• Physical Therapy Korea
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• v.21 no.3
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• pp.45-54
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• 2014

Fall is one of the most intimidating health conditions in elders. Comprehensive assessment is necessary to understand the individual and environmental aspects of the falls such as balancing abilities, depression, and quality of life. The purpose of this study was to compare the balancing ability, depression, and quality of life between elderly fallers and elderly non-fallers. Thirty-two community-dwelling elders (fifteen males and seventeen females between 65 and 83 years old), who have experienced fall on walking during last twelve months, were involved in the elderly fallers group. And twenty-four males and twenty-two females between 65 and 83 years old of community-dwelling elders, who have no experienced fall on walking during last twelve months, were involved in the elderly non-fallers group. Berg balance scale (BBS), timed up and go test (TUG), and functional reach test (FRT), were used to evaluate the ability of the physical balance. 'Beck depression scale in Korean' questionnaire was used to assess the depression. 'Korean version of World Health Organization Quality of Life Assessment Instrument-Bref' questionnaire was used to assess the quality of life. The results were as follows: 1) Balancing abilities measured by the BBS, TUG in the elderly fallers group were meaningfully lower than that of the elderly non-fallers group (p<.05), whereas no significant difference in the FRT was found (p>.05). 2) Depression level in the elderly fallers group was significantly higher than that of the elderly non-fallers group (p<.05). 3) Quality of life in the elderly fallers group was significantly lower than that of the elderly non-fallers group, excluding environment domain (p<.05). Therefore, in order for clinical evaluation of the community-dwelling elders those with reduced balancing ability, it is necessary to evaluate and understand the fall experience, depression, and quality of life.

• Physical Therapy Korea
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• v.25 no.4
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• pp.9-18
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• 2018

Background: Leg length discrepancy (LLD) leads to many musculoskeletal disorders and affects daily activities such as walking. In the majority of the population, mild LLD is a common condition. Nevertheless, it is still controversy among researchers and clinicians on the effects of mild LLD during gait, and available studies have largely overlooked this issue. Objects: The purpose of the present study is to investigate the effects of mild LLD on the gait parameters and trunk acceleration. Methods: A total of 15 female and male participants with no evidence of LLD of >.5 ㎝ participated in the present study. All participants walked under the following two conditions: (1) The non-LLD condition, where the participants walked in shoes of the same heel height; (2) A mild LLD condition induced by wearing a 1.5 ㎝ higher heel on the right shoe. The GAITRite system and tri-axial accelerometer were used to measure gait parameters and trunk acceleration. To compare the variation of each variable, a paired t-test was performed. Results: Compared to the non-LLD condition, step time and swing phase were significantly increased in the mild LLD condition, while stance phase, single support phase, and double support phase significantly decreased in the short limb (p<.05). In the long limb of the mild LLD condition, single support phase significantly increased, while swing phase significantly decreased (p<.05). Furthermore, significant decrease in the gait velocity and cadence in the mild LLD condition were observed (p<.05). In the comparison between both limbs in the mild LLD condition, the step time and swing phase of the short limb significantly increased compared with the long limb, while step length, stance phase, and single support phase of the long limb significantly increased compared with the short limb (p<.05). Additionally, trunk acceleration of all directions (anterior-posterior, medial-lateral, vertical) significantly increased in the mild LLD condition (p<.05). Conclusion: The results of the present study demonstrate that mild LLD causes altered and asymmetrical gait patterns and affects the trunk, resulting in inefficient gait. Therefore, mild LLD should not be overlooked and requires adequate treatment.

• Physical Therapy Korea
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• v.19 no.2
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• pp.1-11
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• 2012

