• Physical Therapy Rehabilitation Science
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• v.3 no.2
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• pp.112-118
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• 2014

Objective: The purpose of this study was to investigate the effects of an exercise with and without neuromuscular electrical stimulation (NMES) of the quadriceps femoris muscle, on strength, pain, and weight distribution in patients with knee instability post surgery. Design: Randomized controlled trial. Methods: Twenty patients in the early stage of rehabilitation after knee surgery were recruited as subjects and were randomly divided into either experimental group (exercise combined with NMES) (n=10) or control group (n=10). Both groups received strength training of the lower limb for 20 min/day, 5 days/week for 4 weeks. The experimental group used NMES for unilateral quadriceps femoris training with incremental increases in the intensity of isometric contraction over 4 weeks. Outcome measurements were assessed using the digital manual muscle testing, 30-chair stand test (30CST), numeric pain rating scale (NPRS) and weight distribution using the foot analyzer before and after 4 weeks of training. Results: After the 4-week intervention, knee extensor strength increased significantly in the experimental group post intervention (p<0.05), and there was a significant improvement in the experimental group compared with the control group (p<0.05). The 30CST and NPRS scores improved significantly in the experimental group compared to the control group (p<0.05), and there was a significant difference between the two groups (p<0.05). Weight distribution was significantly improved in the experimental group compared with the control group, (p<0.05), but there was no significant difference in improvement between the two groups. Conclusions: This study showed that NMES combined with strengthening exercises of the lower limbs is effective in improving lower limb pain and strength in patients with instability after knee surgery.

• PNF and Movement
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• v.18 no.1
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• pp.97-106
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• 2020

Purpose: This study aimed to determine the most effective way to facilitate the abductor hallucis muscle during PNF leg pattern-emphasized hallux abduction. Methods: The study recruited 18 healthy adults. All participants agreed voluntarily to take part in the study following an explanations of its purpose and procedures. They randomly performed the PNF leg pattern-emphasized hallux abduction variations in a hook-lying or sitting position. Activation of the abductor hallucis (AbH), adductor hallucis (AdH), extensor hallucis longus (EHL), and tibialis anterior (TA) muscles, and the ratio of AbH/AdH, were measured during PNF exercises using electromyography. One-way repeated ANOVA was used to compare the activation of foot intrinsic and extrinsic muscles during the four PNF exercises. Results: PNF leg pattern-emphasized hallux abduction using normal timing was significantly higher in TA compared to PNF leg pattern-emphasized hallux abduction using timing for emphasis, regardless of the starting position. The PNF leg pattern-emphasized hallux abduction using timing for emphasis in the hook-lying position was significantly higher in AbH than in other exercises. Although there was no statistically significant difference in the ratio of AbH/AdH, it was higher in the hook-lying position. Conclusion: PNF leg pattern-emphasized hallux abduction using timing for emphasis in the hook-lying position can be recommended as a method to optimize the activation of AbH and the ratio of AbH/AdH.

• Annals of Rehabilitation Medicine
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• v.42 no.6
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• pp.804-813
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• 2018

Objective To elucidate the effect of a 12-week horizontal vibration exercise (HVE) in chronic low back pain (CLBP) patients as compared to vertical vibration exercise (VVE). Methods Twenty-eight CLBP patients were randomly assigned to either the HVE or VVE group. All participants performed the exercise for 30 minutes each day, three times a week, for a total of 12 weeks. Altered pain and functional ability were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI), respectively. Changes in lumbar muscle strength, transverse abdominis (TrA) and multifidus muscle thicknesses, and standing balance were measured using an isokinetic dynamometer, ultrasonography, and balance parameters, respectively. These assessments were evaluated prior to treatment, 6 weeks and 12 weeks after the first treatment, and 4 weeks after the end of treatment (that is, 16 weeks after the first treatment). Results According to the repeated-measures analysis of variance, there were significant improvements with time on VAS, ODI, standing balance score, lumbar flexor, and extensor muscle strength (all p<0.001 in both groups) without any significant changes in TrA (p=0.153 in HVE, p=0.561 in VVE group) or multifidus (p=0.737 in HVE, p=0.380 in VVE group) muscle thickness. Further, there were no significant differences between groups according to time in any of the assessments. No adverse events were noticed during treatment in either group. Conclusion HVE is as effective as VVE in reducing pain, strengthening the lumbar muscle, and improving the balance and functional abilities of CLBP patients. Vibrational exercise increases muscle strength without inducing muscle hypertrophy.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.1
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• pp.19-26
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• 2019

