• Physical Therapy Korea
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• v.20 no.4
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• pp.16-21
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• 2013

The purpose of this study was to determine the effect of contralateral hip adduction (CHA) on the muscle activity of lumbar stabilizers and the angle of pelvic lateral tilting during hip abduction in side lying. Twenty healthy male subjects with no medical history of lower extremity or lumbar spine disorders were recruited for the study. Subjects randomly performed preferred hip abduction (PHA) and hip abduction with contralateral hip adduction in side lying. The muscle activities of the dominant side rectus abdominis, external oblique, internal oblique, quadratus lumborum, gluteus medius, and non-dominant side hip adductor longus were measured during PHA and CHA by using a surface electromyography (EMG) system. Pelvic lateral tilting motion was measured by using a three-dimensional motion analysis system. Data on EMG and pelvic motion were collected at the same time during PHA and CHA. A paired t-test was used to compare EMG activity and the angle of pelvic lateral tilting in the two exercises. The study found that the EMG activities of all muscles were more increased significantly in CHA than PHA condition. The angle of pelvic lateral tilting was more decreased significantly in CHA than PHA condition. These findings suggest that CHA could be recommended as a hip abduction exercise for activating lumbar stabilizers and decreasing compensatory pelvic lateral tilting motion.

• Journal of Korean Neurosurgical Society
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• v.39 no.4
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• pp.256-259
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• 2006

Objective : Having a reliable and reproducible measurement technique to measure the sagittal contour in vertebral fractures is paramount to clinical decision making. This study is designed to determine the most reliable measurement technique in osteoporotic vertebral compression fracture. Methods : Fifteen lateral radiographs of thoracic and lumbar fractures were selected and measured on two separate occasions by three spine surgeons using six different measurement techniques [Centroid, Harrison Posterior Tangent Methods and 4 different types of modified Cobb method]. The radiograph quality was assessed and the center beam location was determined. Statistical analysis including ANOVA for repeated measures was carried out using the SAS software [v 8.0]. Results : The inter and intraobserver variance of the Cobb method 4 and Harrison posterior tangent method were significantly lower than the other four methods. The intraobserver correlation coefficients were the most consistent using the Cobb method 4 [0.982]. which was followed by the Harrison posterior tangent [0.953] and Cobb methods 1 [0.874]. The intraobserver agreement [% of repeated measures within 5 degrees of the original measurement] ranged from 42% to 98% for each technique for all three observers, with the Cobb method 4 showing the best agreement [97.8%] followed by the Harrison posterior tangent method [937%]. Conclusion : The Cobb method-4 and Harrison posterior tangent methods, when applied to measuring the kyphosis, are reliable and have a similar small error range. The Cobb method 4 shows the best overall reliability. However, the centroid method and Cobb method using a fractured endplate do not produce an accurate result due to inter and intraobserver differences in determining the baseline.

• Journal of Korean Neurosurgical Society
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• v.62 no.5
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• pp.603-609
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• 2019

Objective : The purpose of this retrospective study was to determine which of the proximal adjacent segment disease (ASD) and distal ASD was more prevalent and what parameters is more related to ASD in proximal levels and distal levels after more than 2 levels fusions. Methods : The medical records were reviewed retrospectively for 856 cases. A total of 66 cases of ASD were enrolled. On preop magnetic resonance imaging, disc degeneration was measured at the upper and lower parts of surgically treated levels and confirmed by the commonly used Pfirrmann grade. Segmental flexibility in sagittal plane was embodied in segment range of motion (ROM) obtained through flexion and extension X-ray before surgery. Coronal angle was recorded as methods Cobb's angle including fusion levels preoperatively. For the comparison of categorical variables between two independent groups, the chi-square test and Fisher exact test were performed. Results : Proximal ASD and distal ASD were 37/856 (4.32%) and 29/856 (3.39%), respectively. The incidence of proximal ASD was relatively high but insignificant differences. In comparison between ASD group and non ASD group, proximal Pfirmman was higher in proximal ASD and distal Pfirmman was higher in distal ASD group (p=0.005, p<0.008, respectively). However, in the ROM, proximal ROM was higher in proximal ASD, but distal ROM was not different between the two groups (p<0.0001, p=0.995, respectively). Coronal angle was not quite different in both groups (p=0.846). Conclusion : In spite of higher frequency in ASD in proximal level in spinal fusion, it is not clear that incidence of ASD in proximal level is not higher than that of distal ASD group in more than 2 level thoracolumbar fusions. Not only Pfirrmann grade but also proximal segmental ROM is risk factor for predicting the occurrence of ASD in patients more than 2 level of thoracolumbar spine fusion operation excluding L5S1.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.3
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• pp.193-201
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• 2021

