Journal of Physical Therapy Science Vol. 29(2017) No. 7

[Purpose] To find the physical activity level and fall risk among the community-dwelling Malaysian older adults and determine the correlation between them. [Subjects and Methods] A cross-sectional study was conducted in which, the physical activity level was evaluated using the Rapid Assessment of Physical Activity questionnaire and fall risk with Fall Risk Assessment Tool. Subjects recruited were 132 community-dwelling Malaysian older adults using the convenience sampling method. [Results] The majority of the participants were under the category of under-active regular light-activities and most of them reported low fall risk. The statistical analysis using Fisher’s exact test did not show a significant correlation between physical activity level and fall risk. [Conclusion] The majority of community-dwelling Malaysian older adults are performing some form of physical activity and in low fall risk category. But this study did not find any significant correlation between physical activity level and fall risk among community-dwelling older adults in Malaysia.

[Purpose] This study was designed to investigate the effects of lactose-free milk intake and whole-body vibration exercises on bone density in elderly female nursing home residents who had difficulty exercising outdoors and had not consumed milk. [Subjects and Methods] Twenty seven elderly women aged 70 or older from 3 nursing homes located in Incheon, Korea participated in the study. The experimental group (n=13) carried out whole-body vibration exercises and drank lactose-free milk, while the control group (n=14) continued to live their ordinary nursing home lives. Weight, BMI, T-scores, and Z-scores were compared between the experimental and control groups after 12 weeks. [Results] The comparison of changes in weight and BMI in the control group before and after the 12-week experiment found no statistically significant differences. However, bone mineral density was significantly different, with the T-score significantly decreasing from −2.99 to −3.48 and the Z-score decreasing from −1.87 to −2.58. The other comparisons of physical changes in the control group before and after the 12-week experiment found no statistical significance. [Conclusion] The results indicate that regular consumption of lactose-free milk and performing whole-body vibration exercises can delay the progression of bone density loss in older adults in nursing homes; adequate exercise and calcium intake could eventually help prevent fractures.

[Purpose] This study aimed to examine the prevalence of locomotive syndrome among patients with obstructive sleep apnea syndrome (OSAS) using the “loco-check” recently developed by the Japanese Orthopedic Association, and to compare health-related quality of life (HRQOL) among patients with and without locomotive syndrome. [Subjects and Methods] This cross-sectional study evaluated 1,195 outpatients with OSAS (1,030 males and 165 females). Locomotive syndrome was evaluated using the Japanese Orthopedic Association’s “loco-check”. HRQOL and psychological distress were evaluated using the EuroQol 5-dimensional (EQ-5D) and 6-item Kessler questionnaires. [Results] Locomotive syndrome was detected in 578 patients (48.4%), including 398 males (38.6% of males) and 119 females (70.3% of females). Patients with OSAS and locomotive syndrome had significantly lower EQ-5D scores, compared to patients without locomotive syndrome. Multiple regression analysis revealed that HRQOL among patients with OSAS was independently associated with locomotive syndrome, age, gender, body mass index, apnea hypopnea index, the Japanese version of the Epworth Sleepiness Scale score, and exercise habits. [Conclusion] The prevalence of locomotive syndrome was thought to be comparatively high in patients with OSAS, and locomotive syndrome was associated with lower HRQOL, even after adjusting for confounding factors. Prevention or management of locomotive syndrome may be beneficial for improving HRQOL among patients with OSAS.

[Purpose] This study examined the effects of 4-week of balance exercise with medio-lateral unstable sole on ankle muscle activation and functional ability. [Subjects and Methods] Thirty university students without current or past ankle injuries were assigned to either an experimental group or control group. The experimental group participated in a balance exercise program 3 times a week over 4 weeks, which consisted of one-leg stands and semi-squat exercises with medio-lateral unstable sole. The control group continued with their regular life activities without participation in the program. Electromyographic activities of peroneus longus and brevis muscles were recorded during stair descending immediately before and after the exercise program. Functional balance was tested with the Star Excursion Balance test immediately before and after the exercise program. Paired t-tests were used to assess statistical significance. [Results] Activation of peroneus longus and brevis and Star Excursion Balance Test scores in both groups did not show a significant difference between pre- and post-exercise. [Conclusion] A future study is suggested with increased level of medio-lateral perturbation during outcome measurements and exercises with addition of supervision in the exercise training and home program.

