• Journal of The Korean Society of Integrative Medicine
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• v.7 no.3
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• pp.117-125
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• 2019

Purpose : The purpose of this study was to determine the effects of simultaneous application of focal vibration stimulation and task-oriented training on the improvement in upper extremity motor function after stroke. Methods : The study period was from January to April 2019; 23 patients who fulfilled the study eligibility criteria were enrolled. The participants were divided into two groups: the experimental group with vibration stimulation and task-oriented training and the control group with only task-oriented training. Training was conducted in a total of 20 sessions, 5 times a week for 30 minutes a day for 4 weeks. The amount of use of the affected and unaffected side by accelerometers, and Box and Block test (BBT), Action Research Arm Test (ARAT) was measured with a pre-test, a post-test. Wilcoxon Signed Rank Test and Analysis of Covariance were used to compare and analyze the changes within and between the groups. Results : Both the groups showed statistically significant changes in the results of the BBT and the ARAT, as well as the amount of use of the affected and unaffected side. Regarding the use of the affected side, BBT results, and the grasp and gross movement item of the ARAT showed significant changes in the experimental group compared with the control group. Conclusion : We found that simultaneous application of focal vibration stimulation and task-oriented training was more effective than task-oriented training alone. A large-scale comparative study involving a group that is only given vibration stimulation should be conducted for more generalizable results.

• PNF and Movement
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• v.17 no.1
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• pp.47-56
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• 2019

Purpose: This study investigated the effects of neck pattern of proprioceptive neuromuscular facilitation (PNF) on balance and walking ability in patients with chronic stroke. Methods: Fourteen participants with chronic stroke were randomly assigned to vestibular rehabilitation and then divided into two groups: the neck pattern group or treadmill group. Each group underwent 20 sessions (20 minutes/day, five days/week, for four weeks). Patients were assessed with the Berg balance scale (BBS) and gait parameters (gait speed, cadence, step length, and double-limb support period) using a GAITRite system. Results: Vestibular rehabilitation for the neck pattern group and the treadmill group showed significant intragroup improvement on the BBS and in terms of gait speed, cadence, step length, and double-limb support period (p < 0.05). Vestibular rehabilitation was more effective for the neck pattern group than for the treadmill group in terms of the BBS (p = 0.00; 95% CI, 1.49-5.94), gait speed (p = 0.01; 95% CI, 0.05-0.16), cadence (p = 0.02; 95% CI, 0.54-4.99), and step length (p = 0.00, 95% CI, 1.55-4.62). Conclusion: This study used the neck pattern of PNF for vestibular rehabilitation in patients with chronic stroke. The results showed significant improvement in the patients' balance and walking ability. Therefore, the neck pattern of PNF for vestibular stimulation may be more effective than treadmill training to improve balance and walking ability in patients with chronic stroke.

• PNF and Movement
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• v.17 no.1
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• pp.1-9
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• 2019

Purpose: This study investigates the effects of task-oriented training for a left trunk flexion pattern using real-time ultrasound imaging in a stroke patient with unilateral neglect symptoms. Methods: This study used the ABA experimental design, which is a single-subject research method among individual case research methods. For the ABA experimental design, changes in the degree of unilateral neglect, balance ability, and the thickness of the lateral abdominal muscle were visually analyzed during the baseline process, in the intervention period, and after the intervention. The experiments were performed 24 times in total for 8 times in each of the 3 periods. The unilateral neglect was measured using the Albert test, balance ability was measured using the Berg balance test, and the thickness of the lateral abdominal muscle was measured using ultrasound imaging. The subject was a 50-year-old male patient with unilateral neglect caused by right cerebral hemorrhage. He performed task-oriented training for a voluntary left trunk flexion pattern using real-time ultrasound imaging during the intervention period. Results: The result of comparing the data collected during the intervention period with the data point average of the baseline process showed that balance ability improved and the tendency line was above the baseline. The tendency line of unilateral neglect was below the baseline and showed a decreasing tendency. The thickness of the lateral abdominal muscle showed an increasing trend and the tendency line was above the baseline. Conclusion: The results of this study suggest that the task-oriented training for left trunk flexion pattern using real-time ultrasound imaging has a beneficial effect on balance ability, the degree of unilateral neglect, and the strength of the lateral abdominal muscle in unilateral neglect patients.

