• Physical Therapy Korea
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• v.25 no.2
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• pp.62-70
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• 2018

Background: The craniocervical flexion (CCF) exercise is one of the effective exercise in correcting forward head posture (FHP). However, some people with FHP achieve CCF with compensatory movements, for example, low cervical flexion using superficial neck flexors such as the sternocleidomastoid (SCM) muscle. No study has yet investigated whether a dual­pres ure biofeedback unit (D-PBU) method to prevent low cervical flexion would be helpful in performing pure CCF movement. Objects: The purpose of this study was to compare the effects of the CCF using D-PBU method and the traditional CCF method on the cross-sectional area (CSA) of the longus colli muscle (LCM) and the activity of SCM muscle in subjects with FHP. Methods: Twenty­four FHP subjects (male: 16, female: 8) were recruited for this study. All subjects performed CCF using two different methods: the traditional CCF method and the CCF using D-PBU method. The CSA of the LCM was measured via ultrasound, and surface electromyography was used to measure SCM muscle activity. Results: The change in CSA of the LCM was significantly larger during the CCF using D-PBU method ($1.28{\pm}.09$) compared with the traditional CCF method ($1.19{\pm}.08$) (p<.05). The SCM muscle activity using the CCF using D-PBU method ($2.01{\pm}1.97$ %MVIC) was significantly lower than when using the traditional CCF method ($2.79{\pm}2.32$ %MVIC) (p<.05). Conclusion: The CCF using D-PBU method can be recommended for increasing LCM activation and decreasing SCM muscle activity during CCF movement in subjects with FHP.

• Physical Therapy Korea
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• v.27 no.2
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• pp.111-117
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• 2020

Background: The Functional Assessment of Chronic Illness Therapy (FACIT) for Dyspnea was developed to assess multidimensional dyspnea using two subscales (experience of dyspnea and functional limitation) and a total score. Objects: This study aimed to assess the reliability and validity of the Korean version of the FACIT-dyspnea 10-item short form questionnaire (FACIT-dyspnea-K). Methods: Subjects were 163 patients with cancer. Dyspnea-related scales (modified Medical Research Council scale [mMRC], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 [EORTC QLQ-C30], Hospital Anxiety and Depression [HAD], and WHO Performance Scale) were used to validate the FACIT-dyspnea-K. Results: Internal consistency was confirmed by Cronbach's alpha values of 0.90 and 0.95 in factors 1 and 2, respectively. Convergence validity was determined by comparing the two factors and total score of the FACIT-dyspnea-K with conceptually related assessment tools measuring the physical and emotional effects of dyspnea, with which correlations ranged from 0.364 to 0.567. Criterion validity was established by significant differences in the FACIT-dyspnea-K score between groups when the patients were classified by performance status as assessed by the WHO performance scale. Furthermore, the FACIT-dyspnea-K showed notable correlations with other dyspnea scales (mMRC, EORTC QLQ-C30, and HAD) for cancer patients (r = 0.28 to 0.54). The test-retest reliability of the two factors and total score of the FACIT-dyspnea-K appeared to be excellent (Cronbach's alpha = 0.96 to 0.97). Conclusion: This study supports FACIT-dyspnea-K as a valid and reliable instrument to assess the dyspnea experience of cancer patients in clinical settings.

• Physical Therapy Korea
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• v.27 no.2
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• pp.140-148
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• 2020

