[Purpose] This study compared the effect of the Nintendo Wii balance board (NWBB) and Tai Chi Chuan (TCC) on the standing balance (SB) of older adults. [Participants and Methods] Twelve older adults (NWBB=7 and TCC=5) completed the intervention and two testing sessions (pre-post). SB was assessed using posturographic measures with the center of pressure (CoP) in five modes: quiet eyes open (QSB-EO) and eyes closed (QSB-EC), on sponge (SBS-EO and SBS-EC), and with optokinetic field (SB-OF). [Results] Both interventions significantly decrease the area of CoP sway (CoP_Sway) in QSB-EO and SB-OF. The NWBB-group decreased CoP_Sway in SBS-EC and CoP velocity (V_mean) in QSB-EO, QSB-EC, and SBS-EC. The TCC-group decreased the V_mean in SBS-EO and conversely the V_mean in QSB-EC increased. [Conclusion] Sponge and optokinetic field were the most unstable assessments. These findings reveal the potential benefits for SB of both interventions, however the NWBB improved more variables in the postural control of older adults.

[Purpose] This study aimed to examine the effects of health promoting education program on self-efficacy, health promoting behavior, and quality of life of Korean middle-aged women. [Participants and Methods] Participants were total 60 women (experimental: n=30, control: n=30) in the age group of 40–59, who visit community center located at G gu in Seoul. Health promoting education program was performed for 6 weeks, once a week, one hour with 20 minute group discussion. A study questionnaire was designed to measure the general characteristics, self-efficacy, health promoting behavior, and quality of life. [Results] Self-efficacy, health promoting behavior, and quality of life of middle-aged women were significantly improved in experimental group compared to the control group. [Conclusion] Health promoting education program can be utilized as an effective public health intervention in community. It would be appropriate as an addition to the public health policy for middle-aged women in community.

[Purpose] This study aimed to examine the influence of climatic conditions on the daily physical activities of elderly individuals by comparing the physical activity during seasons with and without snowfall. [Participants and Methods] In total, 35 participants attending the Health Promotion Program conducted by Chitose City Office participated in this study. The survey for the seasons with snowfall was conducted in February 2016, while the survey for the seasons without snowfall was conducted in September 2015. The physical activity of the participants was measured using a Kenz Lifecorder GS accelerometer. [Results] Physical activity was found to be significantly lower during seasons with snowfall than in seasons without snowfall. Multivariate analysis revealed that physical activity significantly increased with lower temperature during the seasons with snowfall, and it significantly increased with higher temperature and decreased with larger amounts of precipitation during the seasons without snowfall. [Conclusion] It was found that the climatic conditions affect the level of physical activity during seasons with and without snowfall. A lower level of physical activity was observed in areas that received snowfall than in areas that did not receive snowfall.

[Purpose] The aim of the present study was to examine the effects of brain activation using sensory awareness, imagery, and observation in adults with psychological stress. [Participants and Methods] The participants of the study were 30 adults with psychological stress. They responded to questionnaires, including a stress response inventory. Data for brain activation were collected for sensory awareness, imagery, and observation using electroencephalography. To determine the neurological changes in the brain, this study analysed the relative power of sensory motor rhythm of the participants using electroencephalography. [Results] Results showed that the relative power of the sensory motor rhythm was significantly greater during awareness and imagery of sensory than during observation. [Conclusion] The results of this study suggest that awareness, imagery, and observation of sensation should be considered as useful modalities in people with psychological stress.

[Purpose] The general motor strategy for gait initiation is achieved by the difference between the center of gravity and center of pressure; it be as bigger under speed optimization. This study aimed to investigate the motor pattern in rapid gait initiation under conditions of limited backward displacement of center of pressure. [Participants and Methods] The participants were 30 healthy young males (mean age, 19.7 ± 1.0 years). They performed a gait initiation task at three center of pressure start positions (anterior, middle, and posterior) and two speed conditions (normal and rapid). The gait initiation motion was measured using a video camera and motor pattern in the images was classified. The center of pressure position was continuously monitored using a pressure distribution measurement system. [Results] Forward tilt pattern was the most common under no limited center of pressure control and normal speed. The backward tilt pattern was the most preferred in the posterior position under limited center of pressure control and rapid speed. Displacement of the center of pressure showed a significant decline when the center of pressure start position was displaced backward. [Conclusion] The backward tilt pattern is the most effective motor strategy to increase the forward speed of the center of gravity.

