Comparing the Impact of Upper Body Control and Core Muscle Stabilization Training on Landing Biomechanics in Individuals with Functional Ankle Instability: A Randomized Controlled Trial.

Functional ankle instability (FAI), which is characterized by recurrent ankle sprains and perceived joint instability, arises from various factors contributing to compromised biomechanical control during activities, particularly those involving landing tasks. While current research predominantly addresses lower-extremity and core stabilization interventions for FAI, the contribution of upper body control to landing biomechanics in this population remains insufficiently explored. In this study, 42 participants (19 males, 23 females) with FAI were randomly assigned to either the upper-body control training group (UBCTG) or the core muscle stabilization training group (CMSTG). The groups underwent six-week interventions, with the UBCTG receiving a dynamic core exercise program including upper body control and the CMSTG receiving static core muscle training. Pre- and post-intervention assessments encompassed electromyography of the gastrocnemius, tibialis anterior, and peroneus longus, motion analysis of the lower extremities, and ground reaction force (GRF) readings during a single-leg-jump task. Additionally, dynamic balance was assessed using the Y balance test and self-reported measurements of ankle instability were performed. The results showed similar increases in muscle activation, joint movement, and self-reported ankle instability scores within both groups. However, significant between-group differences were observed in terms of knee flexion angle, dynamic balance, and ankle instability scores, favoring the UBCTG. Although the peak vertical GRF significantly decreased and the time to peak vertical GRF increased in both groups, more changes were noted in the UBCTG. Our results demonstrated that dynamic core exercises with additional upper body control training enhance landing biomechanics, dynamic balance, and stability in individuals with FAI. Consequently, we recommend incorporating shoulder girdle exercises, proprioceptive drills, and balance exercises into dynamic core training.

Effects of Augmented Reality Game-Based Cognitive-Motor Training on Restricted and Repetitive Behaviors and Executive Function in Patients with Autism Spectrum Disorder.

Restricted and repetitive behaviors (RRBs) and executive dysfunction are widely acknowledged as core features and hallmarks in patients with autism spectrum disorder (ASD). This study aimed to investigate the effects of augmented reality (AR) using motivational games with cognitive-motor exercises on RRBs, executive function (EF), attention, and reaction time in patients with ASD. Twenty-four patients (range from 6 to 18 years) diagnosed with ASD were recruited from local social welfare centers and randomly allocated to the AR game-based cognitive-motor training group (study group) or the conventional cognitive training group (control group). Both groups completed 30 min training sessions, twice a week for four weeks. Outcome measures were conducted before and after the intervention. As a result, improvements were observed in all the subscales of the RRBs in the study group except for self-injurious and ritualistic behavior. Significant improvements were observed in EF and reaction time in the study group, which was significantly higher compared to the control group. With the present findings, we can suggest that cognitive-motor training using AR game-based content generates positive effects on improving executive function reaction time and accuracy of responses and has a limited effect on RRBs in patients with ASD. This can be proposed as a complementary intervention associated with individualized daily management.

Effects of Augmented Reality-Based Dual-Task Program on Physical Ability by Cognitive Stage with Developmental Disabilities.

People diagnosed with developmental disabilities are less likely to participate in physical activities even if they are provided opportunities. This study aimed to examine the effects of dual-task exercise-based augmented reality (AR) on muscle strength, muscle endurance, balance ability, and flexibility among people with developmental disabilities. Twenty-seven patients with developmental disabilities were included in the study. The intervention was based on an AR-based rehabilitation program and lasted for 8 weeks. The results showed a statistically significant improvement in muscle strength, muscle endurance, balance ability, and flexibility after the intervention (p < 0.05). The AR-based dual-task program increased interest and motivation in the high-cognitive-stage groups, while less interest and motivation were observed in the low-cognitive-stage groups. Our results suggest that an AR-based dual-task program can be an effective method to improve physical ability in patients with high cognitive levels.

The effects of pelvic diagonal movements and resistance on the lumbar multifidus.

