[Purpose] The effect of duration of smartphone use on neck and shoulder muscle fatigue and pain was investigated in adults with forward head posture. [Subjects and Methods] Thirty-four adults with forward head posture were classified into groups by duration of smartphone use: 11 used a smartphone for 10 minutes each (group 1), 12 for 20 minutes each (group 2), and 11 for 30 minutes each (group 3). Fatigue cervical erector spinae and upper trapezius muscles was measured by electromyography, and pain before and after the experiment was evaluated using Visual Analog Scale (VAS) scores. [Results] There was a significant difference in the degree of fatigue in the left upper trapezius muscles in group 2 and left cervical erector spinae and bilateral upper trapeziuses group 3. There was a significant difference in fatigue in the left upper trapezius in groups 1 and 3. The VAS showed significant differences in all groups before and after the experiment and between groups 1 and 3. [Conclusion] Pain and fatigue worsened with longer smartphone use. This study provided data on the proper duration of smartphone use. Correct posture and breaks of at least 20 minutes are recommend when using smartphones.

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[Purpose] The purpose of this study was to evaluate the immediate effect of stabilizing exercise using the PNF technique on standing balance in one-leg and double-leg stances. [Subjects and Methods] The present study recruited 34 healthy participants from a local university. The Participants performed four balance tests (double-leg stance with and without vision, one-leg stance with and without vision), before and after exercise. The exercise consisted of exercises performed using PNF techniques (stabilizing reversal and rhythmic stabilization), which were applied to facilitate trunk musculature. To examine balance ability, total displacement of the center of pressure was measured during balance tests. [Results] The total anterior–posterior center of pressure displacement was significantly reduced after applying rhythmic stabilization compared before exercise regardless of the balance test conditions. [Conclusion] The present results suggest that trunk stability exercise using rhythmic stabilization could effectively enhance balance ability under one-leg and double-leg conditions.

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[Purpose] The purpose of this study was to evaluate the relationship between malalignment and lower-extremity injury and to determine the optimal dynamic alignment of the lower extremity with wall squats. [Subjects and Methods] Healthy individuals from one therapy school were enrolled and assigned to a wall squat normal or abnormal group based on their forms during wall squats. The abnormal group was found to be more prone to lower-extremity injury on three-dimensional motion analysis. Eight students from each group were randomly chosen for the study. The effects of single-leg landing movements were assessed using three-dimensional motion analysis. [Results] In the sagittal plane, significant flexion of the hip and knee joints occurred 0.02 and 0.04 seconds after initial foot contact with the ground in the normal and abnormal groups, respectively. In the frontal plane, significant adduction of the hip joint occurred at 0.07 seconds in the abnormal group. [Conclusion] The abnormal group tended to display later flexion of the hip and knee joints and narrower hip, knee, and ankle range of motion than the normal group, suggesting that dynamic alignment of the lower extremity in the abnormal group likely made them susceptible to injury.

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[Purpose] Elderly smokers have a reduced chest diameter due to weakening of the respiratory muscles, and this results in decreased ventilation, leading to a vicious circle. Therefore, the present study investigated the effects of an intervention program to enhance the pulmonary function and muscle activity of elderly smokers. [Subjects and Methods] Participants were randomly assigned to one of two experimental groups or a control (CG) group. The experimental groups performed exercises three times per week for six weeks, whereas the CG performed no exercises. One of the experimental groups performed a Feedback Breathing Exercise (FBE) for 15 minutes, and the other repeated three sets of Balloon-Blowing Exercises (BBE) with sufficient rest of more than one minute between sets. [Results] In the experimental groups, FVC, FEV1/FVC, PEF and muscle activity of the rectus abdominis significantly improved after four weeks, but no significant differences were observed in FEV1 or VC after six weeks. [Conclusion] The results show that FBE and BBE improved the pulmonary functions of elderly smokers, demonstrating the potential benefits of the development of various training methods using balloons, and group programs, including recreational factors, for increasing respiratory muscles strength.

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[Purpose] The aim of this study was to identify the contributions of balance to gait and motor function in chronic stroke. [Subjects and Methods] Twenty-three outpatients participated in a cross-sectional assessment. Gait ability was assessed using the functional ambulation category, self-paced 10-m walking speed, and fastest 10-m walking speed. Standing balance and trunk control measures included the Berg Balance Scale and the Trunk Impairment Scale. Univariate and multivariate regression analyses were performed. [Results] Balance was the best predictor of the FAC, self-paced walking speed, and fastest walking speed, accounting for 57% to 61% of the variances. Additionally, the total score of TIS was the only predictor of the motor function of the lower limbs and the dynamic balance of TIS was a predictor of the motor function of the upper limbs, accounting for 41% and 29% of the variance, respectively. [Conclusion] This study demonstrated the relative contribution of standing balance and trunk balance to gait ability and motor function. They show that balance has a high power of explanation of gait ability and that trunk balance is a determinant of motor function rather than gait ability.

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[Purpose] This study attempted to examine whether Pilates is an effective exercise for improving the postural alignment and health of middle-aged women. [Subjects and Methods] The participants in this study were 36 middle-aged women (20 in the experimental group, 16 in the control group). The experimental group participated in Pilates exercise sessions three times a week for 12 weeks. Body alignment and composition measurements before and after applying the Pilates exercise program were performed with a body composition analyzer and a three-dimensional scanner. [Results] Postural alignment in the sagittal and horizontal planes was enhanced in the Pilates exercise group. Trunk alignment showed correlations with body fat and muscle mass. [Conclusion] The Pilates exercises are performed symmetrically and strengthen the deep muscles. Moreover, the results showed that muscle mass was correlated with trunk postural alignment and that the proper amount of muscle is critical in maintaining trunk postural alignment.

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[Purpose] The aim of the study was to investigate the relationships between femoral anteversion and functional balance and postural control in children with spastic cerebral palsy. [Subjects and Methods] Twenty children with spastic cerebral palsy (mean age=12.4 ± 4.5) with grosss motor functional classification system levels I, II, and III were recruited for this study. Functional balance was evaluated using the Pediatric Balance Scale, postural control was evaluated using the Trunk Control Measurement Scale, and femoral anteversion was assessed with a handheld goniometer using the great trochanter prominence method. [Results] The results indicated that there was significant correlation between femoral anteversion and Trunk Control Measurement Scale dynamic reaching score. There were no significant correlation between femoral anteversion and the Trunk Control Measurement Scale static sitting balance, Trunk Control Measurement Scale selective movement control, total Trunk Control Measurement Scale and Pediatric Balance Scale results. [Conclusion] Increased femoral anteversion has not correlation with functional balance, static sitting, and selective control of the trunk. Femoral anteversion is related to dynamic reaching activities of the trunk, and this may be the result of excessive internal pelvic rotation. It is important for the health professionals to understand that increased femoral anteversion needs to be corrected because in addition to leading to femoral internal rotation during walking, it also effects dynamic reaching activities of spastic children with cerebral palsy.

