Myoung-Kwon Kim

Effect of Transcranial Direct Current Stimulation of Function in Patients with Stroke

[Purpose] The purpose of this study was to determine the effect of transcranial direct current stimulation (tDCS) on the upper limb of function of patients with post-stroke hemiplegia. [Subjects] Twenty subjects were randomly allocated to either the upper tDCS group or the functional training group, with 10 subjects in each group. [Methods] The two groups received functional training for thirty minutes a day, five days a week for four weeks. The tDCS group additionally received tDCS for 20 minutes. The outcome was assessed by the Box and Block test (BBT), grip strength, and the Fugl-Meyer assessment (FMA). [Results] There were significant improvements between pre- and post- intervention in both groups, in the BBT, grip strength, and the upper limb and lower lims sub-items of the FMA. The tDCS group showed significantly greater improvements than the control group in the BBT, and upper limb and lower limb sub-items of the FMA. [Conclusion] These findings suggest that tDCS may be more beneficial than functional training for improving the upper and lower limb functions of chronic stroke patients.

Kinematic Analysis of the Lower Extremities of Subjects with Flat Feet at Different Gait Speeds

[Purpose] This study determined the difference between flat feet and normal feet of humans at different gait velocities using electromyography (EMG) and foot pressure analysis. [Subjects] This study was conducted on 30 adults having normal feet (N = 15) and flat feet (N = 15), all of whom were 21 to 30u2005years old and had no neurological history or gait problems. [Methods] A treadmill (AC5000M, SCIFIT, UK) was used to analyze kinematic features during gait. These features were analyzed at slow, normal, and fast gait velocities. A surface electromyogram (TeleMyo 2400T, Noraxon Co., USA) and a foot pressure analyzer (FSA, Vista Medical, Canada) were used to measure muscle activity changes and foot pressure, respectively. [Results] The activities of most muscles of the flat feet, except that of the rectus femoris, were significantly different from the muscle activities of the normal feet at different gait velocities. For example, there was a significant difference in the vastus medialis and abductor hallucis muscle. Likewise, flat feet and normal feet showed significant differences in pressures on the forefoot, midfoot, and medial area of the hindfoot at different gait velocities. Finally, comparison showed there were significant differences in pressures on the 2nd–3rd metatarsal area. [Conclusion] Because muscle activation has a tendency to increase with an increase in gait velocity, we hypothesized that the lower extremity with a flat foot requires more work to move due to the lack of a medial longitudinal arch, and consequently pressure was focused on the 2nd–3rd metatarsal area during the stance phase.

The effect of mirror therapy integrating functional electrical stimulation on the gait of stroke patients.

[Purpose] The aim of the present study was to examine whether mirror therapy in conjunction with FES in stroke patients can improve gait ability. [Subjects] This study was conducted with 30 subjects who were diagnosed with hemiparesis due to stroke. [Methods] Experimental group I contained 10 subjects who received mirror therapy in conjunction with functional electrical stimulation, experimental group II contained 10 subjects who received mirror therapy, and the control group contained 10 subjects who received a sham therapy. A gait analysis was performed using a three-dimensional motion capture system, which was a real-time tracking device that delivers data in an infrared mode via reflective markers using six cameras. [Results] The results showed a significant difference in gait velocity between groups after the experiment, and post hoc analysis revealed significant differences between experimental group I and the control group and between experimental group II and the control group, respectively. There were also significant differences in step length and stride length between the groups after the experiment, and post hoc analysis revealed significant differences between experimental group I and control group. [Conclusion] The present study showed that mirror therapy in conjunction with FES is more effective for improving gait ability than mirror therapy alone.

Effects of High Frequency Repetitive Transcranial Magnetic Stimulation on Function in Subacute Stroke Patients

The aim of the present study was to examine the effects of high and low frequency repetitive transcranial magnetic stimulation on motor cortical excitability and the balance function in subacute stroke patients. Twenty-four subjects were randomly assigned to either the high frequency (HF) rTMS group, or the low frequency (LF) rTMS group, with 12 subjects each. All subjects received routine physical therapy. In addition, both groups performed a total of 20 sessions of rTMS for 20 minutes, once a day, 5 times per week, for a 4- week period. In the HF rTMS group, 10 Hz rTMS was applied daily to the hotspot of the lesional hemisphere; and in the LF rTMS group, 1 Hz rTMS was applied daily to the hotspot of the nonlesional hemisphere. Motor cortex excitability was determined by motor evoked potentials, and the balance function was evaluated by use of the Balance Index (BI) and the Berg Balance Scale (BBS), before and after the intervention. The change rate in the value of each variable differed significantly between the two groups ( p<0.05). Furthermore, significant differences were observed between all post-test variables of the two groups ( p<0.05). In the HF rTMS, significant differences were found in all the pre- and post-test variables ( p<0.05). On the other hand, in the LF rTMS, significant difference was observed only between the pre- and post-test results of BI and BBS ( p<0.05). The findings demonstrate that HF rTMS can be more helpful in improving the motor cortical excitability and balance function of patients with subacute stroke treatment than LF rTMS, and that it may be used as a practical adjunct to routine rehabilitation.