[Purpose] This study investigates whether cognition, balance and dual task performance in institutionalized older adults improves by a virtual reality dual task training. [Subjects and Methods] Randomized controlled trial; Twenty institutionalized older adults with mild cognitive impairment (13 female, 7 male; average age, 87.2 ± 5.96 years) were randomized to the intervention (i.e. Virtual reality dual-task training using the BioRescue) or control group (no additional training). The intervention group took part in a 6-week training program while the elderly in the control group maintained their daily activities. Balance was measured with the Instrumented Timed Up-and-Go Test with and without a cognitive task. The Observed Emotion Rating Scale and Intrinsic Motivation Inventory were administered to evaluate the emotions and motivation regarding the exergaming program. [Results] The intervention group improved significantly on the total Timed Up-and-Go duration and the turn-to-sit duration during single-task walking in comparison to the control group who received no additional training. Participants found the virtual reality dual task training pleasant and useful for their concentration, memory and balance. Pleasure and alertness were the two emotions which were mostly seen during the intervention. [Conclusion] The BioRescue is a pleasant and interesting treatment method, well suited for institutionalized older adults in need of lifelong physical therapy.

[Purpose] The main purpose of this study was to compare the effects of core stabilization and chest mobilization exercises on pulmonary function and chest expansion in chronic stroke patients. [Subjects and Methods] Thirty stroke patients were randomly divided into two groups: a core stabilization exercise group (n=15) and a chest mobilization exercise group (n=15). Each exercise was performed 3 times per week for 30 minutes for 4 weeks, and pulmonary function and chest expansion when breathing were measured for both groups. [Results] There were significant increases in both forced vital capacity and forced expiratory volume in 1 second before and after intervention. Core stabilization exercise resulted in a significant increase in peak expiratory flow, and significant increases in upper and lower chest expansion were detected with chest mobilization exercise. However, no significant difference was revealed between the two groups. [Conclusion] This study suggested that both exercises were effective in some aspects of pulmonary function while core stabilization can help increase peak expiratory flow and chest mobilization can assist with chest expansion.

[Purpose] To investigate and compare the efficacy of three hyaluronic acid formulations in patients with early-stage meniscal injuries. [Subjects and Methods] Male and female patients who were admitted to our clinic between January 2013 and December 2013, diagnosed with early-stage meniscus lesions of the knee, and given a hyaluronic acid treatment were included in this retrospective study. Patients were categorized into 3 groups according to their treatments: MONOVISC, OSTENIL PLUS, or ORTHOVISC. Scores from a Visual Analog Scale and the Western Ontario and McMaster Universities Arthritis Index were evaluated at baseline and one, three, and six months after baseline. [Results] A total of 55 patients were included in this study. Most of the patients were female (55%), and the mean age of the patients was 42.4 (± 8.1) years. Based on the pre- and post-injection data, there was significant reductions both in the Visual Analog Scale score and the Western Ontario and McMaster Universities Arthritis Index score after the injections for all groups. According to intergroup comparisons, no significant difference was observed in terms of efficacy. [Conclusion] Three hyaluronic acid formulations produced a similar efficacy in patients with meniscal injuries, and further studies are needed to evaluate long-term results.

[Purpose] This study examined possible interrelationships between postural sway and posture parameters in children and adolescents with a particular focus on posture weakness. [Subjects and Methods] 308 healthy children and adolescents (124 girls, 184 boys, aged 12.3 ± 2.5 years) participated in the study. Posture parameters (posture index, head protrusion, trunk inclination) were determined based on posture photos in the sagittal plane. Postural sway was measured during 20 seconds on a force plate. The Pearson’s product-moment correlation coefficients between the anthropometric and posture parameters and the sway path length (SPL) were calculated, as well as the coefficient of determination R². [Results] There is a weak but significant correlation between age or body mass index of the test subjects and the SPL. There is no statistically significant correlation between posture parameters and the SPL. Children and adolescents with posture weakness do not exhibit a changed SPL. [Conclusion] Therefore, therapy of poor posture must be considered separately from therapeutic measures for the improvement of balance skills.

[Purpose] This study sought to examine the effects of Pedalo^® training on balance and fall risk in stroke patients. [Subjects and Methods] Thirty-one subjects with stroke were recruited and randomly allocated into two groups: the Pedalo^® group (n=15) and the Treadmill group (n=16). The Pedalo^® group performed conventional physical therapy program with Pedalo^® training for 30 minutes, five times a week, for 8 weeks, while the Treadmill group conducted conventional physical therapy programs and treadmill gait training for 30 minutes, five times a week, for 8 weeks. [Results] After intervention, both groups showed a significant improvement in balance. A significant greater balance improvement was found in the Pedalo^® group compared to the Treadmill group. Also, a significant reduction in risk of fall was seen in both group but this reduction was not significantly different between the two groups. [Conclusion] Pedalo^® training may be used to improve balance and reduce fall risk in stroke patients.

