[Purpose] Muscle quantity (e.g., cross-sectional area) and quality (e.g., muscle adipose tissue), which are muscle strength determinants, can be assessed using ultrasonography. The study aimed to investigate the changes in the quantity and quality of the peroneus longus and evaluate evertor strength in legs with chronic ankle instability (CAI). Furthermore, the associations among cross-sectional area, echogenicity, evertor strength, and frequency of ankle sprain were examined. [Participants and Methods] Nine males with CAI in unilateral legs were the voluntary participants in this study. The cross-sectional area of the peroneus longus, echogenicity, and evertor strength were measured for all the participants on the sides with CAI and that without. [Results] No significant difference in cross-sectional area was observed between the sides. Significant differences in echogenicity (higher on the CAI side) and evertor strength (lower on the CAI side) were observed between the sides. In addition, a moderate correlation was observed between echogenicity and increased sprain frequency on both sides. [Conclusion] Muscle adipose tissue increased, evertor strength decreased, and the cross-sectional area remained unchanged on the CAI side. The study results suggested that muscle adipose tissue increases with increasing frequency of ankle sprain.

[Purpose] Sarcopenia may be associated with malnutrition in patients with vertebral compression fractures which may affect a patient’s functional prognosis. This study investigated the association between sarcopenia, malnutrition, and activities of daily living at the time of hospital discharge in patients with vertebral compression fractures. [Participants and Methods] The study included 36 patients who were hospitalized with vertebral compression fractures. Sarcopenia was assessed by measuring grip strength and calf circumference. The nutritional status was assessed at the time of hospital admission and at discharge using the Mini Nutritional Assessment Short Form screening tool. Activities of daily living were assessed using the Barthel Index. [Results] The prevalence of sarcopenia at the time of admission was 47.2%. The Barthel Index and Mini Nutritional Assessment Short Form scores in patients with sarcopenia at the time of admission were significantly lower at discharge than to those in patients without sarcopenia. Overall, at discharge, weight and calf circumference decreased significantly with a consequent increase in the prevalence of sarcopenia (55.6%). Multivariate analysis showed that the Mini Nutritional Assessment Short Form score, calf circumference loss, and age affected the Barthel Index at discharge. [Conclusion] Patients with vertebral compression fractures often show sarcopenia and malnutrition, which are conditions that may be exacerbated during hospitalization. These conditions can subsequently affect a patient’s activities of daily living; thus, nutritional rehabilitation is important in patients with vertebral compression fractures, as demonstrated in this study.

[Purpose] This study examined the effects of training using virtual reality games on stroke patients’ functional recovery. [Paticipants and Methods] Twenty-four hemiplegia patients whose disease duration was longer than six months participated in this study. The participants were divided at random into a control group (n=12), which received traditional rehabilitation therapy, and an experimental group (n=12), which received both traditional rehabilitation therapy and training using virtual reality games. The program lasted for a total of 12 weeks. To examine the participants’ functional recovery, their upper limb function was measured using the Fugl-Meyer Assessment and Manual Function Test before and after they completed the training and their daily living activities were measured using the Stroke Impact Scale before and after they completed the training. [Results] The experimental group participants’ daily living activities improved after training. In addition, the experimental group scored significantly higher on all the tests than the control group, but upper extremity function between the groups was not significantly different. [Conclusion] Stroke patients who completed the additional training using virtual reality games showed significantly greater improvement in their daily living activities than those who only received traditional rehabilitation therapy.