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[Purpose] To investigate the inter-rater and test-retest reliability of the sitting-rising test (SRT), the correlations of sitting-rising test scores with measures of strength, balance, community integration and quality of life, as well as the cut-off score which best discriminates people with chronic stroke from healthy older adults were investigated. [Subjects and Methods] Subjects with chronic stroke (n=30) and healthy older adults (n=30) were recruited. The study had a cross-sectional design, and was carried out in a university rehabilitation laboratory. Sitting-rising test performance was scored on two occasions. Other measurements included ankle dorsiflexor and plantarflexor strength, the Fugl-Meyer assessment, the Berg Balance Scale, the timed up and go test, the five times sit-to-stand test, the limits of stability test, and measures of quality of health and community integration. [Results] Sitting-rising test scores demonstrated good to excellent inter-rater and test-retest reliabilities (ICC=0.679 to 0.967). Sitting-rising test scores correlated significantly with ankle strength, but not with other test results. The sitting-rising test showed good sensitivity and specificity. A cut-off score of 7.8 best distinguished healthy older adults from stroke subjects. [Conclusions] The sitting-rising test is a reliable and sensitive test for assessing the quality of sitting and rising movements. Further studies with a larger sample are required to investigate the test’s validity.

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[Purpose] This study evaluated the differences in the flexion-relaxation phenomenon (FRP) of the right and left erector spinae muscles in asymptomatic subjects and the effect of lumbar stabilization exercises on these differences. [Subjects and Methods] Twenty-six participants (12 in the exercise group and 14 in the control group) with a difference in the FRP in the right and left erector spinae muscles were recruited from among healthy students attending Silla University. The exercise group performed two lumbar stabilization exercises (back bridge exercise and hand-knee exercise) for 4 weeks. The control group did not exercise. [Results] No significant group-by-exercise interaction was found. The right and left erector spinae muscles did show a difference in FRP between the control and exercise groups (119.2 ± 69.2 and 131.1 ± 85.2 ms, respectively). In addition, the exercise group showed a significant decrease in post-exercise (50.0 ± 27.0 ms) compared to pre-exercise (112.3 ± 41.5 ms) differences in the right and left FRP. [Conclusion] These results suggest that lumbar stabilization exercises may counter asymmetry of the FRP in the erector spinae muscles, possibly preventing low back pain in the general population.

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[Purpose] This study was performed to evaluate the occupational performance of stroke patients and their environment by occupational self-assessment and to investigate the relationship between occupational performance and well-being. [Subjects and Methods] This study enrolled ninety-two stroke patients who were receiving occupational therapy at a general hospital, a rehabilitation hospital, or a community welfare center in the cities of Busan and Gimhae, Republic of Korea. Occupational performance and well-being were investigated with Occupational Self-Assessment Version 2.2 and the Personal Well-being Index-Adult. [Results] Analysis of the correlation between occupational performance as assessed by the “Myself” and “My Environment” sections of Occupational Self-Assessment Version 2.2 and well-being revealed moderate positive correlation for both sections. [Conclusion] The relationship between occupational performance and well-being was identified. Further studies are needed to reveal whether improvement of occupational performance could affect well-being in various dimensions.

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[Purpose] The Safe Driving Behavior Measure (SDBM) is a self-report measurement tools that assesses the safe-driving behaviors of the elderly. The purpose of this study was to evaluate the test-retest reliability of the SDBM among community-dwelling elderly drivers. [Subjects and Methods] A total of sixty-one community-dwelling elderly were enrolled to investigate the reliability of the SDBM. The SDBM was assessed in two sessions that were conducted three days apart in a quiet and well-organized assessment room. That test-retest reliability of overall scores and three domain scores of the SDBM were statistically evaluated using intraclass correlation coefficients [ICC (2.1)]. Pearson correlation coefficients were used to quantify bivariate associations among the three domains of the SDBM. [Results] The SDBM demonstrated excellent rest-retest reliability for community-dwelling elderly drivers. The Cronbach alpha coefficients of the three domains of person-vehicle (0.979), person-environment (0.944), and person-vehicle-environment (0.971) of the SDBM indicate high internal consistency. [Conclusion] The results of this study suggest that the SDBM is a reliable measure for evaluating the safe- driving of automobiles by community-dwelling elderly, and is adequate for detecting changes in scores in clinical settings.

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[Purpose] This study analyzed the acute effects of infrared and neural mobilization on the median nerve on the range of elbow extension of the dominant limb. [Subjects and Methods] Forty participants from university, neurologically asymptomatic, 12 males and 28 females (22.8 ± 1.9 years), were randomly divided into four groups: Group 1 (control) rested for 25 minutes in the supine position; Group 2 received the specific neural mobilization for the median nerve; Group 3 received an application of infrared for 15 minutes on the forearm; Group 4 received the same application of infrared followed by neural mobilization. The goniometric parameters of elbow extension were evaluated after the intervention. [Results] Significant differences of extension value were observed between Group 1 and Group 3 (15.75 degrees), and between Group 1 and Group 4 (14.60 degrees), and the average higher in Group 3 (26.35 degrees). [Conclusion] This research provides new experimental evidence that NM in relation to superficial heat produces an immediate effect on elbow range of motion versus NM isolated.