[Purpose] The purpose of this study was to compare the effects of pelvic diagonal movements, made with and without resistance, on the thickness of lumbar multifidus muscles. [Subjects and Methods] Participants in this study were healthy subjects who had no musculoskeletal disorders or lumbar-related pain. Participants were positioned on their side and instructed to lie with their hip flexor at 40 degrees. Ultrasonography was used for measurement, and the values of two calculations were averaged. [Results] The thickness of ipsilateral lumbar multifidus muscles showed a significant difference following the exercise of pelvic diagonal movements. The results of anterior elevation movements and posterior depression movements also demonstrated significant difference. There was no significant difference in lumbar multifidus muscles thickness between movements made with and without resistance. [Conclusion] These findings suggest that pelvic diagonal movements can be an effective method to promote muscular activation of the ipsilateral multifidus. Furthermore, researchers have concluded that resistance is not required during pelvic diagonal movements to selectively activate the core muscles.

Effect of core muscle thickness and static or dynamic balance on prone bridge exercise with sling by shoulder joint angle in healthy adults.

[Purpose] To date, core muscle activity detected using ultrasonography during prone bridge exercises has not been reported. Here we investigated the effects of core muscle thickness and balance on sling exercise efficacy by shoulder joint angle in healthy individuals. [Subjects and Methods] Forty-three healthy university students were enrolled in this study. Ultrasonography thickness of external oblique, internal oblique, and transversus abdominis during sling workouts was investigated. Muscle thickness was measured on ultrasonography imaging before and after the experiment. Dynamic balance was tested using a functional reaching test. Static balance was tested using a Tetrax Interactive Balance System. [Results] Different muscle thicknesses were observed during the prone bridge exercise with the shoulder flexed at 60°, 90° or 120°. Shoulder flexion at 60° and 90° in the prone bridge exercise with a sling generated the greatest thickness of most transversus abdominis muscles. Shoulder flexion at 120° in the prone bridge exercise with a sling generated the greatest thickness of most external oblique muscles. [Conclusion] The results suggest that the prone bridge exercise with shoulder joint angle is an effective method of increasing global and local muscle strength.

Comparison of trunk muscle activities in lifting and lowering tasks at various heights.

[Purpose] Biomechanical data for manual material handling are important for appropriate engineering design. The goal of this study was to investigate differences in trunk muscle activity in lifting and lowering tasks at various heights. [Subjects and Methods] Thirty healthy, young adult subjects performed 6 asymmetrical lifting and lowering tasks at various heights. Trunk muscle activity of the abdominal external oblique muscle (EO), rectus abdominis muscle (RA), and lumbar erector spinae muscles (ES) were recorded using surface electromyography (EMG). [Results] The EMG activities of the bilateral ES differed significantly among heights. The left EO activity in the ankle to knee lifting task was significantly increased compared with that of the knee to ankle lowering task. However, there were no significant differences in the right EO, bilateral ES, or RA between lifting and lowering tasks. [Conclusion] The results show that the optimal range for manual material handling was at trunk height, not only for lifting but also for lowering tasks.

Effects of visibility and types of the ground surface on the muscle activities of the vastus medialis oblique and vastus lateralis.

[Purpose] The purpose of this study was to compare the effects of visibility and types of ground surface (stable and unstable) during the performance of squats on the muscle activities of the vastus medialis oblique (VMO) and vastus lateralis (VL). [Subjects and Methods] The subjects were 25 healthy adults in their 20s. They performed squats under four conditions: stable ground surface (SGS) with vision-allowed; unstable ground surface (UGS) with vision-allowed; SGS with vision-blocked; and UGS with vision-blocked. The different conditions were performed on different days. Surface electromyogram (EMG) values were recorded. [Results] The most significant difference in the activity of the VMO and VL was observed when the subjects performed squats on the UGS, with their vision blocked. [Conclusion] For the selective activation of the VMO, performing squats on an UGS was effective, and it was more effective when subjects' vision was blocked.

Thalamic Reorganization in Chronic Patients With Intracerebral Hemorrhage: A Retrospective Cross-Sectional Study.