The pelvic compression belt (PCB) contributes to improving sacroiliac joint stability, and it has been used as an additional therapeutic option for patients with sacroiliac joint pain (SIJP). This study aimed to investigate whether the muscle activation patterns of the supporting leg was different between asymptomatic subjects and subjects with SIJP during one-leg standing, and how it changes with the PCB. 15 subjects with SIJP and 10 asymptomatic subjects volunteered to participate in this study. Surface electromyography (EMG) data (reaction time [RT] and muscle activation) were collected from the internal oblique, lumbar multifidius, gluteus maximus and biceps femoris muscles during one-leg standing with and without the PCB. Without the PCB condition, in the SIJP group, the biceps femoris muscle showed the fastest RT among all muscles (p<.05), whereas in the asymptomatic group, the RT of the internal oblique muscle was the most rapid (p<.05). In condition without the PCB, the biceps femoris EMG amplitudes in the SIJP group were significantly greater than that in the asymptomatic group (p<.05). After the application of the PCB, the RT of the biceps femoris muscle was significantly increased only in the SIJP group (p<.05). Moreover, the biceps femoris EMG amplitudes significantly decreased and the gluteus maximus EMG amplitudes significant increased only in the SIJP group by applying the PCB (p<.05). However, this had no such effect on the gluteus maximus and biceps femoris EMG patterns in the asymptomatic group (p>.05). Thus, this study supports the applying the PCB to patients with SIJP can be used as a helpful option to modify the activation patterns of the gluteus maximus and biceps femoris muscle.

• Physical Therapy Korea
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• v.19 no.2
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• pp.29-38
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• 2012

This study aimed to identify the asymmetry observed in the electromyography (EMG) activity patterns of selected trunk and thigh muscles between the affected and unaffected sides during the sit-to-stand movement in ambulatory patients with post-stroke hemiparesis. This study included 20 patients with post-stroke hemiparesis. The differences between stroke fast walkers (${\geq}8m/s$, 11 subjects) and stroke slow walkers (<8 m/s, 9 subjects) were compared. The activation magnitude and onset time of the multifidus, lumbar erector spinae, hamstrings, and quadriceps during the sit-to-stand movement were recorded through surface EMG. Moreover, the EMG activation magnitude and onset time ratios of each bilateral corresponding muscle from the trunk and leg were measured by dividing the relevant values of the unaffected side by those of the affected side. In all the subjects, the activation magnitudes of the multifidus, hamstring, and quadriceps on the affected side significantly decreased compared to those on the unaffected side (p<.05). The onset time of muscle activity in the affected side was markedly delayed for the multifidus and quadriceps during the task (p<.05). The activation magnitude ratios of the quadriceps were markedly decreased in the stroke slow walkers as compared to those in the stroke fast walkers. These findings indicate that the asymmetry in the multifidus, hamstring, and quadriceps muscle activation patterns in patients with post-stroke hemiparesis may be due to the excessive muscle activation in the unaffected side to compensate for the weakened muscle activity in the affected side. Our findings may provide researchers and clinicians with information that can be useful in rehabilitation therapy.

• Physical Therapy Korea
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• v.19 no.2
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• pp.20-28
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• 2012

The lumbar multifidus muscle, which can be separated into deep fascicles (DM) and superficial fascicles (SM), is important for lumbar segmental stability. However, no previous studies have investigated the effect of lumbar stabilization exercises on the thickness of DM and SM. Thus, the purpose of this study was to assess DM thickness after three different lumbar segmental stabilization exercises. In total, 30 healthy male participants were recruited and randomly assigned to one of three exercise groups: hollowing in the quadruped position (H-Quad), contralateral arm and leg lift (CALL), and bilateral arm and leg lift (BALL). Each lumbar segmental stabilization exercise was conducted over 4 weeks. Ultrasonography was used to compare the DM and SM thickness before and after the 4 weeks of exercise. A mixed-model analysis of variance using Scheffe's post-hoc test was used for statistical analysis. The results showed a significant effect for the measurement time (before vs. after 4 weeks of exercise) in the DM (F=31.26, p<.05) and SM (F=4.56, p<.05). At the end of the 4 weeks, the DM thickness had increased significantly in the H-Quad exercise group, and the SM thickness had increased significantly in the CALL and BALL exercise groups. Also in the BALL exercise group, the SM thickness was greater compared with that in the H-Quad exercise group. These findings suggest that the thickness of the DM and SM were increased by different types of lumbar segmental stability exercise after 4 weeks.