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[Purpose] Based on the Starkstein Apathy Scale, an apathy scale was developed for home-care patients with Parkinson’s disease using structural equation modeling (SEM), with which the data compatibility of extraction factors can be verified. [Subjects and Methods] The participants were 122 home-care patients with Parkinson’s disease (mean age: 70.9 ± 7.8 years) who were member of the Aomori branch or Tohoku/Hokkaido block of the Japan Parkinson’s Disease Association. A questionnaire survey (anonymous, self-administered) was carried out by distributing and collecting questionnaires by mail or a collective survey at a workshop. Construct validity was evaluated by confirmatory factor analysis using SEM. Internal consistency was investigated using Cronbach’s alpha coefficient. Criterion-related validity was assessed by correlation analysis with the total score of the Beck Depression Inventory. [Results] Concerning construct validity, 11 of the 14 question items of the original scale were extracted. Cronbach’s α of this scale was 0.939. For criterion-related validity, Spearman’s rank correlation coefficient was 0.831. [Conclusion] The construct validity, internal consistency, and criterion-related validity of the 11-item apathy scale were confirmed. The 11-item apathy scale can serve as a useful tool for the efficient and effective assessment of rehabilitation, establishment of rehabilitation goals and programs for patients with Parkinson’s disease.

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[Purpose] The purpose of this study was to adapt the Lymphoedema Functioning, Disability and Health Questionnaire into the Turkish language, and to evaluate the psychometric properties of the Turkish version in patients with breast cancer-related lymphedema. [Subjects and Methods] After the translation, inter-rater and test-retest reliability were assessed between patients and physiotherapists using the intra-class correlation coefficient. Thirty patients with breast cancer-related lymphedema were asked to fill out the Turkish version of the Lymphoedema Functioning, Disability and Health Questionnaire two times, one week apart. Internal consistency was tested using Cronbach’s alpha, and the test-retest reliability was assessed by calculating the intra-class correlation coefficient. Construct validity was investigated by comparing the results of the Lymphoedema Functioning, Disability and Health and Short Form-36 questionnaires. [Results] The test-retest reliability and inter-tester reliability of the Lymphedema Functioning, Disability and Health Questionnaire total score, physical function score, mental function score, household activities score, mobility activities score, life and social activities score were excellent. [Conclusion] The Turkish version of the Lymphoedema Functioning, Disability and Health Questionnaire was found to be valid and reliable for patients with breast cancer related lymphedema.

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[Purpose] This study performed to investigate the effect of elastic band exercise program on the posture of subjects with rounded shoulder and forward head posture. [Subjects and Methods] The body length, forward shoulder angle, craniovertebral angle, and cranial rotation angle of participants (n=12) were measured before and after the exercise program. Furthermore, the thicknesses of the pectoralis major, rhomboid major, and upper trapezius were measured using an ultrasonographic imaging device. The exercises program was conducted with elastic bands, with 15 repetitions per set and 3 sets in total. [Results] The length of the pectoralis major, forward shoulder angle, and craniovertebral angle showed significant changes between before and after the exercise program, whereas the changes in the other measurements were not significant. The thickness of the upper trapezius showed a significant increase between before and after the elastic band exercise. [Conclusion] These findings suggest that the elastic band exercise program used in the study is effective for lengthening the pectoralis major and correcting rounded shoulder and forward head posture.

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[Purpose] This study investigated the effect of exhalation exercises on trunk muscle activity and Oswestry Disability Index by inducing trunk muscle activity through increasing intra-abdominal pressure and activating muscles, contributing to spinal stability. [Subjects and Methods] This intervention program included 20 male patients with chronic low back pain. A total of 10 subjects each were randomly assigned to an exhalation exercise group as the experimental group and a spinal stabilization exercise group as the control group. [Results] There were significant differences in the activities of the rectus abdominis, transverse abdominis, external oblique abdominal, and erector spinae muscles as well as in the Oswestry Disability Index within the experimental group. There were meaningful differences in the activities of the rectus abdominis, external oblique abdominal, and erector spinae muscles and in the Oswestry Disability Index within the control group. In addition, there was a meaningful intergroup difference in transverse abdominis muscle activity alone and in the Oswestry Disability Index. [Conclusion] The breathing exercise effectively increased muscle activity by training gross and fine motor muscles in the trunk. Moreover, it was verified as a very important element for strengthening body stability because it both released and prevented low back pain.

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[Purpose] The aim of this study was to compare the differences in recovery periods after maximal concentric and eccentric exercises. [Subjects and Methods] Twenty-two participants voluntarily participated and were divided into two groups: the athlete and sedentary groups. An incremental treadmill running test was performed until exhaustion. During the subsequent passive recovery session, heart rate and venous blood lactate level were determined every 3 minutes until the venous blood lactate level reached 2 mmol/l. The same test protocol was implemented 15 days later. [Results] Both groups showed significantly shorter running durations in concentric exercise, while significant differences were found between the athlete and sedentary groups in terms of venous blood lactate level responses. In addition, there were significant differences between the athlete and sedentary groups in terms of running duration and heart rate in concentric and eccentric exercises. [Conclusion] The present study revealed no difference between the athlete and sedentary groups in terms of recovery durations after eccentric and concentric loadings, although the athletes demonstrated faster recovery in terms of HR compared with the sedentary group. It was thought that concentric exercises cause greater physiological responses.

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[Purpose] Several action observation/imagery training studies have been conducted in patients with limited physical activity showing improvements in motor function. However, most studies compared effects of action observation and imagery, so little is known about the changes caused by subsequent observation of target objects. Moreover, few studies analyzed brain wave changes in the EEG mu rhythm. [Subjects and Methods] Eighteen healthy female adults participated in this study, and were divided into two groups: ‘Visual Stimuli’ and ‘Non-Visual Stimuli’. EEG amplitude in the 8–13 Hz frequency band over the sensorimotor cortex was evaluated. [Results] Significant mu suppression was obtained in the action observation trials. Mu power showed a main effect of visual stimuli, with decreased power during action observation, and increased power post-observation in both conditions. Comparing the ‘Visual Stimuli’ and ‘Non-Visual Stimuli’ conditions during the post-observation period, mu power demonstrated a greater increase in the ‘Non-Visual Stimuli’ condition. Furthermore, mu power was lower post-observation than pre-observation. [Conclusion] These results show the effects of visual input between maintaining target objects and no visual input, and their relevance to modulations of the mirror neuron system. It also suggests that greater visual input may be more effective for cognitive rehabilitation.

