Objective: The aim of this study was to evaluate the validity and reliability of using static surface electromyography (sEMG) on persons with neck pain and in healthy adults. Design: Cross-sectional study. Methods: Twenty-two female participants with neck pain and thirty healthy adults in the age group of 20-65 years were recruited in this study. To evaluate the validity and reliability of sEMG in subjects with neck pain, the subjects'characteristics were recorded and the Visual Analog Scale (VAS) and Neck Disability Index (NDI) were examined in addition to sEMG and algometer tests being carried out on the subjects. The site for using the sEMG and algometer was the upper trapezius. sEMG test-retest reliability was measured by intraclass correlation coefficients (ICCs). Independent t-tests were used to analyze the differences in the dependent variables between subjects with neck pain and healthy adults. The Pearson correlation coefficient was used to examine the linear relationship between measured variables. Results: sEMG and algometer tests were reliable according to the test-retest reliability results in subjects with neck pain and healthy adults (ICC=0.815-0.979). The results of this study showed that there were significant differences in respect to age, VAS, sEMG and algometer tests between persons with neck pain and healthy adults (p<0.05). The VAS and NDI were statistically correlated with sEMG and algometer results (p<0.05). Conclusions: In this study, we investigated the clinical usefulness of the static sEMG test in evaluating the pain scale of persons with neck pain with high reliability and validity.

Objective: Degenerative knee arthritis is the most common disease that occurs in older people. Constriction-induced movement therapy (CIMT) has been reported to be as an effective treatment for the impairments, such as asymmetric weight-bearing and reduced balance that occurs after receiving a total knee replacement (TKR). Game-based rehabilitation training for persons with TKR is interesting and provides a variety of feedback. Design: Randomized controlled trial. Methods: Thirty-six subjects with TKR were randomly assigned to either the CIMT game training (n=12), general game training (n=12), or the control (n=12) group. Each group underwent twelve sessions (30 min/d, 3 d/wk for 4 weeks). In the CIMT game training group, the application of CIMT adjusted the weight of the pressure delivered from the two boards used in Wii games. In the general game training group, the game was played without adjusting the weight of pressure. The game training used the Wii Fit's Ski Slalom application. Subjects were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Activities-specific Balance Confidence (ABC) Scale. Results: All three groups showed significant improvements in pain, stiffness and physical function, total WOMAC scores, and ABC scores after the intervention (p<0.05). Significant differences were observed in physical function, total WOMAC scores, and ABC scores of the CIMT game training group compared with the other groups (p<0.05). Conclusions: The CIMT game training and general game training exhibited improvements on stiffness, but the CIMT game training exhibited a larger effect on lower extremity function and balance confidence levels.

Objective: The purpose of this study was to identify whether cutaneous sensory (CS) changes induced by mechanical intervention (MI) increases the trigger point threshold of the same spinal segment as well as to investigate the relationship between the amounts of change in CS pressure pain thresholds (PPT). Design: Randomized controlled trial. Methods: Thirty-nine persons with myofacial pain (MFP) were recruited in this experiment. The subjects consisted of 20 men and 19 women (age 20-39). MI was applied on the subjects using the Graston technique for 5 minutes to induce CS changes. The CS changes were measured with sensory tests by using the Von Frey Filament, and PPT changes were estimated by using the pressure threshold meter. For the observation of sensory and PPT changes with time, the test was conducted for 15 minutes including a pre, post, and after intervention session. Results: CS threshold increased significantly when MI was applied (p<0.001). On the same spinal segment, changes in the right infraspinatus PPT was observed (p<0.001) but the PPT changes in other muscles were not significantly different. Furthermore, the control group CS and PPT were not significantly different. In addition, regression analysis showed that the CS changes have a larger impact on PPT in the same spinal segment (p<0.001). Conclusions: CS changes induced by MI make to change PPT on the same spinal segment. In other words, it is possible to identify PPT changes following CS changes except for the muscle which belongs to a different spinal segment. Therefore, application of MI is necessary for the CS changes in the same spinal segment. Furthermore, it can be useful in the clinical fields as a method of providing pain control and increasing the PPT.

Objective: For knee osteoarthritis (OA), there is a demand for alternative modalities in order to delay surgery and to avoid the side effects of medications. This study compared the effects of applying seaweed pack and mudpack for the treatment of knee OA. Design: Randomized controlled trial. Methods: Twenty-five patients with knee OA who satisfied the criteria were included. The patients were divided into two groups according to the treatment method: mudpack (n=12) and seaweed pack (n=13). The two groups were treated for 20 minutes, twice a day for five continuous days at the Ocean Healing Center at Wando Island, South Korea. Participants were assessed by clinical scores (Western Ontario and McMaster Universities Osteoarthritis Index, Hospital for Special Surgery Knee Score, Knee injury and Osteoarthritis Outcome Score and 36-Item Short Form Health Survey) and lab results (erythrocyte sedimentation rate, C-reactive protein, insulin-like growth factor-1 [IGF-1], tumor necrosis $factor-{\alpha}$ [$TNF-{\alpha}$]) during the follow-up period. Results: For the most part, clinical scores improved after therapy and maintained improvements for four weeks in both groups (p<0.05). In the seaweed group, $TNF-{\alpha}$ was significantly decreased at two weeks post-therapy (p<0.05). In both groups, IGF-1 was significantly increased immediately post-therapy (p<0.05). There were no statistically significant differences after therapy between the groups in clinical scores and labs. Conclusions: Seaweed packs and mudpacks had similar positive effects for knee OA. Additionally, the seaweed pack group showed decreased levels of $TNF-{\alpha}$ at two weeks post-treatment, which may explain the reduced inflammatory reaction. For rehabilitation therapy, use of seaweed packs may serve as an alternative modality for the treatment of knee OA.

