Duck-Won Oh

Visual and kinesthetic locomotor imagery training integrated with auditory step rhythm for walking performance of patients with chronic stroke

Objective: To compare the effect of visual and kinesthetic locomotor imagery training on walking performance and to determine the clinical feasibility of incorporating auditory step rhythm into the training. Design: Randomized crossover trial. Setting: Laboratory of a Department of Physical Therapy. Subjects: Fifteen subjects with post-stroke hemiparesis. Intervention: Four locomotor imagery trainings on walking performance: visual locomotor imagery training, kinesthetic locomotor imagery training, visual locomotor imagery training with auditory step rhythm and kinesthetic locomotor imagery training with auditory step rhythm. Main outcome measures: The timed up-and-go test and electromyographic and kinematic analyses of the affected lower limb during one gait cycle. Results: After the interventions, significant differences were found in the timed up-and-go test results between the visual locomotor imagery training (25.69 ± 16.16 to 23.97 ± 14.30) and the kinesthetic locomotor imagery training with auditory step rhythm (22.68 ± 12.35 to 15.77 ± 8.58) (P<0.05). During the swing and stance phases, the kinesthetic locomotor imagery training exhibited significantly increased activation in a greater number of muscles and increased angular displacement of the knee and ankle joints compared with the visual locomotor imagery training, and these effects were more prominent when auditory step rhythm was integrated into each form of locomotor imagery training. The activation of the hamstring during the swing phase and the gastrocnemius during the stance phase, as well as kinematic data of the knee joint, were significantly different for posttest values between the visual locomotor imagery training and the kinesthetic locomotor imagery training with auditory step rhythm (P<0.05). Conclusions: The therapeutic effect may be further enhanced in the kinesthetic locomotor imagery training than in the visual locomotor imagery training. The auditory step rhythm together with the locomotor imagery training produces a greater positive effect in improving the walking performance of patients with post-stroke hemiparesis.

Effectiveness of community-based ambulation training for walking function of post-stroke hemiparesis: a randomized controlled pilot trial

Objective: To investigate the effect of community-based ambulation training on walking function of patients with post-stroke hemiparesis. Design: Randomized, single-blind, controlled pilot study. Setting: Inpatient rehabilitation hospital. Subjects: Twenty-five subjects were randomly assigned to either the experimental group or the control group, with 13 and 12 subjects, respectively. Interventions: All subjects received a routine physical therapy. The subjects in the experimental group also received community-based ambulation training, which was performed for an hour, once a day, three times a week for a four-week period. Main measures: Ten-metre walk test, 6-minute walk test, community walk test, walking ability questionnaire and activities-specific balance confidence scale before and after the intervention. Results: The change values of the 10-m walk test (0.21 ± 0.12 m/s versus 0.07 ± 0.10 m/s), community walk test (−13.61 ± 10.31 minutes versus −3.27 ± 11.99 minutes), walking ability questionnaire (6.15 ± 3.60 score versus 2.75 ± 2.38 score) and activities-specific balance confidence scale (17.45 ± 11.55 score versus 2.55 ± 10.14 score) were significantly higher in the experimental group than in the control group (P < 0.05). At post-test, the 10-m walk test was significantly higher in the experimental group than in the control group (0.72 ± 0.24 m/s versus 0.50 ± 0.23 m/s) (P < 0.05). In the experimental group, there were significant differences for all variables between pre-test and post-test (P < 0.01), whereas the subjects of the control group showed a significant difference in only the walking ability questionnaire (P < 0.01). Conclusions: The findings demonstrate that community-based ambulation training can be helpful in improving walking ability of patients with post-stroke hemiparesis and may be used as a practical adjunct to routine rehabilitation therapy.

Effects of the pelvic compression belt on gluteus medius, quadratus lumborum, and lumbar multifidus activities during side-lying hip abduction

The aims of this study were to assess the effect of the pelvic compression belt on the electromyographic (EMG) activities of gluteus medius (GM), quadratus lumborum (QL), and lumbar multifidus (LM) during side-lying hip abduction. Thirty-one volunteers (15 men and 16 women) with no history of pathology volunteered for this study. Subjects were instructed to perform hip abduction in side-lying position with and without applying the pelvic compression belt. The pelvic compression belt was adjusted just below the anterior superior iliac spines with the stabilizing pressure using elastic compression bands. Surface EMG data were collected from the GM, QL, and LM of the dominant limb. Significantly decreased EMG activity in the QL (without the pelvic compression belt, 60.19±23.66% maximal voluntary isometric contraction [MVIC]; with the pelvic compression belt, 51.44±23.00% MVIC) and significantly increased EMG activity in the GM (without the pelvic compression belt, 26.71±12.88% MVIC; with the pelvic compression belt, 35.02±18.28% MVIC) and in the LM (without the pelvic compression belt, 30.28±14.60% MVIC; with the pelvic compression belt, 37.47±18.94% MVIC) were found when the pelvic compression belt was applied (p<0.05). However, there were no significant differences of the EMG activity between male and female subjects. The findings suggest that the pelvic compression belt may be helpful to prevent unwanted substitution movement during side-lying hip abduction, through increasing the GM and LM and decreasing the QL.