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[Purpose] Osteoporosis is an inflammatory disease, and platelets play a critical role in bone remodeling. Mean platelet volume has been shown to be influenced by inflammation. Our aim was to evaluate the relationship between mean platelet volume and bone mineral density in postmenopausal women. [Subjects and Methods] The records of female patients who had been referred to a tertiary hospital for bone mineral density analysis were retrospectively reviewed. [Results] A total of 175 patients (mean age: 61.3 ± 9.0 years) were enrolled. Overall, 72% (126/175) of patients met the criteria for osteoporosis. Mean platelet volume was found to be inversely correlated with body mass index. There was a significant positive correlation between mean platelet volume and femoral neck bone mineral density in our normal weight osteoporotic group, whereas there was a significant negative correlation in our overweight-obese osteoporotic group. The negative correlation between mean platelet volume and femoral neck bone mineral density in the overweight-obese osteoporotic group persisted after adjustment for confounding factors. Multivariate analyses revealed that mean platelet volume was significantly associated with femoral neck bone mineral density in osteoporotic patients in both our normal weight and overweight-obese groups. [Conclusion] Regardless of mechanisms, mean platelet volume might be used as a biomarker for osteoporosis in clinical settings.

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[Purpose] Working while sitting for long periods can cause lumbar pain, fatigue, and reduced work efficiency. How a dynamic chair with a seat that moves three-dimensionally affects pelvic mobility before and after work, work efficiency, and post-work fatigue were examined. [Subjects and Methods] Subjects were 17 healthy adults (10 males, 7 females, mean age 21.8 ± 2.7 years). Subjects performed a 30-min Kraepelin test under two conditions: sitting in a standard office chair and sitting in a dynamic sitting balance chair. Root mean square (RMS) values of pelvic movement measured by a triaxial accelerometer during 30 minutes of work, finger-floor distance before and after work, lumbar fatigue, and pelvic movement RMS values during finger-floor distance measurement were used as outcome measures. [Results] Pelvic movement RMS values collected every 5 minutes during 30 minutes of work were significantly higher while sitting in the dynamic balance chair. Changes in pelvic movement RMS values during finger-floor distance measurement after work and amount of work performed during 30 minutes were significantly higher and lumbar fatigue was significantly lower for the dynamic balance chair. [Conclusion] Dynamic sitting maintained or increased pelvic flexibility. The dynamic balance chair may effectively help workers work continuously in seated postures with little fatigue.

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[Purpose] The purpose of this study was to investigate the effects of aerobic exercise on the resting heart rate, physical fitness, and arterial stiffness or female patients with metabolic syndrome. [Subjects and Methods] Subjects were randomly assigned to an exercise group (n=12) or a control group (n=11). Subjects in the exercise group performed aerobic exercise at 60–80% of maximum heart rate for 40 min 5 times a week for 12 weeks. The changes in metabolic syndrome risk factors, resting heart rate, physical fitness, and arterial stiffness were measured and analyzed before and after initiation of the exercise program to determine the effect of exercise. Arterial stiffness was assessed based on brachial-ankle pulse wave velocity (ba-PWV). [Results] Compared to the control group; The metabolic syndrome risk factors (weight, % body fat, waist circumference, systolic blood pressure, diastolic blood pressure, and HDL-Cholesterol) were significantly improved in the exercise: resting heart rate was significantly decreased; VO₂max, muscle strength and muscle endurance were significantly increased; and ba-PWV was significantly decreased. [Conclusion] Aerobic exercise had beneficial effects on the resting heart rate, physical fitness, and arterial stiffness of patients with metabolic syndrome.

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[Purpose] This study investigated the effects of visual stimulus using central and peripheral vision fields on postural control. [Subjects and Methods] The subjects consisted of 40 young adult volunteers (15 males, 25 females) who had been informed of the study purpose and procedure. The subjects were randomly divided into four groups of differing visual stimulus. Each group was given visual intervention in a standing position for 3 minutes. Postural control was evaluated before and after visual intervention. [Results] The results of the functional reach test and body sway test showed significant differences among the four groups. [Conclusion] The two-way peripheral vision-field group showed significantly more body sway after visual intervention than the other three groups. This finding may suggest two-way peripheral vision field is a more effective visual stimulus for training postural control and balance.

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[Purpose] This study explored health science students’ perceptions of motor aphasia and sensory aphasia caused by stroke to provide basic material for the improvement of rehabilitation practitioners’ perceptions of aphasia. [Subjects and Methods] The subjects of this study were 642 freshmen and sophomores majoring in health science. Perceptions of aphasia were surveyed on a semantic differential scale using the Anchoring Vignette Method and the difference in perception of the two types of aphasia was analyzed using multi-dimensional scaling. [Results] The analysis revealed that motor aphasia and sensory aphasia have mutually corresponding images. Motor aphasia had high levels of ‘quiet’, ‘passive’ ‘dumb’, ‘unstable’ and ‘gloomy’ images, while sensory aphasia had high levels of ‘noisy’, ‘unstable’, ‘cheerful’, ‘sensitive’, ‘fluctuating in emotions’, ‘active’, ‘dumb’ and ‘gloomy’ images. [Conclusion] A systematic education is required to be implemented in the future to improve health science students’ negative perceptions of the aftereffects of stroke such as aphasia.

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[Purpose] To verify the identification of the anaerobic threshold through the double product breakpoint (DPBP) method for individuals with type 2 diabetes. [Subjects and Methods] Nine individuals with T2D (7 females; age=63.2 ± 8.9 y) and 10 non-diabetic (ND) (7 females; age=58.3 ± 7.8 y) performed an incremental exercise test on a cycle ergometer. Heart rate (HR), blood pressure (BP) and expired gas were measured at the end of each stage. The ventilatory threshold (VT) and DPBP were considered as the exercise intensities above which an over proportional increases in VE and DP were observed in relation to increasing workload. [Results] No differences were observed between the workloads, HR and VO2 corresponding to the AT identified respectively by VT and DPBP. For the T2D, strong correlations between VT and DBPB workloads (r=0.853), HR (r=0.714), and VO2 (r=0.863) were found. These relationships were similar to those found for the control group (r=0.923; r=0.881; and r=0.863, respectively). [Conclusion] These results demonstrate that the DPBP enables for the prediction of AT and correlated well the VT in both the T2D and ND participants.

