[Purpose]This study aimed to determine the effects of a virtual reality exercise program using the Interactive Rehabilitation and Exercise System (IREX) on the recovery of motor and cognitive function and the performance of activities of daily living in stroke patients. [Subjects] The study enrolled 10 patients diagnosed with stroke who received occupational therapy at the Department of Rehabilitation Medicine of Hospital A between January and March 2014. [Methods] The patients took part in the virtual reality exercise program for 30 minutes each day, three times per week, for 4 weeks. Then, the patients were re-evaluated to determine changes in upper extremity function, cognitive function, and performance of activities of daily living 4 weeks after the baseline assessment. [Results] In the experimental group, there were significant differences in the Korea-Mini Mental Status Evaluation, Korean version of the modified Barthel index, and Fugl-Meyer assessment scores between the baseline and endpoint. [Conclusion] The virtual reality exercise program was effective for restoring function in stroke patients. Further studies should develop systematic protocols for rehabilitation training with a virtual reality exercise program.

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[Purpose] This study aimed to investigate the clinical diagnostic value of dynamic enhanced multislice computed tomography (MSCT) for Fitz-Hugh-Curtis syndrome (FHCS). [Subjects and Methods] This study retrospectively analyzed the clinical features and manifestations of scanning and dynamic enhanced MSCT in 19 patients with FHCS. [Results] MSCT scans showed different degrees of liver capsule thickness in the lesion area: seven cases of sub-capsular effusion and three cases with a small amount of pleural effusion; thickness of the liver capsular arterial phase showing significant enhancement in 17 cases, and slight enhancement in two; portal venous and delayed phase enhancement decreased with no clear boundary of the liver parenchyma; and adjacent hepatic parenchymal involvement in five cases, in which the arterial phase appeared to have patchy or triangular enhancement, and unclear portal vein and delayed phase imaging findings. MSCT revealed pelvic inflammatory disease in 14 cases, peritonitis in two, endometritis combined with bilateral ovarian abscesses in two, and a tube-ovarian abscess in one. [Conclusion] Dynamic enhanced MSCT can accurately display liver capsule lesions and possible pelvic inflammatory diseases related to FHCS, suggest the infection source, and have high application value for making early, accurate diagnoses and improved prognosis.

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[Purpose] This study aimed to evaluate the anti-inflammatory and analgesic effects of intraoral application of low-level laser therapy (660 nm) to control pain, swelling and interincisal opening following the extraction of mandibular third molars. [Subjects and Methods] Ten patients underwent removal of lower third molars using the same surgical protocol and pharmacological approach. In the postoperative period, all patients received four consecutive daily sessions of low-level laser therapy, beginning 24 hours after the surgery. Intraoral applications using the diode laser with 660 nm wavelength in the continuous scan mode were performed covering the entire surgical area, which was divided into four quadrants, each of 1 cm² area at a distance of 1 cm. The energy applied at each point was 5 J/cm² during 8 seconds. [Results] The swelling and interincisal opening returned to normal 24 hours after the first low-level laser therapy application (Friedman test). Moreover, the pain intensity was reduced on the third postoperative day, according to the Friedman test. [Conclusion] Low-level laser therapy (660 nm), at the dosimetry used in this study, was effective in reducing postoperative pain and swelling following oral surgery.

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[Purpose] This study assessed changes in body composition before and after dialysis in chronic hemodialysis patients and determined the relationships between various body composition parameters and blood lipid levels in these patients. [Subjects] The cross-sectional study included 19 dialysis outpatients (17 men and 2 women, aged 35–82 years). [Methods] Body mass index, body weight, percent body fat, and percent skeletal muscle were measured before and after dialysis by using body impedance analysis. Blood lipid levels were obtained from patients’ clinical records. The body composition parameters before and after dialysis were compared using paired t-tests. Spearman’s rank correlation coefficients were calculated to determine relationships between the body composition parameters, before and after dialysis, and the blood lipid levels. [Results] All body composition parameters differed significantly before and after dialysis. High-density lipoprotein cholesterol level significantly correlated with all the body composition parameters, whereas total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels significantly correlated with some of these parameters. The correlation coefficients revealed no major differences in the relationships between blood lipid parameters and body compositions before and after dialysis. [Conclusion] Our findings suggest that body composition parameters, whether measured before or after dialysis, can be used to evaluate obesity in longitudinal studies.

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[Purpose] This study evaluated the effects of caregiver education on pulmonary rehabilitation of patients who have undergone lung resection for cancer. [Subjects] Patients were divided into experimental (n = 22) and control (n = 19) groups. [Methods] The caregivers of the experimental group patients received education on pulmonary rehabilitation, while the control group patients received general management advice for 4 weeks. [Results] Pulmonary muscle strength (maximum inspiratory pressure and maximum expiratory pressure) was increased significantly in the experimental group compared to the control group. Modified Borg scale scores were decreased significantly in the experimental vs. control group. [Conclusion] Providing caregivers with education pertaining to pulmonary rehabilitation was associated with improved pulmonary function in lung cancer patients following lung resection.

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[Purpose] The purpose of this study was to examine the efficiency of chest resistance and chest expansion exercises for improving respiratory function and trunk control ability in patients with stroke. [Subjects] Forty patients with stroke were randomly allocated into a chest resistance exercise group (CREG, n = 20) and a chest expansion exercise group (CEEG, n = 20). [Methods] CREG patients underwent chest resistance exercises, and diaphragmatic resistance exercises by way of the proprioceptive neuromuscular facilitation. CEEG patients underwent respiratory exercises with chest expansion in various positions. Both groups received 30 minutes of training per day, five times per week, for eight weeks. [Results] Both the CERG and CEEG groups showed significant changes in FVC, FEV1, and TIS after the intervention. TIS was significantly increased in the CREG compared to the CEEG after the intervention. [Conclusion] Both chest resistance and chest expansion exercises were effective for improving respiratory function and trunk control ability in stroke patients; however, chest resistance exercise is more efficient for increasing trunk control ability.