The aim of this study was to investigate changes of synaptic area of the spinothalamic tract and its thalamocortical pathway (STT) in the thalamus in chronic patients with putaminal hemorrhage.Twenty four patients with a lesion in the ventral posterior lateral nucleus (VPL) of the thalamus following putaminal hemorrhage were recruited for this study. The subscale for tactile sensation of the Nottingham Sensory Assessment (NSA) was used for the determination of somatosensory function. Diffusion tensor tractography of the STT was reconstructed using the Functional Magnetic Resonance Imaging of the Brain Software Library. We classified patients according to 2 groups: the VPL group, patients whose STTs were synapsed in the VPL; and the non-VPL group, patients whose STTs were synapsed in other thalamic areas, except for the VPL.Thirteen patients belonged to the VPL group, and 8 patients belonged to the non-VPL group. Three patients were excluded from grouping due to interrupted integrity of the STTs. The tactile sensation score of the NSA in the non-VPL group (10.50 ±â€Š0.93) was significantly decreased compared with that of the VPL group (19.45 ±â€Š1.33) (P < 0.05).We found that 2 types of patient had recovered via the VPL area or other areas of the STT. It appears that patients who showed shifting of the thalamic synaptic area of the STT might have recovered by the process of thalamic reorganization following thalamic injury. In addition, thalamic reorganization appears to be related to poorer somatosensory outcome.

The comparison of manual lymph drainage and ultrasound therapy on the leg swelling caused by wearing high heels.

One of the major symptoms when women are wearing high heels for a long time is leg swelling. The purpose of this study was to compare the effect of manual lymph drainage with ultrasound therapy. The forty-five healthy women of twenties were participated in this study and divided randomly into three groups; manual lymph drainage group (n=15), ultrasound therapy group (n=15) and control group (n=15). Swelling was measured before wearing the high heels (10 cm-height), after one-hour of wearing the high heels, wearing the high heels of one-hour after the intervention of 15 minutes. Also swelling was calculated by using a tape measure, volumeter and body composition analyzer. Statistical analysis of the comparison between the three groups was performed by one-way ANOVA. Also comparison to the mean value in swelling according to the time was performed by repeated measure ANOVA. As the result of this study, a significant changes have emerged within each of manual lymph drainage, ultrasound therapy and control group (p< 0.05). However, there were no significant differences between each group (p> 0.05). But the mean value of manual lymph drainage group showed the tendency of fast recovering before causing swelling. Therefore, we consider that the clinical treatment of manual lymph drainage and ongoing studies will be made since manual lymph drainage is very effective in releasing the leg swelling caused by wearing high heels and standing for a long time at work.

Relationship between somatosensory function and the spinothalamocortical pathway in chronic stroke patients.

Diffusion tensor tractography (DTT) allows for identification and evaluation of the spinothalamic tract and its thalamocortical pathway (STP). We attempted to investigate the relationship between tactile sensation and the STP in chronic stroke patients. We measured fractional anisotropy, mean diffusivity, and tract volume of the STP. The tactile sensation score of the affected side in patients with preserved STP integrity was higher compared with that of patients with an interrupted STP. The remaining volume and integrity of the STP in the affected hemisphere were important factors for tactile sensation of the affected side in chronic patients with intracerebral hemorrhage (ICH).

Difference of neural connectivity for motor function in chronic hemiparetic stroke patients with intracerebral hemorrhage.

Difference of neural connectivity for motor function had been studied by observation of neural activity within gray matter and nucleus using functional neuroimaging techniques. Diffusion tensor imaging (DTI) by a probabilistic tracking is useful for exploration of structural connectivity in the brain. We attempted to investigate difference of neural connectivity for motor function of the affected hand in chronic hemiparetic patients with intracerebral hemorrhage (ICH). Forty-four patients with ICH and 31 normal control subjects were recruited. Diffusion tensor imaging was acquired using a sensitivity-encoding head coil at 1.5 T. Motor function was evaluated using the motricity index (MI) for hand and Modified Brunnstrom Classification (MBC). The presence or absence of a connection was confirmed between the precentral knob of the affected hemisphere and seven areas. Compared with healthy subjects, the patient group showed lower connectivity to the contralesional primary motor cortex, ipsilesional basal ganglia, ipsilesional thalamus, contralesional cerebellum, and ipsilesional medullary pyramid in the affected hemisphere (p<0.05). Connections to the ipsilesional basal ganglia, ipsilesional thalamus, and ipsilesional medullary pyramid showed positive correlation with MI and MBC (p<0.05). We found difference of neural connectivity for motor function between chronic hemiparetic patients with ICH and control subjects. Our results suggest that the motor function of the stroke patient is related to neural connectivity between the ipsilesional M1 and the ipsilesional medullary pyramid, ipsilesional basal ganglia, and ipsilesional thalamus.