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[Purpose] The aim of this study was to investigate whether or not a single whole-body vibration treatment after eccentric exercise can reduce muscle soreness and enhance muscle recovery. [Subjects and Methods] Twenty untrained participants were randomly assigned to two groups: a vibration group (n=10) and control group (n=10). Participants performed eccentric quadriceps training of 4 sets of 5 repetitions at 120% 1RM, with 4 min rest between sets. After that, the vibration group received 3 sets of 1 min whole body vibration (12 Hz, 4 mm) with 30 s of passive recovery between sets. Serum creatine kinase, blood urea nitrogen, muscle soreness (visual analog scale) and muscle strength (peak isometric torque) were assessed. [Results] Creatine kinase was lower in the vibration group than in the control group at 24 h (200.2 ± 8.2 vs. 300.5 ± 26.1 U/L) and at 48 h (175.2 ± 12.5 vs. 285.2 ± 19.7 U/L) post-exercise. Muscle soreness decreased in vibration group compared to control group at 48 h post-exercise (34.1 ± 11.4 vs. 65.2 ± 13.2 mm). [Conclusion] Single whole-body vibration treatment after eccentric exercise reduced delayed onset muscle soreness but it did not affect muscle strength recovery.

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[Purpose] The Hybrid Assistive Limb^® (HAL^®) robot suit is a powered exoskeleton that can assist a user’s lower limb movement. The purpose of this study was to assess the effectiveness of HAL^® in stroke rehabilitation, focusing on the change of the sit-to-stand (STS) movement pattern and standing posture. [Subjects and Methods] Five stroke patients participated in this study. Single leg HAL^® was attached to each subject’s paretic lower limb. The subjects performed STS three times both with and without HAL^® use. A tri-axial accelerometer was used to assess the STS movement pattern. Forward-tilt angle (FTA) and the time required for STS were measured with and without HAL^® use. Surface electromyography (EMG) of STS and standing were recorded to assess the vastus medialis muscle activities of the paretic limb. [Results] The average FTA without HAL^® use was 35° and it improved to 43° with HAL^® use. The time required for STS was longer for all subjects with HAL^® use (without HAL^® use: 3.42 s, with HAL^® use: 5.11 s). The integrated EMGs of HAL^® use compared to those without HAL^®, were 83.6% and 66.3% for STS and standing, respectively. [Conclusion] HAL^® may be effective in improving STS and standing patterns of stroke patients.

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[Purpose] This study assessed the effects of combined application of raloxifene and aerobic exercise on senile osteoporosis. [Subjects and Methods] A total of 70 elderly patients with osteoporosis, who treated at our hospital between April 2013 and August 2014, were divided into equal-sized observation and control groups. The control group was administered raloxifene, whereas the observation group received raloxifene treatment plus aerobic exercise. [Results] Outpatient outcomes were considered dependent variables. After treatment, the two groups differed significantly in terms of lumbar spine (L2–L4) and proximal femoral bone mineral density. The urine pyridine/creatinine ratio decreased significantly and serum calcitonin level increased significantly in the observation group. These differences were statistically significant. [Conclusion] Raloxifene combined with aerobic exercise therapy significantly improves bone density and promotes bone formation in patients with senile osteoporosis.

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[Purpose] This study examined the exercise intensity and psychophysiological responses to a self-selected resistance training session in sedentary male subjects. [Subjects and Methods] Twelve sedentary male subjects (35.8 ± 5.8 years; 25.5 ± 2.6 kg·m²) underwent four sessions at 48-h intervals: familiarization; two sessions of one repetition maximum test and a resistance training session in which they were told to self-select a load to complete 3 sets of 10 repetitions of chest press, leg press, seated rows, knee extension, overhead press, biceps curl, and triceps pushdown exercises. During the latter, the percentage of one repetition maximum, affective responses (feeling scale), and rating of perceived exertion (OMNI-RES scale) were measured. [Results] The percentage of one repetition maximum for all exercises was >51% (14–31% variability), the rating of perceived exertion was 5–6 (7–11% variability), and the affective responses was 0–1 point with large variability. [Conclusion] Sedentary male subjects self-selected approximately 55% of one maximum repetition, which was above the intensity suggested to increase strength in sedentary individuals, but below the recommended intensity to improve strength in novice to intermediate exercisers. The rating of perceived exertion was indicative of moderate intensity and slightly positive affective responses.

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[Purpose] The purpose of this study was to clarify whether walking speed affects acceleration variability of the head, lumbar, and lower extremity by simultaneously evaluating of acceleration. [Subjects and Methods] Twenty young individuals recruited from among the staff at Kurashiki Heisei Hospital participated in this study. Eight accelerometers were used to measure the head, lumbar and lower extremity accelerations. The participants were instructed to walk at five walking speeds prescribed by a metronome. Acceleration variability was assessed by a cross-correlation analysis normalized using z-transform in order to evaluate stride-to-stride variability. [Results] Vertical acceleration variability was the smallest in all body parts, and walking speed effect had laterality. Antero-posterior acceleration variability was significantly associated with walking speed at sites other than the head. Medio-lateral acceleration variability of the bilateral hip alone was smaller than the antero-posterior variability. [Conclusion] The findings of this study suggest that the effect of walking speed changes on the stride-to-stride acceleration variability was individual for each body parts, and differs among directions.

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[Purpose] This research explored the positive effects of self-myofascial release on hamstring muscular flexibility and proprioception and investigated the effectiveness of the stretch combined with therapeutic ultrasound. [Subjects and Methods] This study included 30 healthy university students with no history of pain in the Achilles tendon or hamstring within the recent 6 months. Each participant completed two experiments. In the first experiment (MS), they completed self-myofascial stretching using a foam roller for 7 days. In the second experiment (MSU), the same participants performed the self-myofascial stretching after the 15-minute application of ultrasound. This study involved a pre- and post-test on hamstring muscle flexibility and hip joint proprioception. [Results] The use of self-myofascial stretching in the MS experiment had a significant effect on hamstring muscle flexibility and hip joint proprioception. However, the addition of ultrasound in the MSU experiment had no additive effect. [Conclusion] Self-myofascial stretching immediately increased hamstring muscle flexibility and improved hip joint proprioception, but the addition of pre-stretch ultra sound provided no further benefit.

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[Purpose] The effectiveness of neuromuscular electrical stimulation in the rehabilitation of swallowing remains controversial. This study compared the effectiveness of neuromuscular electrical stimulation and thermal tactile oral stimulation, a traditional swallowing recovery treatment, in patients with sub-acute dysphagia caused by stroke. [Subjects and Methods] Subjects of the present study were 55 patients diagnosed with dysphagia caused by stroke. This study had a nonequivalent control group pretest-posttest design. [Results] Analysis of pre-post values of videofluoroscopic studies of the neuromuscular electrical stimulation and thermal tactile oral stimulation groups using a paired t-test showed no significant difference between the two groups despite both having decreased mean values of the videofluoroscopic studies after treatment. [Conclusion] This study’s findings show that both neuromuscular electrical stimulation and thermal tactile oral stimulation significantly enhanced the swallowing function of patients with sub-acute dysphagia.

