The effect of a trunk stabilization exercise program using weight loads on balance and gait in stroke patients: A randomized controlled study.

BACKGROUND: The effects of trunk stabilization exercise programs and exercises applying weight loads for stroke patients are well presented. However, there is not enough objective research to prove the effects of trunk stabilization exercise programs using weight loads for stroke patients. OBJECTIVE: In this study, a trunk stabilization exercise program using weight loads was performed to investigate its impact on the balance and gait ability of stroke patients. METHODS: Thirty patients with stroke were randomly divided into three groups. Experiment group 1 followed a trunk stabilization exercise program using weight loads, experiment group 2 followed a trunk stabilization exercise program, and the control group followed general physiotherapy. Patients' balance ability was assessed using balance measurement equipment BT-4 (postural sway area (PSA), postural sway length (PSL), limit of stability (LOS)), Berg Balance Scale (BBS), and Time Up and Go test (TUG). Gait speed was measured to examine gait ability. RESULT: After the intervention, the PSA, PFSL in experimental groups 1 and 2 decreased but that of the control group increased. BBS, TUG, and LOS scores of experimental group 1 were significantly improved compared to experimental group 2 and the control group. Also, gait speed was significantly improved in experimental group 1 compared to experimental group 2 and the control group. CONCULSION: This study may be used as a basic material for an effective trunk stabilization exercise method for stroke patients and might be of significance as an intervention method for stroke patients requiring long-term treatment.

Effects of Task-Specific Training after Cognitive Sensorimotor Exercise on Proprioception, Spasticity, and Gait Speed in Stroke Patients: A Randomized Controlled Study.

Background and objectives: Common problems in stroke patients include loss of proprioception, spasticity, and impaired gait. The purpose of this study was to examine the effects of task-specific training (TST) combined with cognitive sensorimotor exercise (CSE) on proprioception, spasticity and gait speed in stroke patients. Materials andMethods: Thirty-seven subjects were randomly divided into three groups; (1) the TST after CSE group (Experimental I, n = 13); (2) the TST group (Experimental II, n = 12), and (3) a conventional physical therapy training group (control group, n = 12). Evaluations were performed before the commencement of training and again eight weeks after training was initiated. An electrogoniometer was used to evaluate proprioception variation. The composite spasticity score (CSS) and MyotonePRO were used to evaluate spasticity. In addition, 10 m walk test was used to assess gait speed. Results: After training, the Experimental I group showed significant improvement in proprioception compared to the Experimental II and control group (p < 0.05). In CSS, gastrocnemius muscle tone (GMT) and gait speed among three groups, Experimental I group differed significantly after eight weeks of training compared to the control group (p < 0.05). Conclusions: These findings suggest that the TST combined with CSE provided significant improvements in proprioception, spasticity, and gait speed.

Effects of Cognitive Sensory Motor Training on Lower Extremity Muscle Strength and Balance in Post Stroke Patients: A Randomized Controlled Study.

BACKGROUND: Sensory motor impairment, the most common neuromuscular condition in stroke patients, often contributes to muscle weakness and imbalance. OBJECTIVE: The purpose of this research was to investigate the effects of cognitive sensory-motor training (CSMT) on the muscle strength and balance ability in post-stroke patients. METHODS: Thirty-five participants after stroke were randomly assigned to the CSMT (n = 17) or control group (n = 18). All participants received 30 min of training each time, five times per week, for six weeks. Lower extremity muscle strength of tibialis anterior (LEMTA) was evaluated using a digital muscular dynamometer. The Medical Research Council (MRC) scale was used to evaluate muscle strengths of the hip joint, knee joint, and ankle joint. For balance ability test, the center of pressure (COP) movement distance and limited of stability (LOS) were measured using BioRescue. RESULTS: LEMTA, MRC scale, balance ability were significantly more improved in the CSMT group than in the control group (p < 0.05). CONCLUSIONS: Our findings indicate that CSMT is beneficial and effective for improving muscle strength of the lower extremity and balance ability of post-stroke patients.

Micro- and nano-tomography analysis of mouse soleus muscle using radiation.