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[Purpose] This study examined sex differences in physical activity and social cognitive theory factors in Korean college students. [Subjects and Methods] A cross-sectional survey of 688 college students (285 men and 403 women) in Korea was conducted using a self-reported questionnaire. [Results] There was a significant difference in the level of physical activity between male and female students. The significant predictors of physical activity for male students were physical activity goals, physical activity self-efficacy, and sitting time. Meanwhile, those for female students were perceived weight, physical activity goal, physical activity outcome expectations, and sitting time. [Conclusion] Sex differences should be considered when developing interventions to increase physical activity.

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[Purpose] This study aimed to identify the International Classification of Functioning, Disability, and Health categories addressed by the assessment tools commonly used in post-stroke rehabilitation and characterize patients based on its evaluation model. [Subjects and Methods] An exploratory, descriptive, cross-sectional study was conducted involving 35 individuals with chronic post-stroke hemiparesis. Handgrip strength was assessed to evaluate body functions and structures. The 10-meter gait speed test and Timed Up and Go test were administered to evaluate activity. The Stroke Specific Quality of Life scale was used to evaluate participation. Moreover, a systematic review of the literature was performed to identify studies that have associated these assessment tools with the International Classification of Functioning, Disability, and Health categories. [Results] The tools employed in this study for evaluating function addressed 63 International Classification of Functioning, Disability, and Health categories: 24 related to body functions and structures; 36 related to activity and participation; and 3 related to environmental factors. [Conclusion] The assessment tools employed in this study addressed 63 International Classification of Functioning, Disability, and Health categories and allowed a more complete evaluation of stroke survivors with hemiparesis. Use of this classification can therefore be more easily incorporated into clinical practice.

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[Purpose] This study evaluated the functional ability and kinesthetic sense of the hands of women with breast cancer-related lymphedema. [Subjects and Methods] Fifty-seven women experiencing lymphedema after breast surgery and adjuvant radiotherapy were included. The patients were divided into two groups: women with hand edema (HE+, n = 29) and without hand edema (HE−, n = 28) after breast cancer treatment. Arm edema severity, hand size, functional mobility and kinesthetic sense of the hand, and daily living skills were evaluated. [Results] The mean age of the patients was 55.8 years. In both groups, functional mobility, kinesthetic sense, and daily living skills decreased significantly with increasing edema severity. However, there was no significant difference between groups with respect to functional mobility or daily living skills. The kinesthetic sense of the hand was better in the HE− group than the HE+ group. There was a significant negative relationship between the severity of edema and hand function. [Conclusion] Breast cancer-related lymphedema can negatively impact women’s functional mobility and kinesthetic sense of the hands as well as daily living skills.

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[Purpose] Currently, there are a limited number of amputee-specific instruments for measuring prosthesis-related quality of life with good psychometric properties in Turkey. This study translated the Prosthetic Evaluation Questionnaire to Turkish and analyzed as well as discussed its construct validity and internal consistency. [Subjects and Methods] The Prosthetic Evaluation Questionnaire was adapted for use in Turkish by forward/backward translation. The final Turkish version of this questionnaire was administered to 90 unilateral amputee patients. Second evaluation was possible in 83 participants within a median 28 day time period. [Results] Point estimates for the intraclass correlation coefficient ranged from 0.69 to 0.89 for all 9 Prosthetic Evaluation Questionnaire scales, indicating good correlation. Overall Cronbach’s alpha coefficients ranged from 0.64 to 0.92, except for the perceived response subscale of 0.39. The ambulation subscale was correlated with the physical functioning subscales of Short Form-36 (SF-36) (r=0.48). The social burden subscale score of the Prosthetic Evaluation Questionnaire was correlated with social functioning subscales of SF-36 (r= 0.63). [Conclusion] The Turkish version of the Prosthetic Evaluation Questionnaire is a valid and reliable tool for implementation in the Turkish unilateral amputee population.

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[Purpose] The purpose of this study was to examine the effects of mirror therapy on upper-extremity function and activities of daily living in chronic stroke patients. [Subjects and Methods] Fifteen subjects were each assigned to a mirror therapy group and a sham therapy group. The Fugl-Meyer Motor Function Assessment and the Box and Block Test were performed to compare paretic upper-extremity function and hand coordination abilities. The functional independence measurement was conducted to compare abilities to perform activities of daily living. [Results] Paretic upper-extremity function and hand coordination abilities were significantly different between the mirror therapy and sham therapy groups. Intervention in the mirror therapy group was more effective than in the sham therapy group for improving the ability to perform activities of daily living. Self-care showed statistically significant differences between the two groups. [Conclusion] Mirror therapy is effective in improving paretic upper-extremity function and activities of daily living in chronic stroke patients.

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[Purpose] The purpose of this study was to compare the effects of dynamic trunk exercises and isometric trunk exercises on gait in elderly people. [Subjects] This study randomly allocated 20 elderly people to an isometric trunk exercise group (n=10) and a dynamic trunk exercise group (n=10). The exercises were performed for 30 minutes three times a week for 12 weeks. Gait speed, stride length, cadence, and step width were measured at a normal pace using GAITRite. All groups were evaluated before and after 12 weeks. [Results] The isometric exercise group showed a significant change in gait velocity, cadence, and left and right step lengths. The dynamic trunk exercise group showed a significant change in gait velocity, cadence, left and right step lengths, left and right step times, and left and right stride lengths. Moreover, a comparison of the exercise effect between the two groups showed a significant difference in gait velocity. [Conclusion] The results of this study suggest that isometric trunk exercises and dynamic trunk exercises have a positive effect on gait function in elderly people. In particular, isometric trunk exercises are recommended to promote gait velocity.

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[Purpose] This study investigated physical health status and quality of life among older Saudi adults. [Subjects and Methods] Participants included older adults (N = 55) aged 60–90 years (mean = 67.9± 7.71) from a major hospital in Jeddah. Subjects completed surveys and evaluations including assessments of personal and socio-demographic characteristics, caregiver presence, personal habits, perceived health, primary physical and psychological complaints, physician-diagnosed chronic diseases, and functional capacity (i.e., activities of daily living). [Results] Results showed a significant positive correlation between age and ADL; age and memory problems, anxiety, and loneliness; and sleep disturbance and falls. Main factors contributing to quality of life decline were chronic disease, falls, sedentary lifestyle, sleep disturbances, and financial concerns. Participants with diabetes mellitus (58.18%) and hypertension (29.0%) had a very high fall rate. Participants engaged in minimal physical activity (63%), often due to bone and joint pain (90.0%), and led sedentary lives (69%). Single sensory impairments were significantly and independently linked to high depression risk and decreased self-sufficiency. [Conclusion] Healthy lifestyle and behavioral changes should be promoted through community-based health education programs for older Saudi adults. Chronic disease screening programs for the elderly population (especially diabetes and hypertension) are recommended.

