Sejun Oh

Comparison of the effects of water- and land-based exercises on the physical function and quality of life in community-dwelling elderly people with history of falling: A single-blind, randomized controlled trial

PURPOSE The purpose of this study was to identify the effects of water-based exercises on the physical functions and quality of life (QOL) in community-dwelling elderly people with history of falling. MATERIALS AND METHODS Participants were randomly assigned to the water-based exercise group (n=34) or land-based exercise groups (n=32). To identify the effects on physical functions, muscle strength, flexibility, and mobility were measured. QOL and fear of falling were evaluated using the Short Form 36-item questionnaire and the modified falls efficacy scale (M-FES). The measurements were performed before and after the 10-week training period. RESULTS Within-group analysis indicated that hip abduction and adduction strength improved significantly in both groups (p=0.005; p=0.007). However, no statistically significant within-group differences were found in the back scratch test (p=0.766) and chair sit-and-reach test (p=0.870). QOL was significantly different in both groups (health transition: p=0.014, physical functioning: p<0.001, role physical: p<0.001, role emotional: p=0.002, bodily pain: p<0.001, vitality: p<0.001, and mental health: p<0.001). There was a significant difference in the M-FES in both groups (p=0.040). CONCLUSIONS These results indicate that water-based exercises are beneficial to improve the QOL, as well as physical activities, of community-dwelling elderly compared with land-based exercise. Water-based exercises would be useful to improve physical and psychological health in the elderly people with history of falling.

Myofascial Pain Syndrome in the Elderly and Self-Exercise: A Single-Blind, Randomized, Controlled Trial.

OBJECTIVE This study aimed to demonstrate the effect of self-exercise with a therapeutic inflatable ball (SEIB) in elderly patients with myofascial pain syndrome. DESIGN Single-blind, randomized, controlled noninferiority trial. SETTING University campus. PARTICIPANTS Forty elderly patients with myofascial pain syndrome completed the study. They were randomly allocated to SEIB (n = 22; mean age, 70.23 ± 6.11 years) or ultrasound (US) therapy (n = 18; mean age, 67.99 ± 5.64 years). INTERVENTION SEIB and US therapy (twice weekly for 4 consecutive weeks). OUTCOME MEASURES Visual analog scale (VAS), pressure pain threshold (PPT), and cervical lateral flexion (CLF) were measured at baseline and at 1, 2, 3, and 4 weeks. RESULTS The noninferiority test indicated that SEIB was not inferior to US for VAS, PPT, and CLF. Between-group comparisons showed no significant differences in the VAS (F = 2.579; p = 0.117), the PPT (F = 0.245; p = 0.624), and the CLF (F = 2.072; p = 0.159). In within-group comparisons, both groups presented significant differences in VAS (SEIB after 1 week and US after 1 week), PPT (SEIB after 3 weeks and US after 4 weeks), and CLF (SEIB after 4 weeks and US after 4 weeks) compared with baseline values. CONCLUSIONS SEIB for 4 weeks has an effect similar to that of US for desensitizing myofascial pain and increasing joint flexibility. High accessibility and low cost would make SEIB a practical self-treatment method in elderly patients with myofascial pain syndrome.

Abdominal hollowing and bracing strategies increase joint stability in the trunk region during sudden support surface translation but not in the lower extremities

BACKGROUND AND OBJECTIVE Application of hollowing and bracing, abdominal activation strategies (AAS), has focused on improving trunk stability. This study aimed to clarify the AAS effect on body sway during support surface translation while standing. MATERIALS AND METHODS Twenty healthy subjects (10 male, 10 female; aged 25.45 ± 3.22 years) performed hollowing, bracing, and natural strategies while standing, and exerted to maintain their balance during forward and backward translation. Ultrasonography evaluations confirmed the appropriate application of the 3 strategies by measuring abdominal muscle thickness. Additionally, a motion analysis system was used to capture the whole body sway along the sagittal plane. RESULTS During backward translation, angular displacements of the trunk were significantly different among the 3 strategies (upper thoracic: F = 13.758, p < 0.001; lower thoracic: F = 8.477, p = 0.001; and lumbopelvis: F = 8.651, p = 0.001). AAS significantly decreased the sway by 25-36% in all inter-spinal segments compared with the natural strategy (p < 0.05). During forward translation, only angular displacement of the lower thoracic was significantly different among the 3 strategies (F = 7.640, p = 0.002), and bracing decreased the sway by 33.48% compared with the natural strategy (p = 0.003). No significant differences were seen between hollowing and bracing during forward and backward translation. CONCLUSIONS AAS increased joint stability only in the trunk where joints are adjacent to abdominal muscles, but not in the lower extremities. The low impact of AAS on the lower extremities might have important implications on the paradigm of standing balance.

