• Physical Therapy Rehabilitation Science
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• v.7 no.3
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• pp.95-101
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• 2018

Objective: To determine if the provision of visual biofeedback using real-time rehabilitative ultrasound imaging (RUSI) enhances the acquisition and retention of diaphragm muscle recruitment during exercise. Design: Two group pretest posttest design. Methods: Thirty healthy subjects were randomly assigned to the verbal feedback group (VG, n=15) or the visual and verbal feedback group (VVG, n=15). The VG performed breathing exercises 10 times with verbal feedback, and the VVG also performed breathing exercises 10 times with verbal feedback and visual feedback with the use of RUSI to measure changes in diaphragm thickness (DT). For DT, the mid-axillary lines between ribs 8 and 9 on both sides were measured in standing, and then the chest wall was perpendicularly illuminated using a linear transducer with the patients in supine to observe the region between rib 8 and 9 and to obtain 2-dimensional images. DT was measured as the distance between the two parallel lines that appeared bright in the middle of the pleura and the peritoneum. After one week, three repetitions (follow-up session) were performed to confirm retention effects. Intra- and between- group percent changes in diaphragm muscle thickness were assessed. Results: In the VVG, the intervention value had a medium effect size compared to the baseline value, but the follow-up value decreased to a small effect size. In the between-group comparisons, during the intervention session, the VVG showed no significant effect on percent change of DT but had a medium effect size compared to the VG (p=0.050, Cohen's d=0.764). During the follow-up session, retention effect did not persist (p=0.311, Cohen's d=0.381). Conclusions: RUSI can be used to provide visual biofeedback and improve performance and retention in the ability to activate the diaphragm muscle in healthy subjects. Future research needs to establish a protocol for respiratory intervention to maintain the effect of diaphragmatic breathing training using RUSI with visual feedback.

• Physical Therapy Rehabilitation Science
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• v.8 no.4
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• pp.218-224
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• 2019

Objective: This reliability study examined the effects of applying varying induced inward pressures using a transducer placed at 0° neutral ankle position (NEU) and 15° ankle dorsiflexion (DF) on tibialis anterior (TA) muscle thickness using a custom-made device with a force indicator during rehabilitative ultrasound imaging. Design: Cross-sectional study. Methods: Twenty-four healthy subjects were recruited in this study. Two examiners measured the muscle thickness of the TA at 0° NEU and 15° DF in 3 conditions of inward pressures (1.0 N, 2.0 N, and 4.0 N) using a custom-made holder. The muscle thickness was measured three times for each of the conditions arranged in random order. For intra- and inter-rater reliability, the intraclass correlation coefficients (ICCs) with 95% confidence intervals, standard error of measurement, minimal detectable change, and coefficient of variation were analyzed. One-way repeated measures analysis of variance was conducted for investigating changes of TA muscle thickness according to the inward pressures of the transducers. Results: The intra-rater reliability of TA muscle thickness measurement was excellent (ICC_3,1: 0.92-0.96) for all conditions (at both ankle joint angles per varying inward pressure). Likewise, the inter-rater reliability of TA muscle thickness measurement was excellent (ICC_2,1: 0.89-0.97) under same conditions. The mean of TA thickness showed the trend of decreasing significantly with increased inward pressures at all ankle joint angles (p<0.05). Conclusions: Use of this custom-made device with a force indicator is useful to accomplish the high intra- and inter-rater reliability of TA muscle thickness measurement at both ankle joint angles in reducing the measurement error.

• Physical Therapy Rehabilitation Science
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• v.5 no.4
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• pp.210-214
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• 2016

Objective: The aim of this study was to measure the muscle architectural parameters of abdominal muscles in healthy individuals by rehabilitative ultrasound imaging (RUSI) and to investigate their changes after bridging exercise in various environments. Design: Cross-sectional study. Methods: The study included 40 healthy participants (19 men, 21 women). Subjects were randomly allocated to a stable surface group (SG, n=20) or an unstable surface group (UG, n=20). The participants assumed three positions in rest, bridging exercise with knee flexion $60^{\circ}$, and bridging exercise with knee flexion $90^{\circ}$ for the measurement of abdominal muscle thickness by RUSI. For the resting position, the participants held the head neutral in a hook-lying position and the dominant side was measured. For contraction, the participants performed the bridging exercise with the knee joint in $60^{\circ}$ and $90^{\circ}$ of flexion for 10 seconds each. Results: For transversus abdominis, external oblique muscle thickness, within the stable surface group and the unstable surface group, no significant contraction difference was observed in both the $60^{\circ}$ and $90^{\circ}$ bridge exercise conditions. Contraction difference of internal oblique muscle was significantly larger at $90^{\circ}$ than at $60^{\circ}$ within the SG (p<0.05). But within the UG, no significant contraction difference was shown. There was no significant contraction difference between the surface group and the unstable SG at $60^{\circ}$ condition and at $90^{\circ}$ condition in all measured muscles. Conclusions: The contraction difference is different for each muscle during bridge exercise with knee flexion $60^{\circ}$ and bridging exercise with knee flexion $90^{\circ}$. Muscle contraction difference is generally large when exercised on an unstable surface than a stable surface, but these are not statistically significant when bridging exercise is performed using dynamic air cushion for unstable surface.