In this study, we analyze radiation images of muscle structure of mice soleus muscles using radiation source-based microtomography and nanotomography. Soleus muscle samples were collected for analysis from 8-week-old male Institute of Cancer Research mice. First, phase-contrast X-ray microtomography was employed in these experiments. Then to obtain images with excellent contrast, imaging was performed using monochromatic light with excellent transmission power. To analyze additional muscle structures in higher magnification images than these images, nanotomography was performed, which facilitated obtaining high-magnification and high-resolution images. Muscle tissue microstructures were confirmed through three-dimensional images obtained from phase-contrast X-ray microtomography. Thus, the muscle tissue's overall shape at microscopic level can be captured. Additionally, a single muscle fiber was examined using hard X-ray nano-imaging, through which we could observe the alignment of countless myofibrils, that is, actin and myosin filaments in the muscle fibers. Thus, the methodology adopted here proved to be advantageous in analyzing the muscle tissue's overall structure with microtomography and in observing the myofibrils in detail using nanotomography.

Three-dimensional structure analysis of mouse nails using synchrotron radiation.

Until now, studies on nail diseases have been performed through microscopic diagnosis and microscopic computed tomography (micro-CT). However, these kinds of conventional methods have some limitations. Firstly, the microscopic method is considered the gold standard for medical diagnosis. However, due to the use of fluorescent materials, the sample is damaged and it takes a long time to get results. Secondly, while micro-CT is a noninvasive method to get inner structure images of the sample with high resolution, the penetration and spatial resolution are insufficient for studying the microstructures of the sample, such as the sponge bone and the muscle fibers. In contrast, synchrotron radiation (SR) X-ray imaging technology has the advantage of very vividly demonstrating the anatomic structure of the sample with high penetration, sensitivity and resolution. In this study, we compared the optical microscopic method using hematoxylin and eosin staining and SR imaging to analyze the nail tissue in a mouse model. The results showed that SR could depict the inner structures of a mouse nail without any physical damage. Additionally, we could divide the important anatomical structures of the nail unit into three parts with three-dimensional (3D) images: the nail bed, nail matrix and hyponychium. The images showed that SR could be used for analyzing nails by visualizing the relatively clear and medically semantic structures in a 3D section. We expect that the results of this study will be applied to study nail diseases and conduct pharmaceutical research on their treatment.

Effects of Mirror Therapy Combined with EMG-Triggered Functional Electrical Stimulation to Improve on Standing Balance and Gait Ability in Patient with Chronic Stroke.

This study was performed to evaluate the effects of EMG-triggered functional electrical stimulation on balance and gait ability on patient with Chronic Stroke. A total of 60 chronic stroke patients were divided into mirror treatment and functional electrical (MT-EF) Group, MT group, CON group. Each group performed 60 min a day five times a week for eight weeks. MT-FE group was performed 30 min five times a week for eight weeks in mirror therapy process with EMG-FES. MT group performed 30 min five times a week for eight weeks in mirror therapy process. CON group was performed 30 min five times a week for eight weeks in conservative treatment. To measure the balance ability, Biorescue (COP, LOS), Berg balance scale (BBS) and FRT, and the gait ability test was performed by 10 m walk test. MT-FE group revealed significant differences in COP, LOS, BBS, FRT and 10 m walk test as compared to the MT and CON groups (p < 0.05). Our results showed that MT-FE was more effective on COP, LOS, BBS, FRT and 10 m walk test in patients with chronic stroke. Our results also showed that MT-EF group was more effective on balance and gait ability in patients with chronic stroke. We suggest that this study can be used for intervention data for recovering balance and gait ability in chronic stroke patients.

Three-dimensional analysis of injury conditions of single muscle fibers in small animals using phase-contrast X-ray imaging.

Muscle damage can reduces the biological functions and lead to ultimately a disease state. For the reason, it is important to accurately check the state of an injury such as atrophy, and it is required to identify the state of fibers constituting the muscle. This study describes a novel method of analyzing single muscle fibers with injury conditions in three-dimensions. The muscle fibers of the mice were visualized using phase-contrast X-ray projection the microstructure. In additions, it was possible to confirm the status by quantitatively analyzing the injury severity of muscle fibers. Significantly, the muscle conditions of multiple individuals were individually determined. This study could contributes to areas where it is very important to identify microdetailed and quantitative changes of state, such as new drug development.

Synchrotron radiation imaging analysis of neural damage in mouse soleus muscle.

