[Purpose] We evaluated the effects of functional electrical stimulation (FES) and an ankle/foot orthosis (AFO) in hemiplegic patients exhibiting excessive plantar ﬂexion during the stance phase, associated with genu recurvatum. [Participants and Methods] In total, 12 stroke patients were recruited. We measured changes in knee and ankle joint angles, gait speed, and step and stride length during the gait cycle during barefoot walking, walking while wearing an AFO, and walking after FES application; we used a three dimensional gait analysis system. [Results] In terms of kinematic variables, FES walking was associated with significant increases in peak ankle dorsiflexion during swing, dorsiflexion angle at initial contact, peak ankle dorsiflexion during stance, knee angle at initial contact, and peak knee flexion in the loading response compared to AFO and barefoot walking. AFO walking was associated with a significant difference in peak ankle dorsiflexion during swing compared to barefoot walking. [Conclusion] FES afforded kinematic advantages to the ankle and knee joints compared to AFO in hemiplegic patients with a genu recurvatum gait.
[Purpose] Caregivers experience low back pain owing to frequent patient handling motions such as supporting the body while standing up. To prevent low back pain in caregivers, low load posture while engaging in patient handling motions is required. We determined the relationship between surface electromyography of the erector spinae muscles and subjective step length as “long” and “short” during the supporting standing-up motions of caregivers. [Participants and Methods] Ten young male participants were asked to perform supporting standing-up motion 10 times using two-step lengths comprised of subjective long and short steps. During supporting standing-up motion, we measured surface electromyograms of the erector spinae muscles and calculated the integral electromyographic values. [Results] The subjective long/short-step length normalized by body height did not differ across the participants. In addition, the subjective long-step length was longer than the subjective short-step length in all the participants. Integral electromyographic values for both the left and right erector spinae muscles in the short-step length were significantly lower than those in the long-step length when the data obtained from all the participants were used. [Conclusion] We considered that the load of the erector spinae muscle will be reduced if the short-step instead of the long-step instruction is given. In the future, instructions based on the subjective step-length variation in caregivers must be considered.
[Purpose] To mobilize the knee joint during cast fixation and to determine whether infrapatellar fat pad changes can be prevented. [Materials and Methods] We randomly allocated Wistar rats into 3 groups as follows: normal group, raised in normal conditions (n=5); contracture group, immobilized with cast fixation (n=5); and prevention group, treated with joint movement during immobilization (n=5). We immobilized the right hindlimb using cast fixation. Joint movement in the prevention group was accomplished by repeatedly pulling the right hindlimb caudally and then returning the leg to the bent position for 10 minutes every day for 2 weeks. We used a metronome to maintain a constant speed, with one set lasting 2 seconds (1-second traction and 1-second return). [Results] The contracture group had adipose cells of various sizes and fibrosis in the infrapatellar fat pad. These changes were also found in milder forms in the prevention group. We found significant differences in the cross section of adipose cells and in knee extension restriction between the groups. [Conclusion] Promoting joint movement may not only have a therapeutic effect on adipose cells but also a preventative effect.
[Purpose] The purpose of this study was to examine the agreement between the values obtained by using a hand-held dynamometer with a belt (belt-HHD) and an isokinetic dynamometer (IKD) for the measurement of isometric knee flexion and extension muscle strength. We also studied the factors influencing the measurement. [Participants and Methods] Overall, 26 healthy young adults (16 males, 10 females) participated in the study; the mean age was 21 years. Knee flexion and extension muscle strength were measured by three methods: 1) belt-HHD, 2) conventional IKD with the participant sitting on an attached chair (conv-IKD), and 3) modified IKD with the participant sitting on the same mat table as HHD (mod-IKD). [Results] In the measurement of knee extension, mod-IKD and conv-IKD showed a fixed bias and a proportional bias, conv-IKD and belt-HHD showed a fixed bias, and belt-HHD and mod-IKD showed a fixed bias. In the measurement knee flexion, conv-IKD and mod-IKD showed a proportional bias, belt-HHD and conv-IDK showed a fixed bias, and mod-IKD and belt-HHD showed a fixed bias. In each combination, the measured values were larger in the latter due to errors. However, the types and values of errors differed when analysis was conducted based on gender. [Conclusion] In order to increase the agreement between the values, it is necessary to revise the fixing method of the trunk, and the fixing method of the belt and the sensor pad in belt-HHD.
