, and cadence compared to pre-intervention measurements. Significant differences in post-training gains in static balance, dynamic balance, and cadence were observed between the experimental group and the control group. [Conclusion] Subjects that performed horse riding simulation exercise after blindfolding showed significant improvements in balance and cadence compared to the control group.

Immediate effects of forearm elastic and nonelastic taping on wrist flexor muscle and grip strength of normal adults.

[Purpose] The purpose of this study was to examine the effects of forearm elastic taping on grip and wrist flexor muscle strength. [Subjects and Methods] This was a single-blind, crossover study. This study selected 40 healthy subjects with no history of orthopedic disorders and was conducted after consent to participate was obtained. Grip and wrist flexor muscle strength of subjects were assessed by a handheld dynamometer and a Commander Muscle Tester, respectively, with forearm elastic taping or nonelastic taping. [Results] After application of forearm elastic taping, grip strength and wrist flexor muscle strength significantly increased compared with the nonelastic taping group. [Conclusion] Application of forearm elastic taping is considered to have positive effects on improving wrist and grip strength.

Effects of lumbopelvic sling and abdominal drawing-in exercises on lung capacity in healthy adults.

[Purpose] To examine the effects of lumbopelvic sling and abdominal drawing-in exercises on the lung capacities of healthy subjects. [Subjects and Methods] Twenty-nine healthy subjects with no orthopedic history of the back were recruited. Subjects were randomly assigned to a experimental group and control group. Subjects were allocated to one of two groups; an experimental group that underwent lumbopelvic sling and abdominal drawing-in exercises and a control group that underwent treadmill and abdominal drawing-in exercises. Lung capacities were evaluated 4 weeks after exercises. [Results] The experimental group showed significant increments in EV, ERV, IRV, VT vs. pre-intervention results, and the control group showed significant increments in the EVC and IRV. Significant intergroup differences were observed in terms of post-training gains in EVC, IRV, and VT. [Conclusion] Combined application of lumbopelvic sling and abdominal drawing-in exercises were found to have a positive effect on lung capacity.

Effect of high-frequency repetitive transcranial magnetic stimulation on motor cortical excitability and sensory nerve conduction velocity in subacute-stage incomplete spinal cord injury patients.

[Purpose] The aim of the present study was to determine whether repetitive transcranial magnetic stimulation can improve sensory recovery of the lower extremities in subacute-stage spinal cord injury patients. [Subjects and Methods] This study was conducted on 20 subjects with diagnosed paraplegia due to spinal cord injury. These 20 subjects were allocated to an experimental group of 10 subjects that underwent active repetitive transcranial magnetic stimulation or to a control group of 10 subjects that underwent sham repetitive transcranial magnetic stimulation. The SCI patients in the experimental group underwent active repetitive transcranial magnetic stimulation and conventional rehabilitation therapy, whereas the spinal cord injury patients in the control group underwent sham repetitive transcranial magnetic stimulation and conventional rehabilitation therapy. Participants in both groups received therapy five days per week for six-weeks. Latency, amplitude, and sensory nerve conduction velocity were assessed before and after the six week therapy period. [Results] A significant intergroup difference was observed for posttreatment velocity gains, but no significant intergroup difference was observed for amplitude or latency. [Conclusion] repetitive transcranial magnetic stimulation may be improve sensory recovery of the lower extremities in subacute-stage spinal cord injury patients.

Effects of mental practice on normal adult balance ability.

[Purpose] This study aimed to examine the effects of mental practice on the balance abilities of normal individuals. [Subjects and Methods] Thirty subjects were randomly assigned to an experimental or control group (n=15 each). Participants in both groups performed balance training in a seated position on a gym ball for 20 minutes per session, five sessions per week, for 4 weeks. Members of the experimental group also performed mental practice for 10 minutes before the balance training. After the intervention, balance measuring equipment (Good Balance, Metitur, Finland) was used to quantitatively measure balance ability. [Results] Significant post-training gains were observed in the mediolateral, index of balance function, and time variables of participants of the experimental group. [Conclusion] The application of mental practice with balance training positively affected balance ability.