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[Purpose] This study was performed to investigate the effects of yogic eye exercises on eye fatigue in undergraduate nursing students. [Subjects and Methods] The study used a pretest-posttest design with a non-equivalent control group. Forty undergraduate nursing students were selected by convenience sampling, with 20 assigned to an exercise group and 20 assigned to a control group. The yogic eye exercise intervention was performed for 60 minutes, two days a week for 8 weeks. It consisted of 8 steps: palming, blinking, sideways viewing, front and sideways viewing, rotational viewing, up and down viewing, preliminary nose tip gazing, and near and distant viewing. Eye fatigue was measured using a questionnaire for evaluating ocular fatigue. [Results] The exercise-group measurements revealed a significantly decreased eye-fatigue score compared with that of the control group. [Conclusion] These findings indicate that yogic eye exercises could reduce the eye fatigue score in undergraduate nursing students.

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[Purpose] The present study examined the effects of eye movement training on gait function in patients with stroke. [Subjects and Methods] Fourteen patients with stroke were randomly assigned to either an experimental group or a control group. The experimental group underwent eye movement training while the control group underwent general gait training five times per week for six weeks. [Results] Patient walking speed, cadence, and step length were measured by ink-footprint. The experimental group exhibited significant changes in walking speed, cadence, and step length following training, while the control group exhibited no differences. [Conclusion] Findings indicate that eye movement training should be considered as part of a functional gait training program for patients with stroke.

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[Purpose] The purpose of this study was to analyze the effects of Pilates exercise on static and dynamic balance in chronic stroke patients. [Subjects and Methods] Nineteen individuals with unilateral chronic hemiparetic stroke (age, 64.7 ± 6.9 years; height, 161.7 ± 7.9 cm; weight, 67.0 ± 11.1 kg) were randomly allocated to either a Pilates exercise group (PG, n=10) or a control group (CG, n=9). The PG attended 24 exercise sessions conducted over an 8-week period (3 sessions/week). Center of pressure (COP) sway and COP velocity were measured one week before and after the exercise program and compared to assess training effects. [Results] Pilates exercise positively affected both static and dynamic balance in patients with chronic stroke. For static balance, COP sway and velocity in the medial-lateral (M-L) and anterior-posterior (A-P) directions were significantly decreased in the PG after training while no significant differences were found in the CG. For dynamic balance, measured during treadmill walking, the PG showed significantly reduced COP sway and velocity in the M-L and A-P directions for both the paretic and non-paretic leg. [Conclusions] The findings provide initial evidence that Pilates exercise can enhance static and dynamic balance in patients with chronic stroke.

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[Purpose] The purpose of this study was to examine whether stretching of the scalene muscles would improve slow vital capacity (SVC). [Subjects and Methods] The subjects of this study were 20 healthy female students to whom the study’s methods and purpose were explained and their agreement for participation was obtained. The SVC was measured using spirometry (Pony FX, COSMED Inc., Italy). The intervention used was stretching of the scalene muscles. Stretching was carried out for 15 min, 10 times at per each portion of scalene muscles: the anterior, middle, and posterior parts. [Results] Expiratory vital capacity (EVC) and tidal volume (Vt) noticeably increased after stretching. However, there were no changes in any of the SVC items in the control group. [Conclusion] This study demonstrated that stretching of the scalene muscles can effectively improve SVC. In particular, we confirmed that stretching of the scalene muscles was effective in increasing EVC and Vt, which are items of SVC.

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[Purpose] The purpose of this study was to evaluate the relationships between daily activities, information processing, and motor skills in individuals with hemineglect after having a left hemiparetic stroke. [Subjects and Methods] The instrumental activities of daily living of 35 patients (22 male and 13 female; age: 57.1 ± 16.9 years) with hemineglect after having a left hemiparetic stroke were assessed by using three clinical measurement tools, including activity card sorting, assessment of motor and process skills, and the modified Barthel Index. [Results] The results of the regression analysis indicated that the patients’ processing skills in instrumental activities of daily living after having a left hemiparetic stroke were reduced. Participation in leisure and social activities was also affected as assessed by using the modified Barthel Index. [Conclusion] This study supports the clinical need for rehabilitation intervention after a left hemiparetic stroke to improve patients’ processing skills and independence in performing activities of daily living.

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[Purpose] This study aimed to determine appropriate measures for assessing balance ability according to difficulty level during standing tasks. [Subjects and Methods] The subjects were 56 old (>65 years) and 30 young (20–30 years) adults. By using the Berg balance scale, the subjects were divided into three groups: 29 healthy older (Berg score≥52), 27 impaired older (Berg score≥40), and 30 healthy young (Berg score≥55). One inertial measurement unit sensor was attached at the waist, and the subjects performed standing tasks (1 min/task) with six difficulty levels: eyes open and eyes closed on firm ground, one foam, and two foams. Thirty-nine (24 time-domain, 15 frequency-domain) measures were calculated by using acceleration data. The slope of each derived measure was calculated through the least-squares method. [Results] Five (95% ellipse sway area, root mean squares [anterior-posterior and resultant directions], and mean distance [anterior-posterior and resultant directions] in time domain) of the 39 measures showed significant differences among the groups under specific standing conditions. The slopes of derived measures showed significant differences among the groups and significant correlations with the Berg scores. [Conclusion] The slope according to the difficulty level can be used to assess and discriminate standing balance ability.

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[Purpose] This study aimed to determine if the velocity of mechanical horseback-riding training can improve spinal alignment in young adults. [Subjects and Methods] Thirty-six subjects were enrolled in this study. The subjects were randomly allocated into high-, moderate-, and low-velocity mechanical horseback-riding training groups. All participants completed one 20-minute session per day, 3 days per week, for 6 weeks. The evaluation was performed before and 6 weeks after the training intervention. The spinal alignment was measured by a Formetric III device. The measurement items were kyphotic angle, lordotic angle, trunk inclination, pelvic torsion, pelvic rotation, and lateral deviation. The data were analyzed using analysis of covariance to determine the statistical significance. [Results] The kyphotic angle and trunk inclination were significantly different among the groups. The kyphotic angles of the high- and moderate-velocity groups were significantly lower than that of the low-velocity group after the intervention. The trunk inclination of the high-velocity group was significantly lower than that of the low-velocity group after intervention. [Conclusion] Higher-velocity mechanical horseback-riding training is more effective than lower-velocity mechanical horseback-riding training for improving spinal alignment.

