Stimulus zones of Vojta method and trunk control in children with spastic-type cerebral palsy: A quasi-experimental pilot study.

BACKGROUND: Vojta method improves motor function by inducing a response by pressing the stimulus zones. PURPOSE: To determine the effect of the stimulus zones on trunk muscle thickness, trunk control, trunk angle, and gross motor function in children with spastic-type cerebral palsy. METHODS: A quasi-experimental pilot study was conducted with 19 children with spastic-type cerebral palsy divided into two groups: Vojta method group (n = 10) and general physical therapy group (n = 9). Each group underwent a 6-week intervention, and assessments were conducted to evaluate abdominal muscle thickness, trunk control, trunk angle, and gross motor function. RESULTS: In the Vojta method group, the change rate in the thickness of the internal oblique and transversus abdominis increased significantly within the group (P < 0.05) and the difference (post-pre) of the transversus abdominis was higher (P < 0.05). The trunk angle increased significantly within the group when thoracic 7 and 11, lumbar 3, and sacrum 1 were supported (P < 0.05). There was a significant difference in trunk angle difference (post-pre) between groups when thoracic 11 and sacrum 1 were supported (P < 0.05). Segmental assessment of trunk control and gross motor function measure-88 scores were significantly increased within the group in all groups (P < 0.05). CONCLUSION: The stimulus zones of the Vojta method could improve trunk control in children with spastic-type cerebral palsy through intra-abdominal pressure and anti-gravity movement.

Developmentally delayed children with different muscle tone have different muscle activity and acceleration during sit-to-stand.

Developmental delays cover a wide range, with different movement characteristics occurring depending on differences in muscle tone. We aimed to investigate muscle activity and acceleration during sit-to-stand in developmentally delayed (DD) children with different muscle tones. Forty participants were divided into three groups: typically developing (TD) children (n=18), DD children with hypertonia (n=12), and DD children with hypotonia (n=10). Electromyography was used to measure muscle activity and BTS G-Walk was used to measure acceleration. As a result, the activities of the rectus abdominal muscle and quadriceps muscle were lower in DD children with hypertonia than in TD children (P<0.05). The activity of the tibialis anterior muscle was higher in DD children with hypotonia than in TD children (P<0.05). The trunk angle was greater in DD children with hypotonia than in TD children (P<0.05), and vertical acceleration was lower in DD children with hypertonia than in TD children (P<0.05). Based on these differences, we will be able to provide intervention programs appropriate for the characteristics of DD children with different muscle tone.

Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness.

Dizziness or vertigo can be caused by dysfunction of the vestibular or non-vestibular systems. The diagnosis, treatment, and mechanism of dizziness or vertigo caused by vestibular dysfunction have been described in detail. However, dizziness by the non-vestibular system, especially cervicogenic dizziness, is not well known. This paper explained the cervicogenic dizziness caused by abnormal sensory input with references to several studies. Among head and neck muscles, suboccipital muscles act as stabilizers and controllers of the head. Structural and functional changes of the suboccipital muscles can induce dizziness. Especially, myodural bridges and activation of trigger point stimulated by abnormal head posture may be associated with cervicogenic dizziness.

Vojta Therapy Affects Trunk Control and Postural Sway in Children with Central Hypotonia: A Randomized Controlled Trial.

(1) Background: Decreased trunk stability is accompanied by delay in motor development in children with central hypotonia. We investigated the effect of Vojta therapy on trunk control in the sitting position in children with central hypotonia. (2) Methods: In 20 children with central hypotonia, Vojta therapy was applied to the experimental group (n = 10) and general physical therapy to the control group (n = 10). The intervention was applied for 30 min per session, three times a week, for a total of six weeks. We assessed abdominal muscle thickness, trunk control (segmental assessment of trunk control), trunk angle and trunk sway in a sitting position, and gross motor function measure-88. (3) Results: In the experimental group, the thicknesses of internal oblique and transversus abdominis were significantly increased (p < 0.05). The segmental assessment of trunk control score was significantly increased (p < 0.05), and the trunk sway significantly decreased (p < 0.05). Gross motor function measure-88 was significantly increased (p < 0.05). (4) Conclusions: Vojta therapy can be suggested as an effective intervention method for improving trunk control and gross motor function in children with central hypotonia.

