[Purpose] To investigate the effect of heel height on the distribution of plantar foot force and heel pain in patients with a heel spur. [Subjects and Methods] Plantar force was measured using 8 force sensors in 16 patients (3 men, 13 women), with symptomatic heel spur for 4 heel heights (0–4 cm). Sensors were located at the hallux (T1); medial to lateral metatarsals (M1 through M3), mid-foot (MF); and at the central, lateral, and medial heel (CH, LH, and MH). Pain was evaluated using the minimum compression force that caused pain and was measured using an algometer. [Results] Load bearing shifted from the heel (CH) to the mid-foot (MF) and hallux (T1) with increasing heel height. Raising the heel from 2 to 3 cm reduced the magnitude of load bearing, relative to the minimum compression force for pain, by 3.70% at the LH and 2.35% at the MH. Excellent clinical outcomes, defined by a 70–100% decrease in pain, were achieved in 10/16 participants with the use of a 2-cm and 3-cm heel height in men and women, respectively. [Conclusion] Increasing heel height effectively decreases the plantar force on the heel during weight-bearing activities.

[Purpose] This study investigated the difference in tongue strength with and without visual feedback in healthy adults. [Subjects and Methods] A total of 30 healthy adults were recruited. We measured the strength of the anterior region of the tongue before and after applying visual feedback using the Iowa Oral Performance Instrument. [Results] The tongue strength was measured as 45.5 ± 9.3 kilopascals with visual feedback and 41.1 ± 8.6 kilopascals without visual feedback, showing a statistically significant difference. [Conclusion] Visual feedback may be an effective tool for increasing the strength of the tongue.

[Purpose] We investigated the effects of upper extremity resistance exercise with elastic bands on respiratory function in children with cerebral palsy. [Subjects and Methods] Fifteen children were divided into two groups: the experimental (n=8) and control (n=7) groups. Both groups performed general exercises for 30 minutes per session, two times a week during the intervention period. The experimental group performed an additional upper extremity resistance exercise with elastic bands for 20–30 minutes per session, twice weekly for 8 weeks. Pulmonary function, and respiratory muscle and grip strength were measured before and after the exercise. [Results] There was no significant difference in forced vital capacity, forced expiratory volume in one second, the ratio of forced expiratory volume in one second to forced vital capacity, and peak expiratory flow before and after the intervention in either group. The increment of maximal expiratory pressure was significantly greater in the experimental group, compared with the control group. In addition, grip strength was significantly increased in the experimental group after the intervention than before. [Conclusion] We found that upper extremity resistance exercise with elastic bands has a positive effect on expiration and improves grip strength in children with cerebral palsy.

[Purpose] This study examined the effects of transcutaneous electrical nerve stimulation and concentric contraction of the muscles surrounding the elbow joints on pain and muscular strength in the elbow joints of patients with lateral epicondylitis. [Subjects and Methods] The subjects of this study were 30 patients who visited our hospital with the main complaint of lateral pain in the elbow joint. All subjects were randomly and equally assigned to an experimental group that conducted concentric contraction exercises in sync with a transcutaneous electrical nerve stimulation cycle and a control group that performed concentric contraction after the application of transcutaneous electrical nerve stimulation. Patients used a 10 cm visual analogue scale to evaluate the level of pain in their elbow joints. To measure the strength of muscles around the elbow joints, the subjects’ paretic grip strength was measured using an electronic grip strength dynamometer. [Results] No statistically significant difference in visual analog scale was found between the two groups. Regarding changes in grip strength, changes in the experimental group’s grip strength were significantly greater than those in the control group. [Conclusion] These results can be used as a basis for reducing pain and improving strength in lateral epicondylitis patients.

[Purpose] This study investigated the effects of mirror therapy and neuromuscular electrical stimulation on upper extremity function in stroke patients. [Subjects and Methods] This study recruited 8 stroke patients. All patients were treated with mirror therapy and neuromuscular electrical stimulation five times per week for 4 weeks. Upper limb function evaluation was performed using upper extremity part of fugl meyer assessment. [Results] Before and after intervention, fugl meyer assessment showed significant improvement. [Conclusion] In this study, mirror therapy and neuromuscular electrical stimulation are effective methods for upper extremity function recovery in stroke patients.