[Purpose] The aim of this study was to investigate whether the combination of integrated volitional control functional electrical stimulation and tilt sensor functional electrical stimulation training affected brain activation during the subacute phase following a stroke. [Participant and Methods] The patient was a 60-year-old male with right hemiparesis, secondary to stroke in the left thalamus. Conventional intervention was performed for 60 minutes per day during the first two weeks of treatment (the control condition). Functional electrical stimulation intervention, including integrated volitional control functional electrical stimulation and tilt sensor functional electrical stimulation training, was then performed for 60 minutes per day for two weeks (the experimental condition). These sessions were repeated four times. Brain activity was measured during voluntary right ankle dorsiflexion in both sessions, using functional magnetic resonance imaging. Brain activity measurements were obtained a total of eight times every two weeks (34, 48, 62, 76, 90, 104, 118, and 132 days following the stroke). [Results] There was a significantly higher level of activation in the bilateral cerebellum and the left side of the supplementary motor area in the experimental condition than in the control condition. [Conclusion] The present study demonstrates that the combination of integrated volitional control functional.

[Purpose] Persons with age-related hyperkyphosis often have concomitant sagittal plane imbalance of the spine. This study investigated the reliability of sagittal vertical axis (SVA) measurement of sagittal balance, association between thoracic Cobb angle of kyphosis and SVA measure of sagittal balance, and compared the degree of SVA in males and females with age-related hyperkyphosis. [Participants and Methods] Measurements of SVA and Cobb angle of kyphosis were obtained from baseline radiographs of 112 community-dwelling males and females, mean age 70.0 (SD=5.7) years with kyphosis ≥40 degrees, recruited for a randomized controlled trial. Spearman correlation coefficients were used to determine associations between SVA and kyphosis, and Wilcoxon nonparametric tests to compare SVA between genders. [Results] SVA was acquired with excellent intra-rater [0.95 (95% CI: 0.88, 0.98)] and inter-rater reliability [0.93 (95% CI: 0.83,0.97)]. There was no significant correlation between Cobb angle of thoracic kyphosis and SVA, (r=−0.05). More males than females had sagittal imbalance (SVA≥5 cm). [Conclusion] In older adults with hyperkyphosis, SVA was a reliable measure of sagittal balance, and more extreme in males. SVA was not associated with Cobb angle of thoracic kyphosis, and could be considered an independent phenotype of age-related hyperkyphosis to be targeted in future intervention trials.

[Purpose] The purpose was to determine the correlation between the skeletal muscle mass index and parameters of respiratory function and muscle strength in young healthy adults as predictors of sarcopenia in association with aging and respiratory diseases. [Participants and Methods] Participants were 41 males and 37 females with a mean age of 19.5 ± 1.5 years. The following were measured: body composition (skeletal muscle mass index), respiratory function (vital capacity, inspiratory reserve volume, expiratory reserve volume, inspiratory capacity, forced vital capacity, one-second forced expiratory volume, peak expiratory flow rate), and respiratory muscle strength (maximum inspiratory pressure, maximum expiratory pressure). Correlations between the skeletal muscle mass index and parameters of respiratory function and respiratory muscle strength were assessed using Pearson’s coefficient. [Results] The total skeletal muscle mass index showed a positive correlation with all items. The male skeletal muscle mass index showed a positive correlation with respiratory function excluding inspiratory reserve volume, expiratory reserve volume, maximum inspiratory pressure, and maximum expiratory pressure. The female skeletal muscle mass index showed a positive correlation with all respiratory functions including inspiratory reserve volume and expiratory reserve volume, but was not associated with respiratory muscle strength. [Conclusion] The skeletal muscle mass index showed a positive correlation with respiratory function and respiratory muscle strength. Gender-based features were correlated with respiratory muscle strength in males and lung capacity in females.

[Purpose] The purpose of this study was to investigate the educational needs on the job competence for physical therapist assistant in the students of Quang Tri medical college in Vietnam. [Participants and Methods] Participants consisted of 17 individuals in the educational program for physical therapist assistant in Quang Tri medical college. The importance recognition ranking and current levels were measured by self-assessment for job competence of physical therapist assistant using a questionnaire. The educational needs were calculated by importance recognition ranking and current level by a self-assessment of job competence. [Results] The importance recognition ranking of job competence appeared to show a ‘system checkup’ as the top ranked category. The rank of current levels of competencies was determined by self-assessment of job competence and results showed that ‘cooperation, communication, and documentation’ was the highest category of the current levels. The highest rank of the educational needs was ‘counseling and education’. [Conclusion] The educational needs rank of job competence appeared to be ‘counseling and education’ foremost. Counseling and education with the patient is a fundamental component of effective healthcare. Therefore, it should be considered a priority for the educational curriculum of physical therapist assistant.