• PNF and Movement
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• v.17 no.1
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• pp.137-144
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• 2019

Purpose: This study examined the effects of the abdominal drawing-in maneuver (ADIM) on muscle activity in the trunk and legs while subjects walk on a ramp. Methods: The subjects were healthy adult males (n=15) and females (n=8) in their twenties. The subjects were asked to maintain the ADIM contraction for 15 minutes using a pressure biofeedback unit. Their muscle activity was then measured while ascending or descending the ramp with or without the ADIM contraction maintained. Activity in the sternocleidomastoid, splenius capitis, rectus abdominis, external oblique abdominal, transversus abdominis, erector spinae, vastus medialis, and vastus lateralis muscles was measured using surface electromyography (TM DTS, Noraxon, USA). A paired t-test was conducted using SPSS 18.0 (IBM) for statistical data processing. Results: Maintaining the ADIM contraction during ascension led to a significant increase (p<0.05) in muscle activity for the rectus abdominis, transversus abdominis, vastus medialis, and vastus lateralis, but a significant decrease (p<0.05) in muscle activity for the erector spinae, when compared to the same activity without the ADIM maintained. Furthermore, maintaining the ADIM contraction during descent led to a significant increase (p<0.05) in muscle activity for the rectus abdominis, external abdominal oblique, transversus abdominis, vastus medialis, and vastus lateralis, but a significant decrease (p<0.05) in muscle activity for the erector spinae, when compared to the same activity without the ADIM maintained. Conclusion: As a result of this study, it maintains the ADIM and reduces lumbar muscle activity at the waist and increases muscle activity in the legs when walking on a ramp. Therefore, maintaining the ADIM contraction during ramp walking is recommended as training to improve the function of patients' muscular skeleton.

• PNF and Movement
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• v.19 no.2
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• pp.215-223
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• 2021

Purpose: This study aimed to compare the contraction ratios of the abdominal muscles and the preferential activation ratios of the transversus abdominis muscle (TrA) during the abdominal drawing-in maneuver (ADIM) in the hook-lying, sitting, and standing positions. Methods: This study included 30 healthy participants. The thicknesses of the TrA, internal oblique muscle (IO), and external oblique muscle (EO) were measured at rest and during the ADIM in the hook-lying, sitting, and standing positions using B-mode ultrasound imaging. The contraction ratios of these muscles and the preferential activation ratios of the TrA were calculated for each position. Results: The contraction ratio of the TrA and preferential activation ratio of the TrA during the ADIM in the hook-lying position were significantly higher than those in the sitting and standing positions (p < 0.05). The contraction ratio of the TrA during the ADIM in the sitting position was significantly higher than that in the standing position (p < 0.05). Conclusion: The hook-lying position tended to facilitate TrA activity better than the sitting position. Furthermore, the sitting position tended to facilitate TrA activity better than the standing position. These findings suggest that the ADIM in the hook-lying position should be implemented before that in the sitting position and that the ADIM in the sitting position should be implemented before that in the standing position.

• PNF and Movement
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• v.19 no.2
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• pp.233-242
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• 2021

Purpose: The purpose of this study was to determine the changes in foot contact area and pressure when walking with a functional insole that emphasizes the Hallux point as compared to a general insole. Methods: In this study, an experiment was conducted to investigate changes in plantar pressure and contact area for a functional insole that emphasized the Hallux point as compared to a general insole. A lower extremity robot was used for walking reproduction. First, the gait sequence according to the two insoles was determined through a randomized controlled trial comparison. According to the sequence procedure, the insole was attached to the shoe and then worn on the right side of the lower extremity robot for gait reproduction at a normal gait speed of 20 steps per minute. After programming the robot to walk, the experiment was carried out. The result value was determined by averaging the pressure and area data of the fore and rear foot measures after walking at 20 steps per minute. Results: The functional insole that emphasized the hallux point significantly increased the forefoot and rearfoot contact area (p < 0.05) and significantly decreased the forefoot and rearfoot contact pressure (p < 0.05) compared to the general insole. Conclusion: A functional insole that emphasizes the hallux point does not collapse the medial longitudinal arch during gait, increasing foot stability and reducing fatigue. Thus, this functional insole needs to be widely used clinically.

• PNF and Movement
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• v.12 no.3
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• pp.143-150
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• 2014

Purpose: The corticospinal tract (CST) is known to be an important pyramidal tract for walking and motor function. However, very little is known about the functional role of the CST in the recovery of motor function. In the current study, we investigated the relation between the CST and motor function in chronic hemiparetic stroke patients. Methods: Fifty-four patients and 20 normal subjects were recruited. The Functional Ambulation Category (FAC) was used in measurement of the walking ability. We classified patients into three groups according to the ability to walk independently: group A, patients who could not walk independently (FAC: 0-2); group B, patients who could walk independently (FAC: 3); and group C, patd walk functionally (stairs and uneven surfaces, FAC 4-5). The Motricity Index (MI) was used to measure the motor function of the affected upper and lower extremities (maximum score: 100). The fractional anisotropy (FA) value, apparent diffusion coefficient (ADC) value, and fiber volume of the CST were used for the diffusion tensor imaging (DTI) parameters. Results: In terms of the CST of the unaffected hemisphere, the FA value of group A was significantly lower than that of normal controls (p <0.05). The fiber volume of group C was significantly higher than that of normal controls (p <0.05). In contrast, the ADC values of all patient groups and the control group did not show any difference (p >0.05). In terms of lower MI and total MI, significant differences were observed between all patient groups (p <0.05). In addition, significant differences in terms of the upper MI scores were observed between groups A and C and between groups B and C (p <0.05); however, no significant difference was observed between groups A and B (p>0.05). Conclusion: The increased fiber volume of the CST in the unaffected hemisphere appears to be related to functional walking ability in chronic stroke patients. This result would be useful for elucidation of the neural recovery mechanism of walking and the investigation of new modalities for the recovery of walking following a stroke with CST injury.