[Purpose] To present an efficient treatment regimen for patients with cervicogenic headache by comparatively analyzing the neck disability index (NDI) and cervical muscle activity after an exercise intervention. [Participants and Methods] Thirty patients with cervicogenic headache were assigned to the cranio-cervical flexion group (n=15) and cranio-cervical flexion plus transcranial direct current stimulation (tDCS) group (n=15). Intervention was administered for four weeks, after which the participants’ NDI and sternocleidomastoid muscle activity were measured. [Results] The treatment group demonstrated a significantly greater change in NDI after the intervention compared to the control group. The treatment group also showed a significantly greater change in sternocleidomastoid muscle activity than the control group. [Conclusion] Our results show that applying tDCS during cranio-cervical flexion exercise can strengthen the sternocleidomastoid muscle more effectively while improving pain and associated functions in patients with cervicogenic headache. These results would contribute towards developing a more efficient treatment for patients with cervicogenic headache.

[Purpose] To investigate the effect of increased functional residual capacity on the finger-floor distance and to assess spinal curvature in the sagittal plane using the Spinal Mouse in healthy young participants. [Participants and Methods] Thirty-nine healthy volunteers (age=21.2 ± 0.8 years) participated in this study. The finger-floor distance was used to measure trunk flexion and was recorded at the resting expiration level and at 2 different functional residual capacity levels: 1,000 and 2,000 ml air inhaled at the resting expiration level. Spinal curvature morphology was evaluated using the Spinal Mouse in the sagittal plane when flexion was completed under the 2 increased functional residual capacity and resting expiration level conditions during finger-floor distance measurement. Finger-floor distance and spinal curvature were assessed according to functional residual capacity using one-way repeated measures analysis of variance and post-hoc analysis. [Results] Significant effects and differences were found for the finger-floor distance under all conditions. No significant effect was found for spinal curvature. [Conclusion] An increase in functional residual capacity may decrease trunk flexion. This correlation might also be observed in patients with chronic obstructive pulmonary disease.

[Purpose] This study investigated the effect of different leg angles during push-up plus exercise on shoulder stabilization muscle activity. [Participants and Methods] Fifteen healthy adult males participated in this study. The smart phone application Clinometer was used to measure leg angles of 70°, 90°, and 110° during push-up plus exercise. The muscle activities of the serratus anterior, upper trapezius fibers, and pectoralis major muscles involved in shoulder stabilization were analyzed using surface electromyogram. [Results] Leg angle significantly affected serratus anterior muscle activity, but it did not affect activities of the upper trapezius fibers or pectoralis major muscles. Post-hoc analysis revealed that serratus anterior muscle activity at the leg angle of 110° was significantly higher than at leg angles of 70° and 90°. [Conclusion] A higher leg angle during push-up plus exercise is a more effective intervention for the serratus anterior muscle activity.

[Purpose] The purpose of this study was to examine the effects of time-use intervention on the quality of life of outpatients with chronic stroke. [Participants and Methods] This study randomly allocated 31 chronic stroke outpatients into an experimental group (n=16) and a control group (n=15). The experiment group was given general rehabilitative therapy three times per week for eight weeks, and time-use intervention through counselling once per week for eight weeks. The control group was given general rehabilitative therapy only for three times per week for eight weeks. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) was used to measure the changes in the quality of life of the participants. [Results] After the intervention, the experimental group showed a significant improvement in the overall quality of life in comparison with the control group. Looking at specific categories, the experimental group showed significant improvements in the physical, spiritual, and environmental areas in contrast to the control group. [Conclusion] The findings of this study demonstrated the positive effects of time-use intervention on an improvement in the quality of life of outpatients with chronic stroke.