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[Purpose] Obesity is a global health problem and is associated with a multitude of complications. This study was designed to determine changes in cardiopulmonary functions after aerobic and anaerobic exercise training in obese subjects. [Subjects and Methods] Forty obese subjects, whose ages ranged between 18 and 25 years, were divided into 2 equal groups: group A received aerobic exercise training in addition to dietary measures, and group B received anaerobic exercise training for 3 months in addition to dietary measures. Measurements of systolic blood pressure, diastolic blood pressure, heart rate, maximum voluntary ventilation, maximal oxygen consumption, and body mass index were obtained for both groups before and after the exercise program. [Results] The mean body mass index, systolic blood pressure, diastolic blood pressure, heart rate, and maximal oxygen consumption decreased significantly, whereas the mean maximum voluntary ventilation increased significantly after treatment in group A. The mean maximum voluntary ventilation also increased significantly after treatment in group B. There were significant differences between the mean levels of the investigated parameters in groups A and B after treatment. [Conclusion] Aerobic exercise reduces weight and improves cardiopulmonary fitness in obese subjects better than anaerobic exercise.

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[Purpose] This investigation evaluated the effect of real-time feedback on electrical activation of the quadriceps during 3 weight-bearing tasks of the Wii Fit Plus^®. [Subjects] Thirty male healthy volunteers were recruited. [Methods] Activation of the vastus medialis, vastus lateralis, and rectus femoris muscles was recorded during virtual lunge, single leg extension, and single leg reach exercises. Each exercise was performed twice in 3 randomized experimental conditions (with visual feedback, with auditory feedback, and with no feedback). The normalized electromyographic data (using maximum voluntary isometric contraction) were analyzed using repeated measures analysis of variance and Tukey’s test. [Results] No significant difference was found in the muscles among the feedback conditions during the 3 exercises. However, the variation in the muscle activity of the vastus medialis and vastus lateralis (18.23–29.20% of maximum voluntary isometric contraction) was higher (47–62%) than that in the rectus femoris (7.35–12.98% of maximum voluntary isometric contraction). [Conclusion] Real-time feedback did not alter quadriceps activation during the Wii tasks. Additionally, these games showed electromyographic activation levels similar to those for the same tasks outside the virtual environment. The Wii weight-bearing tasks could therefore constitute a physical activity program but without the additional benefit of feedback.

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[Purpose] This study aimed to clarify differences between home-visit rehabilitation users and providers in their understanding of the content and subjective effects of this practice. [Subjects] The subjects of this study were home-visit rehabilitation users and providers. [Methods] Home-visit rehabilitation users and providers were given self-administered questionnaires regarding home-visit rehabilitation, such as the content and subjective effects. The McNemar’s test was used for statistical analysis. [Results] Responses of 34 pairs meeting the inclusion criteria were analyzed. Mean user age was 75.2 ± 9.2 years, and 58.8% (20/34) of respondents were female. In terms of home-visit rehabilitation content, users believed that the following 3 items had been “implemented” to a greater extent than that estimated by providers: paralysis improvement exercise, floor sitting and standing, and self-care activities. No significant differences in awareness were identified between users and providers regarding the maintenance/improvement effects of home-visit rehabilitation. [Conclusion] Users tend to consider that programs aimed at relieving symptoms and pain and improving mobility are being implemented to a greater extent than that considered by providers. Providers need to explain the aims of home-visit rehabilitation programs in a way that can be understood by users.

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[Purpose] This study investigated the effects of musical tempo on physiological, affective, and perceptual responses as well as the performance of self-selected walking pace. [Subjects] The study included 28 adult women between 29 and 51 years old. [Methods] The subjects were divided into three groups: no musical stimulation group (control), and 90 and 140 beats per minute musical tempo groups. Each subject underwent three experimental sessions: involved familiarization with the equipment, an incremental test to exhaustion, and a 30-min walk on a treadmill at a self-selected pace, respectively. During the self-selected walking session, physiological, perceptual, and affective variables were evaluated, and walking performance was evaluated at the end. [Results] There were no significant differences in physiological variables or affective response among groups. However, there were significant differences in perceptual response and walking performance among groups. [Conclusion] Fast music (140 beats per minute) promotes a higher rating of perceived exertion and greater performance in self-selected walking pace without significantly altering physiological variables or affective response.

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[Purpose] The purpose of this study was to examine the effects of muscle belly compression by a supporter on the paralyzed side soleus muscle of patients with cerebrovascular disability, and to determine the intensity of compression that is effective for improving gait. [Subjects] Eleven patients with chronic cerebral vascular disorder. [Methods] Before setting the supporter, standing posture and 6 m free walking were measured 3 times with the three-dimensional motion analysis system, VICON. Then, supporters were placed on the center of the lower leg of the hemiplegic side of the subjects and inflated to 30 or 50 mmHg. Three minutes after wearing the supporters, the subjects walked again for 3 times. The data measured with VICON were processed using Visial3D.V4, and the angles of the ankle, steps of the hemiplegic and non-hemiplegic sides, walking speed, walk rate and cadence were calculated. [Results] Compared to without a supporter, a supporter with 30 mmHg pressure showed a significant reduction in the angle of the knee at Initial Contact (IC), and a significant increase in the power of the knee extension at Loading Response (LR). [Conclusion] The results reveal a supporter with that of the subjects during pressure over 30 mmHg applied for 3 minutes improved the knee angle power and hemiplegia walking.

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[Purpose] The aim of this study was to develop a method of measuring isometric shoulder joint muscle strength using a handheld dynamometer with a belt and investigate its test-retest reliability. [Subjects] The subjects comprised 40 healthy adults. [Methods] Six types of isometric shoulder muscle strength were measured twice, and reliability was assessed. [Results] The intraclass correlation coefficient (1, 1) values ranged from 0.976 to 0.902. The result of a Bland-Altman analysis showed differences in the types of errors between measurement items. [Conclusion] The relative reliability of isometric shoulder muscle measurement using a handheld dynamometer with a belt was high. However, analysis of absolute reliability revealed errors that may affect interpretation of values; therefore, it was considered that adapting the greater of two measurement values is appropriate.