Effect of the pelvic compression belt on the hip extensor activation patterns of sacroiliac joint pain patients during one-leg standing: A pilot study

As a means of external stabilization of the sacroiliac joint (SIJ), many clinicians have often advocated the use of the pelvic compression belt (PCB). The objective of this pilot study was to compare the effects of the PCB on hip extensor muscle activation patterns during one-leg standing in subjects with and without sacroiliac joint pain (SIJP). Sixteen subjects with SIJP and fifteen asymptomatic volunteers participated in this study. Surface electromyography (EMG) data [signal amplitude and premotor reaction time (RT)] were collected from the gluteus maximus and biceps femoris muscles of the supporting leg during one-leg standing with and without the PCB. Compared to that of the asymptomatic individuals, the EMG amplitude of the biceps femoris was significantly decreased in individuals with SIJP upon the application of the PCB (p < 0.05). Furthermore, on using the PCB, in individuals with SIJP, the RT of the gluteus maximus was significantly decreased; however, the RT of the biceps femoris was increased (p < 0.05). Thus, our data support the use of the PCB to modify the activation patterns of the hip extensors among patients with SIJP.

Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training:

Objective: To investigate the effect of supervised and unsupervised pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence and to compare the outcomes. Design: Randomized, single-blind controlled study. Setting: Outpatient rehabilitation hospital. Subjects: Eighteen subjects with postpartum urinary incontinence. Interventions: Subjects were randomized to either a supervised training group with verbal instruction from a physiotherapist, or an unsupervised training group after undergoing a supervised demonstration session. Main measures: Bristol Female Lower Urinary Tract Symptom questionnaire (urinary symptoms and quality of life) and vaginal function test (maximal vaginal squeeze pressure and holding time) using a perineometer. Results: The change values for urinary symptoms (−27.22 ± 6.20 versus −18.22 ± 5.49), quality of life (−5.33 ± 2.96 versus −1.78 ± 3.93), total score (−32.56 ± 8.17 versus −20.00 ± 6.67), maximal vaginal squeeze pressure (18.96 ± 9.08 versus 2.67 ± 3.64 mmHg), and holding time (11.32 ± 3.17 versus 5.72 ± 2.29 seconds) were more improved in the supervised group than in the unsupervised group (P < 0.05). In the supervised group, significant differences were found for all variables between pre- and post-test values (P < 0.01), whereas the unsupervised group showed significant differences for urinary symptom score, total score and holding time between the pre- and post-test results (P < 0.05). Conclusions: These findings suggest that exercising the pelvic floor muscles by utilizing trunk stabilization under physiotherapist supervision may be beneficial for the management of postpartum urinary incontinence.

Effects of integrating hip movements into bridge exercises on electromyographic activities of selected trunk muscles in healthy individuals.

This study aimed to identify the electromyographic (EMG) effects in selected trunk muscles after incorporating hip movement into bridging exercise. Twenty-six healthy adults (13 men and 13 women) volunteered for this experiment. EMG data (% maximum voluntary isometric contraction) were recorded from the rectus abdominis (RA), obliquus internus (OI), erector spinae (ES), and multifidus (MF) muscles of the dominant side while the subjects performed 3 types of bridging exercise, including bridging alone (Bridging 1), bridging with unilateral hip movements (Bridging 2), and bridging with bilateral hip movements (Bridging 3) in a sling suspension system. The RA and OI showed greater EMG activity during Bridging 2 and 3 compared to Bridging 1, with the greatest OI activity during Bridging 3 (p < 0.05), and the activity of the MF appeared to be greater during Bridging 3 than during Bridging 1 and 2 (p < 0.05). Furthermore, the OI/RA and MF/ES ratios were significantly higher for Bridging 2 (OI/RA = 1.89 ± 1.41; MF/ES = 1.03 ± 0.19) and Bridging 3 (OI/RA = 2.34 ± 1.86; MF/ES = 1.03 ± 0.15) than Bridging 1 (IO/RA = 1.35 ± 0.92; MF/ES = 0.98 ± 0.16). The OI/RA ratio was significantly higher for Bridging 3 than for Bridging 2. Based on these results, adding hip abduction and adduction, particularly bilateral movements, could be a useful method to enhance OI and MF EMG activity and their activities relative to global muscles during bridging exercise.

Clinical feasibility of action observation training for walking function of patients with post-stroke hemiparesis: a randomized controlled trial