[Purpose] To determine the effect of an individualised functional retraining intervention on pain, function, kinematics and self-reported recovery in participants with PFP. [Participants and Methods] Thirty-one participants with unilateral PFP between the ages of 14–40 were included. Data collection and treatment sessions were conducted at the Tygerberg 3D Motion Analysis Laboratory and Physiotherapy Clinic at the University of Stellenbosch Medical School in Cape Town, South Africa. Participants underwent motion analysis testing pre- and post-intervention and attended physiotherapy weekly for a 6-week individualised intervention. [Results] Thirty of the thirty-one participants (96.8%) demonstrated improved pain levels (NPRS) post intervention. Participants demonstrated a statistically significant improvement in function (AKPS) immediately post intervention and continued to improve with greater functional scores at 6-month follow up. Fifteen participants (48.4%) rated themselves as fully recovered on a 7-point Likert scale at 6-month follow up. Nineteen of the 31 participants (61.3%) demonstrated a clinically significant improvement in their priority kinematic outcome post intervention. [Conclusion] Individualised functional retraining may improve pain, function, kinematics and long-term recovery in participants with PFP presenting with kinematic contributing factors. Clinicians need to be educated on common biomechanical contributing factors and how to tailor treatment accordingly.

[Purpose] Sports activity has been shown to improve postural stability and vestibular function in healthy older adults. The hypothesis was that healthy young adults undertaking sports activity will also have better postural stability and vestibular function compared with healthy young adults who do not undertake sports activity. The purpose of this study was to investigate the differences in postural stability and vestibular function between healthy young adults who undertake sports activity and those who do not undertake such activity. [Participants and Methods] Thirty-nine healthy young adults were recruited and divided into sports and non-sports groups on the basis of their response to a questionnaire concerning regular participation in sports activities over the past 12 months. In both groups, postural stability was measured during quiet standing and standing during head rotation, and dynamic visual acuity was assessed during head rotation. [Results] The results showed significant differences in postural stability during head rotation and dynamic visual acuity between the two groups, whereas no significant differences were found in postural stability during quiet standing. [Conclusion] The results suggest that healthy young adults who undertake sports activity have better postural stability during head rotation and better dynamic visual acuity. The causal effect of these differences is not clear and further investigation is warranted.

[Purpose] Improved quadriceps strength is a primary target of rehabilitation early after total knee arthroplasty. However, patients demonstrate varying improvement trends in gait function and quadriceps strength. This study evaluated the relationship between improvements in quadriceps strength and gait function. [Participants and Methods] The study included 49 patients who were scheduled to undergo unilateral total knee arthroplasty. Gait function, bilateral quadriceps strength, and pain were assessed in all patients. All assessments were performed preoperatively and at 2 and 3 weeks postoperatively. [Results] A significant correlation between gait function and the quadriceps strength on the operated side was observed preoperatively and 3 weeks postoperatively. The quadriceps strength on the non-operated side was significantly correlated with gait function at all time points. Multiple regression analysis showed that the quadriceps strength on the non-operated side was significantly associated with gait function, except the gait speed at 2 weeks. However, the quadriceps strength on the operated side was not observed to be an independent variable at all time points. [Conclusion] The quadriceps strength on the operated side is not an important determinant of gait function. It may be necessary to reconsider typical rehabilitation programs by focusing on the quadriceps strength on the operated side in patients undergoing total knee arthroplasty.