[Purpose] The present study aimed to investigate the lower limbs injury risk factors that are based on conventional Hamstring to Quadriceps ratio and limb asymmetry index in varsity American football players. [Participants and Methods] Twenty-six varsity American football players aged 19–27 years and with 2.31 ± 1.29 years of American football experience from Dogu Akdeniz University volunteered to undergo measurements of average peak torque for isokinetic flexion and extension of dominant limb and non-dominant limb at 60°·s−1 and 300°·s−1. Hamstring to Quadriceps ratio and limb asymmetry index were also calculated for Hamstring and Quadriceps muscles. [Results] Statistical analysis revealed that dominant Quadriceps is stronger than non-dominant Quadriceps at 60°·s−1 speed. No statistical difference was found between dominant and non-dominant Hamstring peak torque at 60°·s−1 . Hamstring to Quadriceps ratio determined as normal both for 60°·s−1 and 300°·s−1according to the currently reported cut off value (H:Q ratio >60). Hamstring and Quadriceps limb asymmetry index also determined as normal (cut off value for LSI 10%) at 60°·s−1. However, for both Hamstring and Quadriceps, side- to- side strength asymmetry at 300°·s−1 was observed. [Conclusion] To prevent possible lower limb injury and to increase performance, varsity American football players who are actively training and competing might consider taking strength asymmetry into account to tailor their strength training program accordingly.
[Purpose] The purpose of this study was to identify the factors influencing change in life-space mobility after total knee arthroplasty (TKA) in patients with severe knee osteoarthritis (knee OA). [Participants and Methods] Overall, 58 primary unilateral TKA recipients (9 males and 49 females; age ± SD 74.6 ± 6.5 years) were enrolled. We evaluated Life-Space Assessment (LSA) scores, knee extensor strength, Timed Up and Go test (TUG), one-leg standing time (OLS), Western Ontario and McMaster Universities osteoarthritis Index, and physical activity self-efficacy (SE) before surgery and at 3 months post-operation. [Results] Life space mobility significantly expanded 3 months after surgery compared with preoperative baseline. Preoperatively, walking SE and knee extensor muscle strength on the operative side were found to have strong correlation with LSA scores, while stairs SE and knee extensor muscle strength of the operative side were correlated at 3 months post-operation. [Conclusion] These findings suggest that to expand the life-space mobility of TKA recipients, it is important to enhance self-efficacy for general physical activity in addition to strengthening the quadriceps muscles.
[Purpose] Locomotion training is recommended as a countermeasure against locomotive syndrome. Recently, whole-body vibration has been clinically applied in rehabilitation medicine. Therefore, we aimed to investigate the preliminary effectiveness of whole-body vibration on locomotion training. [Participants and Methods] Overall, 28 healthy adult females were randomly assigned to either a locomotion training group using a whole-body vibration device (whole-body vibration group, n=14) or training on the flat floor (non-whole-body vibration group: n=14). Participants conducted two sets of locomotion training twice a day and three times a week for 12 weeks. [Results] A significant difference was observed in the group factor for all outcome measures and in the before and after the training factor for Timed Up and Go test. After the training, knee muscle strength, dynamic balance, and mobility function in the whole-body vibration group were significantly improved compared with the non-whole-body vibration group. In the whole-body vibration group, the Timed Up and Go time after the training was significantly shorter compared with that before training. [Conclusion] The results suggest that locomotion training with whole-body vibration can improve the physical functions in healthy adult females and locomotion training using whole-body vibration might enhance the effectiveness of locomotion training.