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[Purpose] This study investigated the effects of an end-range mobilization technique on the range of motion of the glenohumeral internal rotation and the skin temperature of the shoulder in individuals with posterior shoulder tightness. [Subjects] Thirteen subjects with posterior shoulder tightness who had glenohumeral internal rotation deficit ≥ 15° participated. [Methods] All subjects underwent glenohumeral joint end-range mobilization intervention. The internal rotation range of motion of the glenohumeral joint was measured by a goniometer and the shoulder skin temperature was measured by a digital infrared thermographic imaging device before and immediately after the intervention. Paired t-tests were used to analyze the differences in these parameter pre and post-intervention. [Results] The glenohumeral internal rotation range of motion and skin temperature of the posterolateral shoulder in increased significantly post-intervention. [Conclusion] The end-range mobilization technique is effective for increasing the glenohumeral internal rotation range of motion and skin temperature of the shoulder in individuals with posterior shoulder tightness.

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[Purpose] This study analyzed type 2 diabetes and its role in complications among adult Saudi patients. [Subjects] Patients attending four primary health care centers in Jeddah were enrolled. [Methods] A cross-sectional design study among Saudi patients attending Ministry of Health primary health care centers in Jeddah was selected for use by the Primary Health Care administration. Patients were interviewed with structured questionnaires to determine the presence of diabetes and risk factors using questions about the history of any disease. [Results] Diabetes mellitus was present in 234 subjects during the data collection period (March–June 2014). Mean patient age was 58 years; diabetes prevalence was 42% in males and 58% in females. The mean age for diabetes onset in males and females was 34 and 39 years, respectively. There was a higher incidence of obesity (75%) associated with a sedentary lifestyle (body mass index ≥25) in females (N= 96; 40%) compared with males (N= 87; 36%). In this study, >44% of individuals aged 55 or older had severe to uncontrolled diabetes with long-term complications. The age-adjusted incidence of hypertension and coronary heart disease was 38% and 24%, respectively, showing a clear incidence of diabetes associated with cardiovascular disease in Saudi Arabia. [Conclusion] This study found that a multifactorial approach to managing diabetes complication risks is needed.

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[Purpose] This study aimed to confirm the specialization of interlimb transfer in occupationally embedded tasks between dominant and non-dominant hands. [Subjects] Twelve neurologically intact participants were recruited. [Methods] The participants were divided into two training groups and performed training with their dominant or non-dominant hand. Three subtests of the Jebsen-Taylor Hand Function Test were used to practice interlimb transfer training in each group. All Jebsen-Taylor Hand Function Test subtests were evaluated using the untrained hand before and after 5 days of training. [Results] The dominant hand group showed significant differences after training when using the untrained hand in the simulated feeding and lifting large heavy objects subtests. Meanwhile, the non-dominant hand group showed significant differences after training when using the untrained hand in the turning cards, simulated feeding, stacking checkers, and lifting large heavy objects subtests. [Conclusion] When performing occupationally embedded tasks, the dominant hand has interlimb transfer advantages with respect to predictable dynamic movements, while the non-dominant hand has interlimb transfer advantages in stabilization.

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[Purpose] To develop and verify the reliability of a new practical evaluation method for pitting edema, which uses the depth of the surface imprint as an indicator. [Subjects] We included 26 inpatients (52 legs). [Methods] The subjects were diagnosed with edema, and we verified the inter- and intra-rater reliabilities of the edema gauge using intraclass correlation coefficients. [Results] For the first and second measurement values and the measured values between the examiners, the intraclass correlation coefficients were high. [Conclusion] Therefore, our findings suggest that the edema gauge, which measures the depth of the surface imprint, has sufficient intra- and inter-rater reliabilities.

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[Purpose] This study investigated upper-extremity muscle activities in natural, ideal, and corrected head positions. [Subjects and Methods] Forty subjects with a forward head posture and rounded shoulder were recruited and randomly assigned to the natural head position group (n = 13), ideal head position group (n = 14), or corrected head position group (n = 13). Muscle activities were measured using a four-channel surface electromyography system at the sternocleidomastoideus, upper and lower trapezius, and serratus anterior muscles on the right side during an overhead reaching task. [Results] The muscle activities of the upper trapezius and serratus anterior differed significantly among head positions. Post hoc tests revealed significant differences between natural and ideal head positions, and natural and ideal head positions for both the upper trapezius and serratus anterior. [Conclusion] Recovery of normal upper trapezius and serratus anterior muscle functions plays an important role in correcting forward head posture and rounded shoulders.

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[Purpose] The purpose of this study was to determine whether muscle activity and pressure-induced pain in the upper extremities are affected by smartphone use, and to compare the effects of phone handling with one hand and with both hands. [Subjects] The study subjects were asymptomatic women 20–22 years of age. [Methods] The subjects sat in a chair with their feet on the floor and the elbow flexed, holding a smartphone positioned on the thigh. Subsequently, the subjects typed the Korean anthem for 3 min, one-handed or with both hands. Each subject repeated the task three times, with a 5-min rest period between tasks to minimize fatigue. Electromyography (EMG) was used to record the muscle activity of the upper trapezius (UT), extensor pollicis longus (EPL), and abductor pollicis (AP) during phone operation. We also used a dolorimeter to measure the pressure-induced pain threshold in the UT. [Results] We observed higher muscle activity in the UT, AP, and EPL in one-handed smartphone use than in its two-handed use. The pressure-induced pain threshold of the UT was lower after use of the smartphone, especially after one-handed use. [Conclusion] Our results show that smartphone operation with one hand caused greater UT pain and induced increased upper extremity muscle activity.