• Physical Therapy Korea
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• v.24 no.1
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• pp.51-60
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• 2017

Background: In cerebral palsy (CP), parents' quality of life and rearing attitude are considered possible factors that influence patients' quality of life, function level, and performance in daily activities. Despite these facts, little attention has been given to demonstrate a relation between these factors. Objects: This study aimed to demonstrate the relationship between parents' quality of life, functional level, and performance in daily activities, the quality of life of school-aged children with spastic CP. Methods: This study included 24 parents of school-aged children with spastic CP. The KIDSCREEN-52 and World Health Organization quality of life (WHOQOL)-BREF questionnaires (including physical, psychological, social, and environmental domains) were used as research tools to assess the quality-of-life profiles of the children with spastic CP and those of their parents, respectively. In addition, the function levels and performance in daily activities of the children with CP were assessed by using the gross motor function measure (GMFM) and modified Barthel index (MBI). Correlation and multiple regression analyses were performed to clarify the determinants of the quality of life of the children with CP. Results: The KIDSCREEN-52 score correlated with the total score (r=.735, p<.01) and all domains of the WHOQOL-BREF questionnaire (physical: r=.542, p<.01; psychological: r=.690, p<.01; social: r=.568, p<.01; and environmental: r=.783, p<.01). In addition, significant correlation was found between the KIDSCREEN-52 and MBI scores (r=.411, p<.05), and between the MBI and GMFM scores (r=.427, p<.05). After controlling for age, gender, paralytic type, GMFM, and MBI, the WHOQOL-BREF score ($R^2=.621$), particularly in the environmental domain ($R^2=.699$), remained independently related to the quality of life of the children. Conclusion: These findings suggest that the quality of life of school-aged children with spastic CP can be influenced by the quality of life of their parents. This study provides useful information for future studies to investigate the quality of life of children with CP.

• Physical Therapy Korea
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• v.27 no.3
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• pp.178-184
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• 2020

Background: Stroke patients have reduced trunk control compared to normal people. The ability to control the trunk of a stroke patient is important for gait and balance. However, there is still a lack of research methods for the characteristics of stroke control in stroke patients. Objects: The aim of this research was to determine whether trunk position sense has any relation with balance and gait. Methods: This study assessed trunk performance by measuring position sense. Trunk position sense was assessed using the David back concept to determine trunk repositioning error in 20 stroke patients and 20 healthy subjects. Four trunk movements (flexion, extension, lateral flexion, rotation) were tested for repositioning error and the measurement was carried out 6 times per move; these parameters were used to compare the mean values obtained. Subjects with stroke were also evaluated with clinical measures of balance and gait. Results: There were significant differences in trunk repositioning error between the stroke group and the control group in flexion, lateral flexion to the affected side, lateral flexion to the unaffected side, rotation to the affected side, and rotation to the unaffected side. Mean flexion error: post-stroke: 7.95 ± 6.76 degrees, control: 3.32 ± 2.27; mean lateral flexion error to the affected side: 6.13 ± 3.79, to the unaffected side: 5.32 ± 3.15, control: 3.57 ± 1.92; mean rotation error to the affected side: 8.25 ± 3.09, to the unaffected side: 9.24 ± 3.94, control: 5.41 ± 1.82. There was an only significant negative correlation between the repositioning error of lateral flexion and the Berg balance scale score to the affected side (-0.483) and to the unaffected side (-0.497). A strong correlation between balance and gait was found. Conclusion: The results of this study indicate that stroke patients exhibit greater trunk repositioning error than age-matched controls on all planes of movement except for extension. And lateral flexion has correlation with balance and gait.

• Physical Therapy Korea
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• v.23 no.3
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• pp.21-28
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• 2016

Background: The toe-spread-out (TSO) exercise has been introduced as a strengthening exercise for the abductor hallucis muscle in subjects with hallux valgus. Visual biofeedback using ultrasound imaging during exercise, may increase the ability to selectively contract the abductor hallucis muscle, compared with exercise alone. Objects: The aim of this study was to investigate the effects of ultrasound imaging visual feedback during the TSO exercise with respect to its influence on the angle of the first metatarsophalangeal joint (1st MPJ) and the cross-sectional area (CSA) of the abductor hallucis muscle in subjects with hallux valgus. Methods: Twenty-five healthy young subjects with a mean average age of 22.5 years, and a standard deviation of 2.3 years, were recruited for this study. Hallux valgus was defined as an angles greater than $15^{\circ}$ angle of 1st MPJ. Goniometric measurement was used to determine the angle of 1st MPJ. In addition, an ultrasound system was used to collect the CSA of the abductor hallucis muscle in each foot. The angle of the 1st MPJ and CSA of the abductor hallucis were measured in three positions; the resting position, during TSO exercise, and during TSO exercise in conjunction with real-time ultrasound imaging feedback. All data analyzed using a repeated analysis of variance with Bonferroni correction in order to compare the dependent variables in all three positions. Statistical level of significance was set up as p<.05. Results: The angle of the 1st MPJ was noted to be significantly reduced and the CSA of the abductor hallucis to be significantly greater during TSO exercise used in conjunction with ultrasound imaging visual feedback, compared to when the values were recorded during TSO exercise alone (p<.05). Conclusion: Based on these findings, it can be concluded that the application of ultrasound imaging visual feedback during TSO exercise is more effective in contracting selectively the abductor hallucis than the use of exercise alone.