[Purpose] This study investigated the effect of forward head posture on upper and lower thoracic shape in adults to better understand the relationship between a forward head posture and respiratory function. [Participants and Methods] Fifteen healthy males were recruited after obtaining informed consent from all participants. All participants were instructed to respire in both the forward and neutral head postures while seated. Respiratory function was assessed using spirometry. Thoracic shape during respiration was assessed using 23 markers on both the upper and the lower thorax and compared between the 2 postures. [Results] Forced vital capacity, expiratory and inspiratory reserve volumes, forced expiratory volume at 1 second, and the peak flow rate observed with the forward head posture were significantly lower than that with the neutral head posture. The upper thorax showed a greater forward shift and the lower thorax showed a greater forward and inward shift with the forward head posture than with the neutral head posture. No significant difference in upper thoracic mobility was observed during respiration between the forward head posture and the neutral head posture. However, mobility of the lower thorax during respiration was significantly reduced with the forward head posture. [Conclusion] The forward head posture causes expansion of the upper thorax and contraction of the lower thorax, and these morphological changes cause decreased respiratory function.

[Purpose] This study aimed to assess the accuracy of a prediction model for dressing independence created with a multilayer perceptron in a small sample at a single facility. [Participants and Methods] This retrospective observational study included 82 first-stroke patients. The prediction models for dressing independence at hospital discharge were created using a multilayer perceptron, logistic regression, and a decision tree, and compared for predictive accuracy. Age, dressing performance, trunk function, visuospatial perception, balance, and cognitive function at admission were used as variables. [Results] The area under the receiver operating characteristic curve, classification accuracy, sensitivity, specificity, positive-predictive value, and negative-predictive value for training data were highest with the multilayer perceptron model. Cochran’s Q and multiple comparison tests revealed a significant difference between logistic regression and multilayer perceptron models. Testing of data in 10-fold cross-validation yielded the same results, except for sensitivity. [Conclusion] The present study suggested that higher accuracy could be expected with a multilayer perceptron than with logistic regression and a decision tree when creating a prediction model for independence of activities of daily living in a small sample of stroke patients.

[Purpose] The minimal clinically important difference (MCID) in grip strength is critical to interpreting changes in hand strength over time. This review was undertaken to summarize extant descriptions of the MCID for grip strength. [Methods] A search of 3 bibliographic databases as well as a hand search were completed to identify articles reporting the MCID for grip forces obtained by dynamometry. [Results] Of 38 unique articles identified as potentially relevant, 4 met the inclusion and exclusion criteria of this review. The MCIDs ranged from 0.04 kg to 6.5 kg. However, only a single study used receiver operating characteristic curve analysis and had an associated area under the curve exceeding 0.70. That study reported an MCID of 6.5 kg, which was similar to the MCIDs of another included study and minimal detectable changes reported elsewhere. [Conclusion] Additional, more rigorous, studies are needed to identify MCIDs for grip strength. In the meantime changes of 5.0 to 6.5 kg may be reasonable estimates of meaningful changes in grip strength.

[Purpose] The purpose of this study was to determine the change in students’ awareness of one’s possibility in terms of being able to make oneself understood in English after an international student exchange program. [Participants and Methods] A total of 15 students (4 males, 11 females), with a mean age of 19.2 ± 0.4 years, who were interested in international exchange programs participated in this survey. The study used a questionnaire that was administered before and after the international student exchange program. A visual analog scale was used to assess the changes in awareness. [Results] Significant differences were noted between students’ responses to the questionnaire before and after the international exchange program. The students indicated that they were “Confident at communicating with foreign people,” interested in “Study abroad or overseas activities in future,” and chose the response “Want more opportunities to study with overseas medical students.” [Conclusion] We investigated the change in awareness before and after an international student exchange program. The results suggested that even a short-term exchange influenced students’ awareness.

[Purpose] The present study aimed to determine the effects of a task-oriented training on paretic upper extremity functional performance in patients with subacute stroke. [Participants and Methods] Twenty-eight subacute stroke sufferers (mean age: 50.07, standard deviation 9.31 years; mean time since stroke 11.11, standard deviation 6.73 weeks) were randomly allocated to task-oriented training (n=14) or conventional exercise program (n=14) group. They were trained as a hospital-based, individualized training 1 hour a session, 5 sessions a week for 4 weeks. Wolf Motor Function Test (primary outcome), motor portion of Fugl-Meyer assessment upper extremity, and hand function domain of Stroke Impact Scale were assessed at baseline, after 2 and 4 weeks of training. [Results] All participants completed their training programs. At all post-training assessments, the task-oriented training group showed significantly more improvements in all outcomes than the conventional exercise program group. No serious adverse effects were observed during or after the training. [Conclusion] Task-oriented training produced statistically significant and clinically meaningful improvements of paretic upper extremity functional performance in patients with subacute stroke. These beneficial effects were observed after 2 weeks (10 hours) of training. Future investigation is warranted to confirm and expand these findings.