• Journal of the Korean Society of Physical Medicine
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• v.10 no.4
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• pp.81-90
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• 2015

PURPOSE: The purpose of this study was to compare the muscle architecture of serratus anterior and lower trapezius using rehabilitative ultrasound imaging (RUSI) in affected and unaffected side of chronic stroke patients. METHODS: The participants were thirty five patients with stroke hemiplegia in this study. RUSI was used to measure the muscle thickness of the serratus anterior and lower trapezius muscles. We compared the muscle thickness according to affected side and sex, determined the reliability of the measurement image. Independent t-test, intra-class correlation coefficient (ICC) and standard error of measurement (SEM) were used for statistical analysis. RESULTS: Significant difference in muscle thickness of serratus anterior was observed between affected and unaffected side (p<.001). Muscle thickness according to gender showed a significant difference in unaffected side of serratus anterior (p<.05). Compare asymmetry ratio of serratus anterior and lower trapezius muscle thickness showed a significant difference (p<.001). ICC for intra-reliability was .944~.962 in serratus anterior and .873~.925 in lower trapezius muscle thickness, respectively. SEM was .001~.004 in serratus anterior and .002~.008 in lower trapezius muscle. CONCLUSION: This study, using RUSI, showed significant difference in muscle thickness of serratus anterior in affected and unaffected side of stroke patients. RUSI is a practical tool for measuring soft-tissue thickness in the scapular region muscle of stroke.

• The Journal of Korean Physical Therapy
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• v.28 no.6
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• pp.349-354
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• 2016

Purpose: The purpose of the study was to investigate the thickness of deep neck flexors (DNF) and sternocleidomastoid muscle (SCM) bilaterally during deep neck flexor endurance test using ultrasonography images. Methods: Healthy volunteers (n=22), 20-25 (mean 22.2) years old, were recruited for the study. Participants were asked to perform the craniocervical flexion test (CCFT) in a seated position to measure deep neck flexor endurance. The thickness of DNF and SCM was assessed bilaterally and was measured using ultrasonography images at resting, contracted, pre-terminal and terminal phases of the neck muscle endurance test. Muscle contraction pattern was also observed along with the changes in muscle thickness from the resting phase to the terminal phase. Repeated-measure ANOVA was employed to compare muscle thickness bilaterally at each phase. Results: The thickness of right and left muscles was found to be significantly different in DNF both at resting and contracted phases (p=0.02, p<0.01, respectively), whereas no significant difference was observed in SCM at resting or contracted phases (p=0.59, p=0.18, respectively). Thickness changes from resting to contracted phase were not significantly different both in DNF and SCM (p=0.18, p=0.22, respectively). Muscle contraction patterns in right and left muscles were shown to be similar. Conclusion: The current study, performed on (with) healthy subjects, significantly detected different right and left muscle thickness in DNF, but the muscle contraction patterns were similar in DNF and SCM bilaterally. Further study is required to investigate DNF and SCM muscle size and function in people with neck pain.

• Physical Therapy Rehabilitation Science
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• v.9 no.4
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• pp.287-294
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• 2020

Objective: This study aimed to investigate the effects of an ultrasound-based bar graph proportional to the quadriceps muscle thickness as a real-time visual feedback training tool in the elderly. Design: Cross-sectional study. Methods: Twenty-four elderly persons participated in this study and were randomly divided into three groups: oral training group (n=8, group 1), ultrasound imaging group (n=8, group 2), and graph group (n=8, group 3). In the pre condition, all participants performed maximal voluntary isometric contraction (MVIC) of the quadriceps with knee extension three times with oral training. In the post condition, group 1 performed MVIC of the quadriceps with oral training, group 2 performed MVIC of the quadriceps with real-time visual feedback using ultrasound imaging, and group 3 performed MVIC of the quadriceps with real-time visual feedback using a bar graph proportional to the quadriceps muscle thickness, three times for all groups. Muscle thickness, activity (mean, peak), tone, stiffness, logarithmic decrement, relaxation, and creep were measured in both conditions in all participants. Results: Visual feedback with a bar graph showed significant effects on muscle thickness, mean muscle activity, and peak muscle activity compared with oral training and visual feedback with ultrasound imaging (p<0.05). Conclusions: Isometric training of the quadriceps with real-time visual feedback using a bar graph proportional to the quadriceps muscle thickness may be more effective than other methods in improving muscle thickness and muscle activity. This study presented a tool that can help increase muscle thickness in the elderly.