• Physical Therapy Korea
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• v.23 no.3
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• pp.11-20
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• 2016

Background: A forward head posture (FHP) is one of the most common types of poor head posture in patients with neck disorder. A prolonged FHP might increase pressure on the posterior cranio-cervical structure and exhibit reduced performance on a cranio-cervical flexion test (CCFT). CCFT is included to activate deep cervical flexor muscles and inhibit excessive activation of superficial cervical flexor muscles. Therefore, the selective activation of deep cervical flexors is needed for effective exercise for FHP. Objects: The purpose of this study was to compare muscle thickness between longus colli (Lco) and sternocleidomastoid (SCM) using ultrasonography in subjects with FHP depending on head support. Methods: This was a cross-sectional, case-control research design study. The ultrasonographic images of Lco and SCM were taken in 17 subjects with FHP during the 5 phases of the CCFT with and without a head support. Towel was used for supporting head to make the neutral head position in supine. Changes in muscle thickness during the test were calculated to infer muscle activation. Data were analyzed using repeated measures of two-way analysis of variance with the significance level of .05. Results: When subjects performed the CCFT with head support, there was a significant difference in muscle thickness of Lco and SCM (p<.05). According to a post hoc paired t-test, change of thickness of Lco was greater at all phases, and change of thickness of SCM muscle was less at phase 4 and 5 in condition with head support (p<.01) compared to condition without head support (p<.01). Conclusion: The result of this study suggest that applying head support for neutral head position during CCFT could be a useful method for activating Lco muscle without excessive activation of SCM muscle.

• Physical Therapy Korea
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• v.21 no.4
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• pp.15-22
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• 2014

The purpose of this study was to determine the muscle activities of the erector spinae (ES), gluteus maximus (Gmax), gluteus medius (Gmed), and the hamstring (HAM) and the ratios of Gmax/ES, Gmax/HAM, and Gmed/HAM during the prone heel squeeze (PHS) with different knee flexion angles ($45^{\circ}$, $90^{\circ}$, and $135^{\circ}$). Fifteen young and healthy subjects (8 men, 7 women) were recruited for the study. Surface electromyography signals were collected on ES, Gmax, Gmed, and HAM during PHS. A separate one-way analysis of variance with repeated measures was used to determine the significance of the muscle activities of ES, Gmax, Gmed, and HAM and the ratios of Gmax/ES, Gmax/HAM, and Gmed/HAM with different knee flexion angles during PHS. There was a significant increase in the Gmax activity at the knee flexion of $90^{\circ}$ in comparison with that of the $45^{\circ}$ (p=.016). There were significant increases in the Gmed activity at the knee flexion of $90^{\circ}$ (p=.008) and $135^{\circ}$ (p=.006) in comparison with that of the $45^{\circ}$. There were significant decreases in the HAM activity at the knee flexion of $90^{\circ}$ (p=.009) and $135^{\circ}$ (p=.004) in comparison with that of the $45^{\circ}$. There were significant increases in the Gmax/HAM muscle activity ratio at the knee flexion of $90^{\circ}$ (p=.007) and $135^{\circ}$ (p=.012) in comparison with that of the $45^{\circ}$. There were significant increase in the Gmed/HAM muscle activity ratio at the knee flexion of $135^{\circ}$ in comparison with that of the $45^{\circ}$ (p=.008). The knee flexion of $90^{\circ}$ during PHS can induce decreasing activity of HAM and increasing activity of Gmax, and the knee flexion of $135^{\circ}$ during PHS can induce decreasing activity of HAM and increasing activity of Gmed. Hence, PHS with different knee flexion positions could be considered for the different target muscle.