Background: Scapular winging (SW) could be caused by tightness or weakness of the periscapular muscles. Although data mining techniques are useful in classifying or predicting risk of musculoskeletal disorder, predictive models for risk of musculoskeletal disorder using the results of clinical test or quantitative data are scarce. Objects: This study aimed to (1) investigate the difference between young women with and without SW, (2) establish a predictive model for presence of SW, and (3) determine the cutoff value of each variable for predicting the risk of SW using the decision tree method. Methods: Fifty young female subjects participated in this study. To classify the presence of SW as the outcome variable, scapular protractor strength, elbow flexor strength, shoulder internal rotation, and whether the scapula is in the dominant or nondominant side were determined. Results: The classification tree selected scapular protractor strength, shoulder internal rotation range of motion, and whether the scapula is in the dominant or nondominant side as predictor variables. The classification tree model correctly classified 78.79% (p = 0.02) of the training data set. The accuracy obtained by the classification tree on the test data set was 82.35% (p = 0.04). Conclusion: The classification tree showed acceptable accuracy (82.35%) and high specificity (95.65%) but low sensitivity (54.55%). Based on the predictive model in this study, we suggested that 20% of body weight in scapular protractor strength is a meaningful cutoff value for presence of SW.

• Physical Therapy Korea
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• v.27 no.2
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• pp.133-139
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• 2020

Background: The gastrocnemius (GCM) is one of the lower extremity muscles that tend to tighten easily. GCM tightness results in limited ankle dorsi-flexion (DF), especially when the knee joint is fully extended. Joint flexibility is determined by the morphological and physiological characteristics of joints, muscles, tendons, and ligaments. Impaired joint flexibility can be attributed to increased susceptibility to muscle injury. High-frequency diathermy is clinically used to reduce pain and muscle tightness and to improve limited range of motion. Objects: This study aimed to investigate the immediate effects of high-frequency therapy in subjects with GCM tightness. Methods: The study was designed as a one-group before-after trial. The subjects included 28 volunteers with GCM tightness (an active ankle DF angle of less than 12°) without any known neurological and musculoskeletal pathologies in the ankle and calf areas. WINBACK Transfer Electrode Capacitive and Resistive Therapy equipment was used to apply high-frequency therapy to the subjects' GCMs for 10-15 minutes. The pennation angle and the fascicle length of the GCM were measured using ultrasonography. The flexibility of the ankle joint, peak torque to the passive ankle DF (Biodex), and soft tissue stiffness (MyotonPRO) were also measured. Results: The pennation angle was significantly decreased following the treatment; however, no significant difference in the fascicle length was found (p < 0.05). The flexibility was significantly increased and both the passive peak torque to passive ankle DF and the soft tissue stiffness significantly decreased (p < 0.05). Conclusion: High-frequency therapy is immediately effective for improving the muscle's architectural properties and functional factors in subjects with GCM tightness. Further longitudinal clinical studies are required to investigate the long-term effects of high-frequency therapy on subjects with GCM tightness from various causes.

• Physical Therapy Korea
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• v.27 no.2
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• pp.118-125
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• 2020

Background: Lateral epicondylitis (LE) is the most common chronic musculoskeletal pain condition of the upper extremities. LE is often related to forceful grip activities that require isometric contraction of the wrist extensors. A previous study evaluated the effect of the diamond taping technique on grip strength and pain; however, there has been no report on the change in the electromyography (EMG) findings of wrist extensors. Objects: The aim of this study was to investigate the effect of diamond taping technique, using a rigid tape, on the EMG activities of the extensor carpi radialis (ECR) during grip activities. Methods: Twenty-four healthy subjects (mean age = 21.50 ± 2.76 years) volunteered to participate in this study. The subjects were instructed to perform forceful grip activities with and without diamond-type taping on the origin area of the ECR. Grip strength tests were performed at 100%, 75%, 50%, and 25% for maximal isometric contraction force. EMG data were collected from the ECR. Repeated measure analysis of variance was used to analyze the effect of grip force and taping (with and without). Statistical significance levels were set at α = 0.05. Comparison of the results with and without taping at different grip force were analyzed using independent t-test. Statistical significance levels were set at α = 0.01. Results: Statistically significant association was observed between the taping application and forceful grip activity as revealed by the EMG data of the ECR (p < 0.05). EMG of the ECR significantly reduced for all muscle strength levels (p < 0.01) after taping. Conclusion: This study shows an impressive effect of the diamond taping technique, using rigid tape, on wrist extensors during grip activities. Decreasing muscle activity via this taping approach could be utilized to enhance pain-free grip force and reduce pain in patients with LE. Our study suggested that this taping technique could be considered as an effective management strategy of LE.