Damage to lower limb muscles requires accurate analysis of the muscular condition via objective microscopic diagnosis. However, microscopic tissue analysis may cause deformation of the tissue structure due to injury induced by external factors during tissue sectioning. To substantiate these muscle injuries, we used synchrotron X-ray imaging technology to project extremely small objects, provide three-dimensional microstructural analysis as extracted samples. In this study, we used mice as experimental animals to create soleus muscle models with various nerve injuries. We morphologically analyzed and quantified the damaged Section and Crush muscles, respectively, via three-dimensional visualization using synchrotron radiation X-ray imaging to diagnose muscle injury. Results of this study can also be used as basic data in the medical imaging field.

Analysis of the Effect of Backpack Design with Reduced Load Moment Arm on Spinal Alignment.

In this study, we designed a backpack that can reduce the moment arm of backpack load by placing the center of gravity of the backpack close to the axis of the spine. In order to investigate the effect of sagittal spinal alignment compared with the general backpack, we conducted the study using radiological images. The participants in this study were 18 adults (8 males and 10 females). The subjects participated in the experiment without carrying the backpack, wearing the normal backpack, and wearing a backpack designed to reduce the load moment arm by placing the center of gravity close to the body. Spinal alignment parameters were measured and analyzed using 3D radiography measurement software based on radiographic images taken under three conditions. The overall angle of lumbar lordosis, upper arc, lower arc, difference between pelvic incidence and lumbar lordosis, lower cervical lordosis, and sagittal vertical axis were measured. In the case of wearing the backpack rather than without the backpack, there was a significant difference in the overall angle of lumbar lordosis, lower arc, lower cervical spine angle, difference between pelvic incidence and lumbar lordosis, and sagittal vertical axis. In the case of wearing the backpack with reduced moment arm, the overall angle and lower arc of lumbar lordosis were significantly increased compared to those with the normal backpack. The difference between pelvic incidence and lumbar lordosis was significantly decreased. The results showed that a normal backpack caused imbalance of sagittal spinal alignment, and the backpack reducing the load moment arm by placing the backpack's center of gravity close to the vertebral joint played a positive role in reducing the change of lumbar alignment compared with the normal backpack.

The Effects of Force That Pushes Forward Lumbar Region on Sagittal Spinal Alignment When Wearing Backpack.

The purpose of this study is to design a backpack to push the lumbar region forward and confirm the change in the sagittal plane of the spine using radiography when wearing the backpack to present an effective backpack wearing method that can help spinal alignment. Place the question addressed in a broad context and highlight the purpose of the study. A total of 14 adult volunteers participated in the study. The study was carried out on the subjects without carrying a backpack, with a general backpack, and with a backpack designed to push the lumbar region forward. We investigated cervical, thoracic, lumbar, and sacral alignment under these three conditions. Lumbar lordosis showed a significant decrease in the state of wearing a general backpack compared to the case without a backpack, and a significant increase in the state of wearing a backpack designed to push the lumbar region forward rather than a general backpack. In addition, the sacral slope was significantly increased when carrying the backpack designed to push the lumbar region forward, compared to carrying the general backpack. There was a significant correlation between the sacral and lumbar alignment change when wearing the backpack compared to the state without a backpack. The results of this study indicate that wearing a backpack designed to push the lumbar region forward may contribute to the recovery of lumbar lordosis that is reduced when wearing a general backpack. This may be due to an increase in the sacral slope corresponding to the inferior angle of lumbar spine.

The effects of the neck stabilization exercise on the muscle activity of trunk respiratory muscles and maximum voluntary ventilation of chronic stroke patients.

BACKGROUND: Unstable neck posture, muscle imbalance, and segmental instability can cause neck pain and decrease the respiratory function. OBJECTIVE: To examine effects of a neck stabilization exercise on respiratory muscle activity and maximal voluntary ventilation (MVV) in patients with a chronic stroke. METHODS: A total of 40 patients with a chronic stroke participated in this study. They were randomly divided into two groups (20 in each group). However, ten patients dropped out of the experiment (5 in each group). The experimental group (n= 15) performed a 15-minute neck stabilization exercise and a 15-minute breathing retraining exercise in addition to a rehabilitation exercise treatment. The control group (n= 15) completed a 30-minute breathing retraining exercise in addition to a rehabilitation exercise treatment. Exercises were conducted for 30 minutes a day, five times a week, for a total of six weeks. Activities of major respiratory muscles and MVV were measured before and after the experiment. RESULTS: Both the experimental group and the control group showed significant difference in activities of major respiratory muscles and MVV before and after the experiment (p< 0.05). The experimental group showed a significantly higher increase compared to the control group (p< 0.05). CONCLUSIONS: The application of a combination of a neck stabilization exercise and a breathing retraining exercise to patients with a chronic stroke can increase activity of respiratory muscles and MVV.