[Purpose] This study was undertaken to measure cardiopulmonary function according to body position during the recovery period after maximal exercise and to identify an effective position after high-intensity exercise. [Subjects and Methods] Fifteen male university students in their twenties participated in the study. The subjects were randomly assigned to the supine position, the sitting position, or the trunk forward leaning position during the recovery period following maximal exercise. Oxygen uptake, minute ventilation volume, respiration rate, and heart rate according to posture were measured in a stable state, at maximal exercise loading, and at 1, 3, and 5 minutes after maximal exercise. [Results] Changes of cardiopulmonary function according to posture during the recovery period after maximal exercise showed that minute ventilation volume was smaller in the trunk forward leaning position than in the sitting or supine positions, and oxygen uptake also declined. [Conclusion] The trunk forward leaning position has a more positive effect on pulmonary ventilation after high-intensity exercise.

[Purpose] The aim of this study was to examine the relationship between physical activity (PA) in elderly people as preventive exercise for lower urinary tract symptoms (LUTS) or overactive bladder (OAB), and how PA in primary preventive care can impact change upon LUTS. [Subjects and Methods] An interview sheet featuring LUTS domains (IPSS/QOL and OABSS questionnaire) was distributed to all participants (104 males and 494 females) who attended the public elderly people’s physical exercise class “Muscle Enhancing Club 2010” in Asahikawa city. [Results] The interview sheet was collected from 65 males (75.4 ± 5.79 years of age) and 304 females (72.7 ± 5.23 years of age). In all cases, there was a statistically significant difference of QOL. In 77 LUTS cases, there was a statistically significant difference in the change of the following LUTS domains: incomplete bladder emptying, frequency, nocturia, QOL, urgency, and OABSS total score. In 61 OAB cases, there was a statistically significant difference in the change of the following LUTS domains: QOL, urgency, and OABSS total score. [Conclusion] PA, as a preventative exercise for elderly people, led to improvements in LUTS, especially storage symptoms and QOL. Our data show that gross movement and education was beneficial. From the point of preventive medicine, various exercise classes, organized by the local government and others, also indicated that these classes increase the possibility of improvement to LUTS.

[Purpose] Motion capture system is difficult to use in daily life. The aim of this study was to propose an estimation model for knee and ankle joint angle measurements and locate body center of gravity (COG) of the extension phase during standing-up motion. [Subjects and Methods] Seven healthy male volunteers were enrolled. An estimation model was proposed for the knee and ankle joint angle measurements by combining the angle and acceleration of the trunk, based on readings from the inertial sensor attachment on the subject’s chest, during the extension phase. Joint angles and COG position were compared to those obtained by a motion capture system. [Results] The joint angles and COG position demonstrated high correlation coefficients which represent strong correlation between the proposed model and the motion capture system. The proposed model could estimate the joint angle during extension phase, with a maximum error of 4.58 degrees, as well as COG position in the horizontal and vertical directions with maximum errors of 4.48 cm and 3.19 cm, respectively. [Conclusion] The proposed system could be used instead of motion capture system to estimate knee and ankle joint angles; however, the estimation of the COG position was insufficient because of lacked accuracy.

[Purpose] “Judgment error,” defined as a difference between the actual and the imagined performance, is often observed in elderly persons. The aims of this study were to assess subjective judgment errors in elderly persons, and to evaluate the relationship between physical function and judgment error in walking speed. [Subjects and Methods] A total of 106 community-dwelling elderly individuals participated. Subjects observed video footage of a model walking an obstacle course, and were asked to subjectively compare the model’s gait speed with their own gait speed. When the subjective comparison differed from the actual difference, it was considered as a judgment error. Physical function was compared between those with and without judgment error. [Results] Significant interaction effects between the actual performance and subjective perception were found for the walking time on the obstacle course and the Activities-specific Balance Confidence Scale score (utilized as an index of self-confidence in own balance ability and a fear of falling). [Conclusion] The results demonstrate that some elderly persons tend to overestimate their balance and ambulation function compared to another person, even though they had low physical function and low self-confidence in terms of balance. These elderly individuals might have a high risk of accidents.