[Purpose] Foot arches are evaluated using radiographic morphometry and body surface somatometry. While several studies have examined the correlations between these methods and the medial longitudinal arch, very few studies have investigated the same for transverse arches. In this study, we analyzed the correlation between radiographic morphometry and body surface somatometry at medial longitudinal and transverse arches. [Participants and Methods] Fifty healthy adults were included in the study. Six medial longitudinal and three transverse arch evaluation methods were evaluated for the correlation, including the foot posture index. [Results] A correlation was found between the evaluation methods for the medial longitudinal arch, except the lateral talocalcaneal angle; however, no correlation was found between the navicular-metatarsal angle and transverse arch-length ratio in transverse arch evaluation. Additionally, there was no correlation between the evaluation methods for the medial longitudinal and transverse arches. The foot posture index was particularly correlated with radiographic medial longitudinal arch evaluation methods. [Conclusion] During evaluation with radiographic morphometry, it is difficult to set bone markers and differences in tarsal bone arrangement affect the relationship between them; in body surface somatometry, there were differences in measurement at sites with excessive soft tissue. Elucidating the cause for the lack of correlation between the medial longitudinal and transverse arches requires further investigation.
[Purpose] This study aimed to develop a method for assessing anticipatory postural adjustments associated with voluntary movements in individuals with functional ankle instability. We examined whether the peroneus longus muscle exhibits anticipatory activation before unilateral abduction of the lower limb in individuals without disability. [Participants and Methods] Twelve healthy young adults participated in this study. Participants maintained a standing posture with 95 ± 2.5% of their weight on the left side and with the thenar of their right foot in contact with a small wooden board fixed to a force platform. Thereafter, they abducted their right lower limb by approximately 35° at maximum speed; during this time, electromyographic activities of the focal and postural muscles were recorded. [Results] The peroneus longus, external oblique, and erector spinae muscles on the left side of the body were activated before the right gluteus medius muscle, which is a focal muscle of abduction of the right lower limb. The activation timing of the left peroneus longus was the fastest among these postural muscles. [Conclusion] These findings suggest that the peroneus longus muscle plays an important role in anticipatory postural adjustments associated with unilateral abduction of the lower limb and that an ankle strategy is adopted in anticipatory postural adjustments during this task.
[Purpose] In this study, we investigated the immediate effect on walking using a custom-made hinged knee brace with adjustable knee flexion and extension support (support brace) in patients in the acute phase of stroke. [Participants and Methods] Thirteen patients (56.8 ± 6.8 years) who experienced stroke and who were able to walk independently participated in the study. The walking speed and mean knee extension strength were evaluated under three conditions: no brace, general brace, and support brace. [Results] The walking speed of patients while using the support brace was significantly faster (0.60 ± 0.11 m/s) than that without brace (0.45 ± 0.16 m/s) and with general brace (0.52 ± 0.14 m/s). The fastest walking speed among all 8 patterns (no brace, general brace, and the support brace with six different patterns of support) was with the support brace. The mean knee extension strength while wearing a support brace (1.01 ± 0.24 Nm/kg) was significantly greater than that without wearing a brace (0.82 ± 0.28 Nm/kg). [Conclusion] The support brace, which allows for customizable adjustment of the flexion and extension strength, enhanced the walking ability of patients who experienced ambient stroke and were in the acute phase.
[Purpose] To estimate the minimal clinically important difference for the Fugl-Meyer assessment of the upper extremity by using anchor-based methods in stroke patients with moderate to severe hemiparesis. [Participants and Methods] Fourteen patients who were hospitalized in a convalescent phase rehabilitation ward were included in this study. Fugl-Meyer assessment of the upper extremity was used to assess the impairment prior to intervention and at follow-up (six weeks later). Participants were asked to evaluate the degree of improvement of paresis of the upper extremity using the global rating of change scale at follow-up. The mean change in Fugl-Meyer assessment scores in the group of patients who answered “a little better, meaningful in daily life” in the global rating of change scale was considered as the minimal clinically important difference. [Results] The mean post-onset period of participants for analysis was 49.4 days. The minimal clinically important difference of the Fugl-Meyer assessment scores were 12.4 (upper extremity), 5.6 (upper arm), and 4.9 (wrist/hand). [Conclusion] A score of 12.4 in the Fugl-Meyer assessment of the upper extremity is likely to be perceived as meaningful in stroke patients with moderate to severe hemiparesis.
[Purpose] We investigated the occurrence of delayed-onset muscle soreness and the suppression of muscle rigidity by ultrasound irradiation before high-load exercise. [Participants and Methods] The study was a randomized crossover controlled trial. The participants were 28 healthy university students (12 males, 16 females). Delayed-onset muscle soreness was induced in the biceps brachii muscle; ultrasound (3 MHz, 1.5 W/cm2, 10 min) was applied before high-load exercise. Pain during elbow motion was evaluated on a visual analog scale. Muscle rigidity was evaluated using a muscle rigidity meter. [Results] After exercise on the second day, the ultrasound group showed significantly less muscle rigidity. [Conclusion] The heat stimulus of ultrasound therapy before high-load exercise reduces muscle rigidity.