Effects of Light Touch on Balance in Patients with Stroke.

Light touch is the combination of cutaneous and kinesthetic inputs. The literature suggests that light touch compensates for a reduced amount of center of pressure information in older peoples, blind subjects and patients with neurological disorder. This study investigated the effects of light touch applied to an external bar, on the postural sway in individuals with hemiparetic stroke. We used a cross sectional study, fifteen individuals with stroke and 15 healthy age-matched adults stood as still as possible on a force plate. Experimental trials (duration, 30 s) included two visual conditions (open eyes and closed eyes), two somatosensory conditions (no touch and light touch) and two support surface conditions (firm and foam surfaces). The area of center of pressure (COP) and the mean velocity of COP in the medio-lateral and anterior-posterior directions were assessed. For both groups, COP velocity and area decreased with light touch regardless of the visual or surface conditions. The effects of light touch were similar in both groups. In addition, results show that the effectiveness of light touch in reducing postural sway was greater on a foam surface than on a firm surface. Our findings indicate that light touch could be beneficial in postural control for individuals with hemi-paretic stroke.

The reliability and validity of the Korean version of the Japanese orthopaedic association back pain evaluation questionnaire.

[Purpose] The purpose of this study was to establish the reliability and validity of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) translated into Korean for use with patients' low back pain. [Subjects and Methods] Sixty-two subjects with low back pain, 28 men and 34 women, participated in the study. Reliability was determined by using the intra class correlation coefficient and Cronbach's alpha for internal consistency. Validity was examined by correlating the JOABPEQ scores with the 36 item short form health survey (SF 36). [Results] Test-retest reliability was 0.75-0.83. The criterion-related validity was established by comparison with the Korean version of the SF 36. [Conclusion] The Korean version of the JOABPEQ was shown to be a reliable and valid instrument for assessing low back pain.

Effects of treadmill speed on the knee angle and stance time of white rats with knee osteoarthritis according to the treadmill speed.

[Purpose] The purpose of this study was to identify whether walking on a treadmill at an adjusted speed is suitable for humans by examining the effects of exercise on the joint functions of white rats with induced knee osteoarthritis. [Subjects and Methods] The subjects were 20 Sprague-Dawley white rats, aged eight weeks, weighing 250 to 300 g. The moderate-speed exercise group performed their exercise at a gradient of 0% and a speed of 15 m/min, and the high-speed exercise group performed their exercise at a gradient of 0% and a speed of 26 m/min. [Results] Statistically significant changes were elicited by the moderate-speed and high-speed exercises. [Conclusion] In conclusion, the results of the present study present the importance of walking exercise. In particular, they demonstrate that changes in knee ROM and stance time are elicited by changes in walking speed.

Effects of an upper-limb exercise program for improving muscular strength and range of movement on respiratory function of stroke patients.

[Purpose] This study aims to investigate the effects of upper-limb exercises on the respiratory functions of stroke patients. [Subjects and Methods] This study was performed with 25 stroke patients. The subjects were divided into the control group (n=12) which did not perform upper arm training and the experimental group (n=13) which conducted upper arm training. Forced vital capacity and forced expiratory volume in the first second, both of which are used in this study, are well-known indicators of respiratory capabilities. Peak cough flow is used to indicate cough capability. [Results] Concerning changes in forced vital capacity, forced expiratory volume in the first second and the peak cough flow of each group after the exercise, while the control group did not show significant differences, the experimental group showed statistically significant increases. [Conclusion] The results of the study indicate that exercise programs that increase the mobility of upper limbs and increase muscular strength have the effect of normalizing vertebral alignment for stroke patients, and thus can provide effective interventions for improving respiratory function.

Effect of thoracic and cervical joint mobilization on pulmonary function in stroke patients.

[Purpose] This study aimed to conduct thoracic and cervical mobilization in stroke patients and determine its effects on respiratory function. [Subjects and Methods] Twenty-one stroke patients were studied. Subjects were divided into a control group (control group, n=11) who did not undergo thoracic and cervical joint mobilization, and an experimental group (thoracic and cervical mobilization group, n=10) who underwent thoracic and cervical joint mobilization. Forced vital capacity and forced expiratory volume in the first second, well-known indicators of respiratory capabilities, were measured. Peak cough flow was measured as an indicator of cough capability. [Results] After the exercise, respiratory function in the thoracic and cervical mobilization group showed statistically significant improvements demonstrated by increases in forced vital capacity, forced expiratory volume in the first second, and peak cough flow. [Conclusion] The findings indicate that thoracic and cervical mobilization can improve the thoracic movements of stroke patients resulting in improved pulmonary function.