[Purpose] The purpose of this study was to investigate the acute effect of low-intensity eccentric hamstring exercise on peak torque angle, range of motion, and passive stiffness. [Participants and Methods] Fourteen healthy young adults exercised as follows: 1) Under low-intensity eccentric hamstring exercise condition, participants performed a stiff-leg deadlift using a 20-kg barbell, 2) Under control condition with participants seated. The peak torque angle during eccentric knee flexion, hip flexion and knee extension range of motion, passive torque, and passive stiffness were measured before and after two conditions in the dominant leg. [Results] The low-intensity stiff-leg deadlift significantly increased hip flexion and knee extension range of motion and significantly decreased passive stiffness. Although the low-intensity stiff-leg deadlift did not change the peak torque angle, the changes in passive torque and passive stiffness were negatively correlated with the change in peak torque angle. [Conclusion] These results suggest that low-intensity eccentric hamstring exercise enhances flexibility, and a decrease in passive torque and passive stiffness are negatively associated with producing the eccentric peak knee flexion torque at a shorter muscle length.

[Purpose] The effect of physiotherapy on stooped posture in Parkinson’s disease patients remains to be clarified. Therefore, the purpose of this study was to investigate whether comprehensive physiotherapy-based rehabilitation can improve stooped posture in Parkinson’s disease patients. [Participants and Methods] The participants were Parkinson’s disease patients with stooped posture. Outpatients were assigned to the control group and inpatients to the postural rehabilitation group. The outcomes measured were trunk bending angle, lumbar lordosis, and thoracic kyphosis. Each group was assessed at baseline and 1 month later. [Results] Of 22 participants identified, 20 were included, with 10 participants in the postural rehabilitation group and 10 in the control group. The age in the postural rehabilitation group was significantly greater than that in the control group, while other parameters were comparable in both groups. After the month-long intervention, the trunk bending angle and lumbar lordosis were significantly improved in the postural rehabilitation group compared to the control group. [Conclusion] The results showed improvement in stooped posture in the postural rehabilitation group as compared to the control group. Furthermore, improvement of lumbar lordosis accompanied improvement of stooped posture. These findings suggest that comprehensive physiotherapy-based rehabilitation may improve stooped posture in Parkinson’s disease patients.

[Purpose] The Balance Evaluation Systems Test (BESTest) is a comprehensive assessment tool, although it is not confined for use in stroke patients. This study aimed to determine the structural validity of the BESTest in self-ambulatory patients with stroke using both factor and Rasch analyses. [Participants and Methods] This retrospective study included 140 self-ambulatory patients with stroke. The structural validity of the BESTest was analyzed according to principal component, exploratory factor, Rasch, confirmatory factor, and correlation analyses. [Results] The analytical results supported a four-factor model comprising 25 items. The four factors included dynamic postural control with gait, static postural control, stepping reaction, and stability limits in sitting. Evidence of high structural validity and reliable internal consistency suggested that the 25-item BESTest is valid and reliable. Each factor was significantly correlated with lower extremity motor function and walking ability. [Conclusion] Eleven items in the BESTest were poorly correlated, and the remaining 25 items were grouped into four factors that demonstrated good structural validity for patients with stroke. Further studies should validate the applicability of the 25-item BESTest four-factor model in a larger sample of patients with stroke in a clinical setting.