Usefulness of diffusion tensor imaging in patients who showed sustained unexplainable clinical symptom of torticollis.

To investigate corticospinal tract (CST) status using diffusion tensor imaging (DTI) in patients who had clinical symptom of torticollis but no definite cause of sustained symptom of torticollis. We evaluated 10 patients with sustained torticollis and 12 age-matched control subjects. All patients showed no specific fibromatosis coli findings on neck sonography. Even after intensive manual therapy, there was no improvement of clinical symptom of torticollis. DTI was performed using 1.5 T with a synergy-L Sensitivity Encoding (SENSE) head coil. Fractional anisotropy and apparent diffusion coefficient were measured using the region of interest method, and diffusion tensor tractography was conducted. We estimated the asymmetric anisotropic index (AA) and asymmetric mean diffusivity index (AD) to evaluate the asymmetry between right and left CSTs. All patients showed only torticollis symptom but no definite hemiplegic pattern on their extremities at initial evaluation. DTT, which was performed to reveal the reason of sustained asymmetric postural symptom showed hemiplegic pattern. The results of DTT corresponded to the delayed hemiplegic symptoms, which were found in the patients at second evaluation. AA and AD values between patients and control group were significantly different. Torticollis is usually caused by fibromatosis coli, but may be one of the symptoms of hemiplegia. DTI may be an additional technique for the early detection of hemiplegia in patients with sustained symptoms of unexplainable postural torticollis.

Limb apraxia in a patient with cerebral infarct: diffusion tensor tractography study.

We report on a patient with ideomotor apraxia (IMA) and limb-kinetic apraxia (LKA) following cerebral infarct, which demonstrated neural tract injuries by diffusion tensor tractography (DTT). A 67-year-old male was diagnosed as cerebral infarct in the left frontal cortex (anterior portion of the precentral gyrus and prefrontal cortex) and centrum semiovale. The patient presented with severe paralysis of the right upper extremity and mild weakness of the right lower extremity at onset. At the time of DTT scanning (5 months after onset), the patient was able to move all joint muscles of the right upper extremity against gravity, except for the finger extensors, which he could extend partially against gravity. The patient showed intact ideational plan for motor performance; however, his movements were slow, clumsy, and mutilated when executing grasp-release movements of his affected hand. The patient's score on the ideomotor apraxia test was 20 (cut-off score < 32). DTTs for premotor cortex fibers, supplementary motor area fibers, and superior longitudinal fasciculus of the left hemisphere showed partial injuries, compared with those of the right side, and these injuries appeared to be responsible for IMA and LKA in this patient.

Termination differences in the primary sensorimotor cortex between the medial lemniscus and spinothalamic pathways in the human brain.

The medial lemniscus (ML) and its thalamocortical pathway is responsible for proprioception, in contrast, the spinothalamic tract (ST) and its thalamocortical pathway is the neural tract for pain and body temperature. Therefore, the ML pathway plays a crucial role in skillful movements and may be more linked to motor function than the ST pathway. We investigated the differences in the distribution of the primary motor cortex (M1) and the primary somatosensory cortex (S1) between the ML and ST pathways. Adults (mean age: 40.4 years, range: 21-61 years) were recruited for this study. The seed masks for the ML and ST pathways were given on the color map of the medulla according to the known anatomy and waypoint masks were placed on the ventro-postero-lateral nucleus of the thalamus. The volume of ML pathway did not show any difference between the M1 (10.94) and S1 (13.02) (p>0.05). By contrast, the mean voxel number of the ST pathway in the M1 (18.25) and S1 (27.38) showed significant difference between the M1 and S1 (p<0.05). As for relative voxel number percentage of the M1 compared to the S1, the ML pathway (84%) was significantly higher than ST pathway (67%) (p<0.05). We found that more neural fibers of the ML pathway were terminated in the M1 relative to the S1 compared to the SLP, and this may be linked to the inherent execution of movements of the M1.