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[Purpose] This study examined the effects of ramp gait training using lower extremity patterns of proprioceptive neuromuscular facilitation (PNF) on chronic stroke patients’ dynamic balance ability. [Subjects and Methods] In total, 30 stroke patients participated in this study, and they were assigned randomly and equally to an experimental group and a control group. The experimental group received exercise treatment for 30 min and ramp gait training with PNF for 30 min. The control group received exercise treatment for 30 min and ground gait training for 30 min. The interventions were conducted in 30 min sessions, three times per week for four week. The subjects were assessed with the Berg balance scale test, timed up and go test, and functional reach test before and after the experiment and the results were compared. [Results] After the intervention, the BBS and FRT values had significantly increased and the TUG value had significantly decreased in the experimental group; however, the BBS, FRT, and TUG values showed no significant differences in the control group. In addition, differences between the two groups before the intervention and after the intervention were not significant. [Conclusion] In conclusion, ramp gait training with PNF improved stroke patients’ dynamic balance ability, and a good outcome of ramp gait training with PNF is also expected for other neurological system disease patients.

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[Purpose] The purpose of this study was to investigate a comprehensive understanding of the factors associated with falls in poststroke patients. [Subjects] Forty-eight stroke patients (22 males and 26 females; age 63.79 years) participated in this study. [Methods] This study applied a cross-sectional design. Fear of falling [Falls Efficacy Scale (FES)], balance function [Berg Balance Scale (BBS) and Modified Rivermead Mobility Index (MRMI)], ADL performance level [Modified Barthel Index (MBI)] and cognitive function [Loewenstein Occupational Therapy Cognitive Assessment for Geriatric Populations (LOTCA-G)] were assessed. [Results] Falls efficacy was moderately correlated with ADL performance, balance, and cognition. In addition, stepwise linear regression analysis revealed that ADL performance was the explanatory variable closely associated with falls efficacy in stroke patients. [Conclusion] ADL performance was the primary explanatory variable of falls efficacy according to regression analysis. Thus, we suggest that these results may be used as basic data for developing rehabilitation programs for prevention of falls in stroke patients.

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[Purpose] The five times-sit-to stand test (FTSTS) is a clinical test which is commonly used to assessed the functional muscle strength of the lower limbs of older adults. The aim of this study was to examine the effect of different arm positions and foot placements on the FTSTS completion times of older female adults. [Subjects and Methods] Twenty-nine healthy female subjects, aged 63.1±5.3 years participated in this cross-sectional study. The times required to complete the FTSTS with 3 different arm positions (hands on thighs, arms crossed over chest, and an augmented arm position with the arms extended forward) and 2 foot placements (neutral and posterior) were recorded. The interaction effect and main effect of arm positions and foot placements were examined using a 3 (arm position) × 2 (foot placement) two-way repeated measures analysis of variance (ANOVA). [Results] There was no interaction effect among the 3 arm positions in the 2 foot placements. A significant main effect was identified for foot placement, but not arm position. Posterior foot placement led to a shorter FTSTS time compared to that of normal foot placement. [Conclusion] With the same arm position, FTSTS completion times with posterior foot placement tended to be shorter. Therefore, the standard foot placement should be used for FTSTS administration.

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[Purpose] The aim of this study was to compare functional capacity and peripheral muscle strength in preterm children with bronchopulmonary dysplasia (BPD) with those of age-matched full-term healthy controls. [Subjects and Methods] Eighteen BPD subjects and 20 healthy subjects were enrolled in the study. Pulmonary function testing was performed. Body composition was determined using the skinfold method. An analysis of posture was scored. Muscle strength was evaluated using a dynamometer. Functional capacity was assessed using the six-minute walking test (6MWT). [Results] Pulmonary function testing parameters, 6MWT distance, and quadriceps strength of the children with BPD were significantly lower than those of healthy peers. The scores of posture analysis of the children with BPD were significantly higher than those of healthy subjects. Exercise heart rate was significantly higher in the children with BPD compared to healthy children. The 6MWT distance correlated with height, fat-free mass, exercise dyspnea perception, and hand grip strength in BPD children. [Conclusion] The study showed that preterm children with BPD had disturbed pulmonary and extrapulmonary characteristics. BPD had lower fat free mass, reduced lung function, worsen postural function, a shorter 6MWT distance, and lower quadriceps strength than healthy children. These features may provide insights into the choice of outcome measures for pulmonary rehabilitation for BPD.

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[Purpose] This study investigated the optimal thickness of the wheelchair backrest for lumbar load and increased comfort. [Subjects] Fifteen healthy people participated. [Methods] The study examined three randomized backrest conditions: no pad; a 3-cm-thick lumbar pad; and a 6-cm-thick lumbar pad. The location of the lumbar pad was standardized at the mid-lumbar level (L3). Participants were instructed to propel the wheelchair using only the handrims. [Results] Activation of the anterior deltoid, upper trapezius, and biceps brachii muscles was significantly reduced when the participants used the 3-cm pad compared to no pad, while it was significantly increased in the anterior deltoid, upper trapezius, posterior deltoid, and biceps brachii when the participants used the 6-cm pad compared to the 3-cm pad. Muscle activation did not differ significantly between the no pad and the 6-cm lumbar pad conditions. [Conclusion] A lumbar pad decreased the activation of the upper extremity muscles. We believe that padding of the appropriate thickness will lead to effective muscle activation while propelling a wheelchair and decrease the risk of musculoskeletal disease.

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[Purpose] Although previous studies have demonstrated several effects of sesamol on neurological diseases, its effects on ischemic stroke are unclear. We evaluated the direct effects of sesamol on infarcts and efficacy in terms of functional improvement in rats with transient middle cerebral artery occlusion (MCAO). [Subjects and Methods] Male Sprague Dawley rats (n = 30) were randomly divided into two groups: an MCAO with sesamol group and an MCAO group. MCAO was induced for 2 h, and sesamol was administered in the treatment group just after reperfusion. Infarct size was calculated 5 days after MCAO. Efficacy in function was assessed using a modified sticky-tape test (MST) and percent weight borne on the paretic leg during 5 days. [Results] Infarct volumes did not differ significantly between the two MCAO groups. The values of MST did not differ between the two MCAO groups. Based on the values of percent weight borne on the paretic leg, function of the hindlimb in the MCAO with sesamol group was significantly better than in the MCAO group throughout the experimental period. [Conclusion] These results demonstrate that sesamol induced functional improvements during 5 days after MCAO, and could be a useful addition to the therapeutic regimen for the treatment of ischemic stroke.