• Journal of Haehwa Medicine
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• v.22 no.1
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• pp.217-224
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• 2013

Objectives : The object of this study is to report the effectiveness of Korean medicine treatment and to urge in-depth research on plantar fasciitis. Methods : Four patients, diagnosed as plantar fasciitis, were treated by Korean medicine interventions; acupuncture at K13, BL60, BL40, indirect moxibustion at local region, oral intake herbal medicine and Korean physical therapy on plantar fascia. Visual analog scale(VAS) was adpoted as a method of measuring the effect of treatment on plantar pain. Results : As a result, the plantar pain decreased and VAS score was declined at three cases. However, at one case, the symptom was not changed and VAS score was same. Conclusions : Korean rehabilitative complex therapy can be effectively used for plantar fasciitis. Further studies are needed to set up a rehabilitation protocol with Korean medicine interventions on this disease.

• Physical Therapy Rehabilitation Science
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• v.3 no.2
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• pp.101-106
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• 2014

Objective: To investigate the appropriate position for abdominal drawing-in maneuver (ADIM) exercise by rehabilitative ultrasound image. Design: Cross-sectional study. Methods: Twenty-eight young adults with no history of low back pain participated in the study. Three positions compared were crook lying position with hip $60^{\circ}$ flexion, standing position with the feet hip width apart and knees straight, and saddle standing positionunsupported with the knees $20^{\circ}$ flexed. Once in the appropriate position, the subjects were verbally cued to draw in their abdominal wall, with the intention of pulling their navel inward toward their lower back. The thickness of each transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles were measured via ultrasound and recorded at the end of inspiration. Results: When compared to the TrA thickness of rest, the TrA thickness was significantly increased in all three positions (crook lying, standing, and saddle standing) during the ADIM (p<0.05). IO thickness was significantly greater in standing and saddle standing than in crook lying (p<0.05). EO thickness was constant in all the three positions. Conclusions: The present study suggests that standing and saddle standing positions could be recommended for the ADIM to maximize recruitment of the TrA and IO activation. Specifically, the saddle standing position with knees flexed to $20^{\circ}$ was observed to increase the TrA activation more than the standing position. These findings should be considered when core stability exercises such as the ADIM are conducted.

• Journal of the Korean Society of Physical Medicine
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• v.7 no.3
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• pp.319-327
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• 2012

Purpose : This study aimed to identify the asymmetry observed in the rehabilitative ultrasound imaging of lateral abdominal muscle thickness and performance between the affected and unaffected side during the abdominal drawing-in maneuver (ADIM), an exercise used to facilitate activation of selectively TrA to stabilize the trunk prior to limb movement. Methods : The Participants were twenty one patients with post-stroke hemiplegia in this study. Ultrasound imaging was used to measure amount of changes in thickness of the external oblique (EO), internal oblique (IO), transversus abdominis (TrA). A Paired t-test was used to compare relaxed muscle thickness to contracted muscle thickness of all 3 muscles between the affected and unaffected sides. Results : The outcome measures included side to side differences of absolute thickness, contraction ratio among the lateral abdominal muscles. There was no significantly difference in between the affected and unaffected side at rest. But, there was a significantly difference in absolute muscle thickness between the affected and unaffected side of only TrA muscle. Also contraction ratio was a significantly difference between the affected and unaffected TrA muscle. Conclusion : These findings support the asymmetrical activation of TrA muscle during abdominal muscle contraction in patients with post-stroke hemiplegia. Further studies are warranted for confirming this outcome.

• Journal of International Academy of Physical Therapy Research
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• v.3 no.2
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• pp.458-463
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• 2012

This study is to examine the effects of a feedback breathing device exercise and diaphragm breathing exercise on pulmonary functions of chronic strokes patients. The selection of 20 subjects was divided equally and placed into a experiment group and a control group and the intervention was applied four times per a week for five weeks. In each session, both groups received rehabilitative exercise treatment for 30 minutes, and a feedback breathing device exercise for 15 minutes. In addition, experimental group conducted a combination of diaphragm breathing exercise for 15 minutes. Prior to and after the experiment, patients' pulmonary functions were measured using a spirometer. The pulmonary function tests included FVC, FEV1, FEV1/FVC, PEF, VC, TV, IC, ERV, IRV. With respect to changes in the pulmonary functions of both groups, the experimental group significantly differed in FVC, FEV1, TV, ERV but did not in PEF, FEV1/FVC, VC, IRV. The control group did not significantly differ in any of the tests. There were significant differences in FEV1, FEV1/FVC, TV, ERV between the two groups, but no significant differences in FVC, PEF, FEV1/FVC, VC, IRV between them after the experiment. The experimental group, which conducted a combination of a feedback breathing device exercise and diaphragm breathing exercise, saw their respiratory ability increase more significantly than the control group. The breathing exercise was found to improve pulmonary function in chronic stroke patients.