Purpose : The aim of this study was to investigate the effects of the abdominal draw-in (ADI) exercise on the onset times of the gluteus maximus (GM) and erector spinae (ES) as well as the pelvic anterior tilt angle during prone hip extension (PHE). Methods : A total of 24 female adults were divided into two groups: those with normal abdominal muscles (n=12) and those with weak abdominal muscles (WAM; n=12). Before the intervention, the onset times of the GM and ES along with the pelvic angle during PHE were measured. Subsequently, the participants conducted the ADI exercise for 10 minutes. After conducting the ADI exercise, the onset times and the pelvic angle were re-measured. Results : In the pre-intervention comparison between the two groups, the WAM group showed faster ES onset times and higher pelvic angle than the normal group (p<0.05). In the WAM group, the ES onset times were significantly delayed after the ADI exercise (p<0.05). In both groups, the pelvic angle was significantly decreased after the ADI exercise (p<0.05). The decrease in the pelvic angle was significantly greater in the WAM group than in the normal group (p<0.05). The GM onset time was found to be not significant in all comparisons (p>0.05). Conclusion : Therefore, it can be concluded that after performing the ADI exercise, the pelvic anterior tilt during PHE is decreased in normal women and those with WAM, especially in the WAM group, suggesting that the ADI exercise can reduce the compensatory pelvic anterior tilt more effectively by delaying the ES onset times.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.4
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• pp.75-84
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• 2018

PURPOSE: This study was conducted to determine the effects of whole-body tilt exercise with visual feedback on trunk control, strength, and balance in patients with acute stroke. METHODS: The study included 18 patients with acute stroke who were randomly allocated to a Whole Body Tilt Exercise Group (WBTEG, N=9) and a General Trunk Exercise Group (GTEG, N=9). The WBTEG conducted whole-body tilt exercises with visual feedback, and the GTEG performed general trunk exercises. Both groups performed the exercises five times a week for 4 weeks. Outcomes were assessed using the trunk impairment scale (TIS), the trunk flexor and extensor strength test, the static balance test, and the Brunel Balance Assessment. RESULTS: After 4 weeks of intervention, both groups showed significantly improved TIS scores, muscle strength, and balance components (p<.05 in both groups). However, the improvement in TIS, muscle strength, and static balance in the WBTEG was significantly better than that in the GTEG (p<.05). CONCLUSION: Although both groups in this study showed post-intervention improvement, patients from the WBTEG who received visual feedback demonstrated more improvement. These findings indicate that whole-body tilt exercise with visual feedback may be effective at improving trunk control, trunk muscle strength, and balance in patients with acute stroke. Further studies are needed to gain a better understanding of the effectiveness of whole-body tilt exercise in patients with acute stroke.

• Journal of Digital Convergence
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• v.17 no.6
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• pp.389-399
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• 2019

The purpose of this study was to investigate the effects of muscle asymmetry of knee joint among elite cyclists on anaerobic pedaling power related capacity. In another word, based on isokinetic strength of Non-Dominant, ND and Dominant, D, side, high, moderate and low ratio of ND to D were classified as High Symmetry Group, Moderate Symmetry Group and Asymmetry Group, respectively. Analysis of muscle asymmetry of extensor's ND and D side might not lead to any difference between the three groups. Based on muscle strength analysis of the flexor's ND and D, there was statistical difference between the groups in ND flexor and in the muscle balance index of the flexor muscle. This result also leads to significant difference in pedaling power functionality, but this effects might not lead to any negative pedaling power. Therefore, among even cyclists who may show almost the same recruitment pattern of ND and D side during pedaling stroke muscle asymmetry could exist but this phenomena might not negatively contribute to the pedaling capacity.

• PNF and Movement
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• v.16 no.3
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• pp.415-424
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• 2018

Purpose: This study aimed to determine the effects of various wheelchair handling directions on the upper limb muscle activities of wheelchair attendants while climbing a ramp. Methods: For the study participants, healthy males over 20 years of age were chosen, and the order of the direction of wheelchair handle grip was determined using a randomized method. The handling directions for pushing the wheelchair up a ramp included a general grip with ulnar deviation, a medial grip with wrist pronation, and a neutral grip with a neutral wrist. The muscle activities in the participants' upper limbs were measured using surface electromyography. For statistical data processing, SPSS 18.0 was used to perform repeated measures ANOVA in order to compare the muscle activity among the intervention groups. A contrast test was also conducted among the participants. The significance level (${\alpha}$) was set to 0.05. Results: There was a significant difference between groups using a general grip and a medial grip in the biceps brachii, triceps brachii, and flexor carpi radialis muscles (p<0.05). There was also a significant difference between using a general grip and a neutral grip in the biceps brachii and flexor carpi radialis muscles (p<0.05), and there was a significant difference between using a medial grip and a neutral grip in the biceps brachii and extensor carpi radialis brevis muscles (p<0.05). Conclusion: In this study, the wheelchair assistants' wrist muscle activity was the lowest with a neutral grip while ascending a ramp. Accordingly, this study proposes that wheelchair assistants push wheelchairs up ramps with a neutral grip.