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[Purpose] This study compared the effects of Swiss ball exercise and resistance exercise on the respiratory function and trunk control ability of patients with scoliosis. [Subjects] Forty scoliosis patients were randomly divided into the Swiss ball exercise group (n= 20) and resistance exercise group (n = 20). [Methods] The Swiss ball and resistance exercise groups performed chest expansion and breathing exercises with a Swiss ball and a therapist’s resistance, respectively. Both groups received training 30 min per day, 5 times per week for 8 weeks. [Results] Both groups exhibited significant changes in forced vital capacity, forced expiratory volume in one second, and trunk impairment scale after the intervention. However, there was no significant change in the forced expiratory volume in one second/forced vital capacity ratio after the intervention in either group. Meanwhile, forced expiratory volume in one second and trunk impairment scale were significantly greater in the resistance exercise group after the intervention. [Conclusion] Both Swiss ball exercise and resistance exercise are effective for improving the respiratory function and trunk control ability of patients with scoliosis. However, resistance exercise is more effective for increasing the forced expiratory volume in one second and trunk control ability.

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[Purpose] This study investigated gait velocity and center of mass acceleration in three directions during square and semicircular turning gait tasks in old-old elderly women. [Subjects] Fifteen community-dwelling, old-old elderly women (≥75 years old) who could walk independently were recruited. [Methods] We measured gait velocity and center of mass acceleration in three directions using an accelerometer during two different turning gait tasks. [Results] The velocity during square turning was significantly slower than that during semicircular turning gait. There were no significant differences between gait tasks with respect to normalized antero-posterior, medo-lateral, or vertical center of mass acceleration. [Conclusion] Changing the direction of travel while walking regardless of turning angle is one of the greatest challenges for balance in old-old elderly people. Furthermore, gait velocity is a useful clinical marker for predicting falls in old-old elderly populations.

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[Purpose] There are various treatment modalities for fibromyalgia syndrome (FMS), which is characterized by widespread pain and fatigue. The aim of this study was to investigate the effects of aquatic, aerobic and isometric strength-stretching exercises on the physical and psychological parameters of patients with FMS. [Subjects and Methods] Seventy five female patients with FMS were randomly selected and divided into three groups. Patients (18–50 years) were treated for 3 months using one of three methods: a home-based isometric strength and stretching exercise program (ISSEP), a gym-based aerobic exercise program (AEP), and a pool-based aquatic aerobic exercise program (AAEP). Items evaluated were: the number of tender points, Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), the Six-Minute Walk Test (6MWT), SF-36 physical and mental health scores, and the Beck Depression Inventory (BDI). [Results] The results revealed that AAEP was the most effective treatment of the three. All of the groups showed significant improvements in all variables between pre-and post-test, except the mean values of VAS and BDI in ISSEP. [Conclusion] The results suggest that aquatic aerobic exercise program is more effective than AEP and ISSEP in the treatment of FMS.

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[Purpose] Degree of curvature on the spine is known to affect respiratory function and back muscle activation. We compared pulmonary function and back muscle strength according to the degree of curvature of the spine of healthy adults. [Subjects and Methods] Twenty-three healthy volunteers were enrolled. They were divided into two groups according to the degree of curvature of the spine: the below 2° group, and the above 2° group. The degree of curvature was assessed using the Adams forward bending test and a scoliometer. A pulmonary function test (PFT) was conducted, and back muscle strength was measured. [Results] No significant differences in PFT were found between the below 2° group and the above 2° group, in terms of forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), ratio of forced expiratory volume in one second to forced vital capacity (FEV₁/FVC), or peak expiratory flow (PEF). However, back muscle strength in the below 2 group was significantly higher than that of the above 2 group. [Conclusion] Our findings indicate that the degree of curvature of the spine is associated with back muscle strength in subjects who have spinal curvature within the normal range. Therefore, evaluation and treatment of back muscle strength might be helpful for preventing the progress of curvature of the spine in adolescents with potential scoliosis.

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[Purpose] The present study investigated the effect of an exercise program for posture correction on musculoskeletal pain. [Subjects] Between September 2, 2013 and November 3, 2013, an exercise program was performed in 88 students from S University in K city (male students, n = 34; female students, n = 54). [Methods] The exercise program for posture correction was performed for 20 minutes per session, 3 times a week for 8 weeks. Pain levels were measured using a pain scale, and pain levels before and after the exercise program were compared. [Results] Overall, pain levels of the participants were lower after the exercise program than before the program, and significant differences in pain levels were noted in the shoulders, middle back, and lower back. [Conclusion] In conclusion, shoulder pain, mid back pain, and low back pain were relieved with the exercise program for posture correction. Therefore, the findings of this study can be used to improve the work efficiency of students as well as people engaged in sedentary work.

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[Purpose] The purpose of this study was to determine the relationship between navicular drop and plantar flexion torque of the first and second-fifth metatarsophalangeal joints. [Subjects] Ten healthy young men participated in this study. [Methods] The Pearson product-moment correlation coefficient was calculated to determine the relationship between navicular drop and plantar flexion torque of the first and second-fifth metatarsophalangeal joints. [Results] Significant negative correlations were observed between navicular drop and plantar flexion torques in the lengthened position of the intrinsic toe plantar flexion muscles, but no correlations were found between navicular drop and plantar flexion torques in the neutral position of the ankle and metatarsophalangeal joints. Moreover, the intrinsic toe plantar flexion muscles were found to contribute to the formation of the medial longitudinal arch. [Conclusion] Navicular drop correlates with metatarsophalangeal joint muscle strength in plantar flexion where the intrinsic toe muscles are capable of exerting force.

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[Purpose] The purpose of this study was to examine the intra- and inter-rater reliabilities of lower extremity muscle strength assessment of healthy adults using hand held dynamometer. [Subjects and Methods] A total of 55 students (19 males and 36 females) in Y University in Gyeongsangnam-do, South Korea participated in this study. Lower extremity muscle strength was measured using a hand-held dynamometer (Commander Muscle Tester, JTech, USA). Flexion and extension strengths of the hip joint, the knee joint, and the ankle joint were measured. [Results] The intra-rater reliabilities were excellent (above 0.9) for the flexion and extension strengths of the ankle, knee, and hip joints. The inter-rater reliabilities were also excellent (above 0.8) for the flexion and extension strengths of the ankle, knee, and hip joint. [Conclusion] Lower extremity muscle strength assessment using a hand-held dynamometer provided consistent results when conducted by different examiners and when measured several times. Therefore, this method is a useful way of deriving objective and quantitative measurement values.