Purpose : The purpose of this study was to compare the effect of pelvic exercise on the CVA and spinal curve in adults with forward head posture compared to the group using only neck exercise when pelvic exercise was performed in parallel with conventional neck exercise. Methods : GPS 400 and Formetric were used to identify craniovertebral angle (CVA), thoracic kyphosis, lumbar lordosis, and pelvic torsion and were measured by an experienced research manager. Forward head posture (FHP) was selected for people whose angle between the line connecting the ear ball and the seventh cervical spine and the horizontal line is 50 degrees or less. The 30 selected students were randomly divided into 15 experimental groups and 15 control groups. Mackenzie exercise and sling exercise were performed for neck exercise in both the experimental group and the control group, and pelvic exercise using a Swiss ball was additionally performed in the experimental group. All data collected in this study were analyzed using SPSS statistics 21.0. Cervical vetebral angle (CVA), thoracic kyphosis, lumbar lordosis, and pelvic torsion were compared at 0 weeks, 3 weeks, and 6 weeks for each measurement factor using ANOVA with repeated measures. For the statistical significance test, the significance level of α was set to .05. Results : The changes of pelvic torsion, thoracic kyphosis and CVA due to pelvic exercise using Swiss Ball and neck exercise were changed over time, but lumbar lordosis were not changed. And there were no significant differences among the groups. Conclusion : In conclusion, the pelvic correction exercise is considered to be an effective exercise for correcting the FHP and requires regular pelvic correction exercises. We expect the results to be used in clinical trials.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.3
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• pp.13-25
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• 2022

Purpose : The purpose of this study was to investigate the effects of combined cervical stabilization exercise (CSE) and stretching exercise (SE) on office workers with forward head posture (FHP). Methods : A total of 32 office workers with forward head posture were randomly assigned to experimental (n=16) and control (n=16) groups. The experimental group underwent combined CSE and SE, and the control group underwent cervical self-myofascial release and SE. Both groups performed exercises for 40 min per day, thrice per week for a total of 6 weeks. Craniovertebral angle (CVA), respiration, disability, and joint range of motion (ROM) before and 6 weeks after intervention were measured and compared. Results : There was no significant between-group difference in the general characteristics (p>.05). The intra-group comparison showed significant differences in the visual analog scale (VAS) and neck disability index (NDI) of both groups post-intervention (p<.05). CVA and forced expiratory volume in 1 seconds (FEV₁) were significantly improved post-intervention in the experimental group only (p<.05). In the experimental group, all ROM variables were significantly improved post-intervention. In contrast, in the control group, all ROM variables improved significantly post-intervention, except for extension (p<.05). The inter-group comparison showed significant differences in NDI, left lateral flexion, right lateral flexion, and left rotation between the two groups (p<.05). Conclusion : The combination of CSE and SE, which stabilizes the cervical spine, had positive effects on cranial rotation angle, respiration, disability, and joint ROM in office workers with forward head posture. Therefore, the combination of the two exercises may be an effective option to reduce symptoms and prevent postural problems in office workers with FHP.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.28 no.1
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• pp.39-51
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• 2022

