• The Journal of Korean Physical Therapy
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• v.20 no.3
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• pp.9-18
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• 2008

Purpose: We determined the effect of global synkinesis(GS) on gait ability, muscle contraction, and central neuron action potentials in post-stroke hemiplegic subjects. Methods: Thirty hemiplegia patients were evaluated for walking ability, muscle contraction, central neuron action potential, and comparing differences between the H-GS(high-global synkinesis) group and L-GS(low-global synkinesis) group. To obtain the GS level, surface electromyography(EMG) data were digitized and processed to root mean square(RMS). Walking ability was tested with a modified motor assessment scale(MMAS), a 10 m walking test, timed up and go(TUG) test, and a Fugl-Meyer assessment(FMA). Muscle contraction ability was measured as maximal isometric contraction(MIC) peak, MIC slope, and MIC ramp up using mechanomyography(MMG). Central neuron action potential was measured as the H/Mmax ratio or V/Mmax ratio using EMG. The data were analyzed with t-tests to determine the statistical significance. Results: MMAS(p<0.01), 10 m walking velocity(p<0.01), TUG(p<0.01), FMA-HKA(Hip, Knee, Ankle)(p<0.05), FMA-coordination(p<0.05), MIC peak (p<0.05), MIC slope(p<0.01), and MIC ramp up(p<0.05) were significantly different between H-GS and L-GS, as was the V/Mmax ratio(p<0.05), but H/Mmax was not. Conclusion: Lower GS levels indicated better walking ability and motor function. Therefore, intervention programs should consider GS levels in gait training of chronic hemiplegia.

• Journal of International Academy of Physical Therapy Research
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• v.10 no.3
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• pp.1849-1855
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• 2019

Background: Stroke patients require arm movement exercising for various stimulations in standing position for various stimulations rather than in a sitting position because they require integrated skillful movements, such as stretching, holding, and controlling. Objective: This study was conducted to provide foundational clinical data about lower limb global synkinesis in stroke patients using arm movements in a standing position. Design: Randomized controlled trial. Methods: The subjects were divided into a control group (n = 10) and an experimental group (n = 10), and a pre-test was conducted to evaluate leg global synkinesis (GS) and balance. Intervention method is stretching an arm to hold a ball, repeating supination and pronation of the hand only while maintaining the arm extended as much as possible, repeating shoulder abduction and adduction while holding the pegboard. This was followed by a three-week intervention during which re-measurement was conducted in the same way as was done for the pre-test. Results: The control group showed a significant difference in GS and balance during plantar flexion (p<.05), and the experimental group showed a significant difference in GS and balance during all movements (p<.05, p<.01, respectively). There was a significant difference in GS and balance between the two groups during dorsiflexion (p<.05, p<.01, respectively). Conclusion: The findings demonstrate that human arm movements in a standing position can reduce GS in the affected limb, and balance can be improved by stimulating the surrounding tissues of the affected limb and changing them positively.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.12 no.11
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• pp.5019-5026
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• 2011

The purpose of this study was to investigate the effect of the increased sympathetic outflow on the changes of muscle tone and central nervous system excitability in the chronic stroke patients. This study was conducted from October 12th 2009 to December 4th 2009. 30 patients with chronic hemiplegia for at least 6 months were participated. Before and during the mental arithmetic, static handgrip and post-handgrip ischemia tasks, the central nervous system action potentials and global synkinesis level were compared. The central nerve action potentials were measured with H/Mmax ratio and V/Mmax ratio. To obtain global synkinesis level, surface electromyography data were digitized, processed to root mean square. In our study, The global synkinesis level during knee flexion and extension was decreased in the mental arithmetic and in the post-handgrip ischemia task(p<.05) but not in the grip task. Also, V/Mmax ratio was decreased all in the three task(p<.05). In conclusion, we know that the central nervous system excitability and the muscle tone in chronic hemiplegic patients were decreased by the increased sympathetic outflow.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.2
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• pp.63-70
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• 2021