[Purpose] The aim of this study was to investigate the effects of static and dynamic balance by using Medicine-ball and Swiss-ball exercises. [Subjects and Methods] Thirty-six normal adults who agreed to participate were included in the study. Subjects were randomly assigned to the Medicine-ball (n=18) and Swiss-ball groups (n=18). The participants performed the exercise for 6 weeks. Balance error scoring system and one leg standing test were performed to determine static balance, and functional reach test and timed up and go test were performed to determine dynamic balance. [Results] A significant improvement was observed from the Medicine-ball and Swiss-ball exercises, but no difference was found between the groups. In addition, a significant difference was found between balance error scoring system, one leg standing test and functional reach test after pre- and post-exercise of the Medicine-ball and Swiss-ball. [Conclusion] The findings of this study showed that the Medicine-ball and Swiss-balls were effective in improving static and dynamic balance.

[Purpose] This study aims to determine the effects of various wheelchair handle grip directions on the muscle activities of the upper body of an assistant during movement on ascending and descending ramps. [Subjects and Methods] The study subjects were 17 young and healthy participants whose mean age, height, and weight was 23.0 ± 2.7 years, 175.5 ± 4.7 cm, and 70.0 ± 14.2 kg, respectively; all subjects voluntarily consented to participate. Three grip directions were tested: general grip, medial grip, and neutral grip. Muscle activities in the serratus anterior, rhomboid, erector spine, biceps brachii, triceps brachii, bracioradialis, flexor carpi radialis, and extensor carpi radialis were measured using an electromyograph (EMG). [Results] Significant differences were seen in the muscle activities of the biceps brachii, bracioradialis, and flexor carpi radialis during wheelchair movement on an ascending ramp and in the biceps brachii and triceps brachii during movement on a descending ramp. [Conclusion] Measurement results showed that the general grip resulted in the highest muscle activities in the upper body of assistants during wheelchair movement on both ascending and descending ramps.

[Purpose] Hypervigilance to pain is an important aspect of the fear-avoidance model of pain that may be associated with disability more than other psychological factors examined. The aim of the study was to investigate how hypervigilance to pain influences disability compared with other psychological factors examined. [Subjects and Methods] The subjects of this study were 50 elderly patients with chronic pain (7 men and 43 women, 80.3 ± 7.8 years). To assess the pain level, the Numerical Rating Scale (NRS) was used. To assess psychological factors, the Hospital Anxiety and Depression Scale (HADS), the Tampa Scale for Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), and the Pain Vigilance Awareness Questionnaire (PVAQ) were used. To assess activities of daily living, the Pain Disability Assessment Scale (PDAS) was used. A multiple regression analysis (stepwise method) was performed with the PDAS as the dependent variable, and the NRS, HADS-anxiety, HADS-depression, TSK, PCS-rumination, PCS-magnification, PCS-helplessness, and PVAQ, as the independent variables. [Results] The results of a multiple regression analysis showed that the PDAS scores were affected by the PVAQ and NRS scores. [Conclusion] Hypervigilance influenced disability more than other psychological factors examined.

[Purpose] The purpose of this study was to investigate the effect of balance and computerized cognitive training on psychomotor performance in elderly females. [Subjects and Methods] Twentynine elderly females with the mean age of 63–71 years old were applied voluntarily and randomly allocated to four groups: balance training (3 d/wk for 12 wk), balance training with computerized cognitive training (3 d/wk for 12 wk), computerized cognitive training group and control group. Psychomotor performance of all subjects was measured by Vienna Test System which was a computerized psychological assessment tool. Determination test (DT) and Visual Pursuit Test (VPT) were used as indexes of psychomotor performance. [Results] The results suggested that DT and VPT were significantly improved in all experimental groups with greater improvement in the balance supplemented with computerized cognitive training group. [Conclusion] Balance training and computerized cognitive are highly recommended in elderly with the aim of increasing cognitive performance.

[Purpose] This study aimed to develop a tablet app that emulates paper questionnaires used in clinical care, and to verify the difference between the utility of tablet survey methods and paper questionnaire methods with elderly people. [Subjects and Methods] A tablet app was developed in the Java language. A questionnaire was provided to 30 community-dwelling elderly people. The subjects were randomly allocated to the group responding on the tablet (tablet group) or that responding to a paper-based questionnaire (questionnaire group). Assessed items included response time to questions, whether or not they had queries regarding the survey, and data input time. For the tablet group, a questionnaire was conducted regarding the operability of the tablet. [Results] There was no difference in response time between the two groups. Significantly more people in the tablet group had queries regarding the survey. Data input time was 426 seconds for the tablet group and 1268 seconds for the questionnaire group. In the survey regarding tablet operability, there were no negative opinions about the visibility of the screen. [Conclusion] Tablets can be used with elderly people to shorten the data input time. The present findings suggested that tablet surveys could be effective for a large-scale investigation.

