The purpose of this study was to establish reliability of the Tone Assessment Scale (TAS) translated into Korean in patients with stroke. The TAS consists of resting posture, response to passive movement, and associated reaction to active effort. Fifteen patients (14 males, 1 female) were examined by two raters. Surface electromyography (EMG) data at elbow flexor muscle and joint excursion were collected from 6 patients. To identify the correlation between muscle activity and angular changes of elbow muscle, Pearson product moment correlation was used. The inter-rater and intra-rater reliability of the TAS ranged from very good to good (K/Kw=.61~1.00 for intra-rater and K/Kw=.73~1.00 for intra-rater comparisons) in the sections of resting posture and associated reaction. However, in the section of response to passive movement, the reliability coefficients ranged from very good to fair (Kw=.29~1.00). In the 11th item, correlation between EMG ratio of elbow flexor and angular changes of elbow joint showed statistically strong positive relationship (r=.94, p<.05). These results indicate that the TAS is selectively reliable in the sections of resting posture and associated reaction.
The purpose of this study was to investigate the effect of proprioceptive neuromuscular facilitation (PNF) approach on the spasticity of affected side in patients with hemiplegia. Three subjects with hemiplegia participated in this study. In single-subject research design (a multiple baseline across individuals) was employed in this study. The intervention program including PNF to the unaffected side was introduced for 30 minutes each day during each intervention phase. Muscle tone of affected side was measured with Tone Assessment Scale, and active hip abduction distance of affected side was taken with the subject supine. And then the muscle tone and the hip abduction distance were measured again 30 minutes later following the intervention. The results showed that the PNF application had some beneficial effects on both muscle tone and active hip abduction. This result suggest that PNF application to non-paretic limb can be effective in reducing muscle tone and improving hip abduction range on paretic limb in persons with hemiplegia. However, further research is needed to prove the effect of PNF application on functional improvement.
The purpose of this study was to find any correlations among Postural Assessment Scale for Stroke (PASS), Modified Barthel Index (MBI), Tone Assessment Scale (TAS), Motor Assessment Scale-Gait (MAS-G), Fugl Meyer-Balance (FM-B), and to predict MBI from subscales of the PASS. The subjects were 41 stroke patients of the Korea National Rehabilitation Center in Seoul. The main outcome measures were postural control (PASS), gait (MAS-G), Balance (FM-B), Tone (TAS), ADL (MBI). The data was analyzed using the Pearson product correlation. PASS scale was used between other clinical and instrumental indexes, multiple stepwise regression analyses were performed to identify prognostic factors for ADL incline, and Cronbach's alpha coefficient was used to identify internal consistency on PASS scale. The results of this study areas follows: 1. The highest level was sitting without support, the lowest level was standing on paretic leg on PASS scale. The highest level was chair/bed transfer, the lowest level was bathing on MBI. 2. All items of the PASS, except postural tone were significantly correlated with Gait, Balance, MBI (p<.01), 3. The Internal Consistency (Cronbach's alpha coefficient=.85) was very high, indicating that the PASS is homogeneous and is likely to produce consistent response. Furthermore, the sums of maintaining position items and of changing-position items were strongly correlated (r=.64, p<.05) and there were significant correlations between sums of PASS, sums of maintaining position items (r=.87, p<.01), and changing-position items (r=.93, p<.01). 4. The standing without support of the PASS items was the strongest variance ($R^2$=.85) of the predicting ADL function. These findings provide strong evidence of the predictive value of the postural control on gait, Balance, ADL function in stroke patients and to can provide a reference for the successful therapeutic program and more improved functional recovery.