PURPOSE: This study aimed to analyze the factors influencing the improvement of global synkinesis (GS) and gait in stroke patients by the weight shift exercise. METHODS: Twenty stroke patients were randomly assigned to experimental group I (n = 10) and experimental group II (n = 10). In experimental group I, weight shift with upper extremity exercises in a standing position were mediated and in experimental group II, upper extremity exercises in a standing position were mediated. These interventions were conducted in both groups for three sessions per week, 30 minutes per session over four weeks. Before the interventions, leg GS was measured using surface electromyography and the 10m walk test (10MWT). The same parameters were measured four weeks later. RESULTS: The GS and 10MWT of the experimental group I showed that there was a statistically significant difference between dorsiflexion (p < .05) and plantarflexion (p < .01) and 10MWT (p < .01). In experimental group II, there was a statistically significant difference only in 10MWT (p < .01). The comparison between the changes in both groups showed that in the case of GS, there was a statistically significant difference in the dorsiflexion (p < .01) and plantarflexion (p < .05), and in the 10MWT too (p < .05). CONCLUSION: GS of the lower extremities was decreased by improving posture control and enlarging soft tissues due to the symmetrical weight shift in experimental group I, which turned out to be effective in improving the gait speed.

• Journal of International Academy of Physical Therapy Research
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• v.11 no.3
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• pp.2140-2146
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• 2020

Background: Stroke patients exhibit arm global synkinesis (GS), involuntary movement due to muscle weakness and irregular muscle tension. But currently there are few studies examined the effects of GS on activates of daily living in stroke patients. Objectives: To investigate the effects the effects of task-oriented bilateral movements, which promote brain plasticity and are based on neurological theory, using the unaffected arm and the affected arm. Design: Quasi-randomized trial. Methods: Twenty stroke patients were randomly assigned to experimental group I (n=10) and experimental group II (n=10). Before the intervention, arm GS was measured using surface electromyography, and the Motor Activity Log evaluated the quantitative and qualitative uses of the affected arm in daily life. The same items were measured four weeks later. Results: The changes in the GS of the arm of experimental group I showed statistically significant differences only in bending motions (P<.05). Both groups showed statistically significant differences in the amount of use (AOU) and the quality of movement (QOM) scores (P<.01). Comparing the groups, statistically significant differences in GS appeared during bending motions (P<.05), and in the AOU (P<.01) and the QOM scores (P<.05). Conclusion: The intervention in GS reduced the abnormal muscle tension of the affected side by increasing the use of the ipsilateral motor pathway, indicating its effectiveness in improving upper limb functions with smooth contraction and relaxation of the muscles.

• Journal of International Academy of Physical Therapy Research
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• v.10 no.3
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• pp.1856-1861
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• 2019

Background: Although there are interventions available for the improvement of arm functions of patients with stroke, measuring changes in global synkinesis (GS) according to changes in the muscle activity of paretic and nonparetic side muscles is an important factor and studies to investigate such potential factors are evaluated necessary. Objective: To examine the correlation between the affected arm muscle activity and GS changes in patients with stroke. Design: Randomized controlled trial Methods: In order to measure muscle activities of 30 stroke patients, anterior deltoid, posterior deltoid, biceps brachii and triceps brachii of the affected arms were measured using surface electromyography (EMG) and for analyzing GS, biceps brachii and triceps brachi of the affected arms were measured using the same instrument. Results: When the correlations between the muscle activity and GS of the affected arm were analyzed, the results showed significant correlations between the posterior deltoid and the triceps brachii(p < .01) and between the triceps brachii and GS(p < .05). Conclusion: : The results of this study suggest that the efficient movements of the affected arms of stroke patients, it is possible to increase extensor activity by improving smooth antagonism of the arm.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.8 no.1
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• pp.7-13
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• 2010

Purpose : This study was performed as follows in order to investigate the effect of presynaptic inhibition mechanism using the transcutaneous electrical stimulation (TES) for global synkinesis (GS) on the post-stroke hemiplegic patients. Methods : The subjects consist of 38 post stroke hemiplegic patients; experiments were performed on thirty patients excluding eight. The experiment was performed on sham group, sensory level stimulation group, and motor level stimulation group for 20 minutes a day 5 times a week for 6 weeks total. We compared the differences in GS levels and walking ability. The measurements were carried out pre, immediated, post 10th, and 20th, for a total of four measurements. Results : The GS level using sEMG found significant differences between groups at the post 10th and post 20th in dorsiflexion, and post 20th in plantarflexion (p<0.05, p<0.01). The motor level group indicated more significant differences when the number of electrical stimulations increased. TUG and 10 m walking test indicated a significant difference at immediated, post 10th, and post 20th. The motor level group showed more significant decreasing tendency than the sensory level group. Conclusion: From these results, electrical stimulation using presynaptic inhibition mechanism of transcutaneous electrical stimulation (TES) had positive effects for walking ability on inhibition of muscle tone in lower extremity. The motor level stimulation group experienced a more significant effect than the sensory level stimulation group. Therefore, the transcutaneous electrical stimulation (TES) is considered to be effective on walking ability increasing through inhibition of muscle tone in lower extremity for rehabilitation of post stroke hemiplegic patients.