[Purpose] This study aimed to investigate whether a virtual reality (VR) intervention has an influence in improving the motor function and activities of daily living (ADLs) in patients with lesions in different regions of the brain. [Subjects and Methods] Eleven subjects with hemiplegic stroke were recruited in this study, which was conducted from January to February, 2017. They received a VR intervention once a day for 30 min, 5 times a week for 4 weeks. The Fugl-Meyer Assessment (FMA) and the Korean version of the Modified Barthel Index (K-MBI) were used to assess the post-stroke patients’ motor function and ADLs, respectively. [Results] There were significant differences in pre- and post-test outcomes of the Arm and Coordination and Speed (CS) in the FMA and K-MBI in the middle cerebral artery group (MCAG). Moreover, there were significant differences in all sub-tests of FMA and K-MBI in the Basal ganglia group (BGG). In addition, there were significant differences in the pre-test outcomes of Arm and pre- and post-test outcomes of Hand in the FMA between the two groups. [Conclusion] This study revealed that VR intervention improved the upper limb motor function and ADLs of post-stroke patients, especially those in the BGG.

[Purpose] Problems involving the temporomandibular joint and associated structures can lead to temporomandibular disorder (TMD). The aim of the present study was to evaluate muscle activity in individuals with a diagnosis of TMD before and after treatment with low-level laser therapy (LLLT) through the use of electromyography (EMG). [Subjects and Methods] Male and female individuals aged 14 to 23 years were evaluated. TMD was determined by a clinical examination and the administration of the Research Diagnostic Criteria for Temporomandibular Disorders, followed by the evaluation of sensitivity to palpation of the masseter and anterior temporal muscles as well as the EMG determination of muscle activity. The participants were randomly allocated to an active LLLT group (n=9) and sham group (n=7). Twelve sessions of LLLT were conducted using a wavelength of 780 nm, energy density of 25 J/cm², power of 50 mW, power density of 1.25 W/cm² and a 20-second exposure time or sham LLLT. Muscle activity was determined prior to treatment and after the last session. [Results] During the isometric evaluation of the masseter and anterior temporal muscles, an increase in the mean EMG signal was found in the group submitted to active LLLT. When evaluated individually, some participants in the active LLLT group demonstrated a reduction in muscle activity, but no significant differences were found in the mean EMG signal between the initial and final evaluations. [Conclusion] Further studies with a larger sample size are needed to confirm the present findings.

[Purpose] This study was carried out to determine the effect of an exercise program on pelvic pain and posture associated with endometriosis. [Subjects and Methods] This study was designed as repeated measures design that compared one group of 20 patients (age range 26–32 years) diagnosed by laparoscope as having mild or moderate endometriosis before, after 4 weeks, and after 8 weeks of exercise program. The exercise program parameters were based on the American College of Obstetricians and Gynecologists guidelines for exercise suitable for sedentary women. To assess the intensity of endometriosis pain, a present pain intensity scale was used. On the other hand, a raster stereography system was used to assess the posture. [Results] After 8 weeks of performing the exercise regimen, there was a statistically significant decrease in the patients’ pain intensity and thoracic kyphosis angle program in compared with pre treatment. [Conclusion] Ultimately it was proven that eight weeks of an exercise program is very effective in decreasing pain and postural abnormalities associated with endometriosis.

[Purpose] The relationship between white matter lesions (WMLs) and pushing behavior (PB) is still poorly understood. The purpose of this study was to investigate whether damage from WMLs affects the functional outcome of PB after acute stroke. [Subjects and Methods] In total, 37 patients were included. PB was assessed using the standardized Scale for Contraversive Pushing (SCP). Stroke types were classified as total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), or lacunar syndrome using the Bamford classification. WML severity was categorized into four groups using the Fazekas visual scale. Thereafter, patients were divided into 4 groups according to the stroke type and/or presence of WMLs. The SCP, Trunk Control Test (TCT), Stroke Impairment Assessment Set (SIAS), and Barthel Index were the outcome measures. [Results] The SCP and TCT in patients with PACI without WMLs were better than those in patients with TACI with or without WMLs. Regarding SCP, TCT, and SIAS, patients with TACI had poorer values compared with PACI, regardless of WML severity. Barthel Index efficiency was not significantly different between the groups. [Conclusion] Our results suggest that moderate to severe WMLs and PACI had a relationship with PB severity and truncal balance.

[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery.