Effects of Mental Practice in Conjunction with Repetitive Transcranial Magnetic Stimulation on the Upper Limbs of Sub-acute Stroke Patients

The aim of the present study was to examine whether mental practice (MP) in conjunction with repetitive transcranial magnetic stimulation (rTMS) can improve the upper limb function of sub-acute stroke patients. This study was conducted with 32 subjects who were diagnosed with hemiparesis by stroke. The experimental group consisted of 16 members upon each of whom was performed MP in conjunction with rTMS, whreas the control group consisted of 16 members upon each of whom was performed MP and sham rTMS. Both groups received traditional physical therapy for 30 minutes a day, 5 days a week, for 6 weeks; additionally, they received mental practice for 15 minutes a day. The experimental group was instructed to perform rTMS, and the control group was instructed to apply sham rTMS for 15 minutes. A motor cortex excitability analysis was performed by motor evoked potentials (MEPs), and upper limb function was evaluated by Fugl-Meyer Assessment (FMA) and the Box and Block test (BBT). Results showed that the amplitude, latency, FMA, and BBT of the experimental group and the latency, FMA, and BBT of the control group were significantly improved after the experiment (p<0.05). Significant differences were found between the groups in amplitude and latency after the experiment (p<0.05). The results showed that MP in conjunction with rTMS is more effective in improving upper limb function than MP alone.

Therapeutic Efficacy of Low Frequency Transcranial Magnetic Stimulation in Conjunction with Mirror Therapy for Sub-acute Stroke Patients

The purpose of the current study was to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) in conjunction with mirror therapy on the balance function of patients with sub-acute stroke hemiparesis. This study was conducted with 36 subjects who were diagnosed with a hemiparesis due to stroke. Participants in the experimental (19 members) and control groups (17 members) received rTMS and sham rTMS during 10 minute sessions each, which were carried out five days per week for four weeks. This was followed by the mirror therapy over 30 minute sessions, which were carried out five days per week for four weeks. Motor recovery was assessed by balance index, dynamic limits of stability, Berg balance scale, and time up go test. The change values of the balance index (?2.06 ± 1.99 versus ?0.41 ± 1.11), dynamic limits of stability (3.68 ± 2.71 versus 1.17 ± 2.38), and time up go test (?7.05 ± 5.64 score versus ?3.35 ± 5.30 score) were significantly higher in the experimental group than in the control group ( p < 0.05). At post-test, balance index (4.08 ± 1.14 versus 5.09 ± 1.04), dynamic limits of stability (13.75 ± 0.60 versus 11.73 ± 3.53), and time up go test (23.89 ± 4.51 versus 28.82 ± 3.07) were significantly higher in the experimental group than in the control group ( p ＜ 0.05). In the experimental group, significant differences were found in the pre- and post-test scores for the balance index, dynamic limits of stability, Berg balance scale, and time up go test ( p ＜ 0.01). In the control group, a significant difference was observed between the pre- and post-test only for the Berg balance scale and time up go test ( p ＜ 0.05). These findings demonstrate that the application of 1㎐ rTMS in conjunction with mirror therapy can be helpful in improving the balance function of patients with sub-acute stroke hemiparesis, and this may be used as a practical adjunct to routine rehabilitation therapy.

A Comparison of Muscle Activities in the Lower Extremity between Flat and Normal Feet during One-leg Standing

[Purpose] This study examined the differences in muscle activation between flat and normal feet in the one-leg standing position which delivers the greatest load to the lower extremity. [Subjects] This study was conducted with 23 adults, 12 with normal feet and 12 with flat feet, with ages ranging from 21 to 30u2005years old, who had no neurological history or gait problems. [Methods] The leg used for one leg standing was the dominant leg of the subjects. The experimenter instructed the subjects to raise the non-dominant leg with their eyes open, and the subjects maintained a posture with the non-dominant legs knee flexed at 90° and the hip joint flexed at 45° for six seconds. In the position of one-leg standing, a horizontal rod was set at the height of the waist line of the subjects who lightly placed two fingers of each hand on the rod to prevent inclination of the trunk to one side. Measurements were taken three times and the maximum value was used. A surface electromyogram (TeleMyo 2400T, Noraxon Co., USA) was used to measure muscle activities. [Results] We compared muscle activities between flat and normal foot, and the results show a significant difference between normal and flat feet in the muscle activity of the abductor hallucis muscle. [Conclusion] The subjects with flat feet had relatively lower activation of the abductor hallucis muscle than those with normal feet during one leg standing. We infer from this that the abductor hallucis muscle of flat foot doesnt work as well as a dynamic stabilizer, compared to a normal foot, during one leg standing.