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[Purpose] The purpose of this study was to determine the normal range of the side-to-side difference in three dimensional knee kinematics measured by the point cluster technique (PCT). [Subjects] The subjects were twenty-one healthy normal volunteers without knee pain or an episode of injury to the legs. [Methods] The subjects were tested bilaterally at a self-selected normal walking speed and six degrees of freedom knee kinematics were measured using the PCT, and the 95% confidence intervals of the average side-to-side differences in flexion-extension (FE), adduction-abduction (AA), internal-external (IE) rotation, and anterior-posterior (AP), medial-lateral (ML), superior-inferior (SI) translation in each stage of the gait cycle were determined. [Results] The average side-to-side differences and their 95% confidence intervals in rotation/translation in each stage of the gait cycle were determined. The side-to-side differences in AA rotation and AP translation of the tibia were significantly larger in the swing phase than in the stance phase. [Conclusion] The side-to-side differences in AA rotation and AP translation were highly dependent on the stage of the gait cycle. Therefore, the normal ranges of the side-to-side differences in knee kinematics in each stage of the gait cycle, in particular AA rotation and AP translation of the tibia, is useful information for evaluating knee kinematics during walking.

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[Purpose] This study investigated the effects of purposeful action observation on upper extremity kinematic patterns in individuals with hemiplegia. [Subjects and Methods] Twelve patients were recruited in accordance with the inclusion criteria. The experimental group (n=6) was trained with a purposeful action observation program. The control group (n=6) was trained with only purposeful action without action observation. The programs were performed 30 min/session, 5 times per week for 30 sessions in 6 weeks of training. Upper extremity kinematic patterns were measured by a 3-dimensional motion analysis system before and after training, and the results were analyzed. [Results] The experimental group and the control group showed improvements in average velocity, trajectory ratio, and movement degree, but no statistically significant differences were observed between the groups. The experimental group showed statistically significant improvements in average velocity, trajectory ratio after the intervention. The experimental group also showed an improvement in movement degree, but the post-intervention difference was not significant. [Conclusion] The results of this study show that purposeful action observation training program improved the average velocity and trajectory ratio of stroke patients. Further research should enroll more subjects divided into more specific groups for treatment.

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[Purpose] The purpose of this study was to elucidate changes in balance strategy during pregnancy from a kinematics perspective. [Subjects] Eight pregnant women and eight non-pregnant women participated. [Methods] A 3D motion analysis system, two force plates, and 10 infrared cameras were used to measure the kinematics of the balance strategy. The 3D motion analysis system was used to analyze performance of the functional reach test (FRT). Parameters were compared between non-pregnant women and pregnant women during each trimester, and between pregnant women in the second and third trimesters. [Results] The FRT of pregnant women was shorter than that of non-pregnant women. Bilateral hip joint extension moments were smaller in pregnant women in the second and third trimesters compared to non-pregnant women. Bilateral ankle plantar flexion moments were larger in pregnant women in their third trimester compared to non-pregnant women. In pregnant women, the right ankle plantar flexion moment was larger in the third trimester than in the second trimester. [Conclusion] These results suggest that forward reach distance is reduced, and that the ankle joint strategy takes precedence over the hip joint strategy in maintaining balance during pregnancy compared to non-pregnancy.

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[Purpose] The purpose of this study was to investigate whether the occurrence of cardiac-locomotor synchronization (CLS) improves lower leg muscle blood perfusion during walking. [Subjects and Methods] Eleven healthy men were studied while performing two treadmill protocols. The CLS protocol involved subjects walking at the frequency of their heart rate (HR) to induce CLS. The free protocol (reference) involved subjects walking at a self-selected cadence. The treadmill load was identical in the two protocols. Electrocardiographic signals for HR, foot switch signals for step rate and near-infrared spectroscopy (NIRS) signals for total haemoglobin (total Hb) in the lower leg muscles were measured continuously for 10 min after HR reached a steady state. [Results] The mean HR and mean step rate did not differ between the CLS and free protocols. However, total Hb was significantly higher in the CLS protocol than in the free protocol. The rate of increase in total Hb positively correlated with the strength of CLS. [Conclusion] These results suggest that the occurrence of CLS enhances lower leg muscle blood perfusion by increasing the strength of CLS during walking.

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[Purpose] The purpose of this study was to determine the effects of chewing gum on driving performance in a driving simulator. [Subjects] In total, 26 young licensed drivers participated. [Methods] The driving scenario was typical of an urban environment: a single-carriageway, two-way road consisting of a mix of curved and straight sections, with considerable levels of traffic, pedestrians, and parked cars. Mean distance driven above the speed limit, lane position, mean distance driven across the center line, and mean distance driven off the road were used as estimates of brake, accelerator, and steering control. The results were compared with those of a non-chewing gum control condition. [Results] The driving performance while chewing gum was significantly better: the mean distance driven above the speed limit was 26.61% shorter, and the mean distance driven off the road was 31.99% shorter. Lane position and mean distance driven across the center line did not differ significantly between the two conditions. [Conclusion] Chewing gum appears to enhance driving performance during a sustained attention driving task.

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[Purpose] To report perceptions about the importance and use of therapeutic massage as a treatment modality among physical therapists working in Saudi Arabia. [Subjects and Methods] A 21-item structured questionnaire was used to assess various domains including the demographic and professional characteristics of physical therapists and their perceptions about the importance and use of therapeutic massage in their daily practice. The questionnaire was uploaded online and the web link was sent to 140 members of the Saudi Physical Therapy Association (SPTA). [Results] The overall response rate was 86%. Among the respondents, 31% reported occasional use of therapeutic massage in their clinical practice, and 55% reported to have received formal training for therapeutic massage. Use of therapeutic massage was more common among female physical therapists. [Conclusion] Many physical therapists working in Saudi Arabia consider therapeutic massage to be an important treatment modality, but its use is relatively limited, either due to the time and effort required to dispense it, or the lack of scientific evidence for its efficacy.