[Purpose] The purpose of this study was to examine the effect of manual spinal traction therapy on the pain and Oswestry disability index of patients with chronic back pain. [Participants and Methods] In this study, 30 patients with chronic back pain were evenly divided into an experimental group 1, who received manual traction therapy, and an experimental group 2, who received intermittent traction therapy. Both groups received therapy three times a week for eight weeks. A visual analogue scale was used to measure participants’ back pain, and the Oswestry disability index was used to check the functional impediment they experienced as a result. [Results] In a within-group comparison, visual analogue scale and Oswestry disability index significantly decreased in both the experimental 1 and experimental 2. In a between-group comparison after treatment, there was a significantly greater decrease in visual analogue scale and Oswestry disability index in the experimental group 1 compared to the experimental 2. [Conclusion] The manual spinal traction therapy was an effective intervention scheme for the treatment of pain and disorder in patients with chronic back pain.

[Purpose] This case study describes the reacquisition of knee joint function in a patient with Down syndrome after surgery for patellar dislocation using external focus training. [Participant and Methods] The patient was a female aged 24 years with Down syndrome and a low Intelligence Quotient, who suffered from right patellar dislocation. The range of motion in the right knee while walking was 2 to 23 degrees at 3 weeks after surgery. A compensatory gait while walking was confirmed, with her right leg fixed in extension. Her range of motion while lying was 0 to 155 degrees. A task in which the patient reached and touched a ball was performed with the lower extremities while lying down, according to simple instructions from a therapist. Instructions were given using a simple directive phrase. The intervention started with a single-joint exercise and progressed to a multi-joint exercise. [Results] The range of motion was 0 to 68 degrees at 9 weeks after surgery. Her compensatory gait disappeared and she was able to walk more than 2 km. [Conclusion] Even though the patient’s low cognitive function made it difficult for her to complete some tasks, training based on external focus enabled her to acquire adequate knee joint function. External focus training was found to be effective for a patient with a low Intelligence Quotient.

[Purpose] This study compared lower garment-lifting postural control characteristics during toilet-related activities between healthy participants and a post-stroke patient, and studied changes in the stroke patient’s characteristics during rehabilitation. [Participants and Methods] Six healthy individuals and one stroke participant with right hemiparesis were asked to lift a pair of pants with the left arm while on the toilet. During the process, we measured the mean percentage of body weight (%BW) on each leg and the foot center of pressure (COP) using portable force plates. Measurements were conducted twice for the stroke participant during rehabilitation. [Results] In healthy participants, the %BW and respective COP indices for both legs were not different during lifting, but the COP sway velocity and excursion were greater in the anterior-posterior (AP) than the lateral axis in both legs. In the stroke participant, no marked change was seen in the high %BW of the non-paretic leg while lifting during rehabilitation, but both legs’ COP positional asymmetry improved on the AP axis and the COP sway velocity and excursion of the non-paretic leg increased. [Conclusion] Facilitating selective COP mobility on the AP axis of the non-paretic leg during lower garment lifting could become an effective intervention for stroke patients.

[Purpose] This study aimed to clarify the effects and to verify the efficacy of various breathing exercises performed while sitting on a small foam roller on the contraction of pelvic floor muscles in males. [Participants and Methods] This study, involving 10 healthy males (age 19.9 ± 1.6 years), had a crossover design and involved two conditions: sitting at rest for 10 min (CON condition) and sitting on a small foam roller placed on a chair while performing seven breathing exercises (EXE condition). Movement of the posterior side of the bladder was examined in both conditions using ultrasonic imaging. Pelvic floor muscle contraction was evaluated based on the movement distance. [Results] No significant difference was found in any parameter for CON conditions. The distance of bladder posterior side movement was 5.58 ± 2.51 mm (pre), 13.66 ± 5.16 mm (post), and 9.59 ± 3.67 mm (post-1 month) for EXE conditions. Subjective evaluation also demonstrated that the feeling of contraction was stronger immediately after the experiment. [Conclusion] Results demonstrated that various breathing exercises, performed while sitting on a small foam roller, enhanced the voluntary contraction of pelvic floor muscles in males. Efficacy was demonstrated, at least in young males.