[Purpose] This study assessed the effects of type 2 diabetes without diabetic polyneuropathy on muscle strength according to body composition in middle age patients. [Subjects and Methods] This study included 45 non-diabetic individuals (control group) and 50 patients with type 2 diabetes (DM group), 40 to 64 years of age. The body composition was examined, including the leg muscle volume (LMV), which was the sum of the lower-limb muscle mass. The muscle strength was also examined, and the knee extension force (KEF), ankle dorsiflexion force (ADF). The KEF and ADF were normalized to the bodyweight, and the total leg muscle force (TLMF) were calculated by combining the KEF and ADF. The leg muscle quality (LMQ) was calculated as the TLMF normalized with the LMV. [Results] While no significant differences were found in the LMV between groups, the body mass index were higher in the DM group than in the control group. Significant differences were observed in %KEF, %ADF, and the LMQ in the DM group, with 15.8%, 18.7%, and 11.5% lower values than those in the control group, respectively. [Conclusion] The results of this study may demonstrate that muscle weakness occurs before diabetes progresses to a severe condition.

[Purpose] This study investigated temporal changes in trunk flexion angle and gluteal pressure during computer work with continuous sitting. [Subjects and Methods] This study involved 10 males subjects aged 21–29 years. During 30 min of data collection with a Tekscan system and a video camera, peak gluteal pressure and changes in trunk flexion angle were analyzed with the COMFOM at research 6.20 and Pro-Trainer 10.1 programs, respectively, at 10, 20, and 30 min. [Results] The result showed no significant change in gluteal pressure after 10, 20, or 30 min. However, changes in trunk flexion angle increased significantly after 10 min <20 min <30 min. [Conclusion] Trunk flexion is necessary for repositioning, unless one can maintain a posture for a long time without movement. Future research should analyze repositioning methods according to individual characteristics.

[Purpose] The purpose of this study was to investigate the effects of an occupation-centered activity program for dementia patients living in a local community, and examined the effects of the occupation-centered activity program on their cognitive functions, fall-related factors, and quality of life. [Subjects and Methods] Thirty subjects were divided into two groups: the experiment group (n=15) and the control group (n=15). The occupation-centered activity program was then applied to dementia patients for 60 minutes, 5 times/week for 12 weeks. To identify their cognitive functions before and after the intervention occupation-centered activity program, Mini-Mental State Examination-Korea (MMSE-K) and the Global Deterioration Scale (GDS) were used. To assess fall-related factors, Korean Falls Efficacy Scale for the Elderly (FES-K) was used and leg strength, agility, and balance of the participants was measured. To examine quality of life, the Korean version of Quality of Life-Alzheimer’s Disease Scale (KQOL-AD) was used. [Results] The results of the intervention showed that although cognitive function improved in both the experimental and control groups, fall-related factors and the quality of life significantly improved only in the experimental group. [Conclusion] This indicates that the occupation-centered activity program had a positive effect on dementia patients’ cognitive functions, fall-related factors, and quality of life.

[Purpose] The purpose of this study was to determine whether collagen fibers cause a difference in a contracture resulting from a combination of joint fixation and hindlimb unloading as compared to joint fixation only. [Subjects and Methods] The subjects of this study were 21 female Wistar rats divided into 4 groups as follows: Control Group (CON, n=7); Joint Fixation Group (JF, n=7), Hindlimb Unloading Group (HU, n=7), Joint Fixation Plus Hindlimb Unloading Group (JF+HU, n=7). This study was conducted for 1-week. Ankle joint range of motion and positive areas of collagen using fluorescent stain were analyzed. [Results] Ankle joint range of motion in JF + HU showed an increase compared to that of JF. Positive areas of Type I collagen in JF+HU showed an increase as compared with that of JF. [Conclusion] The results of this study suggested that the difference in a contracture caused by only joint immobilization and by a combination of joint immobilization and hindlimb unloading were significantly associated with Type I collagen.

[Purpose] The purpose of this study was to provide basic information as reference and guidelines for the implementation of abdominal muscle exercise programs for people with intellectual disabilities residing in residential care facilities. [Subjects and Methods] The study period was 12 weeks, from July 1, 2015, to September 30, 2015. The study participants comprised of 10 people with intellectual disabilities who were residing in a residential care facility. An occupational therapist measured each subject’s weight and physical fitness (muscle strength and flexibility). Collected data were encoded by using items and analyzed using SPSS ver.18.0. [Results] Weight decreased significantly, and physical fitness (muscle strength and flexibility) increased significantly. [Conclusion] To actively improve abdominal muscle strength and health management in people with intellectual disabilities residing in residential care facilities, consistent implementation of abdominal muscle exercise programs and improvements are indispensable, as these could lead to the development of systematic programs for rehabilitation physical activities.