Abdominal and lower extremity muscles activity and thickness in typically developing children and children with developmental delay.

We investigated abdominal and lower extremity muscle activity and thickness in typically developing children and children with developmental delays. A total of 35 children participated: typically developing peers (n=13), children with hypotonia (n=10), and children with spasticity (n=12). Muscle activity and thickness were measured at rest and during activity. Electromyography was used to measure abdominal and lower extremity muscle activities, and abdominal muscle thickness was measured using ultrasonography. There was a significant difference between the groups in the activity of the rectus abdominis and quadriceps muscles at rest and during activity (P<0.05). There was a significant difference between the groups in the thickness of the external oblique and transversus abdominis muscles during activity (P<0.05). There was a significant difference between the groups in the thickness of the external oblique and internal oblique muscles in the sitting position (P<0.05). Therefore, the characteristics of muscle tone should be considered when applying interventions to children with developmental delay.

Vojta Approach Affects Neck Stability and Static Balance in Sitting Position of Children With Hypotonia.

PURPOSE: In this study, the effect of the Vojta approach on neck stability and static balance in children with hypotonia was studied. METHODS: Seventeen children with hypotonia were randomly divided into the Vojta approach group (n=9) and the general physical therapy group (n=8). Each group was applied intervention for 30 minutes per session, 3 times a week, for a total of 4 weeks. Ultrasonography was used to measure deep neck flexor muscle thickness, craniovertebral angle (CVA) to measure neck alignment along the spine segment, and Balancia software program to measure static balance. RESULTS: In the Vojta approach group, the deep neck flexor muscle thickness was significantly increased (P<0.05), and the CVA was significantly improved (P<0.05). In addition, path area among static balance was significantly improved (P<0.05). CONCLUSION: The Vojta approach can be suggested as an effective intervention method for improving neck stability and static balance in children with hypotonia.

Treadmill Exercise Ameliorates Short-term Memory Impairment by Suppressing Hippocampal Neuroinflammation in Poloxamer-407-Induced Hyperlipidemia Rats.

PURPOSE: Poloxamer-407 (P-407) is used to induce hyperlipidemia. Exercise is effective in improving arteriosclerosis and cognitive impairment. In this research, the effect of treadmill running on short-term memory in the P-407-treated hyperlipidemia rats was studied focusing on neuroinflammation. METHODS: Rats were classified in normal group, normal and treadmill exercise group, P-407-treated group, and P-407-treated and treadmill exercise group. Hyperlipidemia rats were made by single intraperitoneal injection with P-407 (500 mg/kg). Treadmill exercise was conducted for 30 minutes once a day, 5 days per week during 28 days. Step-down avoidance task was done to measure short-term memory. Glial fibrillary acidic protein and ionized calcium binding adaptor molecule 1 were assessed by immunohistochemistry. Expression of adhesion molecules and proinflammatory cytokines was determined by western blot analysis. RESULTS: Treadmill exercise alleviated lipid profiles in the P-407-induced hyperlipidemia rats. Treadmill exercise improved short-term memory, inhibited reactive astrogliosis and microglia activation, and suppressed expression of adhesion molecules and proinflammatory cytokines in the hyperlipidemic rats. CONCLUSION: Treadmill exercise exerts alleviating effect on memory deficits by inhibiting hippocampal neuroinflammation in the hyperlipidemia. The current results suggest that treadmill running serves as the treatment strategy for the cognitive dysfunction caused by hyperlipidemia.

Changes of Neural Pathways after Vojta Approach in a Child with Developmental Delay.

The development of motor function is related to the development of neural pathways in the white matter. Children with developmental delay (DD) and hypotonia have reduced motor function, and their neural pathways are observed differently from those of typically developed children. We investigated changes in neural pathways through diffusion tensor imaging (DTI) after utilizing the Vojta approach. The participant was a child with DD and hypotonia, and had delayed motor function. Although he had no brain damage on magnetic resonance imaging findings, damage to the neural pathway was confirmed through DTI due to cytomegalovirus infection in the mother's womb. From 11 months of age, the Vojta approach was performed for a total of 8 months. In this study, we found that in CST, the left FA and right TV increased in follow-up DTI more than in the initial DTI. In CRP, Wallerian degeneration was observed in the left FA, MD, and TV in follow-up DTI. GMFM-88 improved after intervention. The structural change of neural pathways through the Vojta approach influenced the improvement of gross motor function. Therefore, it is thought that the Vojta approach can be suggested as a meaningful intervention for children with DD and hypotonia.