[Purpose] This study aimed to evaluate the sustainability and efficacy of exercise intervention, as implemented by professionally trained volunteers, on the health-related quality of life among Japanese community-dwelling older females. [Subjects and Methods] We conducted a non-randomized observational prospective study of a six-month exercise intervention delivered by volunteers or health professionals. Health-related quality of life was scored using the Short Form 36 Health Survey before and after the intervention. Participants were classified into three groups, comprising those with improved health, maintained health, and reduced health. [Results] Among 127 Japanese community-dwelling females aged >65 years, 50 of 62 (80.6%) females involved in the intervention conducted by volunteers, and 55 of 65 (84.6%) females involved in the intervention conducted by health professionals, completed the six-month intervention program. Scoring revealed that interventions by both volunteers and health professionals had a maintaining or improving effect on scores in >70% of participants instead of an expected six-month aging decline. [Conclusion] Exercise intervention by trained volunteers was sustainable and effective for improving the health-related quality of life among Japanese community-dwelling older females. Professionally trained volunteers could benefit communities in helping older persons avoid the need for daily nursing care through promoting health activities.

[Purpose] This study examined the immediate effects of transcutaneous electrical nerve stimulation on a six-minute walking test, Borg scale questionnaire and hemodynamic responses in patients with chronic heart failure. [Subjects and Methods] Thirty patients with stable systolic chronic heart failure came to the pathophysiology laboratory three times. The tests were randomly performed in three sessions. In one session, current was applied to the quadriceps muscles of both extremities for 30 minutes and a six-minute walking test was performed immediately afterward. In another session, the same procedure was followed except that the current intensity was set to zero. In the third session, the patients walked for six minutes without application of a current. The distance covered in each session was measured. At the end of each session, the subjects completed a Borg scale questionnaire. [Results] The mean distance traveled in the six-minute walking test and the mean score of the Borg scale questionnaire were significantly different across sessions. The mean systolic and diastolic pressures showed no significant differences across sessions. [Conclusion] The increase in distance traveled during the six-minute walking test and decrease in fatigue after the use of current may be due to a decrease in sympathetic overactivity and an increase in peripheral and muscular microcirculation in these patients.

[Purpose] The aim of the present study was to evaluate the immediate effects of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on activity of the tibialis anterior muscle (TA) and static balance of individuals with hemiparesis stemming from stroke. [Subjects and Methods] A randomized, double-blind, crossover, clinical trial conducted with 30 individuals with chronic post-stroke hemiparesis. Median frequency of electrical activity of the TA were determined using electromyography in five contractions concentrics and Static balance (body sway velocity and frequency), both before and immediately after the intervention. The participants were submitted to four 20-minute intervention protocols with 48-hour interval: anodal tDCS + sham FES; sham tDCS + active FES; anodal tDCS + active FES and sham tDCS + sham FES. Anodal tDCS was administered over C3 or C4, the cathode was positioned in the supraorbital region on the contralateral side and FES was administered to the affected TA. [Results] No significant differences among the protocols were found regarding electrical activity of the TA and static balance. [Conclusion] The results demonstrate that tDCS alone or in combination with FES had no immediate effect on electrical activity of the TA and static balance of the 30 individuals analyzed.

[Purpose] To determine whether repetitive trampoline or hard surface jumping affects lower extremity alignment on jump landing. [Subjects and Methods] Twenty healthy females participated in this study. All subjects performed a drop vertical jump before and after repeated maximum effort trampoline or hard surface jumping. A three-dimensional motion analysis system and two force plates were used to record lower extremity angles, moments, and vertical ground reaction force during drop vertical jumps. [Results] Knee extensor moment after trampoline jumping was greater than that after hard surface jumping. There were no significant differences between trials in vertical ground reaction force and lower extremity joint angles following each form of exercise. Repeated jumping on a trampoline increased peak vertical ground reaction force, hip extensor, knee extensor moments, and hip adduction angle, while decreasing hip flexion angle during drop vertical jumps. In contrast, repeated jumping on a hard surface increased peak vertical ground reaction force, ankle dorsiflexion angle, and hip extensor moment during drop vertical jumps. [Conclusion] Repeated jumping on the trampoline compared to jumping on a hard surface has different effects on lower limb kinetics and kinematics. Knowledge of these effects may be useful in designing exercise programs for different clinical presentations.

[Purpose] Parkinson’s disease (PD) patients often freeze in actual daily living but seldom in clinical setting. This study aimed to identify the factors contributing to freezing of gait (FOG). [Subjects and Methods] The participants included 28 adults with PD. Principal component analysis was used to investigate the characteristics of 14 common FOG situations adopted from previous studies. Cluster analysis classified the subjects into four groups. Kruskal-Wallis test was performed to compare the PD Questionnaire-39 mobility dimension between the groups. [Results] The major variables of the first principal component in 14 FOG situations were unfamiliar places, unpredictable schedule changes, entering an automatic door, when another person suddenly crossed, and change in the walking surface. These situations were unrelated to the second principal component. Getting on/off a public transport and crowded places were major variables for the second principal component, and related to both the first and second principal components. Although fatigue was the most frequent FOG situation, not all principal components were influenced. The values of the PD Questionnaire-39 revealed significant differences between the groups. [Conclusion] Actual FOG situations may be categorized into (1) task complexity, (2) both task complexity and emotional factors, and (3) fatigue as decreased attentional resources.