• PNF and Movement
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• v.12 no.4
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• pp.243-248
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• 2014

Purpose: The transverse abdominis and themultifidus muscle are located in the core. They surround one's trunk and help in body stabilization. Specifically, they control spine articulation to maintain posture and balance. Therefore, weakened deep muscle in the trunk may cause spinal malalignment. This study aims to compare the correlation between the thickness of the transverse abdominis and the multifidus muscle and the spine alignment among college students in their 20s. Methods: This study measured the thickness of the transverse abdominis and the multifidus muscle of 42 healthy college students in their 20s using ultrasonic waves. The thickness of the muscle was measured for the length of the cross-section except for fascia. The thickness of the left and right muscles was measured, and the mean value was calculated. As the thickness of the transverse abdominis can increase because of pressure during exhalation, it was measured at the last moment of exhalation. Spinal alignment was measured by the kyphosis angle, lordosis angle, pelvic tilt, trunk inclination, lateral deviation, trunk imbalance, and surface rotation using Formetric III, which is a three-dimensional imaging equipment. They were measured for three times, and the mean values were calculated. The general characteristics of the subjects were analyzed using descriptive statistics. The correlations between each factor were analyzed using Pearson's correlation analysis. Results: The transverse abdominis showed asignificant correlation with trunk inclination (p<.05). The multifidus muscle showed a significant positive correlation with pelvic tilt and a negative correlation with surface rotation (p<.05). Conclusion: The thickness of transverse abdominis and the multifidus muscle appears to influence spinal alignment. Specifically, the multifidus muscle, which plays an important role on the sagittal plane, influences surface rotation, thus making it an important muscle for scoliosis patients. Therefore, a strengthening training program for the transverse abdominis and the multifidus muscle is necessary according to specific purposes among adults with spinal malalignment.

• PNF and Movement
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• v.12 no.2
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• pp.123-132
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• 2014

Purpose: The discovery of mirror neuron system may positively affect functional recovery; therefore, rehabilitation is needed that is practical for use in clinical settings. The purpose of this study was to examine the effect of action observation training on upper motor function in people who had suffered strokes. Methods: Three elderly patients with stroke, aged to years, were recruited from a stroke rehabilitation center. A nonconcurrent, multiple baseline subject approach was taken, with an A-B-A treatment single-subject experimental design, and the experiment was conducted for 3 weeks. The action observation training was repeated 5 times in 5 days during the intervention period. The arm function, including WMFT, BBT, and grip and pinch strength, was evaluated in each subject 5 times during the baseline period, the intervention period, and the baseline regression period. Results: The results of the evaluation for each subject were presented as mean values and video graphs. The WMFT scores of 2 subjects were improved during the intervention period in comparison with the baseline period, and this improvement was maintained even during the regression baseline period. The BBT and the grip and pinch strength were not improved. Conclusion: Based on these results, we suggest that the action observation training for 5 sessions was effective in improving upper limb function of stroke patients but was not effective in improving hand dexterity or grip and pinch strength.

• PNF and Movement
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• v.9 no.2
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• pp.29-37
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• 2011

Purpose : The purpose of this study was to find out of an effect of forward, backward walking using partial weight bearing on walking of the patient with incomplete spinal cord injury. Methods : The average age, and the term of being sick of 6 patients who were selected as the subjects with incomplete spinal cord injury and who received medical attention in the National Rehabilitation Hospital, was 50.3 years old, and 10.7 months, and those were also the patients that were classified as ASIA-C or D by ASIA. The forward, backward walking using a partial weight bearing system as the research method, took total 6 weeks, 3 days per week, 3 times per day, total 45 minutes for each time(15 minutes for a time, 5 minutes for a breathing time), and the 15 minutes was used for forward walking 7.30 minutes, backward walking for 7.30 minutes, to find out before and after the test of WISCI, PCI, Walking Speed, Motor Score of Lower Limbs for the selected patients with incomplete spinal cord injury. Results : The result was showed WISCI from 17 points to 17 points that is, no change occurred at all, and PCI from $161.01{\pm}103.06$ to $74.97{\pm}58.19$, some amount of reduction that is not statistically significant(p<.05). Regarding walking speed, it increased from $24{\pm}.07m/sec$ to. $61{\pm}.35m/sec$, that is statistically significant(p<.05), and motor score of lower limbs showed statistically significant increase like from $33.17{\pm}7.08$ to $37{\pm}5.14$(P<.05). Conclusion : The 4 evaluation categories seem to have shown differences due to an insufficient number of subjects, and short test term, and it seems the more diverse task-oriented walking exercises should be studied in the coming days.