The effects of exercising on an unstable surface on the gait and balance ability of normal adults.

[Purpose] This study aimed to examine that therapeutic efficacy of an unstable surface on balance and gait ability in normal individuals. [Subjects and Methods] Forty subjects participated in the experiment and were randomly assigned to an experimental group of 20 subjects and a control group of 20 subjects. The experimental group performed balance exercise on an Aero-Step device (Aero-Step XL, TOGU, Prien-Bachham, Germany). The control group performed balance exercise on rigid ground. All subjects performed balance training 30 minutes a day, 5 days a week, for 4 weeks. After the intervention, balance measuring equipment (Good Balance, Metitur, Jyvaskyla, Finland) was used to quantitatively measure balance ability. [Results] Significant differences in post-training gains in the variables of static balance, dynamic balance, and velocity were observed between the experimental group and the control group. [Conclusion] Unstable surface training aimed at improving balance ability is considered to have a positive effect.

Therapeutic efficacy of walking backward and forward on a slope in normal adults.

In this study, the therapeutic effects of backward walking were examined. [Subjects and Methods] In all, 16 subjects were randomly assigned to an experimental group and 17 to a control group. All subjects walked barefoot on a treadmill (HM50EX, Daeho, Korea) for 20 min, five times per week, for a total of 4 weeks. The average gait velocity of the subjects was 3 km/h on a 10% slope. The experimental group walked backwards and the control group walked forwards. [Results] The experimental group showed significant increments in both medial-lateral and anterior-posterior balance, step length, and velocity compared with the pre-intervention results. In addition, the control group showed significant increments in anterior-posterior balance and velocity compared to the pre-intervention results. Significant differences in post-training gains in anterior-posterior balance, step length, and velocity were observed between the experimental and control groups. [Conclusion] Backward walking positively affected gait and balance ability after intervention.

A content analysis of stroke physical therapy intervention using stroke physiotherapy intervention recording tool.

[Purpose] Physical therapy for recovery of function in people with stroke is known to be effective, but which type of physical therapy intervention is most effective is uncertain because a concrete and detailed record of interventions is done. This study aimed to record, analyze, and describe the content of physical therapy interventions for recovery of function after stroke using stroke physiotherapy intervention recording tool (SPIRIT). [Subjects and Methods] A convenience sample of 23 physical therapists from a rehabilitation hospital in Chung-nam recorded the interventions for 73 patients with stroke who were treated for 30 minutes in 670 treatment sessions. Treatment session contents were recorded using SPIRIT. Descriptive statistics were used to describe the interventions accurately and to investigate the differences according to time since stroke. [Results] Facilitation techniques were the most frequently used interventions (n=1,342, 35.1%), followed by practice (n=1,056, 27.6%), and exercise (n=748, 19.6%) in the physical therapists' clinical practice. [Conclusion] This pattern shows that physical therapists were focused on functional activity. Organizing or teaching patient activities for independent practice interventions (n=286, 7.5%) were used to encourage patient activity and independence outside the treatment sessions. Interventions according to time since stroke were not significantly different.

The initial effects of an upper extremity neural mobilization technique on muscle fatigue and pressure pain threshold of healthy adults: a randomized control trial.

[Purpose] The purpose of this study was to determine the effects of an upper extremity neural mobilization technique on delayed onset muscle soreness. [Subjects] Forty-five healthy subjects were randomly assigned to two groups: a nerve mobilization group (experimental) and a control group. [Methods] The subjects of the experimental group were administered a median nerve mobilization technique and ultrasound for the biceps brachii muscle. The subjects in the control group were only administered ultrasound for the biceps brachii muscle. Muscle fatigue and the pressure pain threshold were assessed before and after the intervention. [Results] The experimental group showed significant improvements in all variables, compared to pre-intervention. Furthermore, the control group showed significant improvements in the pressure pain threshold, compared to pre-intervention. Significant differences in the post-intervention gains in muscle fatigue and pressure pain threshold were found between the experimental group and the control group. [Conclusion] Application of the upper extremity neural mobilization technique is considered to have a positive effect on recovery from delayed onset muscle soreness.