[Purpose] The purpose of this study is to explore the effect of a VR exercise program on falls and depression in the elderly with mild depression who reside in the local community. [Subjects and Methods] This study was performed by targeting 15 elderly subjects with mild depression who resided in the local community. The targeted subjects voluntarily selected 3 VR exercise programs (each lasting 10 minutes) among 4 activities, and a resting time of 5 minutes was given for an interval after each activity. The VR exercise program was performed for total 12 weeks (36 times), 3 times a week, 45 minutes per session. [Results] After exercise, scores of static balance test (anteroposterior), Falls Efficacy Scale, and the Activities-specific Balance Confidence Scale in the test subjects were improved and depression and internal stress scores were significantly decreased after the intervention. [Conclusion] It can be concluded that the VR exercise program exerts a positive effect not only on the physical factor but also on the mental factor of the elderly subjects with mild depression who reside in the local community. It is expected that based on the VR exercise program, diversified home programs for the elderly should be developed in the future.

[Purpose] To investigate lower-extremity joint torque during walking direction changes, focused on gender differences in pelvic width. [Subjects and Methods] Healthy males and females (n=10) changed direction while walking by side-stepping (SS) and crossover stepping (CS), stepping the left leg to the left or right, respectively, over the right leg. Movements were recorded using four infrared cameras, and ground reaction force of each lower extremity measured using two force platforms. Joint torque of each lower extremity was calculated, and each joint peak torque among walking, SS and CS was compared between genders. Moreover, correlation between joint torque showed a gender difference and width of pelvis normalized by width of shoulder (P/S ratio) was examined. [Results] Right external and internal rotation torques during CS were higher in males. Left- and right-ankle plantar flexion torques were also higher in males during CS, while the P/S ratio was larger in females, with a positive correlation between P/S ratio and hip external and internal rotation torques. [Conclusion] No gender differences were found in joint torque during walking and SS, but only during CS. The hip external and internal rotators are necessary for smooth CS in females in terms of P/S ratio.

[Purpose] The purpose of this study was to present the effects of Interactive metronome (IM) on timing for children with Attention-Deficit Hyperactivity Disorder (ADHD). [Subjects and Methods] The subjects of the present study were 2 children diagnosed with ADHD. Pre- and post-intervention tests were completed by the researcher using Long Form Assessment (LFA) test of IM and K-WPPSI-IV. The subjects were provided with IM for 40 minutes at a time, 2 times per week, for a total of 8 weeks. [Results] The timing decreased after IM intervention. The subjects showed improvement in attention span after IM intervention. Working memory index as well as processing speed index were increased after intervention, as shown by the Korean-Wechsler Preschool and Primary Scale of Intelligence-IV (K-WPPSI-IV). [Conclusion] IM was effective in improving timing, attention, working memory and processing speed in children with ADHD.

[Purpose] The purpose of this study is to examine prejudices and attitudes of students in the department of physical therapy, in order to suggest basic data for constructing an effective program to develop a positive attitude toward people with disabilities and lower social distance from them. [Subjects and Methods] For this study, students in the department of physical therapy participate in the survey examining prejudices and attitude towards people with disabilities. [Results] First, there were statistically significant differences in the prejudice against people with disabilities among student groups divided by whether they had contact on a frequent basis currently with those who have disabilities. Second, there were statistically significant differences in the prejudice against people with disabilities among student groups divided by whether they had an experience of being harmed by people with disabilities. Third, there was a correlation among prejudices against people with disabilities with each other that is articulated in the eighth domain. Finally, as a result of regression analysis, the students’ attitudes towards people with disabilities were explained appropriately by the prejudices about performance of daily tasks and NIMBY (Not In My Back Yard) syndrome. [Conclusion] It is crucial to create an environment where University students in the department of physical therapy can have positive interactions with people with disabilities, to reduce the overall prejudices, and specifically, the prejudices about performance of daily tasks and about NIMBY syndrome.