[Purpose] Brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) are simple, accurate, and reproducible indices of arterial stiffness. However, only a few studies have evaluated the influence of exercise-training baPWV and CAVI on arterial stiffness. Thus, this study aimed to examine the influence of aerobic-training baPWV and CAVI on arterial stiffness. [Participants and Methods] The participants were 20 middle-aged females (age, 60.1 ± 1.6 years) who were sedentary non-smokers. The participants underwent an exercise intervention, including a 50-min session of moderate-intensity exercises two or three times a week for 12 weeks. Blood pressure (BP), baPWV, and CAVI were measured before and after exercise. Blood nitrite/nitrate (NOx) was also measured as an index of vascular endothelial function. [Results] BaPWV significantly decreased after exercise, whereas CAVI and blood NOx did not change significantly after exercise. A significant correlation was observed between the decrease in baPWV and systolic BP after exercise. In addition, the participants with higher systolic BP before exercise showed a greater decrease in baPWV after exercise. [Conclusion] These results suggest that BP has a significant role in decreasing arterial stiffness after exercise. Further studies are required to elucidate the similarities and differences between baPWV and CAVI to use them more effectively as assessment parameters for arterial stiffness.

[Purpose] This study aims to investigate the effect of electrical stimulation on aspiration in children with cerebral palsy and dysphagia. [Participants and Methods] Five children with cerebral palsy and dysphagia were recruited. Electrical stimulation was applied to the submental region targeting submental muscles. All participants received electrical stimulation 30 min/day, 5 days/week, for 4 weeks. Evaluation was performed using the penetration-aspiration scale (PAS), based on a videofluoroscopic swallowing study. [Results] PAS scores showed a statistically significant decrease from 3.8 ± 1.5 to 2.1 ± 1.2 and from 6.4 ± 2.1 to 4.3 ± 2.5 for semisolids type and liquids respectively. [Conclusion] The use of electrical stimulation is effective in reducing aspiration in children with cerebral palsy and dysphagia.

[Purpose] The aim of this study was to determine whether the consumption of a leucine-enriched essential amino acid mixture (LEAA), which is known to increase protein synthesis in muscles, alleviates muscle damage and accelerates recovery by ameliorating muscle damage. [Participants and Methods] A double-blind, randomized crossover trial was conducted over a 5-week period. Ten untrained males (age, 23.0 ± 1.6 years) were asked to repeatedly flex and extend their elbows for 10 counts/set × 5 sets at full power while using a dynamometer. The participants took 3.6-g supplements (LEAA mixture or placebo) 3 times daily on day 0 and for the next 7 days. Changes in serum creatine phosphokinase (CPK) activity and myoglobin concentration as markers of muscle tissue damage were evaluated prior to and after exercise and on days 1, 2, 3, 5, and 7. [Results] The relative ratio of the changes in peak serum CPK activity measured on day 5 was significantly lower after taking LEAA than after taking the placebo. [Conclusion] LEAA consumption suppressed exercise-induced elevation of muscle damage markers in blood, which suggests that LEAA could attenuate muscle damage and aid muscle recovery.