Objective: The aim of this study is to investigate the effects of whole body vibratory stimulation on muscle strength, balance, and fall efficacy among super-aged women. Design: Randomized controlled trial. Methods: Twenty-eight super-aged women over 80 years of age were assigned to either the experimental group (n=14) and control group (n=14). The experimental group received an exercise program that used the whole body vibratory stimulation with a frequency of 30 Hz and amplitude of 3 mm, and the control group received an exercise program without vibratory stimulation. Intervention was provided for 4 weeks, 3 sessions per week, and 30 minutes per session. In order to measure lower extremity muscle strength the 30-second chair stand test (CST) was used. The Berg Balance Scale (BBS) was used to measure dynamic balance. Static balance was measured by tracking the path length, velocity, and area of the center of pressure (CoP). The Falls Efficacy Scale (FES) was used to measure the subjects' fear of falling. Results: Both the experimental and control group demonstrated statistically significant increase in muscle strength, dynamic balance, and fall efficacy (p<0.05). Only the experimental group showed significant improvements in static balance before and after the intervention (p<0.05). The experimental group showed significantly greater improvements in CST, BBS, and CoP (path length, velocity) than control group (p<0.05). Conclusions: Whole body vibratory stimulation exercise is shown to be a safe and appropriate physical therapy intervention method to enhance muscle strength, balance, and fall efficacy of super-aged women.

Objective: The purpose of this study was to examine the changes in postural stability according to ankle fixation in healthy university students. Design: Cross-sectional study. Methods: Thirty healthy subjects (15 males and 15 females, 20.13 years, 167.49 cm, 65.87 kg) were recruited on a voluntary basis. The BT4 system (HUR Laps Oy, Tampere, Finland) was used to measure the static (standing posture with eyes open and eyes closed) and dynamic (external perturbation and limits of stability (LOS) in the forward, backward, left, and right side) balance abilities. External perturbation was measured by the subject's postural sway velocity and area for 20 seconds after being impacted by a gym ball. Static and dynamic stabilities were measured with ankle joint fixation and non-fixation conditions. Ankle fixation was provided using Mueller tape on both ankle joints. Results: For static stability under the standing posture, there was no significant difference between standing with ankle joint fixation and non-fixation conditions. However, dynamic stability (external perturbation and LOS in the forward, backward, left, and right side) was significantly higher in the standing with the non-fixation condition compared to the standing with ankle joint fixation condition (p<0.05). Conclusions: Our results reveal that ankle joint fixation can influence dynamic stability during standing. Thus, we believe that this result provides basic information for making improvements in postural control and may be useful in balance training for fall prevention.

Objective: The purpose of this study was to investigate the muscle activity ratio of the lower limb according to changes in straight leg raise (SLR) test angles on hamstring muscle shortening during squat exercises. Design: Randomized controlled trial. Methods: The subjects were 14 healthy adults who were informed of and agreed to the method and purpose of the study. The participants were classified into SLR groups according to two angles (over $80^{\circ}$ or under $80^{\circ}$) assessed using the SLR tests. After training and practicing the wall squat posture to be applied to the experiment, electromyography (EMG) was used to measure changes in muscle activity during the performance of a wall squat. After stretching, a sequence of pre-stretch tests were performed again, and the active and passive SLR tests were also reconducted; thereafter, a wall squat was performed again by attaching EMG electrodes. The EMG results before and after stretching were compared. Results: The muscle activity of the vastus lateralis oblique muscle increased in both groups. The muscle activity of the vastus medialis oblique muscle decreased in over both group. Rectus femorus activity increased in the under 80-degree groups but decreased in the over 80-degree group. The muscle activity of the biceps femoris muscle decreased after stretching in the over 80-degree group and increased in the under 80-degree group, and the semitendinosus muscle activity after stretching was decreased. The quadriceps-to-hamstring muscle (Q:H) ratio before and after stretching between groups showed that the hamstring muscle ratio decreased after stretching in both groups. Conclusions: The results of this study showed that the Q:H ratio before and after stretching between groups was not significantly different.

Objective: The purpose of this review was to investigate whether motor imagery training has an effect on the recovery of upper extremity function in individuals with hemiparetic stroke or not. Design: A systematic review and meta-analysis. Methods: PubMed and three other databases were searched up to December 18th, 2018 and randomized controlled trials (RCTs) evaluating motor imagery training on upper extremity function in persons with a diagnosis of hemiparetic stroke were included. This review selected the following information from each study: surname of the first author, published year, nation, population, intervention, therapeutic intensity of intervention, therapeutic comparison, outcome measures, additional therapy, summary of results, and descriptive statistics of outcome measures. Results: This review selected seventeen RCTs with 487 stroke survivors and the following intervention methods: six motor imagery training with additional therapeutic technology, two motor imagery training with additional modified constraint-induced therapy, four mirror therapy, and five motor imagery training. Ten RCTs were eligible for meta-analysis after systematic review. The motor imagery group were more effective than the control group based on the Fugl-Meyer assessment (3.43; 95% confidence interval [CI], 1.65 to 5.22; heterogeneity [$chi^2=8.03$, df=8, $I^2=0%$], test of overall effect Z=3.76; test for subgroup differences [$chi^2=2.56$, df=2, $I^2=21.8%$]) and the Action Research Arm Test (1.32; 95% CI, -8.12 to 10.76; heterogeneity [$Tau^2=70.74$, $chi^2=15.22$, df=3, $I^2=80%$], test of overall effect Z=3.76). Conclusions: The results of this review suggests that motor imagery shows positive effectiveness on improving upper extremity function in persons with hemiparetic stroke.