[Purpose] This study investigated the effects of lingual strength training (LST) on lingual strength and articulator function in stroke patients with dysarthria. [Subjects and Methods] 16 stroke patients with dysarthria were randomly assigned into two groups: the experimental group (n=8) or the control group (n=8). Both groups received the conventional rehabilitation therapy at 30 min/day, 5 times for week, and during 4 weeks, and the experimental group received an additional 30 min of LST using the Iowa Oral Performance Instrument (IOPI). The Maximum Isometric Tongue Pressures (MIPs) was used to assess the lingual strength and the Alternating-Motion Rate (AMR) and Sequential-Motion Rate (SMR) were used to measure the articulator function. [Results] After the intervention, the experimental group showed a significant improvement in MIPs and AMR (/tə/) than the control group. [Conclusion] Findings of this study suggest that LST provides positive effects on lingual strength and articulator function, and thus can be used as an interventional method in stroke patients with dysarthria.

[Purpose] The purpose of this study is to investigate effects of kinesio taping to the quadriceps femoris on functions of elderly women. [Subjects and Methods] The subjects of this study were 22 elderly women with osteoarthritis, who were divided into two groups of a general exercise group 12 elderly and a kinesiology taping group 12 elderly. Two groups underwent a 30-min exercise for strengthening the lower limb muscles three times per week for four weeks. After the exercise, the kinesiology taping group was treated by the kinesio taping. Kinesio tapes were attached to the quadriceps femoris, three times per week for four weeks. The Korean Western Ontario and McMaster Universities Osteoarthritis Index, sit to standing, and Time up & Go test were used for assessment before and after the intervention. [Results] As a result, the kinesiology taping group showed significant differences in the Korean Western Ontario and McMaster Universities Osteoarthritis Index, sit to standing, and Time up & Go test between pre- and post-intervention, while the general exercise group showed no significant differences in pre- and post-intervention. There was a significant difference in between-group comparison. [Conclusion] The kinesio taping for the quadriceps femoris was effective on improving functions of elderly women with osteoarthritis.

[Purpose] The purpose of this study was to identify the effects of task-oriented training with altered somatosensory input on the balance ability of chronic stroke patients. [Subjects and Methods] Twenty-six subjects with chronic stroke were divided into an experimental group (n=14) and a control group (n=12). Both groups attended physical therapy sessions five times a week for four weeks. The experimental group performed additional, task-oriented training with altered sensory input three times a week for four weeks. Limit-of-stability tests were conducted before and after the intervention. In addition, all subjects were evaluated using the Berg Balance Scale (BBS) and Korean Activities-Specific Balance Confidence Scale before and after the intervention. [Results] There was a significant interaction between time and group on BBS scores, on the total surface area of the limit of stability, and on the surface area of the limit of stability of the affected side. However, an analysis of covariance in which the baseline values of each variable served as the covariates showed that only the post-intervention BBS score of the experimental group was significantly higher than that of the control group. [Conclusion] Task-oriented training with altered somatosensory input can improve functional balance in patients with chronic stroke.

[Purpose] It is very important to consider effects that postural deviations has on muscle activity when treating low back pain. Therefore, activities of trunk and hip joint muscles in healthy adults while they attempted three postural conditions of neutral, sway-back, and lordosis was compared and evaluated in this study. [Subjects and Methods] The subjects comprised 17 healthy adult male volunteers. The muscle activity and spinal curve were measured while the subjects attempted different postural conditions (neutral, sway-back, and lordosis) as defined in the text. [Results] Activity of trunk and hip inner muscles was decreased in sway-back posture, and only activity of the trunk back muscles was increased in lordosis. [Conclusion] This results were suggested that postural deviations affected muscle control in the lumbo-pelvic area.

[Purpose] The purpose of this study was to investigate the effects of endurance exercise and half-bath on body composition, cardiorespiratory system, and arterial pulse wave velocity of men with intellectual disabilities. [Subjects and Methods] Twenty-four men with intellectual disabilities, but capable of learning, were randomly assigned to aerobic exercise (N=8), half-bath (N=8), or control (N=8) treatment groups. Over the 12-week treatment period, the aerobic exercise group did treadmill and stationary bicycle. The half-bath treatment group was placed in a sitting position in a 39–40°C bath for 10 minutes. [Results] The aerobic exercise group showed a significant decrease in body fat than those in the half-bath and control groups. In addition, there was an increase in the respiratory system of the aerobic exercise group but no increase in the half-bath and control groups. The arterial pulse wave velocity change was greatest in the aerobic exercise group, but the half-bath group also showed a velocity change from that in the control group. [Conclusion] Aerobic exercise and a half-bath can have positive effects on improving body composition, respiratory system, and vascular function of people with intellectual disabilities.