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[Purpose] This study examined the relationships between joint moment and the control of the vertical ground reaction force during walking in the elderly and young male and female individuals. [Subjects and Methods] Forty elderly people, 65 years old or older (20 males and 20 females), and 40 young people, 20 to 29 years old (20 males and 20 females), participated in this study. Joint moment and vertical ground reaction force during walking were obtained using a 3D motion analysis system and force plates. Stepwise linear regression analysis determined the joint moments that predict the amplitude of the vertical ground reaction force. [Results] Knee extension moment was related to the vertical ground reaction force in the young males and females. On the other hand, in the elderly females, hip, ankle, and knee joint moments were related to the first peak and second peak forces, and the minimum value of vertical ground reaction force, respectively. [Conclusion] Our results suggest that the young males and females make use of the knee joint moment to control of the vertical ground reaction force. There were differences between the elderly and the young females with regard to the joints used for the control of the vertical ground reaction force.

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[Purpose] This study investigated the intra-rater, inter-rater and test-retest reliability of the sideways step test (SST), its correlation with other indicators of stroke-specific impairment, and the cut-off count best discriminating subjects with stroke from their healthy counterparts. [Subjects and Methods] Forty-three subjects with chronic stroke and 41 healthy subjects older than 50 years participated in this study. The SST was administered along with the Fugl-Meyer motor assessment for the lower extremities (FMA-LE), the five-times sit to stand (5TSTS) test, the Berg Balance Scale (BBS), the movement velocity (MVL) by the limits of stability (LOS) test, the ten-metre walk (10mW) test, the timed “Up and Go” (TUG) test and the Activities-specific Balance Confidence (ABC) scale. [Results] The SST showed good to excellent intra-rater, inter-rater and test-retest reliability. The SST counts correlated with 5TSTS times, 10mW times, TUG times, and the FMA-LE and BBS scores. SST counts of 11 for the paretic leg and 14 for the non-paretic leg were found to distinguish the healthy adults from subjects with stroke. [Conclusion] The sideways step test is a reliable clinical test, which correlates with the functional strength, gait speed, and functional balance of people with chronic stroke.

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[Purpose] The purpose of this study was to examine the influence of the cervical flexion angle when using a smart phone on muscle fatigue of the cervical erector spinae (CES) and upper trapezius (UT). [Subjects] This study recruited 12 healthy adults. [Methods] Each subject sat on a chair, with his/her back against the wall and held a smart phone with both hands. Fatigue of the neck and shoulder muscles at different cervical flexion angles (0°, 30°, and 50°) was measured by electromyography. The following muscles were assessed: the right upper trapezius (RtUT), left upper trapezius (LtUT), right cervical erector spinae (RtCES), and left cervical erector spinae (LtCES). A cervical range of motion instrument was attached to the subjects’ heads to measure the cervical angle during the experiment. [Results] The RtUT and LtUT showed the highest muscle fatigue at a cervical flexion angle of 50° and the lowest fatigue at an angle of 30°. There was no significant difference in the muscle fatigue of the RtCES and LtCES at any of the cervical flexion angles. [Conclusion] UT muscle fatigue depends on the cervical flexion angle when using a smart phone.

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[Purpose] To determine the effects of cervical sustained natural apophyseal glide on forward head posture and respiratory function. [Subjects and Methods] Thirty male and female adults in their 20s with forward head posture were included in the study. The subjects were divided randomly into experimental and control groups (n=15 each). Subjects in the experimental group performed cervical sustained natural apophyseal glide three times/week for four weeks while subjects in the control group did not perform the intervention. The craniovertebral angle, forced vital capacity and forced expiratory volume in the first second, as well as the % predicted value of each measurement were assessed to determine the changes in respiration functions before and after the exercise. [Results] The craniovertebral angle four weeks after the experiment was increased in the experimental group, whereas the control group showed no significant difference compared to baseline. The forced vital capacity, forced expiratory volume in the first second, and the % predicted values thereof were significantly increased in the experimental group four weeks after the experiment, but not in the control group. [Conclusion] Cervical sustained natural apophyseal glide was determined to be effective in improving neck posture and respiratory functions for patients with forward head posture.

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[Purpose] This study aimed to evaluate the effect of in-hospital physical activity on patient prognosis after lower extremity bypass surgery for peripheral arterial disease. [Subjects and Methods] A total of 13 patients (16 limbs; 11 males and 2 females; mean age [standard deviation], 72.8 [5.9] years) who underwent lower extremity bypass surgery for Fontaine stage 2 peripheral arterial disease were included in this study and assigned to either an active group (n = 6) to perform increased physical activity after surgery or an inactive group (n = 7) to perform decreased physical activity after surgery. Daily in-hospital physical activity levels were measured continuously with a triaxial accelerometer. The occurrence of adverse cardiovascular events within a 2 year follow-up period was compared between groups. [Results] At discharge, the patients in the active group were able to walk more steps daily than those in the inactive group. The incidence of adverse events was 16.7% in the active group and 71.4% in the inactive group. [Conclusion] A higher in-hospital physical activity level was associated with a better long-term prognosis after lower extremity bypass surgery in patients with peripheral arterial disease.

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[Purpose] This study investigated the effect of stepper exercise with visual feedback on strength, walking, and stair climbing in stroke patients. [Subjects] Twenty-six stroke patients were divided randomly into the stepper exercise with visual feedback group (n = 13) or the stepper exercise group (n = 13). [Methods] Subjects in the experimental group received feedback through the mirror during exercise, while those in the control group performed the exercise without visual feedback; both groups exercised for the 30 min thrice per week for 6 weeks. The hip extensor and knee extensor strength, 10-m walking test results, and 11-step stair climbing test results were evaluated before and after the intervention. [Results] The stepper exercise with visual feedback group showed significantly greater improvement for hip extensor strength and the 10-m walking test. The knee extensor strength and 11-step stair climbing in both groups showed significantly greater improvement after the intervention, but without any significant difference between groups. [Conclusion] The findings of this study indicate that the stepper exercise with visual feedback can help improve the strength of the hip extensor and the 10-m walking test; the stepper exercise alone may also improve the knee extensor strength and stair climbing ability.

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