• Journal of International Academy of Physical Therapy Research
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• v.11 no.1
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• pp.2012-2020
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• 2020

Background: Multifaceted approaches will be needed, such as global synkinesis (GS) achieve functional improvements in the arms of stroke patients from involuntary movements during exercise. Objective: To identify changes in arm GS and muscle activity, functional evaluation and the correlation with variables through action observation training, combined with functional electrical stimulation (FES), thereby verifying the effect on stroke patients. Design: A quasi-experimental study. Methods: The subjects of this study were 20 stroke patients who were divided into two groups: Control group (n=10) and experimental group (n=10). Before the intervention, arm GS and muscle activity were measured using surface electromyography (EMG), and arm function was evaluated using the Fugl-Meyer Assessment (FMA) scale. At the end of the intervention, which lasted 4-wk, arm GS and muscle activity were measured again using the same scale. Results: There was a decrease statistically significant difference in GS during the bending action in experimental group (P<.01). Both groups showed a significant difference increased only in the activity of the anterior deltoid (AD) and biceps brachii (BB) (P<.05). The results of the arm functional assessment revealed a significant difference increase in both groups (P<.05). In the between-group comparison, there was a significant difference decrease in GS during the bending action (P<.05). Only the muscle activity of the AD and BB were significantly increase different (P<.05). There was a significant between-group difference increase in the arm functional assessment (P<.05). There was a positive correlation between GS and muscle activity on the FMA in the control group (r=.678, P<.05). In experimental group, GS during the bending arm action exhibited a negative correlation (r=-.749, P<.05), and the muscle activity of the AD and BB showed a positive correlation (r=.701, P<.05). Furthermore, in experimental group, the activity of the extensor carpi radialis increased, and the activity of the flexor carpi radialis decreased, which exhibited a negative correlation (r=-.708, P<.05). Conclusion: These results suggest that brain plasticity could be more efficiently stimulated by combining surface stimulation in the affected arm of stroke patients.

• Journal of the Korean Society of Physical Medicine
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• v.17 no.1
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• pp.85-92
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• 2022

PURPOSE: This study aimed to analyze the effects of task exercise on an unstable surface on the involuntary arm and leg movement and balance in stroke patients. METHODS: 20 stroke patients were clinically sampled and randomly assigned to two groups of 10 patients each. Experimental group I received task exercise intervention on an unstable surface and experimental group II received task exercise intervention. The interventions were carried out 3 times a week for 4 weeks (30 minutes per session). The global synkinesis (GS) and Berg Balance Scale (BBS) of the patients were evaluated as pre-tests prior to intervention, and then the post-tests were re-measured in the same manner as the pre-tests after a 4-week intervention period. RESULTS: In the experimental group I, there were statistically significant differences in the changes in the arm and leg GS (p < .01) and in the BBS (p < .05). On the other hand, in the experimental group II, there were statistically significant differences in the changes only in the arm GS (p < .01) and in the BBS (p < .05). Also, in the comparison of the changes between the two groups, there was a statistically significant difference in the changes in the leg GS only (p < .05). CONCLUSION: In the experimental group I, the arm and leg GS were statistically significantly reduced, but the balance ability was statistically significantly improved. The reason was that in the experimental group I, similar movements of the paralyzed arm were promoted due to the double-task exercise on the unstable surface, and sensory feedback and posture strategies were well utilized in the legs, which was found to be effective in reducing the GS and improving the balance ability. Therefore, based on these results, the double-task exercise on an unstable surface should be fully utilized for the rapid rehabilitation of stroke patients.