[Purpose] The aim of this study was to estimate the prevalence of abnormal shoulder ultrasonographic findings in a sample of asymptomatic women. [Subjects and Methods] A secondary analysis of a cross-sectional study was performed. We recruited 305 women (aged 18–56 years). All the subjects had a structured interview screening for self-reported symptoms and underwent a shoulder ultrasonographic examination, in which both shoulders were examined. The radiologist was blinded to the clinical history of the participants. All detectable shoulder abnormalities were collected. [Results] Of the subjects, 228 (74.75%) were asymptomatic at both shoulders, and 456 asymptomatic shoulders were analyzed. Lack of uniformity (supraspinatus, infraspinatus, subscapularis, and biceps brachii long head) was found in 28 shoulders (6.14%), 19 (4.17%) on the dominant side and 9 (1.97%) on the non-dominant side. Tendinosis (supraspinatus, infraspinatus, subscapularis, and biceps brachii long head) was found in 19 shoulders (5.32%), 12 (2.63%) on the dominant side and 7 (1.53%) on the non-dominant side. Calcification and other abnormal findings were reported. [Conclusion] The most common abnormalities were calcifications within the rotator-cuff tendons and humeral head geodes; other degenerative findings were less common.

[Purpose] The present study was conducted to evaluate the effect of motor imagery training for trunk movements on trunk muscle control and proprioception in stroke patients. [Subjects and Methods] A total of 12 study subjects were randomly assigned to the experimental group (a motor imagery training group) and the control group (a neurodevelopmental treatment, NDT) group. The two groups were treated five times (30 minutes each time) per week for 4 weeks. The experimental group underwent imagery training for 10 minutes and trunk control centered NDT for 20 minutes and the control group underwent only trunk control centered NDT for 30 minutes. The trunk muscle activity and the position sense of the subjects were evaluated before and after the intervention. [Results] The two groups showed significant improvements in muscle activity after the intervention. Only the experimental group showed significant improvements in proprioception. The experimental group showed significant improvements in the variations of muscle activity and proprioception compared to the control group. [Conclusion] Motor imagery training for trunk movements can be effectively used to improve trunk muscle activity and proprioception in stroke patients.

[Purpose] To determine the effects of progressive neuromuscular training on postural balance and functionality in elderly patients with knee osteoarthritis (OA). [Subjects and Methods] Eleven participants between 60 and 75 years of age performed the progressive neuromuscular training for 8 weeks and 4 weeks of follow-up. The area and velocity of the center of pressure were measured on a force platform, and the functionality was measured with a Western Ontario and McMaster Universities Osteoarthritis Index. [Results] The area and velocity (anteroposterior and mediolateral directions) of the center of pressure showed significant differences after 4 and 8 weeks of intervention. Additionally, the global score and some questionnaire dimensions (pain and physical function) showed significant differences after 4 and 8 weeks of intervention. These changes were maintained in all variables at week 4 of follow-up. [Conclusion] The intervention generated improvements in balance and functionality in elderly patients with knee OA. These changes were observed after 4 weeks of training and were maintained 4 weeks after the end of the intervention.

[Purpose] It has also been reported that decreased activity in the reward pathway causes a decrease in brain activity in the descending pain control system in people with high trait anxiety. Activation of this system is dependent on both the reward pathway and motor areas. Recently, studies have also shown that motor areas are activated by illusory kinesthesia. It was aimed to explore whether anxiety trait modulates the influence of illusory kinesthesia on pain threshold. [Subjects and Methods] The pain threshold and trait anxiety at rest before vibratory tendon stimulation (the task) were measured. After the task, the pain threshold, the illusory kinesthesia angle, and the intensity of illusory kinesthesia for patients with and without illusory kinesthesia were measured. A total of 35 healthy right-handed students participated, among whom 22 and 13 were included in the illusion and no-illusion groups, respectively. [Results] There was a significant increase in the pain threshold after task completion in both groups; however, there was no statistically significant difference between the two groups. Correlational analysis revealed that State-Trait Anxiety Inventory-trait score correlated negatively with the pain threshold in the no-illusion group, but there was no correlation in the illusion group. [Conclusion] The pain threshold improved regardless of the size of trait anxiety in the illusion group, but did not improve merely through sensory input by vibratory stimulation in the no-illusion group. Thus, illusory kinesthesia has effect of increasing the pain threshold.