[Purpose] This study examines how difference in sandy ground between firm ground influences the effects of gait training in patients with chronic stroke. [Subjects and Methods] A total of 28 patients with chronic stroke were evenly divided into experimental and control groups. Initial evaluation of the subjects was conducted by Timed Up & Go (TUG) and 6-Minute Walking Test (6MWT). Each patient in both groups received daily, 30-minute gait training on sandy ground and firm ground, five times each week, for a total of six weeks, after which reevaluation was conducted. [Results] In TUG, both groups showed significant improvement after the intervention. In 6MWT, only the experimental group achieved significantly increased distance after the intervention. However, there was no between-group difference. Improvement in dynamic balancing ability depends on repeated gait training rather than differences in the ground environment. However, gait endurance showed a difference depending on the types of ground, regardless of repeated gait training. [Conclusion] This can be attributed to the fact that gait training on sand requires use of more diverse muscles. Hence, we can confirm the potential of sand as a new material for training ground when attempting to improve walking ability, particularly gait endurance, among patients with chronic stroke.

[Purpose] This study aimed to investigate the correlation between the diaphragm thickness and diaphragm excursion, and pulmonary function in individuals with stroke. [Subjects and Methods] One hundred fourteen patients who were clinically diagnosed with ischemic or hemorrhagic stroke were included. The diaphragm thickness and excursion were assessed using ultrasonography, and the diaphragm thickening ratio was standardized using a formula. To analyze pulmonary function, we measured the forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. [Results] A statistically significant correlation was found between the diaphragm thickness, thickness ratio, and diaphragm excursion; and the forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. [Conclusion] This study demonstrated that there is a relationship between respiratory function and diaphragm thickness and diaphragm excursion, especially in the paretic side of the diaphragm. Therefore, the role of the respiratory muscles of the paretic side is important in rehabilitation programs to improve the respiratory function of stroke patients.

[Purpose] The purpose of this study was to investigate the effect of fluidotherapy on hand’s dexterity and activities of daily living for stroke patients with upper limb edema. [Subjects and Methods] The objective of the present study was to treat 30 stroke patients with a three-week course of fluidotherapy to investigate the efficacy of such therapy for reduction of edema. For accurate baseline and post-intervention assessment of edema volume, hand edema was measured in the morning using a forearm volumeter. [Results] Mean edematous volume in the affected side measured 600.53 ± 29.94 ml prior to intervention, significantly decreasing to 533.53 ± 27.85 ml after three weeks of fluidotherapy. To investigate how such reduction may have enhanced the ability to perform activities of daily living, Korean Version of Modified Barthel Index assessment was performed. The results showed 46.10 ± 4.27 points at baseline and significantly improved to a mean score of 49.96 ± 4.34 points at the time of reassessment. Furthermore, Box and Block Test was performed to investigate hand dexterity. Before fluidotherapy, affected patients transferred 21.13 ± 3.63 blocks in one minute, increasing to 23.20 ± 3.42 blocks transferred in one minute following three weeks of treatment. Although the number of blocks transferred did increase slightly, the difference was not statistically significant. [Conclusion] These findings suggest that using fluidotherapy can reduce edema, and such a reduction can have a positive effect on activities of daily living. Based on our current findings, we hypothesize that long-term fluidotherapy treatment may be more effective in reducing edema.

[Purpose] This study was carried out to examine the effect of the application of group exercise program composed to induce interests and assertive participation of adults with cerebral palsy on the self-efficacy and activities of daily living, as well as to provide basic clinical data that are effective and trustworthy in enhancing the physical and emotional interaction in the future. [Subjects and Methods] Those among the 23 adult with cerebral palsy who are the subjects of research and able to participate only in the evaluation of measurement tools prior to and after the experiment were allocated to the control group while only those who can participate in the group exercise program implemented over 12 sessions were allocated to the experimental group. For the control group, a range of motion of joint exercise and stretching exercise were executed on the arms, legs and trunk, while for the experimental group, group exercise that is implemented with participation of several subjects simultaneously was executed 2 times a week with 40 minutes for each session over a period of 6 weeks for the total of 12 sessions. [Results] In both the experimental group and the control group, there were statistically significant changes in the average scores of self-efficacy and activities of daily living after the exercise in comparison to that prior to the exercise. Moreover, there were statistically significant differences in self-efficacy and activities of daily living in terms of quantity of change prior to and after the exercise between the two groups. [Conclusion] Therefore, group exercise program composed to induce physical and emotional interaction, and active participation of adults with cerebral palsy can be considered as an effective intervention method in improving their self-efficacy and activities of daily living.