Background: The purpose of this study is to investigate the effect of neck and shoulder self-stretching exercise using audiovisual media on neck pain, postural alignment, and joint position error in women with chronic neck pain. Methods: The subjects included 20 women that gave consent to participate in the study voluntarily. They performed the self-stretching exercises using audiovisual media was carried out 20 minutes 5 times a week during 3 weeks. Neck disability index (NDI) and visual analogue scale (VAS) were used to measure the functional disability and pain, A pressure pain threshold was measured using an algometer, and a cervical range of motion (CROM) measurement tool was used to measure the range of motion and error of proprioceptive position sense of the cervical spine. To assess posture alignment, forward head angle (FHA), forward shoulder angle (FSA) were measured using image J software. Results: The neck pain intensity was statistically significantly within group (p<.05). Neck and shoulder functional disability were a statistically significant difference within group (p<.05). Splenius capitis and upper trapezius pressure pain threshold were statistically significant difference in within group (p<.05). The postural alignment was statistically significantly within group (p<.05). The cervical range of motion in neck extension, right and left lateral flexion were statistically significantly within group (p<.05). The joint position error in neck flexion, extension, right and left lateral flexion decreased statistically significantly within group (p<.05). Conclusion: Self-stretching exercise using audiovisual media increased the mobility of the neck, decreased neck pain and joint position error, and improved posture alignment. As a result, there was a positive effect by applying the self-stretching exercise using audiovisual media to people with neck pain. Based on this, it is thought that it can be used as the basis for research related to home training programs for healthy self-management.

• Journal of Korean Foot and Ankle Society
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• v.28 no.2
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• pp.48-54
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• 2024

Purpose: Foot alignment affects the overall balance and alignment of the body. This study examined the relationship between the foot parameters and scoliosis in children and adolescents through simple radiographs. Materials and Methods: Two hundred and forty-one outpatients under 15 years old from 2013 to 2022 were evaluated. Patients with an abnormal leg length discrepancy or pelvic tilt were screened. The patients included were divided into four groups. Each group was tested to determine if they had scoliosis. The foot anterior-posterior/lateral X-rays were selected for the foot parameters, and the EOS system was used for the spline and pelvis parameters. Results: A t-test of all groups showed no statistically significant difference as the p-value exceeded 0.05. An analysis of variance (ANOVA) comparing the Cobb's angle and foot parameters did not show a significant correlation. On the other hand, female and older patients had a higher Cobb's angle. Conclusion: No direct relationship was noted between scoliosis and the foot parameters that could be measured radiographically among children and adolescents. In addition, no correction between the Cobb's angle and foot parameters was found.

• The Journal of Korean Physical Therapy
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• v.35 no.6
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• pp.177-184
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• 2023

Purpose: The purpose of this study was to compare the concurrent validity and test-retest reliability of 'KPIMT Torticollis Protractor', a smart phone and I-pad application for convenient range of motion measurement, and 'Image J', an analysis software with high reliability and validity, according to head tilt and active cervical rotation angle. This was done to determine the clinical utility of 'KPIMT Torticollis Protractor'. Methods: Head tilt and active cervical spine rotation angles of 40 children with congenital muscular torticollis were measured using Image J and KPIMT Torticollis Protractor, respectively. The level of concurrent validity and inter-rater and intra-rater reliability between the two measurement methods were analyzed. Results: For forty participants, the concurrent validity between Image J and KPIMT Torticollis Protractor showed very high validity with ICC of ICC 0.977 (0.995-0.999), 0.994 (0.994-0.998), CV_ME% 0.71-0.72%, SEM% 0.31-0.34%, MDC% 0.86-0.94%. The test-retest intra-rater reliability showed very high reliability ICC 0.911 (0.911-0.966), CV_ME% 0.71%, SEM% 0.34-0.36%, MDC% 0.81-0.94%. The test-retest inter-rater showed very high reliability ICC 0.936 (0.933-0.957), CV_ME% 0.70%, SEM% 0.34-0.35%, MDC% 0.81-0.83%. Conclusion: The KPIMT Torticollis Protractor, a smart phone and IPD application, is a highly reliable and valid device for angle measurement in children with congenital myotonia and can be easily used in clinical practice.

• Journal of The Korean Society of Integrative Medicine
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• v.12 no.3
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• pp.71-81
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• 2024