The effect of scapular strengthening exercise using elastic band on balance and quality of life in the old people.

The old people are weakened and misaligned due to aging, and their balance and quality of life are reduced. We investigated that the effect of scapular strengthening exercise on balance and quality of life in the old people. A scapular strengthening exercise was applied to the experimental group, and the general conditioning exercise was applied to the control group for 40 min per session, 5 times a week, for a total of 4 weeks. As a result, the static balance and Y-balance test performance improved in the experimental group (P<0.05). The physical function and mental health, and general health of 36-item Short Form health survey improved in the experimental group (P<0.05). Therefore, the scapular strengthening exercise could be suggested as an intervention method that could improve the balance and quality of life of the old people.

Upper cervical spine dysfunction and dizziness.

Although various causes of dizziness have been identified, many patients suffer from dizziness of unknown etiology and continue to visit hospitals to resolve their symptoms. Problems that occur in the ligaments or muscles of the upper cervical spine can cause confusion in proprioception. These changes can convey misinformation to the vestibular nucleus, resulting in abnormal reactions that can lead to cervicogenic dizziness (CGD). Though CGD remains controversial, it should be considered while diagnosing patients with dizziness. Understanding CGD can help create treatment strategies for them. This article suggested a relationship between the structure and function of the upper cervical spine and dizziness, and presented evaluations and treatments for the same.

Attentional concentration during physiotherapeutic intervention improves gait and trunk control in patients with stroke.

The restoration of motor function is important in daily life in patients with brain damage. Although attentional concentration can affect motor function, most physical therapists focus only on therapeutic exercise. Therefore, we investigated changes in motor function in patients with high attentional concentration during our intervention. A total of 21 subjects diagnosed with stroke participated in the study. They were divided into the high attentional concentration group and low attentional concentration group based on the self-programmed attention index. The subjects underwent trunk strengthening and gait training for 30 min per session, twice a day, 5 days a week, for a total of 4 weeks. All patients wore electroencephalogram (EEG) devices during the treatment to enable EEG examinations. Diagnostic ultrasound was used to measure muscles of the abdomen: external oblique abdominal, internal oblique abdominal, transversus abdominis, and rectus abdominal muscles. A trunk impairment scale was used to evaluate trunk control. We used Gaitrite to measure the spatial and temporal components during gait. The group with high attentional concentration showed significant differences in abdominal muscle strength and trunk control. In gait, there was a significant difference in swing cycle, stance cycle, single cycle, double support cycle, stance time, and double support time. Therefore, attentional concentration should be considered to improve motor function as a part of therapeutic exercises for stroke patients.

Treadmill Exercise Improves Motor Function and Short-term Memory by Enhancing Synaptic Plasticity and Neurogenesis in Photothrombotic Stroke Mice.

PURPOSE: Thrombotic stroke is a type of ischemic stroke characterized by motor dysfunction and memory impairments. In the present study, the effect of treadmill exercise on motor function and short-term memory was evaluated in relation with synaptic plasticity in the mice with photothrombotic stroke. METHODS: Photothrombotic stroke was induced by cortical photothrombotic vascular occlusion. The mice in the treadmill exercise groups performed running on a motorized treadmill for 28 days. Motor function was determined using rota-rod test and foot fault test. Step-through avoidance task was conducted to evaluate short-term memory. Immunohistochemistry for 5-bromo-2'-deoxyuridine and doublecortin was conducted to detect new cell generation. Postsynaptic density protein 95, synaptophysin, brain-derived neurotrophic factor (BDNF), and tyrosine kinase B receptor (TrkB) were determined using western blot. The number of dendritic spines was determined using Golgi stain. RESULTS: Treadmill exercise improved motor function and short-term memory in mice with the photothrombotic stroke. The infarct size was reduced and the number of dendritic spines and expression of postsynaptic density protein 95 and synaptophysin in the peri-infarct cortex and hippocampus were increased by treadmill exercise in photothrombotic stroke mice. Treadmill exercise enhanced neurogenesis through increasing the expression of the hippocampal BDNF and TrkB in photothrombotic stroke mice. CONCLUSION: Treadmill exercise improved motor function and short-term memory through increasing synaptic plasticity and neurogenesis in photothrombotic stroke mice. Treadmill exercise can be used as an effective treatment strategy to improve brain function related to stroke.