[Purpose] This study aimed to assess the influence of ultrasound (US) transducer tilt on muscle thickness and echo intensity of the rectus femoris muscle (RF) in healthy subjects. [Subjects and Methods] Fourteen healthy male subjects (20.8 ± 0.8 years) participated in this study. Transducer tilt was measured during US, with a digital angle gauge. Muscle thickness and echo intensity were measured in 4 transducer tilt conditions: reference angle; +3°; +6°; and +9° cranial from the reference angle. [Results] All differences in transducer tilt relative to the reference condition were larger than the minimal detectable change (MDC) of the reference condition. All differences in muscle thickness relative to the reference condition were not larger than the MDC of the reference condition. All differences in the echo intensity relative to the reference condition, except between the reference and the +3° condition, were larger than the MDC of the reference condition. [Conclusion] Our results indicated that an examiner should maintain a precise transducer tilt during repeated US measurements to quantify the minimal change in the echo intensity of the RF.

[Purpose] Literature has revealed age-related changes in body regional tissues in the form of reduced muscle size and increased adipose tissue. There is also a decline in the performance of physical function with aging. The aim of this study is to examine the partial and part correlations between physical performance and thigh tissue composition among elderly adults. [Subjects and Methods] Twenty-two elderly participants enrolled in this cross-sectional study. Mid-thigh CT images were used to determine the cross-sectional area of the muscular and adipose tissues. Principal component score of physical function was calculated from 5 performance based physical function tests using principal component analysis. Partial and part correlation statistics were used to explore the association between physical performance and tissue composition. [Results] There were significant, moderate negative partial and part associations between the principal component score and cross-sectional area of thigh muscles, quadriceps muscle and quadriceps normal density muscle. Significant, moderate positive partial and part correlations were found between intramuscular adipose tissue and the principal component score. [Conclusion] Elderly adults’ performance of physical function is associated with regional tissue composition.

[Purpose] The purpose of this study is to examine the effects of elastic and non-elastic taping on induced quadriceps fatigue by knee extension exercise. [Subjects and Methods] Thirty healthy females were randomly assigned to an elastic tape group (ET, n=10), a non-elastic tape group (NET, n=10), or a no tape group (NT, n=10). Taping groups attached taping on quadriceps femoris. Three groups are conducted knee extension exercise for 10 times and 3 sets during 10 minutes. Knee extension peak torque measured before and after knee extension exercise. One-way analysis of variance was used to assess the statistical significance of knee extension peak torque. [Results] No significant difference in changes in maximum muscle strength per unit weight from before to after the muscle fatigue exercise was found in the ET, NET, or NT groups (12.1 ± 4.2, 11.7 ± 7.1, and 6.7 ± 3.4 N/kg, respectively). [Conclusion] Taping facilitated muscle performance, but it also increased susceptibility to fatigue resulting from greater muscle activation.

[Purpose] To compare the effect of an aquatic-based versus a land-based exercise regimen on the physical performance of severely burned patients. [Subjects and Methods] Forty patients suffering from severe burn (total body surface area more than 30%) were recruited from several outpatient clinics in Greater Cairo. Their ages ranged between 20 to 40 years and were randomly assigned into two equal groups: group (A), which received an aquatic based exercise program, and group (B), which received a land-based exercise program. The exercise program, which took place in 12 consecutive weeks, consisted of flexibility, endurance, and lower and upper body training. Physical performance was assessed using 30 seconds chair stand test, stair climb test, 30 meter fast paced walk test, time up and go test, 6-minute walk test and a VO2max evaluation. [Results] Significantly increase in the 30 second chair stand, 6-minute walk, 30 meter fast paced walk, stair climb, and VO2 max tests and significantly decrease in the time up and go test in group A (aquatic based exercise) compared with group B (a land-based exercise) at the post treatment. [Conclusion] Twelve-week program of an aquatic program yields improvement in both physical performance and VO2 max in patients with severe burns.

[Purpose] The objective of the present study was to examine the factors, including physical and mental functions, that are associated with the prognosis for activities of daily living in patients with stroke in a recovery rehabilitation unit. [Subjects and Methods] The subjects were 13 patients with stroke who were admitted to the recovery rehabilitation unit of Tokai Memorial Hospital between March and October 2014 and followed up for 2 months. Their physical and mental functions were evaluated at the time of admission and the relationship between these functions and activities of daily living was assessed 2 months later. [Results] The activities of daily living at 2 months after admission showed a significant correlation not only with the severity of motor paralysis (R=−0.80) but mental function (R=−0.69) at the time of admission. No significant correlation was noted between the severity of motor paralysis and the mental function. [Conclusion] It is important to evaluate both mental function and severity of motor paralysis immediately after patients’ admission to the recovery rehabilitation unit. Mental health intervention should be considered in the future to effectively improve subsequent activities of daily living.