[Purpose] The purpose of this study was to compare the range of motion (ROM) during supine-to-sitting position (StSP) movement between healthy young and elderly participants to understand age-related tendencies, which is beneficial for the assessment and treatment of frail elderly. [Participants and Methods] The participants were 14 healthy young males (age, 19–24 years) and 16 healthy elderly individuals (8 males and 8 females; age, 65–74 years). Rising movement was performed 5 times freely at a comfortable speed. [Results] The joint angles during StSP movements in right shoulder abduction, extension of both shoulder joints, right elbow flexion, trunk extension, and adduction of both hip joints were significantly larger, whereas neck flexion, trunk flexion, and left hip joint abduction were significantly smaller in the healthy elderly participants than in the healthy young participants. All joint movements were earlier in the elderly participants than in the healthy young participants. [Conclusion] The results of this study suggest that focusing on how to use both upper limbs is important, in addition to the neck and trunk, when evaluating StSP movement. Similarly, to encourage independence during StSP movement, the elbow extensors must be strengthened.

[Purpose] Urinary incontinence is a frequent postpartum complication. Thus, this study aimed to examine the associations of transversus abdominis muscle thicknesses at rest and during an abdominal drawing-in maneuver with urinary incontinence in females at 2 months postpartum. [Participants and Methods] The participants included 18 females at 2 months postpartum with or without urinary incontinence, and 10 nulliparous females as controls. Transversus abdominis thickness was measured at rest and during the abdominal drawing-in maneuver using diagnostic ultrasonography. The Japanese version of the International Consultation on Incontinence Questionnaire-Short Form was used to evaluate urinary incontinence. [Results] Females at 2 months postpartum were divided into groups with and without urinary incontinence according to questionnaire scores. The muscle thickness during the abdominal drawing-in maneuver contraction was significantly lower in those with urinary incontinence than in those without urinary incontinence and controls. [Conclusion] The results showed significantly reduced transversus abdominis thickness during contraction, which suggested reduced transversus abdominis strength in females with postpartum urinary incontinence. Thus, promoting synergistic contraction of the inner unit, including the transversus abdominis, in exercise therapy may be more effective for postpartum urinary incontinence.

[Purpose] This study aimed to elucidate the effect of intensive physiotherapy and community-based rehabilitation on motor function for patients with cerebral malaria in the rural areas of Malawi. [Participants and Methods] The participants were 10- and 9-year-old children with cerebral malaria. At ages 8 and 6 years, they contracted malaria, and their motor function decreased to Gross Motor Function Classification System level III. They underwent intensive physiotherapy for 2 weeks administered by their mothers and volunteers, who were taught rehabilitation exercises. The improvements in the participants’ motor functions were assessed after completion of therapy and 2 months later. [Results] In case 1, no improvement was observed in the 88-item Gross Motor Function Measure (GMFM-88) score after intensive physiotherapy. However, after 2 months of intensive physiotherapy, the total score improved by 6% from 61% to 67%, and the scores for the target areas improved from 12% to 20%. In case 2, the total GMFM-88 score improved from 66% to 68% during physiotherapy and further improved from 68% to 78% after 2 months. The score for the target areas improved from 25% to 26% and further improved from 26% to 49% after 2 months. [Conclusion] The participants in this study achieved improvements in GMFM-88 score after receiving intensive rehabilitation by community members. The effect was more pronounced after 2 months than immediately after intensive physiotherapy.

[Purpose] To establish a standardized sonographic approach to quantify anterior translation of the mandibular condyle during mouth opening by examining the reliability of image acquisition and processing, and to understand how anterior condylar translation contributes to mouth opening. [Participants and Methods] Twenty-eight participants without temporomandibular disorder (TMD) participated. During day 1 of data collection, all participants performed maximal mouth opening while an examiner recorded anterior condylar translation using sonography. The mouth opening range of motion was also obtained. On day 2 of data collection, the same procedure was performed on 6 participants that participated in day 1 of data collection. To establish reliability of image processing, 3 examiners measured condylar translations on 2 separate days. To determine reliability of image acquisition, images obtained from 2 days of data collection were analyzed. [Results] Excellent intra-class correlation coefficients (ICCs) and small standard errors of measurement (SEMs) for image acquisition and processing were shown. A significant, linear model was found to describe the relationship between condylar anterior translations and mouth opening. [Conclusion] Anterior condylar translation during mouth opening can be reliably measured using sonography. The linear relation between condylar motion and mouth opening can be used to guide clinical practices.