[Purpose] The aim of this study was to evaluate the effect of pulsed high intensity neodymium-doped yttrium aluminum garnet (Nd: YAG) laser on staphylococcus aureus (S. aureus) and pseudomonas aeruginosa (P. aeruginosa) bacterial growth, which cause many health problems and establish which doses are effective in bacterial inhibition. [Materials and Methods] Five samples of S. aureus and five samples of P. aeruginosa were prepared in the microbiology lab, one used as control sample and the other 4 samples acted as experimental samples. The experimental samples received pulsed high intensity Nd: YAG laser with a total dose of 500, 600, 700 and 800 joules. The primary measures are colony count and the percentage decrease in colony count, the colony count was assessed at baseline and after 24 h of laser application. [Result] There was significant decrease in colony count and the percentage decrease in colony count after pulsed high intensity Nd: YAG laser application in all experimental samples of S. aureus and P. aeruginosa after 24 h of application for all doses (500, 600, 700 and 800 j) as compared with the control sample, with the most effect in higher doses of pulsed high intensity Nd: YAG laser than lower doses in both types of bacteria. [Conclusion] pulsed high intensity Nd: YAG laser was found to be an effective modality for inhibition of S. aureus and P. aeruginosa growth after a single application.
[Purpose] The aim of this study was to clarify the movement pattern of the pelvis and trunk of junior high school baseball players based on the lateral reach motion of the lower limb, which is related to poor pitching movement. [Participants and Methods] Twenty-five male students belonging to a baseball club participated in this study. Each participant performed the lower limb side reach movement in the standing position, during which the movements of the knee joint, hip joint, pelvis, and trunk were analyzed. [Results] A significant correlation was found between reach distance and reach leg hip abduction, supporting leg hip abduction, trunk side bending, and trunk tilt. We found a significant correlation between reach leg hip abduction and pelvic tilt and trunk side bending and between supporting leg hip abduction and pelvic tilt, knee valgus, and trunk side bending. Furthermore, we found a significant correlation between knee valgus and lower leg tilt and trunk tilt and between trunk side bending and pelvic tilt. [Conclusion] This study suggests that in the standing position movement at this age, the hip and trunk movements are related to and affect performance.
[Purpose] This study aimed to measure the thickness of the muscles located on the ventral side of the hip joint and to identify the muscles involved in exercise against the load that results in femoral head translation in the ventral direction, which can be used as an index of exercise performance for the prevention and improvement of hip joint disease caused by femoral head translation. [Participants and Methods] The participants were 10 healthy young males. During the measurement task, we asked them to hold a 10 kgf load in the ventral direction to the femoral head in the supine position. We measured the thickness of the gluteus minimus, gluteus medius, tensor fascia latae, and iliopsoas both at rest and during exercise using ultrasonography. [Results] We compared muscle thicknesses at rest and during exercise and found that only the gluteus minimus had significantly lower values during exercise. We also compared the rate of change in muscle thickness and found that the gluteus minimus exhibited significantly higher values than those of the gluteus medius and tensor fasciae latae. [Conclusion] Our study indicates that the gluteus minimus is more involved than the gluteus medius, tensor fasciae latae, and iliopsoas in the exercise for the ventral displacement of the femoral head.
[Purpose] No previous studies have confirmed whether the effects of visual feedback on motor learning vary according to learner skill level for a learning task. The purpose of this study was to clarify whether differences in skill influence the effects of visual feedback on motor learning. [Participants and Methods] Sixty-four participants were assigned to one of four different feedback groups (concurrent-100%, concurrent-50%, terminal-100%, or terminal-50%). The learning task was to adjust the load amount continuously to the left lower limb in accordance with sound stimulation at intervals of 1 Hz. The four groups performed a pretest, practice sessions, and a retention test 24 hours after practice. After completing these measurements, the participants were classified as either high- or low-skilled based on the results of the pretest. [Results] Only the groups of low-skilled participants who used concurrent feedback showed lower root mean square errors in the retention test compared to in the pretest. [Conclusion] Differences in skill level for the same task influenced the effects of visual feedback on motor learning. Furthermore, concurrent visual feedback can help improve motor learning in low-skilled learners for the same task.