Neuronal loss in the medial cholinergic pathway from the nucleus basalis of Meynert in patients with traumatic axonal injury: a preliminary diffusion tensor imaging study.

OBJECTIVE: The recent development of diffusion tensor imaging (DTI) allows visualization and estimation of the medial cholinergic pathway (MCP), which originates from the nucleus basalis of Meynert and provides cortical cholinergic innervation to the cerebral cortex. We investigated the injury to the MCP in patients with traumatic axonal injury (TAI), using DTI. DESIGN: Retrospective survey. PARTICIPANTS: Fourteen patients with chronic TAI and 14 age- and sex-matched normal control subjects. MAIN OUTCOME MEASURES: Using the Functional Magnetic Resonance Imaging of the Brain (FMRIB) Software Library (FMRIB analysis group, Oxford University, United Kingdom), diffusion tensor images were acquired by using a sensitivity-encoding head coil at 1.5 T DTIs. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume of the MCP were measured. RESULTS: The FA value and tract volume were significantly decreased in the group with TAI compared with those of the control group (P < .05); in contrast, there was no difference in the MD value between the 2 groups (P > .05). CONCLUSIONS: Changes in DTI parameters of the TAI group appear to be due to neuronal loss of the MCP. We believe that DTI would be useful for the evaluation of the MCP in patients with TAI.

Injuries of the cingulum and fornix after rupture of an anterior communicating artery aneurysm: a diffusion tensor tractography study.

BACKGROUND: After rupture of an anterior communicating artery (ACoA) aneurysm, the anterior cingulum and the fornix can be vulnerable to injury. However, very little is known about this topic. OBJECTIVE: To investigate injuries of the cingulum and fornix in patients with an ACoA aneurysm rupture with diffusion tensor tractography. METHODS: Eleven consecutive patients with an ACoA aneurysm rupture and 11 age- and sex-matched normal control subjects were recruited. Diffusion tensor imaging was scanned at an average of 54.1 days (range, 29-97 days) after onset of ACoA aneurysm rupture. RESULTS: We found that 6 (54.5%) and 7 (63.6%) of 11 patients revealed no trajectory of the anterior cingulum and the fornical body on diffusion tensor tractography, respectively. In terms of diffusion tensor imaging parameters, we found that the fractional anisotropy value and tract volume of the cingulum and fornix were decreased (P < .05) and that mean diffusivity values were increased (P < .05), except for those of the left fornix, which showed no difference (P > .05). CONCLUSION: We found injuries of the cingulum and fornix in patients with an ACoA aneurysm rupture. It is our belief that sustained memory impairment of patients with an ACoA aneurysm rupture might be related to injury of the cingulum and fornix. Therefore, we recommend evaluation of the cingulum and fornix with diffusion tensor tractography for patients with an ACoA aneurysm rupture.

Neural tract injuries by brain herniations after head trauma.

OBJECTIVES: : Little is known about the usefulness and findings of brain herniation on diffusion tensor tractography (DTT). Using DTT, we demonstrated neural tract injuries in 2 patients who showed subfalcine and trasntentorial herniations after subdural hematoma resulting from motor vehicle accident. DESIGN: : Two patients and 6 age- and sex-matched, healthy volunteers were recruited for this study. SETTING: : An inpatient rehabilitation unit. MAIN OUTCOME MEASURES: : Diffusion tensor tractography for the patients was performed 5 weeks after onset. RESULTS: : Diffusion tensor tractography of patient 1 showed complete injury of both cingulums at or around the rostrum of the corpus callosum, the fornix at the anterior and posterior body, and both corticospinal tracts at the pons. In addition, partial injury of both somatosensory tracts at the midbrain was also observed. Patient 2 showed complete injury of both cingulums above the body of the corpus callosum, the fornix at the anterior and posterior body, and right corticospinal tracts at the pons level and partial injury of the right somatosensory tract. We found that the fractional anisotropy values of all neural tracts, except fornix, in both patients and left somatosensory tract in patient 2 and voxel number for left somatosensory tract in patient 2 were decreased 2 SDs below that of normal controls. CONCLUSIONS: : We determined that DTT would be a good technique for use in the detection of underlying lesions in patients with brain herniation.