A temporary forward head posture decreases function of cervical proprioception.

Increased use of smartphones can cause abnormal alignment of head and neck, resulting in forward head posture (FHP). This can lead to change in the structures and function of the cervical vertebrae. The purpose of this study was to determine the impact on deep neck flexor muscles, proprioception, vestibular function, and balance of subjects with induced FHP by using smartphone. Twenty-two healthy persons were randomly divided into two groups. The FHP group maintained a craniovertebral angle (CVA) of <49° and a normal head posture group maintained a CVA of >50° watching the smartphone for 40 min. We measured the area of the longus colli and longus capitis muscles, cervical joint position sense, Romberg test, subjective visual vertical test, and subjective visual horizontal test. There was no significant difference in the deep neck flexor muscles, vestibular function, and static balance between the groups. However, there was a significant difference in the cervical proprioception (P<0.05). Proprioception may be considered to be the most influential factor in induced FHP by smartphone viewing.

Awareness about the necessity of vestibular rehabilitation education in Korean physical therapists.

Vestibular rehabilitation (VR) improves dizziness and vertigo, postural control, and quality of life. It is a beneficial and safe intervention for pa-tients with peripheral vestibular disease. Physical therapists play an im-portant role in treating them, but Korean physical therapists have little experience in VR or treating peripheral vestibular disease. Furthermore, there are few studies on the current status of Korean physical thera-pists regarding VR. Therefore, we aimed to identify the awareness and current status of Korean physical therapists regarding VR and to discuss the necessity of VR education. The data were obtained from an online survey conducted among 483 licensed physical therapists. In total, 393 questionnaires were analyzed, after excluding 90 questionnaires (18.6%) with poor answers. Most physical therapists had no VR education (75.6%) and had a high positive response for the necessity of VR education (68.2%) and intention to receive VR education (63.9%). There was a significant difference in clinical experience and intention to receive VR education (P<0.05) with respect to presence or absence of VR education. For the necessity of VR education, there was a statistically significant difference in academic background, institutional type, and intention to receive VR education (P<0.05). In conclusion, many physical therapists in Korea are very interested in VR education, and various factors have highlighted the need for VR education. Therefore, professional education for VR and the cooperation and attention of related medical staff are urgently required.

Effects of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia: A randomized controlled trial pilot study.

BACKGROUND: Fresnel prism shifts the field of view and converts object position in space, but its effect on stroke patients without unilateral neglect has not been examined. OBJECTIVE: We aimed to investigate the effect of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia. METHODS: This study included 17 stroke patients with hemiplegia without unilateral neglect. Balance and gait training were applied in the control group (n= 9), and Fresnel prism glasses were applied with balance and gait training in the experimental group (n= 8). In all groups, interventions were done for 30 min/day for 5 times/week for 4 weeks. Motor-free visual perception test for visual perception (MVPT), Berg Balance Scale (BBS), and functional reach test (FRT) for dynamic balance ability, and gait were performed. Measurements were done before and after interventions. RESULTS: MVPT showed no significant difference between the groups (p> 0.05). A significant increase in BBS and FRT results was found before and after interventions in the experimental group (p< 0.05). Gait variables showed significant difference in the experimental group (p< 0.05). CONCLUSION: Fresnel prism glasses may effectively improve dynamic balance and gait functions by shifting body weight to the affected side of stroke patients with hemiplegia without vision loss.

Ankle exercise with functional electrical stimulation affects spasticity and balance in stroke patients.