Objective: To identify the effects of action observation training (AOT) on the walking ability of subjects with post-stroke hemiparesis. Design: Randomized, single-blind, controlled pilot study. Setting: Inpatient rehabilitation hospital. Subjects: Twenty-one subjects with post-stroke hemiparesis were randomly allocated to either the experimental group (EG) or the control group (CG), with 11 and 10 patients, respectively. Interventions: The subjects in the EG and CG watched video clips demonstrating four functional walking tasks and showing different landscape images, respectively. All subjects subsequently performed the walking tasks (a total of 30 min, once a day, 3 times weekly for a 4-week period). Main measures: 10-m walk test, figure-of-8 walk test (time and steps), dynamic gait index (DGI), and gait symmetry score (swing and stance phases, and stride length) before and after the intervention. Results: The changes between the pre- and post-test values of the 10-m walk test (median [interquartile range], -5.10 [-15.80–-1.60] versus 0.00 [-6.60–4.06]), figure-of-8 walk test (time: -3.50 [-12.60–-2.00] versus -1.25 [-4.98–0.25]; steps:-5.00 [-8.00–-2.00] versus 0.00 [-3.25–0.25]), and DGI (4.00 [3.00–6.00] versus 1.00 [-4.00–3.00]) showed significant differences between the EG and CG (p < 0.05). In the EG, the 10-m walk test, time and steps of figure-of-8 walk test, DGI, and gait symmetry score in the stance phase showed significant differences between pre- and post-test (p < 0.05). Conclusions: The findings suggest that AOT can be beneficial in enhancing walking ability of patients with post-stroke hemiparesis, and may be clinically feasible as a practical adjunct to routine rehabilitation therapy. A power calculation on our data showed that 20 subjects in each group were required for further definitive studies.

Effect of motor imagery training on symmetrical use of knee extensors during sit-to-stand and stand-to-sit tasks in post-stroke hemiparesis.

OBJECTIVE To investigate the effect of motor imagery training (MIT) on the symmetrical use of knee extensors during sit-to-stand and stand-to-sit tasks. METHODS We measured the electromyographic (EMG) data in the knee extensor on the affected side of 3 volunteers with post-stroke hemiparesis. We used a single-subject multiple-baseline research design across individuals. The EMG data were collected from knee extensors while performing the sit-to-stand and stand-to-sit tasks. The EMG activation and onset time ratios for the knee extensors were calculated by dividing the EMG activation and onset time of knee extensor action on the affected side by these on the unaffected side. MIT consisted of a 10-min detailed description of 5 stages: preparation, sit-to-stand tasks, weight shifting during standing, stand-to-sit tasks, and completion. RESULTS During MIT, the EMG activation ratios of participants 1, 2, and 3 increased by 11.24%, 18.07%, and 26.91%, respectively, in the sit-to-stand task and by 12.11%, 14.31%, and 25.92%, respectively, in the stand-to-sit task. During MIT, the onset time of participants 1, 2, and 3 decreased by 36.09%, 24.27%, and 25.61%, respectively, in the sit-to-stand task and by 26.81%, 27.20%, and 22.83%, respectively, for the stand-to-sit task. CONCLUSION These findings suggest that MIT has a positive effect on the symmetrical use of knee extensors during sit-to-stand and stand-to-sit tasks.

Integrating arm movement into bridge exercise: Effect on EMG activity of selected trunk muscles

The purpose of this study was to determine whether incorporating arm movement into bridge exercise changes the electromyographic (EMG) activity of selected trunk muscles. Twenty healthy young men were recruited for this study. EMG data were collected for the rectus abdominis (RA), internal oblique (IO), erector spinae (ES), and multifidus (MF) muscles of the dominant side. During bridging, an experimental procedure was performed with two options: an intervention factor (with and without arm movement) and a bridging factor (on the floor and on a therapeutic ball). There were significant main effects for the intervention factor in the IO and ES and for the bridging factor in the IO. The RA and IO showed significant interaction between the intervention and bridge factors. Furthermore, IO/RA ratio during bridging on the floor (without arm movement, 2.05±2.61; with arm movement, 3.24±3.42) and bridging on the ball (without arm movement: 2.95±3.87; with arm movement: 5.77±4.85) showed significant main effects for, and significant interaction between the intervention and bridge factors. However, no significant main effects or interaction were found for the MF/ES ratio. These findings suggest that integrating arm movements during bridge exercises may be used to provide preferential loading to certain trunk muscle groups and that these effects may be better derived by performing bridge exercises on a therapeutic ball.

Acute effect of repeated passive motion exercise on shoulder position sense in patients with hemiplegia: A pilot study

OBJECTIVE To determine the effect of repeated passive motion (RPM) exercise on position sense of the shoulder joint in patients with hemiplegia. METHODS Shoulder flexion position sense was evaluated for the affected side of 15 patients with hemiplegia, using an assessment board set at five angles (30 degrees, 60 degrees, 90 degrees, 120 degrees and 150 degrees). First, the affected shoulder was positioned passively, twice at each angle. Then, with the patient blindfolded, a repositioning test was performed twice at each angle, presented in random order. The assessment score was calculated as the proportion of correct responses (PCRs) for repositioning. After the testing, the RPM exercise, consisting of scapular and shoulder motions, was performed in a supine position for 15 min, and the testing was repeated. RESULTS After the RPM exercise, there was a significant difference in total PCR for right hemiplegia (p < 0.05) and in total PCR and PCR at 90 degrees for left hemiplegia (p < 0.05). However, the PCR was not significantly different between right and left hemiplegia at any angle. For all of the patients, the total PCR and the PCRs for every angle except 30 degrees and 150 degrees were significantly greater after the RPM exercise (p < 0.05). CONCLUSION The RPM exercise was helpful in improving proprioception in patients with hemiplegia. Further studies are needed to generalize these findings.