Nerve growth factor expression in stroke induced rats after shock wave.

[Purpose] This study investigates effects of extracorporeal shock wave therapy on nerve growth factor expression in stroke in rats. [Subjects and Methods] Sixteen eight-week-old Sprague-Dawley rats were used and randomly divided into two groups: an experimental group, a control group. The experimental group received extracorporeal shock wave therapy after the stroke. The spinal cord encompassing the lumbar 4-lumbar 5 level was then removed for Western blot analysis. [Results] There was a significant difference in nerve growth factor expression between the groups after the impairment. [Conclusion] Application of extracorporeal shock wave therapy increased the expression of nerve growth factor and nerve growth factor postulated to promote nerve growth factor upregulation through formation of a microenvironment at the spinal cord level related to the injured area.

Impact of sensory integration training on balance among stroke patients: sensory integration training on balance among stroke patients.

This study attempts to investigate the impact that the sensory integration training has on the recovery of balance among patients with stroke by examining the muscle activity and limit of stability (LOS). A total of 28 subjects participated. The subjects were randomly allocated by the computer program to one of two groups: control (CON) group (n=15), sensory integration training (SIT) group (n=13). The research subjects received intervention five days a week for a total of four weeks. The CON group additionally received 30-minute general balance training, while the SIT group additionally received 30-minute sensory integration training. In the muscle activity, the improvement of Erector spinae (ES) and Gluteus medius (GM) was more significant in the SIT group than in the CON group. In the LOS, the improvement of affected side and forward side was significantly higher in the SIT group compared to the CON group. Sensory integration training can improve balance ability of patients with stroke by increasing muscle activity of stance limb muscles such as GM and trunk extensor such as ES along with enhancement of the limit of stability.

The effects of stabilization exercise with an oral assistive device on pain and functionality of low back pain patients.

[Purpose] This study examined low back pain patients' decrease in pain and improvement in functionality after performance of a lumbar stabilization exercise using an oral assistive device, which can replace a lumbar assistive device. [Subjects and Methods] The experimental group (n=12) conducted a stabilization exercise using an oral assistive device after conventional physical therapy. The control group (n=12) received conventional physical therapy. In order to objectively measure pain in this study, a visual analogue scale (VAS) was used. In order to evaluate the subjects' functional aspects while living with low back pain, the Oswestry Disability Index (ODI) was used. [Results] There were statistically significant improvements in the comparison of the VAS and ODI of the experimental group and the control group. The experimental group's VAS and ODI significantly improved after the intervention compared to the control group. [Conclusion] The stabilization exercise using the assistive device after conventional physical therapy in the rehabilitation of low back pain patients reduced subjects' pain and increased their functional activities.

The influence of an ankle foot orthosis on the percentage of weight loading during standing tasks in stroke patients.

[Purpose] The aim of this study was to investigate the effects of an ankle foot orthosis on weight-bearing abilities of stroke patients by comparing weight loading during performance of tasks in various standing positions on the affected side. [Subjects and Methods] This study was performed with 16 stroke patients. To measure the weight loading value and percentage of weight loading in affected lower extremities, 5 standing tasks were performed with and without an ankle foot orthosis in random order. [Results] In the rising from a chair, maintaining a standing position, and forward weight shifting tasks, the affected lower extremities showed a significantly higher percentage of weight loading with an ankle foot orthosis. In the tasks requiring weight shifting to one leg, weight shifting to the lateral side showed the best weight-bearing ability with or without an ankle foot orthosis, followed by the forward and backward weight shifting, respectively. There were statistically significant correlations in all 5 tasks with or without an ankle foot orthosis. [Conclusion] An ankle foot orthosis improves the weight-bearing ability, especially when shifting weight forward, resulting in increased weight-bearing ability in activities of daily living tasks such as quiet standing and rising from a chair. The 5 tasks in this study would be a fine assessment tool under clinical conditions to investigate the postural stability of the affected side with or without application of an ankle foot orthosis.