A self-determination theory-based self-myofascial release program in older adults with myofascial trigger points in the neck and back: A pilot study

ABSTRACT Purpose: To examine the effectiveness and adherence to a self-determination theory (SDT)-based self-myofascial release (SMR) program in older adults with myofascial trigger points (MTrPs), and to investigate the factors that influence participant behavioral change while conducting the program in a home setting. Methods: An explanatory mixed-method design was used to evaluate a 12-week SDT-based SMR program, including a 4-week group-based education and practice (EP) phase and an 8-week home-based self-management (SM) phase. Pain intensity on palpation and sensitivity to pain were assessed at baseline and the post EP and post SM phase. Focus group interviews were conducted at the post SM phase. Findings: Fifteen participants completed the study. Pain intensity and sensitivity to pain significantly improved at the post SM phase compared with the baseline. Adherence increased during the SM phase compared with that during the EP phase. Four main themes emerged as factors that influenced participant behavioral change: 1) “awareness of the effectiveness”; 2) “a sense of duty to perform the exercise”; 3) “obedience to expert instruction”; and 4) “lack of friendship.” Conclusions: These results support the effectiveness of an SDT-based SMR program for the treatment of MTrPs and in motivating older adults to participate in the program.

Aquomanual Therapy Program Development for Workers with Chronic Musculoskeletal Disorders

Abstract Objective: The aim of this study was to develop an aquomanual therapy program for workers with chronic musculoskeletal disorders. Method: This study was discussed intensively by the program development team, underwater exercise program based on the analysis of the development process program and developed a program of aquomanual therapy during 1 year. The therapy program development process consisted of analysis, design, and development components. Aquomanual therapy programs are man-to-man fundamental methods for treating chronic musculoskeletal disorders. Results: All program treatment times were 60 minutes: adaptation to the water for 10 minutes, main treatment for 40 minutes, and cool down for 10 minutes. The main treatment consisted of static stretching; manually assisted movement; mobilization; and manipulation of the cervical spine, thoracic spine, shoulder complex, and lumbar spine. In addition, treatment plan was organized by body system and consisted of four main components. Conclusion: Here we designed a new rehabilitation program by modifying land-based manual therapeutic techniques to meet the unique properties of bodies of water and maximize their benefits.

Equine Exercise in Younger and Older Adults: Simulated Versus Real Horseback Riding:

Horseback riding is an effective exercise for improving postural control and balance. To reduce costs and improve accessibility, simulated horseback riding has been developed; but no differential effects of simulated and real horseback riding on muscle activation patterns in older adults have been studied. Thus, we compared muscle activation patterns for older and younger adults engaged in real and simulated horseback riding exercises, using surface electromyography recordings of the erector spinae, rectus abdominis, internal oblique abdominis, and rectus femoris muscles. We recorded muscle activity for three riding patterns: walk, slow trot, and fast trot. Muscle activation was uniformly higher for simulated (vs. real) horseback riding and increased from the walking pattern through slow and fast trot. There was no age effect, but among older participants, muscle activation was higher for simulated (vs. real) horseback riding across all gait types. Simulated and real riding produced a similar pattern of muscle activation of the thigh and trunk. These results demonstrate that simulated horseback riding can be an effective alternative to actual riding for increasing trunk and thigh muscle activation and improving postural control and balance, perhaps especially among older adults.

Noninvasive Brain Stimulation over the M1 Enhances Bimanual Force Control Ability: A Randomized Double-Blind Sham-Controlled Study

Abstract Well-coordinated bimanual force control is common in daily life. We investigated the effects of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex on bimanual force control. Under a cross-over study, young adults (n = 19; female = 6, male = 13) completed three bimanual force control tasks at 5%, 25%, and 50% of bimanual maximum voluntary force (BMVF) before and after real or sham tDCS. Real tDCS enhanced accuracy at all BMVF, reduced variability at 5% BMVF, and increased coordination at 5% BMVF. Real tDCS improved force control at 5% and 25% BMVF, and especially increased bimanual coordination at 5% BMVF. These findings might have implications for establishing interventions for patients with hand force control deficits.

Patient-centered evaluation of home-based rehabilitation developed using community-based participatory research approach for people with disabilities: a case series.

Abstract Purpose: The purpose of this study was to evaluate the effectiveness of the locally tailored and individualized home-based rehabilitation (HBR) program developed using the community-based participatory research (CBPR) approach, in terms of perceived health in patients with different levels of social engagement, and to explore the perceived facilitators and barriers to rehabilitation. Method: A concurrent mixed-method design was employed. Four patients participated in the combined therapist- and self-delivered HBR program for 5 months. The perceived health outcomes were quantitatively assessed at baseline, after the therapist-delivered intervention period, and at 1 and 3 months after the self-delivered intervention period. Then, in-depth individual interviews were conducted to explore the facilitators and barriers to rehabilitation. Results: The perceived health of patients who were fully or partially engaged in society was increased during the therapist-delivered intervention period, and maintained the increased level during the self-delivered intervention period, whereas that of patients who were rarely or not engaged dropped again to lower than the baseline. These results were caused by differentiated facilitators and barriers to rehabilitation depending on the level of social engagement. Conclusions: Applying tailored strategies to patients with differing levels of social engagement is recommended to further optimize the local relevance of the HBR program. Implications for rehabilitation A community-based participatory research approach can provide an opportunity to enhance local relevance through community-academic partnerships, in developing a home-based rehabilitation (HBR) program for the people with disabilities. For community therapists, enhancing the local relevance of the HBR program, applying tailored strategies to patients with differing levels of social engagement is recommended because the perceived health of the HBR program can be different owing to differing perceived facilitators and barriers to rehabilitation, depending on the level of social engagement. For patients with rare or no engagement in society, satisfying their need for interaction with the therapists and helping them cope with their wrong belief about the possibility of their recovery is important to encourage behavioral change and perceived physical improvements.