[Purpose] Evaluation of motor function in preventive care services using a convenient method is necessary. The two-step test is clinically useful in evaluating motor function. Thus, we aimed to assess motor function using the two-step test in day care service type C. [Participants and Methods] The two-step test value and motor function used in day care service type C were evaluated in 23 elderly females (mean age: 77.4 ± 6.7 years). [Results] Timed Up and Go test and two-step test results were highly correlated. [Conclusion] The results suggest that the factors constituting the two-step test showed a dynamic balance. Intervention for step or dynamic balance is important to improve the gait ability of elderly females in type C day care service.
[Purpose] This review synthesizes findings from studies on two forms of Constraint-Induced Movement Therapies: the original Constraint-Induced Movement Therapy and the modified Constraint-Induced Movement Therapy, in adult stroke patients including the evidence, current limitations and future directions. [Methods] We critically reviewed studies evaluating the effectiveness of Constraint-Induced Movement Therapies in chronic stoke focusing on the functional (i.e. motor recovery) and the neural (i.e. cortical organization) levels. [Results] Constraint-Induced Movement Therapies seemed to improve the upper limb functional usage in chronic stoke with no reliable neurophysiological underlying mechanisms. The Motor Activity Log was the common outcome measuring motor recovery. The work that has been done on modified Constraint-Induced Movement Therapy was far less than the work done on the original Constraint-Induced Movement Therapy. [Conclusion] Evident lack of understanding of the association between changes in motor recovery and the underlying neural mechanisms in-terms of measures of assessing and defining functional recovery (i.e Motor Activity Log) that lacks sufficient sensitivity to characterize changes in movement strategies and thereby lack of distinction between recovery and behavioral compensation. Future studies should employ using kinematic metrics to quantify and explain the training-related changes in behavior following Constraint-Induced Movement Therapies in chronic stroke.
[Purpose] Although there is evidence that non-specific chronic pain can be influenced by physical therapy, some patients with scoliosis and chronic pain may benefit from additional brace treatment. The purpose of this review is to answer the question whether there are studies on the use of brace treatment in patients with scoliosis and pain and to investigate whether brace treatment does positively influence chronic pain. [Methods] A PubMed review has been undertaken using the key words (1) scoliosis and pain and brace treatment and (2) scoliosis and pain and orthotics. From both searches the studies were extracted that included a patient group with the diagnosis of a scoliosis and with additional chronic non-specific low back pain, treated with a brace. [Results] One hundred forty two items have been found for search (1) and 111 for search (2). The total number of relevant items found in both searches was 10. According to the studies found, bracing seems an effective treatment for this condition. [Conclusion] Brace treatment in patients with scoliosis and chronic non-specific low back pain has demonstrated to be effective. It should be used when exercise treatment is not effective. A clinical test is demonstrated to predict the most beneficial approach in brace treatment.
[Purpose] To present the dramatic improvement of sagittal posture in a young male with Scheuermann’s disease suffering from pain ailments as treated by Chiropractic BioPhysics® technique. [Participant and Methods] An 18 year old reported low back pain and headaches for several years. Full spine radiographic assessment revealed pronounced thoracic hyperkyphosis, anterior head translation, posterior thoracolumbar sagittal balance, and a reduced sacral base orientation. The patient was treated by Chiropractic BioPhysics methods incorporating mirror image® exercises, traction, as well as spinal manipulation. [Results] Assessment after 35 treatment sessions over 14-weeks revealed a dramatic improvement in postural parameters. The thoracic kyphosis reduced by 13°, and was accompanied by a reduction in forward head posture, reduction in posterior sagittal balance, and an increase in sacral base angle to normal. The low back pain and headaches were alleviated. [Conclusion] This case adds to the accumulating evidence demonstrating CBP methods offers an effective approach to reduce the burden of postural disorders including those with Scheuermann’s disease. Since thoracic hyperkyphosis is a serious disorder, the routine comprehensive assessment via full-spine radiography is essential for the quantification of relevant postural parameters.