The prevalence of central poststroke pain according to the integrity of the spino-thalamo-cortical pathway.

OBJECTIVES: Little is known about the prevalence of central poststroke pain (CPSP) according to the integrity of the spino-thalamo-cortical pathway (STP). Using diffusion tensor tractography, we investigated the prevalence of CPSP according to the integrity of the STP in patients with intracerebral hemorrhage. METHODS: We recruited 52 consecutive chronic patients and 10 normal control subjects. Patients were classified into two groups according to preservation of the integrity of the STP. Each group was divided into two subgroups according to the presence of CPSP. RESULTS: The preserved group included 34 patients [CPSP subgroup, 16 (47%) patients; non-CPSP subgroup, 18 (53%) patients], and 18 patients were enrolled into the disrupted group [CPSP subgroup, 3 (17%) patients; non-CPSP subgroup, 15 (83%) patients]. The fractional anisotropy and mean diffusivity values of the CPSP and non-CPSP subgroups of the preserved group were decreased and increased when compared with those of the control group, respectively (p < 0.05). CONCLUSIONS: We found that the prevalence of CPSP in patients with partial injury of the STP was higher than that of patients with complete injury of the STP. Partial injury of the STP appears to be more vulnerable to development of CPSP than complete injury of the STP in patients with intracerebral hemorrhage.

The anatomical characteristics of superior longitudinal fasciculus I in human brain: Diffusion tensor tractography study.

The superior longitudinal fasciculus (SLF) I is known to be involved in regulation of higher aspects of motor function. Using diffusion tensor imaging (DTI), we attempted to identify the SLF I and to investigate the anatomical characteristics of the SLF I in the human brain. We recruited 30 healthy subjects for this study. The SLF I was obtained using the FMRIB Software Library. The seed region of interest (ROI) was given at the superior parietal lobule (SPL) and the target ROI was the supplementary motor area (SMA) along with the dorsal part of the premotor area (PMA). Values of fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The SLF I originated from the SPL and medial parietal cortex, passed through the white matter of the SPL and superior frontal gyrus, and then terminated in the SMA and dorsal PMA. There were no significant differences between hemispheres in terms of the FA, MD, and tract volume. We present with the anatomical characteristics of the SLF I in the human brain using DTI. We think that the methodology and results of this study would be helpful to researchers in this field.

The rubrospinal tract in the human brain: diffusion tensor imaging study.

The rubrospinal tract (RST) is an extrapyramidal motor pathway in the human brain. In this study, using diffusion tensor tractography (DTT), we attempted to identify the RST in the normal human brain. Twenty-one healthy volunteers were recruited for this study. A 1.5-T scanner was used for scanning of diffusion tensor images, and the RSTs were isolated by DTT using FMRIB software. Values of fractional anisotropy (FA), mean diffusivity (MD), and tract volume of the RSTs were measured. Among 42 hemispheres of 21 subjects, RSTs were isolated in 27 hemispheres (64.28%) of 15 subjects. All identified tracts originated from the red nucleus and crossed the midline via ventral tegmental decussation. Then, they passed through the area between the inferior olivary nucleus and the inferior cerebellar peduncle in the contralateral medulla. The tracts finally descended through the lateral funiculus of the upper spinal cord. Mean values of FA, MD, and tract volume did not differ significantly between the left and right hemispheres (P>0.05). We believe that the methodologies used and the results of this study would be helpful to researchers interested in the function of the human RST and its clinical implications.