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[Purpose] This study aimed to investigate the effect of simultaneous application of postural techniques and expiratory muscle strength training on the enhancement of the swallowing function of patients with dysphagia caused by Parkinson’s disease. [Subjects and Methods] The subjects of this study were 18 patients who received simultaneous application of postural techniques and expiratory muscle strength training and 15 patients who received expiratory muscle strength training only. Postural techniques were conducted in the order of chin tucking, head rotation, head tilting, bending head back, and lying down, while expiratory muscle strength training was conducted at a resistance level of about 70% of the maximal expiratory pressure. Swallowing recovery was assessed by using the Functional Dysphagia Scale based on videofluoroscopic studies. [Results] The mean value obtained in the videofluoroscopic studies for both groups decreased after the treatment. In the postural techniques plus expiratory muscle strength training group, the decrease was significantly greater than that in the expiratory muscle strength training-only group. [Conclusion] The results imply that simultaneous performance of postural techniques and expiratory muscle strength training is more effective than expiratory muscle strength training alone when applied in the swallowing rehabilitation for patients with dysphagia caused by Parkinson’s disease.

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[Purpose] This study aimed to assess the quality of life of elderly people related to physical function, cognitive function, and health, and devised methods to enhance their health-related quality of life. [Subjects and Methods] This study was conducted from November 2014 to January 2015 in 140 people over 65 registered at welfare centers. Those with a functional psychological disorder or difficulty communicating were excluded. Data were collected for physical function, cognitive function, and health-related quality of life (HRQOL) using an assessment tool and questionnaire for healthy elderly people over 65. Physical function was measured using muscle strength muscle endurance, reaction time, and balance. [Results] Correlations were observed between cognitive function and endurance, reaction time, and balance. Physical HRQOL showed correlations with all domains of physical function; mental HRQOL showed correlations with all items of physical function except muscle strength. Among factors that influence HRQOL, all items except educational background were significant variables. Educational background had no influence on HRQOL. [Conclusion] Interventions will correct factors with a negative influence on HRQOL, utilizing regular checks on physical, cognitive, and other functions of elderly people, with early detection and intervention to enhance HRQOL. Cognitive intervention related to physical and other functions will be applied.

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[Purpose] This study assessed the activity of the abdominal muscles according to the angle of the knee joints during sit-to-stand. [Subjects and Methods] Thirty healthy adult males participated in this study. Subjects initiated sit-to-stand at knee joint angles of 60°, 90°, or 120°. An electromyography system was used to measure the maximum voluntary isometric contraction of the rectus abdominis, external oblique, and internal oblique and transverse abdominis muscles. [Results] Percent contraction differed significantly among the three knee joint angles, most notably for the internal oblique and transverse abdominis muscles. [Conclusion] Wider knee joint angles more effectively activate the abdominal muscles, especially those in the deep abdomen, than do narrower angles.

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[Purpose] Clinicians have reported the effects of various instrument assisted soft tissue mobilization (IASTM) in patients. The purpose of this study was to investigated the effects of the Graston technique and general exercise on pain and range of motion (ROM) in patients with CLBP. [Subjects and Methods] 30 patients with CLBP participated in the study (Graston technique: 15; Control: 15). Before and after the 4-week intervention program, pain was assessed using a visual analog scale (VAS). Lumbar ROM was measured using a smartphone. The main effects and interaction were analyzed by two-way repeated ANOVA. [Results] A significant time-by-group interaction was observed for the VAS and ROM. A post hoc paired t-test showed that pain decreased significantly post-intervention within the Graston group. The lumbar ROM significantly increased post-intervention in both groups. [Conclusion] The Graston technique and general exercise resulted in pain relief and increased ROM. However, the Graston group showed significantly increased VAS and ROM more than control group. These findings suggest that the Graston technique can be useful as a pain decrease and ROM increase for patients with CLBP.

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[Purpose] The purpose of this study was to investigate the effects of exercise on muscle damage indices in male Sprague-Dawley rats. Two groups of rats were trained in either moderate- or high-intensity treadmill running for 4 weeks. Subsequently, the concentrations of creatine kinase, lactate dehydrogenase, and high-sensitivity C-reactive protein were examined following a single bout of prolonged (3-h) intensive exercise. [Subjects and Methods] The study included forty 6-week-old male Sprague-Dawley rats weighing 150–180 g each. The aerobic exercise group was divided into high-intensity (28 m/min) and moderate-intensity (15 m/min) subgroups. Both subgroups were trained for 35 min daily for 6 days per week (excluding Sunday) over a 4-week period. Following training, the high- and moderate-intensity exercise groups and a non-exercise group performed one bout of prolonged (3-h) treadmill exercise for 3 hours at a speed of 15 m/min. [Results] Creatine kinase and lactate dehydrogenase levels differed significantly among the groups. [Conclusion] The preliminary exercise groups showed lower muscle damage and inflammatory response levels than the non-exercise group after the bout of prolonged intensive exercise.

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[Purpose] The present study investigated the effects of wearing germanium-coated functional clothing on tympanic temperature, thermal sensation, heat shock protein 70 (Hsp70), and lactate during endurance exercise. [Subjects and Methods] Nine healthy and untrained male subjects were enrolled. Subjects ran for 60 min on a treadmill (75% heart rate reserve) in the following 2 tests: 1) control test (wearing conventional clothing) and 2) experimental test (wearing germanium-coated functional clothing). During each test, the tympanic temperature and thermal sensation were measured, and blood samples were collected immediately before exercise and immediately after exercise. Thermal sensation was measured using a DISC score. [Results] The tympanic temperature immediately after exercise was significantly increased compared to the temperature immediately before exercise in the control test, while no significant change was observed in the experimental test. In both tests, the DISC score and Hsp70 and lactate levels immediately after exercise were significantly increased compared to those immediately before exercise. In addition, the DISC score immediately after exercise was significantly higher in the control test than in the experimental test. [Conclusion] Wearing germanium-coated functional clothing during endurance exercise may have the positive effect of alleviating thermal stress that accumulates in the body during exercise.