• Physical Therapy Korea
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• v.27 no.2
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• pp.126-132
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• 2020

Background: Augmented somatosensory feedback stimulates the mechanoreceptor to deliver information on bodily position, improving the postural control. The various types of such feedback include ankle-foot orthoses (AFOs) and vibration. The optimal feedback to mitigate postural sway remains unclear, as does the effect of augmented somatosensory feedback on muscle co-contraction. Objects: We compared postural sway and ankle muscle co-contraction without feedback (control) and with either of two forms of somatosensory feedback (AFOs and vibration). Methods: We recruited 15 healthy subjects and tested them under three feedback conditions (control, AFOs, vibration) with two sensory conditions (eyes open, or eyes closed and the head tilted back), in random order. Postural sway was measured using a force platform; the mean sway area of the 95% confidence ellipse (AREA) and the mean velocity of the center-of-pressure displacement (VEL) were assessed. Co-contraction of the tibialis anterior and gastrocnemius muscles was measured using electromyography and converted into a co-contraction index (CI). Results: We found significant main effects of the three feedback states on postural sway (AREA, VEL) and the CI. The two sensory conditions exerted significant main effects on postural sway (AREA and VEL). AFOs reduced postural sway to a level significantly lower than that of the control (p = 0.014, p < 0.001) or that afforded by vibration (p = 0.024, p < 0.001). In terms of CI amelioration, the AFOs condition was significantly better than the control (p = 0.004). Vibration did not significantly improve either postural sway or the CI compared to the control condition. There was no significant interaction effect between the three feedback conditions and the two sensory conditions. Conclusion: Lower-extremity devices such as AFOs enhance somatosensory perception, improving postural control and decreasing the CI during static standing.

• Physical Therapy Korea
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• v.27 no.2
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• pp.93-101
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• 2020

Background: For performing various movements well, cooperation between the muscles around the scapula and shoulder has been emphasized. Taping has been widely used clinically as a helpful adjunct to other physiotherapy methods for shoulder pathology and dysfunction treatment. Previous studies have evaluated the effect of taping techniques using dynamic tapes on shoulder function and pain. However, no study investigated the electromyographic (EMG) changes in the shoulder muscles. Objects: This study aimed to investigate the effect of the upper limb offload taping technique using a dynamic tape on EMG activities of the upper trapezius (UT), lower trapezius, serratus anterior (SA), and middle deltoid (MD) muscles during scaption plane elevation. Methods: A total of 26 healthy subjects (19.85 ± 6.40 years, male = 20) volunteered to participate in this study. The subjects were instructed to perform scaption elevation with and without dynamic taping on the shoulder. Shoulder elevation strength tests were performed at 100%, 75%, 50%, and 25%, for the maximal isometric contraction force. Results: There were statistically significant interaction effects between the taping application and shoulder scaption elevation force in EMG activities in the UT (p < 0.05) and MD (p < 0.05). EMG activities in the UT showed significant increases in 50%RVC (reference voluntary contraction, p < 0.05) and 25%RVC (p < 0.01). Furthermore, the EMG activity of the SA significantly increased in 50%RVC (p < 0.01) and 25%RVC (p < 0.01) after dynamic taping. For the MD, the EMG activity level significantly decreased in 100%RVC (p < 0.05). Conclusion: These results indicated that upper limb offload dynamic taping application affects the muscle activities of some shoulder muscles depending on different scaption elevation strength levels. Therefore, we suggest that the upper limb offload dynamic taping can be applied to the shoulders when patients need middle deltoid inhibition or upper trapezius facilitation, such as patients with shoulder impingement syndrome.