Purpose : In this study, we compared the effects of ankle, McKenzie, and cervical stabilization exercises in individuals with a forward head posture. Outcome measures investigated included the neck disability index, craniovertebral angle (CVA), cranial rotation angle (CRA), and thickness of the longus colli muscle (LC) and carotid artery (CA) post-intervention. Methods : The study included 20 individuals with a forward head posture, who were assigned to an experimental group (EG, individuals performed ankle exercises) or control group (CG, individuals performed McKenzie and cervical stabilization exercises). The EG intervention was specifically designed to enhance proprioception in the ankle joint and strengthen the ankle muscles to improve overall stability and function. In contrast, CG interventions aimed to improve neck muscle balance and cervical spine alignment. Paired t-tests were used to analyze intragroup changes and independent t-tests to determine intergroup differences pre-and post-intervention. The significance level for all statistical tests was set at α=.05. Results : We observed significant post-intervention improvements in both groups, specifically, in the CVA, CRA, and LC and CA thickness (p<.05). These results indicate that ankle, McKenzie, and cervical stabilization exercises were useful for neck posture correction, improved muscle balance, and enhanced blood flow to the neck. Conclusion : This study underscores the positive effects of ankle, McKenzie, and cervical stabilization exercises in individuals with a forward head posture. Our study highlights the benefits of these exercises for posture correction and overall neck health and the clinical effectiveness and usefulness of ankle exercises as an important intervention to improve forward head posture.

• Journal of Korean Neurosurgical Society
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• v.30 no.10
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• pp.1210-1219
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• 2001

Introduction : The purpose of this study was to analyze the safety, pullout strength and radiographic characteristics of unicortical and bicortical screws of cervical facet within cadaveric specimens and evaluate the influence of level of training on the positioning of these screws. Methods : Twenty-one cadavers, mean 78.9 years of age, underwent bilateral placement of 3.5mm AO lateral mass screw from C3-C6(n=168) using a slight variation of the Magerl technique. Intraoperative imaging was not used. The right side(unicortical) utilized only 14mm screws(effective length of 11mm) while on the left side to determine the length of the screw after the ventral cortex had been drilled. Three spine surgeons(attending, fellow, chief resident) with varying levels of spine training performed the procedure on seven cadavers each. All spines were harvested and lateral radiographs were taken. Individual cervical vertebrae were carefully dissected and then axial radiographs were taken. The screws were evaluated clinically and radiographically for their safety. Screws were graded clinically for their safety with respect to the spinal cord, facet joint, nerve root and vertebral artery. The grades consisted of the following categories : "satisfactory", "at risk" and "direct injury". Each screw was also graded according to its zone placement. Screw position was quantified by measuring a sagittal angle from the lateral radiograph and an axial angle from the axial radiograph. Pull-out force was determined for all screws using a material testing machine. Results : Dissection revealed that fifteen screws on the left side actually had only unicortical and not bicortical purchase as intended. The majority of screws(92.8%) were satisfactory in terms of safety. There were no injuries to the spinal cord. On the right side(unicortical), 98.9% of the screws were "satisfactory" and on the left side(bicortical) 68.1% were "satisfactory". There was a 5.8% incidence of direct arterial injury and a 17.4% incidence of direct nerve root injury with the bicortical screws. There were no "direct injuries" with the unicortical screws for the nerve root or vertebral artery. The unicortical screws had a 21.4% incidence of direct injury of the facet joint, while the bicortical screws had a 21.7% incidence. The majority of "direct injury" of bicortical screws were placed by the surgeon with the least experience. The performance of the resident surgeon was significantly different from the attending or fellow(p<0.05) in terms of safety of the nerve root and vertebral artery. The attending's performance was significantly better than the resident or fellow(p<0.05) in terms of safety of the facet joint. There was no relationship between the safety of a screw and its zone placement. The axial deviation angle measured $23.5{\pm}6.6$ degrees and $19.8{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The resident surgeon had a significantly lower angle than the attending or fellow(p<0.05). The sagittal angle measured $66.3{\pm}7.0$ degrees and $62.3{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The attending had a significantly lower sagittal angle than the fellow or resident(p<0.05). Thirty-three screws that entered the facet joint were tested for pull-out strength but excluded from the data because they were not lateral mass screws per-se and had deviated substantially from the intended final trajectory. The mean pull-out force for all screws was $542.9{\pm}296.6N$. There was no statistically significant difference between the pull-out force for unicortical($519.9{\pm}286.9N$) and bicortical($565.2{\pm}306N$) screws. There was no significant difference in pull-out strengths with respect to zone placement. Conclusion : It is our belief that the risk associated with bicortical purchase mandates formal spine training if it is to be done safely and accurately. Unicortical screws are safer regardless of level of training. It is apparent that 14mm lateral mass screws placed in a supero-lateral trajectory in the adult cervical spine provide an equivalent strength with a much lower risk of injury than the longer bicortical screws placed in a similar orientation.