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[Purpose] This study aimed to investigate the effect of trapezius muscle isometric strength on three-dimensional scapular kinematics in asymptomatic shoulders. [Subjects and Methods] Thirty asymptomatic subjects were included to the study. Isometric strengths of the upper, middle, and lower trapezius muscle were measured using a handheld dynamometer. Three-dimensional scapular kinematics was recorded by an electromagnetic tracking device during frontal and sagittal plane elevation. For each muscle, the cut-off value for muscle strength was determined with the upper bound of the 95% confidence interval, and Student’s t-test was used to compare the scapular kinematics between subjects with relatively weaker or stronger trapezius muscles. [Results] Shoulders with stronger upper trapezius muscles showed greater upward scapular rotation at 30°, 60°, 90°, and 120° of elevation in the frontal plane. Shoulders with stronger middle trapezius had greater scapular upward rotation at 90° of elevation in the frontal plane. Shoulders with stronger lower trapezius showed greater scapular posterior tilt at 90° of elevation in the sagittal plane. [Conclusion] This study’s findings showed that isometric strength of the trapezius muscle affects upward scapular rotation and posterior tilt in asymptomatic shoulders. Therefore, trapezius muscle strength should be assessed and potential weakness should be addressed in shoulder rehabilitation programs.

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[Purpose] The aim of this study was to investigate differences in selective voluntary motor control of the lower extremities by objective assessment and determine the relationship between selective voluntary motor control and knee extensor strength in children with spastic diplegia. [Subjects and Methods] Forty individuals who had spastic cerebral palsy, with Gross Motor Function Classification System levels ranging from I to III, were assessed using the Selective Control Assessment of the Lower Extremity and by testing the maximum knee extensor strength. The unaffected side was defined as the lower limb with the higher score, and the affected side was defined as the lower limb with the lower score. [Results] The Selective Control Assessment of the Lower Extremity score on the affected side had a lower average than that on the unaffected side. The scores showed a significant inverse correlation with the maximum knee extensor strength. [Conclusion] There was bilateral difference in the selective voluntary motor control of the lower extremities in children with spastic diplegia, and the selective voluntary motor control of the lower extremity was related to maximum knee extensor strength.

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[Purpose] The purpose of this study was to analyze the effects of task-oriented circuit training on the balance ability and gait endurance of chronic stroke inpatients. [Subjects and Methods] The participants were 30 patients who had stroke >6 months previously, resulting in a disability such as hemiparesis. The participants were randomly divided into the group task-oriented circuit training group and the individual task-oriented circuit-training group. They performed eight types of modified task-oriented training. Balance ability and gait endurance were measured by using the Berg balance scale questionnaire and the 6-min walk test, respectively, before and after the experiment. [Results] Significant differences were observed between before and after the intervention in all variables. There was a significant difference between groups in Berg balance scale scores; however, no significant differences were seen in the timed up and go test and the 6-min walk test. [Conclusion] The results of this study indicated that group exercise can better improve the balance ability of chronic stroke inpatients after stroke than can individualized exercise intervention.

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[Purpose] Early postoperative passive motion exercise after arthroscopic rotator cuff repair remains controversial. To better understand this issue, this study was aimed at evaluating scapular kinematics and muscle activities during passive arm elevation in healthy subjects. [Subjects and Methods] The dominant shoulders of 27 healthy subjects were examined. Electromagnetic sensors attached to the scapula, thorax, and humerus were used to determine three-dimensional scapular kinematics during active arm elevation with or without external loads and passive arm elevation. Simultaneously, the activities of seven shoulder muscles were recorded with surface and intramuscular fine-wire electrodes. [Results] Compared with active arm elevation, passive elevation between 30° and 100° significantly decreased the scapular upward rotation and increased the glenohumeral elevation angle. However, no significant differences in scapular posterior tilt and external rotation were observed between active and passive arm elevation, and scapular plane kinematics were not affected by muscle activity. [Conclusion] Unlike active motion with or without an external load, passive arm elevation significantly decreased the scapular upward rotation and significantly increased the mid-range glenohumeral elevation. These data, which suggest that passive arm elevation should be avoided during the early postoperative period, may expand the understanding of rehabilitation after arthroscopic rotator cuff repair.

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[Purpose] Dressing is an activity of daily living for which stroke patients often show discrepancies between capacity and actual performance. The aim of this study was to elucidate the physical function and unilateral spatial neglect in stroke patients that reduce their level of actual performance despite having the capacity for dressing independently. [Subjects and Methods] This retrospective study included 60 first-time stroke patients judged by occupational therapists as able to dress independently. The patients were divided into two groups according to their FIM^® instrument scores for dressing the upper and lower body: an independent group with both scores ≥6 and an assistance group with one or both scores ≤5. After adjusting for confounding factors through propensity score matching, the groups were compared by using Stroke Impairment Assessment Set items, the Simple Test for Evaluating Hand Function of both upper limbs, and the Berg balance scale. [Results] The assistance group had a significantly lower score for the Berg balance scale than the independent dressing group (31.0 ± 12.3 vs. 47.8 ± 7.4). [Conclusion] The results of the present study suggested that the balance function has an effect on the discrepancy between dressing capacity and performance.

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[Purpose] This study attempted to investigate the effect of physical therapy frequency based on neurodevelopmental therapy on gross motor function in children with cerebral palsy. [Subjects and Methods] The study sample included 161 children with cerebral palsy who attended a convalescent or rehabilitation center for disabled individuals or a special school for children with physical disabilities in South Korea. Gross Motor Function Measure data were collected according to physical therapy frequency based on neurodevelopmental therapy for a period of 1 year. [Results] The correlation between physical therapy frequency and Gross Motor Function Measure scores for crawling and kneeling, standing, walking, running and jumping, and rolling, and the Gross Motor Function Measure total score was significant. The differences in gross motor function according to physical therapy frequency were significant for crawling, kneeling, standing, and Gross Motor Function Measure total score. The differences in gross motor function according to frequency of physical therapy were significant for standing in Gross Motor Function Classification System Level V. [Conclusion] Intensive physical therapy was more effective for improving gross motor function in children with cerebral palsy. In particular, crawling and kneeling, and standing ability showed greater increases with intensive physical therapy.

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