Objective: The purpose of this study to investigate the correlations among the motor function, balance, and gait velocity and the strength that could explain the variation of gait velocity of chronic stroke survivors. Design: This was a cross-sectional cohort study. Methods: Thirty hemiplegic stroke survivors hospitalized in an inpatient rehabilitation center were participated. The muscle tone of ankle plantarflexor and muscle strength of ankle dorsiflexor were measured respectively with modified Ashworth scale (MAS) and hand-held dynamometer. And the motor recovery and function with Fugl-Meyer assessment (FMA), balance with Berg balance scale (BBS) and timed up and go (TUG) test were measured. Gait velocity was measured with GAITRite. The correlation among motor function, muscle tone, muscle strength, balance, and gait were analyzed. In addition, the strength of the relationship between the response (gait velocity) and the explanatory variables was analyzed. Results: The gait velocity had positive correlations with FMA, muscle strength, and BBS, and negative correlation with MAS and TUG. Regression analysis showed that TUG (𝛽=-0.829) was a major explanatory variable for gait velocity. Conclusions: Our results suggest that gait velocity had correlations with muscle strength, MAS, FMA, BBS, and TUG. The tests and measurements affecting the variation of gait velocity the greatest were TUG, followed by FMA, BBS, muscle strength, and MAS. This study shows that TUG would be a possible assessment tool to determine the variation of gait velocity in stroke rehabilitation.
The purpose of this study was to investigate the effect of watsu therapy on muscle tone in adult hemiparesis patient after stroke. The subject was a 66 year old patient with left hemiparesis whose self gait was independent with minimal assist. The subject was ambulatory with some degree of limitation and demonstrated a little tremor and asymmetry in the body. A multiple treatment design(A-B-C-B) for a single-subject research was used for this study. The watsu therapy consisted of basic moves, head cradle, underfar leg, near leg cradle in watsu I (transition flow), for 25 minutes, which lasted 12 sessions for a total 21 sessions. A baseline was conducted for a first time and a general ROM exercise was conducted after the first watsu therapy. Tone assessment scale was tested : 1. posturing at rest 2. response to passive movement 3. associated reaction Comparing to the baseline and general ROM exercise, The results showed that the watsu therapy had some positive effects on improvement of three tests and there was a more positive effects of both response to passive movement and associated reaction.
The purpose of this study was to investigate the effect of submerged relaxation therapy for the spasticity on the affected side in three subjects with post-stroke hemiparesis. A single-subject alternating design with multiple baselines across individuals was employed in this study. Each subject alternately participated in a range of motion exercises on the mat and in the pool, and relaxation exercises in the pool. The muscle tone of the affected side was measured using the tone assessment scale (TAS). Measurements were made immediately and one hour following the intervention. The findings showed a therapeutic effect of submerged relaxation exercise on reducing spasticity for all subjects. The effect of submerged relaxation exercise on decreasing muscle tone was maintained for one hour measurements after the submerged relaxation exercise, although the mean TAS score assessed one hour after intervention was higher than that assessed immediately. The results of this study suggest that submerged relaxation exercise has a positive effect on decreasing spasticity on the affected side in persons suffering from post-stroke hemiparesis. Future research on submerged relaxation exercise should focus on objective evaluation and functional the aspects relevant to activities of daily living.
Purpose: This study aimed to determine the appropriate stimulus strength that could result in a positive effect on the ankle joint spasticity when patients with chronic stroke performed whole body vibration (WBV) exercise. Methods: Among 72 patients who were diagnosed with stroke at least 6 months ago, those able to perform a half squat pose with ambulation issues due to ankle joint spasticity (modified Ashworth scale, $MAS{\geq}2$) were included for analysis. Individuals participated in four different frequencies of vertical WBV exercise; 0 Hz, 10 Hz, 20 Hz, and 30 Hz. Vibration amplitude was 3-4 mm and 5 minutes WBV exercise was performed at each frequency, followed by a measurement after 2-minute rest. We assigned 18 individuals to each frequency and asked them to participate in the WBV exercise once every 3 weeks. The level of spasticity was evaluated by visual analogue scale (VAS) for self-assessment. The myoton PRO was utilized to objectively evaluate the level of spasticity and check the muscle tone and stiffness. Results: Participants showed 0 Hz VAS was a significant difference between 20 Hz application conditions (p<0.05). Muscle tone was significantly different at 0 Hz between 20 Hz, and 30 Hz (p<0.05), significantly difference at 10 Hz between 30 Hz (p<0.05). Muscle stiffness significantly difference at 0 Hz between 20 Hz, and 30 Hz (p<0.05), significantly difference at 10 Hz between 20 Hz, and 30 Hz (p<0.05). Conclusion: Findings of this study show that the frequency of more than 20 Hz was effective in improving the ambulatory ability in patients with chronic stroke. Currently, the effective WBV protocol is limited. Hence, this study was designed to suggest an effective WBV protocol to improve neuromodulation ability for chronic stroke patients.