[Purpose] The purpose of this study was to measure gluteal pressure and center of force (COF) during sitting in children with cerebral palsy (CP). [Subjects and Methods] The participants were five children with CP and five typically developing controls. We measured peak gluteal pressure and COF using the TekScan system. During the measurements, all children sat on the therapeutic table for 1 minute without back and foot support. [Results] The peak gluteal pressure and COF in children with CP were significantly higher than values in controls. [Conclusion] This study suggests that it is important to distribute hip pressure evenly and transfer COF in a forward direction during rehabilitation in children with CP.

[Purpose] This study was conducted to compare the immediate effects of different electrotherapies on the gait parameters for stroke patients. [Subjects and Methods] Thirty patients with stroke were randomly assigned either to the functional electrical stimulation group or the transcutaneous electrical nerve stimulation group, with 15 patients in each group. Each electrotherapy was performed for 30 minutes simultaneously with the therapeutic exercise, and the changes in the spatial and temporal parameters of gait were measured. [Results] After the intervention, a significant, immediate improvement in cadence and speed was observed only in the functional electrical stimulation group. [Conclusion] Based on this study, functional electrical stimulation that stimulates motor nerves of the dorsiflexor muscles on the paretic side is recommended to achieve immediate improvement in the gait ability of stroke patients.

[Purpose] To ensure that elderly individuals continue performing their activities of daily living, rehabilitation specialists have focused on several intervention programs, including programs that help maintain the functionality of digits. Grasping motion, including the ability to adjust grip, both spatially and temporally, is important for the elderly to continue independent living. The iWakka is a device used to measure the adjustability of grasping force and developed in Japan in 2012. This study aimed to evaluate the range of error of the iWakka, and verify its usefulness for evaluating adjustability of grasping force in elderly subjects. [Subjects and Methods] In 36 community-dwelling elderly subjects, over 65 years old, two readings of adjustability of grasping force, in the dominant and non-dominant hands were obtained using the iWakka, and a Bland-Altman analysis of the data was performed. [Results] The results demonstrated significant fixed bias in the dominant and non-dominant hands, but no significant proportional bias was observed. The limits of agreement were −2.8 to 4.4 g for dominant hand and −2.6 to 3.9 g for non-dominant hand. [Conclusion] Therefore, it is possible to measure the efficacy of interventions and detect declines in adjustability of grasping force using iWakka. Interventional programs can be designed for daily life based on the grasping force results shown by iWakka.

[Purpose] The purpose of this study was to examine whether a trunk forward bending angle in sitting position affected slow vital capacity (SVC). [Subjects and Methods] The subjects of this study were 18 healthy college students to whom the study’s methods and purpose were explained and their agreement for participation was obtained. Slow vital capacity was measured using spirometry (Pony FX, COSMED Inc., Italy), repeatedly at a body bending angle of 0°, 15°, and 30° in the sitting position. [Results] Vital capacity, expiratory reserve volume, and inspiratory reserve volume were significantly different according to the trunk forward bending angle. There were no statistically significant differences in tidal volume and inspiratory capacity. [Conclusion] The results demonstrated that the body bending angle of 15° in the sitting position was the most effective angle for increasing lung volume.

[Purpose] This meta-analysis was undertaken to establish normative reference values for the two-minute walk test. [Methods] Three database searches and a hand search were conducted. Meta-analysis was used to consolidate two-minute walk test data stratified by gender and age group. [Results] Data from four articles was consolidated. Normative two-minute walk test distances varied from 150.3 m (women, 70 to 79 years) to 217.9 m (men, 20 to 29 tears). [Conclusion] Normative reference values derived using meta-analysis should provide a better standard than individual studies for interpreting the two-minute walk test performance of adults.

[Purpose] To investigate the effectiveness of cognitive-behavioural therapy (CBT) and pain coping skills training (PCST) on pain level in adults with osteoarthritis of the knee (KOA) in comparison with usual care. [Subjects and Methods] Five databases were systematically searched for relevant randomised controlled trials (RCTs) according to the selected eligibility criteria (inception to June 7, 2016). PEDro scale was used to assess the validity of included studies. [Results] Four studies met the inclusion criteria and all studies had high methodological quality. The total number of participants was 665 across the four included studies. All participants had been diagnosed with KOA (clinical and radiographic evaluation). The majority of the population were female (71.13%). The interventions utilised were: CBT, CBT for insomnia (CBT-I), PCST, and PCST combined with behavioral weight management (BWM) in one study and with exercise in another study. The outcome measure for pain in KOA was the WOMAC scale. Overall, three studies have reported clinical improvement in KOA pain perception after 12-month follow-up time point. [Conclusion] This review has recognised the need for future studies that have rigorous methodological quality, and investigate the effect of mutual CBT and PCST protocols on KOA pain and pain-related functional and psychological abilities.