• Physical Therapy Korea
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• v.19 no.3
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• pp.1-10
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• 2012

The aim of this study is to compare measurements of abdominal muscle thickness using ultrasonography imaging (USI) to those using a special transducer head device, during five different trunk stabilization exercises, ultimately to determine which exercise led to the greatest muscle thickness. Thirty eight healthy subjects participated in this cross-sectional study. The five types of trunk stabilization - i.e., a sit-up on the supine, an upper and lower extremity raise with quadruped on the prone, a leg raise in sitting on the ball, trunk rolling on the ball, and balance using sling on the prone position - were each performed with an abdominal draw. The thickness of the abdominal muscle - including the transverse abdominal (TrA), internal oblique (IO), and external oblique (EO) - was measured by USI with a special transducer head device, at rest and then at contraction in each position. Data were analyzed using one-way repeated ANOVA with the level of significance set at ${\alpha}$=.05. The results were as follows: 1) the TrA thickness was statistically significant (p<.05), whereas the IO and EO thicknesses were not (p>.05); 2) among the five types of trunk stabilization, TrA thickness significantly increased with the balance using a sling in the prone position, (p<.05), whereas no significant difference was noted for the four types of trunk stabilization (p>.05); 3) reliability data showed that there was a high degree of consistency among the measurements taken using the special transducer head device (ICC=.92). In conclusion, the balance using a sling in the prone position was more effective than any of the four other types of trunk stabilization in increasing TrA thickness in healthy subjects.

• Physical Therapy Korea
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• v.19 no.3
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• pp.11-19
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• 2012

This study aimed to investigate whether isometric lower limb exercise can activate contralateral trunk muscles and whether the magnitude of muscle activation is related to lower limb movement in sitting. This study included 25 healthy young subjects (20 males and 5 females). The magnitude of trunk muscle activation was measured using surface electromyography (EMG) during hip flexion, extension, adduction, and abduction, and a significant difference was observed in the activation levels of trunk muscles among the tests (p<.01). The EMG activity of the multifidus (MF) and erector spinae (ES) muscles on the contralateral side were significantly greater during hip extension. However, the activation levels of the contralateral internal oblique (IO) and rectus abdominis (RA) muscles were greatest during hip flexion. The MF : ES EMG ratio was significantly greater during hip isometric during hip isometric flexion and abduction compared to hip extension and adduction. There was no significantly difference in the IO : RA ratio during the isometric contractions toward different directions. These findings indicate that isometric lower limb exercise can elicit trunk muscle contraction on the contralateral side and may therefore be helped for developing contralateral trunk muscle strength in individuals undergoing rehabilitation.

• Physical Therapy Korea
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• v.19 no.3
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• pp.51-60
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• 2012

This study aimed to determine the usefulness of classifying patients with neck pain on the basis of the results of passive scapular elevation test. We classified 21 patients with neck pain into positive (n=12) and negative (n=9) groups on the basis of passive scapular elevation test; the 2 groups then equally performed scapular stabilization exercise program for 30 min, 3 times a week, for 4 weeks. Visual analogue scale (VAS), neck disability index (NDI), and range of motion (ROM) were recorded both before and after the intervention for both groups. Paired t-test was used to determine that there were significant changes between before and after the intervention, and independent t-test was used for analyzing changes between two groups of dependent variables. After 4 weeks of training, we observed significant decrease in pain and disability (p<.05) and a significant increase in rotation, flexion, extension, and side-bending ROM (p<.05) in both groups. Further, between pre- and post-intervention evaluations, we observed a significant decrease in pain and disability and a significant increase in rotation and flexion ROM in the positive group than in the negative group (p<.05). These results indicate that passive scapular elevation test may be used to identify mechanical disorders of the cervicoscapular muscle in patients with neck pain. Therefore, we recommend the use of passive scapular elevation test to determine appropriate treatment intervention when treating patients with neck pain.