The purpose of this study was to propose a task-related circuits program for stroke patients and to test the difference in functional improvements between patients undergoing conventional physical therapy and those participating in a task-related circuits exercise program. The subjects were 10 stroke in-patients of the Korea National Rehabilitation Center in Seoul. We measured the following variables: Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Tone Assessment Scale (TAS), speed of gait, rate of step, physiological costs index, age, weight, height, site of lesion, onset day and whether the subject participated in an exercise program. Collected data were statistically analyzed by SPSS 10.0/PC using descriptive statistics, Mann-Whitney U test, Wilcoxon rank sum test and Spearman's correlation. The results of the experiment were as follows: (1) In the pre-test and post-test for function, there was not a statistical significance between the group partaking in a task-related circuits program and the group of conventional physical therapy (p>.05). (2) In the MAS, BBS and speed of gait test, the group undergoing conventional physical therapy showed a statistical significance (p<.05). (3) In the MAS, BBS, speed of gait, PCI, TAS (passive, associated reaction, TAS total score), the group of task-related circuits program showed a statistical significance (p<.05). As a result, the group participating in a task-related circuits program had a more functional improvement than the group participating in conventional physical therapy. Therefore, an intervention recommended for a stroke patient would be a task-related circuits program consisting of a longer session of each task for a more improved functional recovery.
Background : This study verified a correlation between gross motor performance measure (GMPM) and pediatric balance scale (PBS) for children, which are most widely used for assessment of children with cerebral palsy. Methods : The study subjects are 20 children aged between five and 13 who were diagnosed with cerebral palsy. Their mean age was $8.15{\pm}2.96years$ and consists of 15 males and 5 females. The subjects were divided into three groups according to muscle tone and motility disorders and then GMPM and PBS were assessed. In the assessment items in the GMPM, alignment, coordination, dissociated movement, stability, and weight shift were measured. The PBS consists of sitting to standing, standing to sitting, moving between chairs, standing without using hands, standing with one foot, turning 360 degrees, turning to look behind, retrieving object from floor, and reaching forward with outstretched arm while standing. A correlation of the collected data was analyzed using SPSS 18.0 for windows. Results : From Significant correlations were shown between items of GMPM and PBS as well as total scores of GMPM and PBS. Among them, coordination and weight transfer in the GMPM items had a high correlation with the PBS. In addition, the higher the GMPM total score was, the higher the PBS score was. Conclusion : This study result showed a significant correlation between GMPM and PBS, and this relation can be used to pediatric physical examination.
The purpose of this study was to establish the basic information for natural drainage capacity assessment in urban area. We sorted midium watershed of Han river and Nak-dong river, and selected 30 rainfall events during 1995 to 2000 according to high level of damage. The inundated area showed high watershed slope about 25% and it indicated the greatest damage around the watershed located in 200-300m of altitude. Besides, the great damage by inundation was occurred in the mountainous agriculture region, where the forest scale was high and the urbanization was being progressed gradually. However, inundated area was small in case of grassland, water tone such as riparian area, bare ground and wetland. Moreover, the inundated area was different according to river shape and characteristics of river distribution such as the density of the stream order, conservation constant of the river system, and the number of undulations in the watershed. Therefore, it showed that land use, river shape and distribution characteristics of stream influence on inundation.
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