• PNF and Movement
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• v.16 no.3
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• pp.441-449
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• 2018

Purpose: This study aimed to compare the impact of proprioceptive neuromuscular facilitation leg patterns emphasizing hallux abduction (PNF-LPHA) on the intrinsic foot muscles of participants with hallux valgus (HV) using the toe-spread-out exercise (TSO). Methods: The present study recruited 12 individuals with HV. All the participants voluntarily agreed to participate in the study after hearing explanations of its purpose and process. All participants performed the TSO, PNF-LPHA 1, and PNF-LPHA 2. The participants' abductor hallucis (AbH), adductor hallucis (AdH), extensor hallucis longus (EHL), and flexor hallucis brevis (FHB) activity was measured, and the ratio of AbH:AdH was measured during the three interventions using electromyography. Additionally, the participants' AbH thickness was measured by ultrasonography. An intraclass correlation coefficient (ICC) was used to verify the intra-rater reliability of ultrasonography at rest and during contraction. Results: The intra-rater reliability was excellent at rest and during contraction ($ICC_{3,1}=0.90$ and $ICC_{3,1}=0.83$, respectively). There were no statistically significant differences in the activity of the AbH, the ratio of AbH: AdH, and the thickness of AbH between the TSO and PNF-LPHA2 groups. Additionally, EHL activity was significantly higher in the PNF-LPHA2 group than in the TSOgroup. Conclusion: PNF-LPHA 2 can be recommended as a method to optimize AbH and EHL activity, the ratio of AbH:AdH, and the thickness of AbH in individuals with HV.

• Physical Therapy Korea
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• v.26 no.3
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• pp.84-90
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• 2019

Background: Ankle evertor muscles are important for preventing lateral ankle sprain. Since, the evertor muscles cross the ankle and toe joints, the position at which the ankle evertor muscle strength is measured is important. However, no studies have previously investigated the effect of ankle and toe positions on the strength of the ankle evertor muscle. Objects: This study is aimed to determine the effect of various ankle and toe joint positions on the strength of the ankle evertor muscles in healthy subjects. Methods: Eighteen healthy subjects participated in this study. Isometric ankle evertor strength of the dominant leg was determined in each subject in different ankle and toe positions (dorsiflexion (DF) with toe extension (TE), DF with toe flexion (TF), plantar flexion (PF) with TE, and PF with TF). A 2 by 2 repeated analysis of variance (ANOVA) was used to determine the difference in the evertor strength between the ankle positions (PF and DF) and toe positions (TE and TF). Results: The results indicate that there was no significant ankle position by toe position interaction effect (p=.83). However, the ankle evertor strength was significantly increased in the ankle DF position than in the PF position (p<.01), and the ankle evertor strength during eversion with TE was significantly higher than eversion with TF (p<.01). Conclusion: The findings of this study suggest that clinicians should consider the ankle and toe positions when measuring the muscle strength and during performance of selective muscle strengthening exercises of the ankle evertor muscles.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.2
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• pp.137-144
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• 2019

PURPOSE: The continued use of smartphones has resulted in an abnormal body posture and neck alignment changes. Maintaining this posture for a long time weakens the flexor muscles in the neck and shortens the extensor muscles in the neck. This study examined the correlation between the suboccipital muscle tension and deep neck flexor muscle physical endurance according to the craniovertebral angles. METHODS: The craniovertebral angle, tension of the suboccipital muscle and endurance of the deep neck flexor muscle were measured in 58 healthy 20-year-old male and female college students. The tension of suboccipital muscle and endurance of the deep neck flexor muscle were then divided according to the body mass index (BMI). Their correlation with the craniovertebral angle was then examined. Each parameter was measured three times to determine the interrater reliability. RESULTS: The craniovertebral angle and suboccipital muscle tension showed differed significantly. On the other hand, the craniovertebral angle and deep neck flexor muscle physical endurance showed no significant differences. CONCLUSION: The results show that the craniovertebral angle and deep neck flexor muscle physical endurance were not correlated, but a smaller craniovertebral angle resulted in a higher suboccipital muscle tension.