[Purpose] The purpose of this study was to investigate the modular control of locomotor tasks and compared the modules before and after a running intervention. [Subjects and Methods] Electromyographic measurements were performed on eight young, healthy males engaged in a 60s run on a treadmill at 2.8 m/s before and immediately after the 600s of running intervention. Electromyographic data for 15 trunk and lower-limb muscles on the right side were recorded. Muscle synergies were extracted from the electromyography signals using non-negative matrix factorization. [Results] Four modules explained the electromyographic activity of all muscles and had the functions of load acceptance (module 1), push-off (module 2), preparation of landing (module 3), and trunk-stabilization activity during the stance phase (module 4). Modules 1, 2, and 3 matched the basic modules reported in previous studies; whereas, module 4 was different before and after the intervention. [Conclusion] Before the intervention, module 4 engaged the trunk muscles and it was activated in the stance phase during running. However, after the intervention, module 4 engaged the muscles around the pelvis and it was activated after landing. This result suggests that the posture control changes from the trunk muscles to the lower-limb muscles after 10 minutes running.

[Purpose] The purpose of this study was to investigate the perceived treatment times and emotional reactions under different light colors in the treatment room. [Subjects and Methods] Subjects in this study were 20 healthy young students in their 20s. Under each lighting condition (blue, red, white, and yellow) differentiated by color, each subject laid on a therapeutic bed and underwent ultrasound therapy. Subjects were instructed to press a stopwatch every 1 minute, for a total of 5 times, after therapy started according to their perception of time while the stopwatch’s time indicator was blocked. After the experiments, self-administered questionnaires were given to subjects to measure their emotional reactions. [Results] In terms of K-POMS scores, the mood states of depression-dejection, anger-hostility, and confusion-bewilderment were higher scores for blue and red lights compared to yellow light. The mood state of vigor-activity were higher scores for yellow and white lights compared to blue and red lights. [Conclusion] Therefore, it is important to take necessary measures to prevent the negative effects that blue and red light-based therapy can have on patient mood.

[Purpose] The purpose of this study was to establish the reliability and validity of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) translated into Korean for use with patients’ low back pain. [Subjects and Methods] Sixty-two subjects with low back pain, 28 men and 34 women, participated in the study. Reliability was determined by using the intra class correlation coefficient and Cronbach’s alpha for internal consistency. Validity was examined by correlating the JOABPEQ scores with the 36 item short form health survey (SF 36). [Results] Test-retest reliability was 0.75–0.83. The criterion-related validity was established by comparison with the Korean version of the SF 36. [Conclusion] The Korean version of the JOABPEQ was shown to be a reliable and valid instrument for assessing low back pain.

[Purpose] This study was conducted with a view to find out the effect of yoga practices on micronutrient absorption in urban residential school children. [Subjects and Methods] The study population comprised 66 urban school children aged 11–15 years staying in a residential school in Pune City, Maharashtra, India. A stratified random sampling method was used to divide the students into experimental and control groups. There were 33 students in experimental group and 33 students in control group. Both experimental and control groups were assessed for the status of zinc, copper, iron and magnesium at the baseline and at the end of 12 weeks of yoga training. The study participants of experimental group underwent yoga training for 12 weeks, for one hour in the morning for six days a week. The control group did not undergo any yoga training during this time period. [Results] The experimental group participants showed significant improvement in micronutrient absorption as compared to control group. [Conclusion] The findings of this study indicate that yoga practices could improve micronutrient absorption in urban residential school children.

[Purpose] The aim of the study was to evaluate the benefits of physical therapy for urinary incontinence in patients with multiple sclerosis and to verify the impact of urinary incontinence on the patient’s quality of life. [Subject and Methods] A case study of a 55-year-old female patient diagnosed with multiple sclerosis and mixed urinary incontinence was conducted. Physical therapy sessions were conducted once a week, in total 15 sessions, making use of targeted functional electrical vaginal stimulation, along with active exercises for the pelvic floor muscles and electrical stimulation of the posterior tibial nerve, behavioral rehabilitation and exercise at home. [Results] After 15 physical therapy sessions, a patient diagnosed with multiple sclerosis and mixed urinary incontinence showed continued satisfactory results after five months. She showed better quality of life, higher strength of pelvic floor muscle and reduced urinary frequency without nocturia and enuresis. [Conclusion] The physical therapy protocol in this patient with multiple sclerosis and mixed urinary incontinence showed satisfactory results reducing urinary incontinence symptomatology and improving the patient’s quality of life.

[Purpose] To present a case of non-surgical reduction of thoracic hyperkyphosis utilizing a multimodal rehabilitation program emphasizing the mirror image^® concept. [Subject and Methods] A 15-year-old female presented to a rehabilitation office suffering from back and neck pains and headaches. The patient was treated sporadically over a period of 13-months. Treatment consisted of anterior thoracic translation and thoracic extension exercises, spinal traction and spinal manipulation. [Results] After 13-months of treatment the patient displayed a significant reduction in hyperkyphosis and a dramatic correction of her overall posture and spine alignment corresponding to the reduction in back/neck pains, headaches and the simultaneous improvement of various other health issues. [Conclusion] Thoracic hyperkyphosis can be reduced through a multimodal rehabilitation program emphasizing mirror image thoracic extension procedures.