The effects of a pelvic belt on trunk and lower extremity muscles in the bridge position.

[Purpose] The purpose of this study was to investigate the effects of a pelvic belt on the activities of trunk and lower extremity muscles in normal adults. [Subjects and Methods] The subjects were 20 normal individuals without a history of orthopedic problems. The pelvic compression belt (The Com-Pressor, OPTP, Minneapolis, MN, USA) was an adjustable body belt with four elastic compression bands that provide stabilizing pressure and was designed to adjust the amount of force applied and to alter sites of compression. The body belt was placed below the anterior superior iliac spine, and stabilizing pressure was applied to the belt using the elastic compression bands in the bridge position after confirming the site of compression. [Results] The subjects showed a significant decrease in muscle activation in the erector spinae, oblique internus abdominis, rectus femoris, and biceps femoris while wearing the pelvic belt. [Conclusion] The use of a pelvic compression belt with external pelvic compression might improve pelvic joint stability and alter neuromotor control of the lumbopelvic and thigh muscles.

The effects of visual biofeedback using ultrasonograpy on deep trunk muscle activation.

[Purpose] The objective of this study is to investigate the effect of visual biofeedback using ulatrasonography on the functional improvement of deep trunk muscle. [Subjects and Methods] This study selected ten healthy people without orthopedic history and information on the study. The average ages, heights, and weights were 22.70 ± 2.06 years old, 171.15 ± 9.18 cm, and 66.86 ± 8.88 kg in the experimental group, respectively. The abdominal drawing-in maneuver were executed for subjects through monitoring the status of muscle contraction using ultrasonic waves. And motor control exercises were performed during 6 weeks, 20 minutes/day and three times/week. We collected the data using electromyography MP150 system (BIOPAC system Inc., CA, USA) in order to measure trunk muscle activation. [Results] The subjects showed significant improvements in Internal oblique abdominis and lumbar multifidus muscle after intervention. [Conclusion] Visual biofeedback training using ultrasonography might be effective in improving function of the deep trunk muscle.

Effects of repetitive transcranial magnetic stimulation on arm function and decreasing unilateral spatial neglect in subacute stroke: a randomized controlled trial.

OBJECTIVE: The objective of this study is to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the functional recovery of stroke patients with unilateral neglect. DESIGN: Randomized controlled experimental study. SETTING: Outpatient rehabilitation hospital. SUBJECTS: Thirty patients with stroke were randomly assigned to two groups: an rTMS group (experimental) and a control group. INTERVENTIONS: Stroke patients in the experimental group underwent comprehensive rehabilitation therapy and rTMS. Stroke patients in the control group underwent sham therapy and comprehensive rehabilitation therapy. Participants in both groups received therapy 5 days per week for 4 weeks. MAIN MEASURES: Line bisection, Albert, Box and block and Grip strength tests were assessed before and after the four-week therapy period. RESULTS: A significant difference in the post-training gains in Line bisection (16.53 SD 9.78 vs. 3.60 SD 5.02), Albert (14.13 SD 4.92 vs. 3.26 SD 2.01), Box and block (15.06 SD 9.68 vs. 6.93 SD 7.52), and Grip strength tests (3.60 SD 2.66 vs 0.80 SD 1.26) was observed between the experimental group and the control group (P<0.05). In addition, the effect size for gains in the experimental and control groups was very strong in AT, BBT (effect size=2.15, 0.77 respectively). CONCLUSION: We conclude that rTMS might be effective in improvement in reduction of the unilateral neglect and motor function.