The Effects on Muscle Activation of Flatfoot during Gait According to the Velocity on an Ascending Slope.

[Purpose] This study determined the difference between flatfeet and normal feet in humans on an ascending slope using electromyography (EMG). [Subjects] This study was conducted on 30 adults having normal feet (n=15) and flatfeet (n=15), all of whom were 21 to 30u2005years old. [Methods] A treadmill (AC5000M, SCIFIT,) was used to analyze kinematic features during gait. These features were analyzed at slow, normal, and fast gait velocities on an ascending slope. A surface electromyogram (TeleMyo 2400T, Noraxon Co., USA) was used to measure muscle activity changes. [Results] The activities of most muscles in the subjects with flatfeet were significantly different from the muscle activities in the subjects with normal feet at different gait velocities on an ascending slope. There were significant differences in the vastus medialis and abductor hallucis muscles. [Conclusion] Because muscle activation of the vastus medialis in relation to stability of the lower extremity has a tendency to increase with an increase in gait velocity on an ascending slope, we hypothesized that higher impact transfer to the knee joints occurs in subjects with flatfeet due to the lack of a medial longitudinal arch and that the abductor halluces muscles, which provide dynamic stability to the medial longitudinal arches, do not activate well when they are needed in subjects with flatfeet.

Stroke Recovery Can be Enhanced by using Repetitive Transcranial Magnetic Stimulation Combined with Mirror Therapy

The aim of the present study was to examine whether mirror therapy, in conjunction with repetitive transcranial magnetic stimulation (rTMS), can improve the upper extremity function of stroke patient. This study was conducted with 35 subjects, who were diagnosed as a hemiparesis by stroke. The Mirror plus rTMS group was of 12 members who undertook mirror therapy in conjunction with rTMS, the Mirror group was of 11 members who undertook mirror therapy, and the control group was of 12 members who undertook sham therapy. A motor cortex excitability was performed by motor evoked potential, and upper limb function was evaluated by Fugl-Meyer Assessment, and Box and Block Test. Significant difference was shown after the experiment, in comparison of the groups in terms of latency, and as the result of post hoc test, significant difference was shown between the Mirror plus rTMS group and control group, and between the Mirror group and control group, respectively. Significant difference was shown after the experiment in comparison of the groups in amplitude, and as the result of post hoc test, significant difference was shown between the Mirror plus rTMS group and Mirror group, and between the Mirror plus rTMS group and control group. Significant difference was shown after the experiment, in comparison of the groups in FMA and BBT, and as the result of post hoc test, significant difference was shown between the Mirror plus rTMS group and Mirror group, and between the Mirror group and control group. The study showed that mirror therapy in conjunction with rTMS is more effective to improve upper extremity function, than mirror therapy and sham therapy.

A Three-dimensional Gait Analysis of People with Flat Arched Feet on an Ascending Slope.

[Purpose] The purpose of the study was to discover why people who have flat feet show a higher risk of damage to the musculoskeletal system than those who have normal feet. Furthermore, we examined the kinematic differences in the lower extremity between flat feet and normal feet in individuals on an ascending slope using three-dimensional gait analysis. [Subjects] This study was conducted on 30 adults having normal feet (N = 15) and flat feet (N = 15), all of whom were 21 to 30u2005years old. [Methods] A treadmill (AC5000M, SCIFIT, Berkshire, UK) was used to analyze the kinematic features during gait. These features were analyzed at slow, normal, and fast gait velocities on an ascending slope. Gait data were obtained using a 6-camera motion analysis system (Eagle system, Motion Analysis, Santa Rosa, CA, USA). [Results] Both groups showed significant differences in the sagittal, frontal, and transverse planes according to the speed changes. After comparing the lower extremity kinematics between those with flat feet and those with normal feet, significant differences were found with respect to hip adduction (frontal plane) in the stance phase and hip internal rotation (transverse plane) in the swing phase. [Conclusion] Due to hip adduction, the internal rotation angle of the lower extremity has a tendency to increase according to the increase in gait velocity on an ascending slope, and we can expect that the hip adductor muscles and internal rotator muscles in individuals with flat feet are used much more than would be the case for those with normal feet when they perform actions that require a lot of power, such as walking on an ascending slope and walking quickly.