[Purpose] The aim of this study was to examine the usefulness of aquatic walking exercise using a walker for chronic stroke patients. We also examined the psychological effects on the study subject and the primary caregiver before and after aquatic walking exercise. [Subject and Methods] The subject was a 60-year-old male with bilateral paralysis after a cerebrovascular accident. The Fugl-Meyer Assessment (FMA) total score was 116 on the right and 115 on the left. The intervention combined aquatic and land walking exercise. A U-shaped walker was used for both water and land exercise. Continuous walking distance was the measure used to evaluate land walking ability. The psychological effects on the study subject and the primary caregiver were examined with the questionnaire. [Results] In aquatic walking, the mean time to walk 5 m showed an increase from the intervention after two months. After the aquatic walking and land walking combination, continuous walking distance also showed a prolonged trend. In the survey given to the main caregivers, improvements were observed. [Conclusion] Aquatic walking practice using a walker improved motivation in a chronic stroke patient, leading to improved walking ability, with a positive psychological influence on the participant and family caregiver.

[Purpose] The purpose of this case study was to determine the effectiveness of bandaging the arm of a patient with secondary lymphedema on the patient’s quality of life, arm volume and arm function using an additional pad and taping along with some other standard therapy modalities for lymphedema. [Subjects and Methods] I used a bandage with an additional pad and taping, along with MLD, exercise, and skin care to treat a patient with unilateral breast-cancer-related arm lymphedema who had fibrotic tissue on her lower arm and hand. I made a pad called a “muff” and applied it under tape while using Vodder’s technique. Treatment was performed during 5 therapy sessions a week for 2 weeks. [Results] After the physiotherapy sessions, the excess edema volume decreased to 608 ml, and the percentage of excess volume (PEV) was 9.6%. The therapeutic efficacy, measured as percentage reduction of excess volume (PREV), was −79.5%, meaning that the edema volume was reduced 79.5%. The use of an additional pad and taping on a large edematous site with fibrotic changes can produce more efficacious lymphedema care. [Conclusion] The use of an additional pad and taping on a large edematous site with fibrotic changes has demonstrated a positive result in lymphedema management for a post mastectomy patient and, therefore, further studies on this method are suggested with a larger sample size.

[Purpose] The aim of this study was to determine the effects of central and unilateral posteroanterior (PA) mobilization on cervical lordosis, muscle stiffness and range of motion in a patient with ankylosing spondylitis (AS). [Subject and Methods] The subject of this case study was diagnosed with AS in 1997. At baseline, variance was measured without any intervention during the first 3 days (2016.6.13–2016.6.15). Cervical PA mobilization was applied to each segment from C2–C7 from the 4th to the 11th day for 8 days. Intervention was not performed from the 12th to the 15th days for 4 days. Variances were measured a final time without intervention on the 16th day (2016.6.28). [Results] Cervical lordosis was seen to have increased. Muscle stiffness was significantly decreased after intervention and the effect of treatment lasted for five days without any additional intervention. The cervical flexion and extension angles were increased. However these increases were not statistically significant. Both the lateral flexion and left rotation angle were significantly increased and the effects of treatment lasted for five days without any additional intervention. [Conclusion] These results suggest that central and unilateral PA mobilization is effective in increasing cervical lordosis and range of motion, and decreasing muscle stiffness in patients with AS.

[Purpose] This study developed a modified active leg-raising exercise to decrease lumbar lordosis and assessed its effectiveness in a patient with low back pain and excessive lumbar lordosis. [Subject and Methods] The subject was a 56-year-old woman with excessive lordosis, who complained of continuous severe LBP pain at the L5 level for 1 year. The subject performed the modified active leg-raising exercise while flexing the neck. She performed the modified active leg-raising exercises for 2 weeks, performing three sets of 30 repetitions per day. [Results] The patient’s anterior pelvic tilt angle decreased from 20° and 23° to 16° and 17° on the right and left sides, respectively. In backward trunk extension, the VAS score of her back pain decreased to 4 (from the initial score 8). [Conclusion] This result suggests that the modified leg-raising combined with neck flexion helped to recovery the pelvic posture and back pain. The subject could also easily fix her pelvis and avoid moving her lower trunk while exercising.