Stroke patients have limited motor function due to ankle spasticity, and various interventions are applied to solve this problem. The purpose of this study was to investigate the effects of functional electrical stimulation (FES) with ankle exercise on spinal cord motor neuron excitability and balance in stroke patients. Twenty-five stroke patients were divided into the three groups. For the intervention, the control group applied general physiotherapy, the experimental group I applied a sham FES with ankle exercise, and the experimental group II applied a FES with ankle exercise. All groups applied the intervention for 30 min per session, 5 times a week, for a total of 8 weeks. The functional reaching test (FRT), Timed Up and Go test was used to measure balance ability, and H-reflex was used to measure spinal motor neuron excitability. All tests were measured before and after the intervention. In the ankle exercise with FES group, spinal motor neuron excitability significantly decreased (P<0.05), and FRT was significantly increased (P<0.05). Therefore, FES with ankle exercise for stroke patients could be suggested as an effective intervention for improving motor function.

The Vojta approach changes thicknesses of abdominal muscles and gait in children with spastic cerebral palsy: A randomized controlled trial, pilot study.

BACKGROUND: Children with cerebral palsy (CP) have abnormal postures and gait patterns. Many physiotherapists use the Vojta approach as intervention for children with CP. However, its effects remain unclear. OBJECTIVE: This study aimed to investigate the effect of the Vojta approach on abdominal muscles and gait in children with spastic CP. METHODS: Thirteen children with spastic CP were randomly assigned to a general exercise and a Vojta approach group. The interventions were administered in 30 min sessions, 3 times a week for a total of 6 weeks. We used ultrasonography to measure the thicknesses of the abdominal muscles. The gait and foot pressure were measured by GAITRite. RESULTS: The Vojta approach group showed significant difference in the thicknesses of the rectus abdominis, and external oblique abdominal muscles, which are involved in trunk stability (p< 0.05). There were significant differences in the step width, functional ambulation profile, swing time, stance time, and single support % of cycle as well as foot pressure distribution (p< 0.05). CONCLUSION: The Vojta approach may be considered as an effective treatment method for improving trunk stability and gait functions of children with spastic CP.

Effects of visual feedback training using transient Fresnel prism glasses on balance ability in stroke patients without hemispatial neglect.

The center of mass of the body in patients with stroke was oriented toward the nonparetic side. Abnormal weight shift increases the risk of falls. Therefore, many therapists make an effort to help their functional recovery through balance training. Our aim was to investigate the effect of visual feedback intervention using a Fresnel prism on static and dynamic balance in stroke patients without hemispatial neglect. Participants were assigned to control group (n=10) and experimental group (n=9). In the control group, neurodevelopmental therapy was performance for 30 min. In the experimental group, Fresnel prism glasses were applied with neurodevelopmental therapy for 30 min. We executed motor-free visual perception test for visual perception, balancia for static balance ability, and functional reach test and Berg balance test for dynamic balance ability, respectively. All tests were measured immediately after intervention. The visual perception function showed significant difference between unaffected side performance behaviors and visual perceptual processing time (P<0.05). In the static balance, there was a significant difference in sway velocity and sway distances (P<0.05). Dynamic balance was also significant different between groups (P<0.05). Visual feedback using Fresnel prism helps to control the static and dynamic balance ability by inducing weight shift toward the affected side in stroke patients. Therefore, a Fresnel prism may be suggested as an intervention tool to assist weight training for patients with stroke.

Effects of ankle strengthening exercise program on an unstable supporting surface on proprioception and balance in adults with functional ankle instability.

The present study was conducted to investigate the effect of ankle strengthening exercise applied on unstable supporting surfaces on the proprioceptive sense and balance in adults with functional ankle instability. As for the study method, 30 adults with functional ankle instability were randomly assigned to an ankle strengthening exercise group and a stretching group on unstable supporting surfaces, and the interventions were implemented for 40 min. Before and after the interventions, a digital dual inclinometer was used to measure the proprioceptive sense of the ankle, the Balancia program was used to measure static balance ability, and the functional reach test was used to measure dynamic balance ability. In the results, both proprioceptive sense and static dynamic balance ability were significantly different between before and after the intervention in the experimental group (P<0.05). When such results are put together, it can be seen that ankle strengthening exercise applied on unstable supporting surfaces may be presented as an effective treatment method for enhancing the proprioceptive sense and balance ability in adults with functional ankle instability.