NONINVASIVE BRAIN STIMULATION OVER DORSOLATERAL PREFRONTAL CORTEX FOR PAIN PERCEPTION AND EXECUTIVE FUNCTION IN AGING

OBJECTIVES Based on the evidence that the dorsolateral prefrontal cortex (DLPFC) is the main region affected by the aging process, and that tDCS modulates cortical excitability, the aim of the study is to prove the feasibility of tDCS for pain perception and executive function of community-dwelling elderly individuals. METHODS We performed a double-blind, single-arm trial, including a sham period. 5 consecutive anodal tDCS was applied over DLPFC of twenty-four elderly for 20 min during each intervention periods (in order of Sham-1 mA-2 mA). First, we classified chronic non-inflammatory pain sites into three domain (Neck and upper extremity, low back, lower extremity). Then, we used visual analogue scale, pain self-efficacy scale, Tampa scale for kinesiophobia, and Global perceived Effect scale to observe the change in pain perception, as well as Trailing Making Test and Timed Up and Go (dual) to observe the change in executive function. The changes in maximal grip strength and 12-item Short Form survey were measured secondarily. RESULTS In the results, we observed significant improvement in pain perception and quality of life, while executive function and grip strength did not change significantly. CONCLUSION Our findings demonstrated the feasibility of tDCS for aging-related pain perception and suggest that further randomized controlled trials with longer duration are necessary to examine the effects on executive function.

The Effectiveness of Hollowing and Bracing Strategies With Lumbar Stabilization Exercise in Older Adult Women With Nonspecific Low Back Pain: A Quasi-Experimental Study on a Community-based Rehabilitation

Objective: The purpose of this study was to explore the therapeutic effectiveness of hollowing lumbar stabilization exercise (HLSE) and bracing lumbar stabilization exercise (BLSE) for older adult women with nonspecific low back pain (NSLBP) in community welfare centers. Method: A total of 38 older adult women with NSLBP were allocated to either the HLSE group (n = 17, 70.4 ± 1.7 years) or the BLSE group (n = 21, 66.8 ± 4.4 years). Both groups performed intervention for 12 consecutive weeks, 3 times per week. Each group performed 5 lumbar stabilization exercises, including side plank exercise, bridge exercise, 4‐kneeling exercise, prone plank exercise, and prone back extension exercise with hollowing and bracing strategy, respectively. The baseline and post‐test values of trunk strength, low back disability (Korean Oswestry Disability Index [K‐ODI] and Korean Roland Morris Disability Questionnaire [K‐RMDQ]), and static balance (1‐leg standing test) were compared by using per‐protocol analysis. Results: In trunk strength, the trunk flexor had significant difference (F = 11.10, P = .001) between groups and within groups of BLSE (t = –5.56, P = .001) and HLSE (t = –2.50, P = .024). Trunk back extensor of HLSE (t = –6.00, P = .001) and BLSE (t = –9.19, P = .001) only had significant within‐group difference. However, in trunk side flexor, HLSE and BLSE had only significant difference between groups. In low back disability, K‐ODI for HLSE (t = 4.50, P = .001) and BLSE (t = 4.60, P = .001) had significant within‐group difference but no significant difference between groups (F = 0.28, P = .202). In K‐RMDQ, HLSE only had significant within‐group difference (t = 3.97, P = .001). In trunk muscle strength, the effect size of HLSE and BLSE groups for trunk flexor was HLSE –0.53 (medium) and BLSE –1.21 (large); trunk side flexor: HLSE 0.27 (small) and BLSE –0.24 (small); and trunk back extensor: HLSE 1.1 (large) and BLSE 2.00 (large), respectively. In low back disability, the effect size of both groups for K‐ODI was HLSE 0.88 (large) and BLSE 1.05 (large), and K‐RMDQ, HLSE 0.19 (small) and BLSE 0.40 (small), respectively. Conclusion: Our findings suggest that HLSE and BLSE could be recommended for community settings to improve trunk strength and low back disability in older adult women with NSLBP. Especially, HLSE and BLSE could be recommended for elderly women with NSLBP who have lower back disability and weak trunk muscle strength, respectively.