[Purpose] This study involved performing longitudinal measurements of muscle mass in elderly patients with mild disequilibrium using a body composition meter. The rate of change and characteristics were determined according to the level of care needed. [Participants and Methods] Bioelectrical impedance was used to measure body composition in 20 elderly females in Care Needs Category 1 (n=10) and 2 (n=8); body composition was measured every 3 months for 1 year. [Results] Compared to Category 1, the muscle mass at each body site was lower in Category 2 and the muscle mass of the whole body and thighs in Category 2 decreased throughout the year. [Conclusion] Muscle mass in elderly patients needing assistance depended on the level of care, as suggested by the decrease in muscle mass in the whole body and thighs in Category 2 over time. In addition, effective rehabilitation intervention for the trunk is important.

[Purpose] The purpose of this study was to compare the strength and endurance of the orbicularis oris muscle in healthy Korean (young vs. elderly adults). [Participants and Methods] A total of 60 participants (30 young adults and 30 elderly adults) were recruited. The Iowa Oral Performance Instrument was used to measure orbicularis oris muscle maximal strength and endurance. [Results] Elderly adults showed significantly lower orbicularis oris muscle strength and endurance than younger adults. [Conclusion] This study confirmed a significant age-related decrease in orbicularis oris muscle strength and endurance. The data collected will be useful as a basis for future on speech and swallowing therapy.

[Purpose] This study aimed to elucidate the dynamics of the kinematic chain of shank rotation accompanying calcaneal pronation/supination during weight-bearing changes associated with ankle positions during plantar/dorsiflexion and whether this biomechanical phenomenon is affected by age. [Participants and Methods] The study included 54 participants (108 legs, 25 young and 29 old participants). A 3-dimensional motion analysis system measured the calcaneal pronation/supination and the shank rotation angles during pronation/supination of the foot when upright. The kinematic chain ratio was defined as the linear regression coefficient (shank rotation angle/calcaneal pronation/supination angle). The kinematic chain ratio was measured during plantar flexion, in an intermediate position, and dorsiflexion. [Results] Significant differences in the kinematic chain ratio were related to ankle position but not age. The mean kinematic chain ratio in all participants was 0.9 ± 0.3 for plantar flexion, 1.0 ± 0.2 for an intermediate position, and 1.3 ± 0.4 for dorsiflexion, showing significant differences between the 3 ankle positions. [Conclusion] During dorsiflexion, the long axis of the shank and that of the subtalar joint are nearly parallel; thus, shank rotation increases (larger kinematic chain ratio). During plantar flexion, a larger angle is created; thus, shank rotation decreases (smaller kinematic chain ratio). When analyzing the kinematic chain between calcaneal pronation/supination and shank rotation, it is essential to consider the ankle position during plantar/dorsiflexion.

[Purpose] Amputee soccer is a game for individuals with amputations. Players use lofstrand crutches to move around the field and kick the ball. Scoring quick goals during a match requires players to have maximum running skills. Notably, a few parameters affect the running speed in players; however, no study has reported the biomechanical analysis of running in amputee soccer. Thus study aimed to analyze the biomechanics of single-leg running using lofstrand crutches in 12 healthy adult males (6 with prior amputee soccer experience and 6 without such experience). [Participants and Methods] The kinematics of the lower limb and the pelvis, the ground reaction force, and skill in using the crutches were evaluated using 3 dimensional motion analysis combined with 8 force plates. Lower leg amputation was simulated in all participants by maintaining the non-dominant knee in a position of maximum flexion using an elastic band. [Results] Significant differences were observed between experienced and non-experienced participants with regard to the angle of the pelvis and the crutch stance phase. Specifically, higher running speed was associated with an increased forward tilt of the pelvis and a shorter crutch stance phase. [Conclusion] These findings will be useful to improve the running speed of amputee soccer players.