Suhn-Yeop Kim

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.

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.

Correlation between the Severity of Female Urinary Incontinence and Concomitant Morbidities: A Multi-Center Cross-Sectional Clinical Study

Purpose The aim of this study was to identify the relationship between urinary incontinence (UI) and low back pain (LBP) discomfort and disability, static balance, and demographic factors. Methods A total of 348 women aged 20-80 years were included in this cross-sectional study. The general characteristics of the subjects and the main outcome (UI condition, LBP discomfort, LBP disability, and static balance ability) were assessed by using clinical questionnaires and assessment tools. Results Of all the subjects, 22.8% had experienced UI. Women with UI showed a significantly higher relationship of LBP and disability, and static balance ability (P<0.01). We found a significant correlation between UI, age, LBP and disability, and static balance ability (P<0.01). Conclusions These findings suggest that UI correlates negatively with LBP discomfort, LBP disability, and static balance ability. Further studies should focus on the identification of the precise mechanisms underlying UI and its related physical symptoms and on the development of therapeutic strategies to manage this condition.

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.

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.

Effects of augmented trunk stabilization with external compression support on shoulder and scapular muscle activity and maximum strength during isometric shoulder abduction

The aim of the present study was to investigate the effects of augmented trunk stabilization with external compression support (ECS) on the electromyography (EMG) activity of shoulder and scapular muscles and shoulder abductor strength during isometric shoulder abduction. Twenty-six women volunteered for the study. Surface EMG was used to monitor the activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and middle deltoid (MD), and shoulder abductor strength was measured using a dynamometer during three experimental conditions: (1) no external support (condition-1), (2) pelvic support (condition-2), and (3) pelvic and thoracic supports (condition-3) in an active therapeutic movement device. EMG activities were significantly lower for UT and higher for MD during condition 3 than during condition 1 (p < 0.05). The MD/UT ratio was significantly higher during condition 3 than during conditions 1 and 2, and higher during condition 2 than during condition 1 (p < 0.05). Shoulder abductor strength was significantly higher during condition 3 than during condition 1 (p < 0.05). These findings suggest that augmented trunk stabilization with the ECS may be advantageous with regard to reducing the compensatory muscle effort of the UT during isometric shoulder abduction and increasing shoulder abductor strength.

Effects of hip exercises for chronic low-back pain patients with lumbar instability.

[Purpose] The purpose of this study was to compare hip range of motion between a lumbar stability group and a lumbar instability group, and to evaluate the effectiveness of hip exercises for low-back pain patients with lumbar instability. [Subjects] Seventy-eight patients with chronic low-back pain were the subjects. [Methods] The patients were divided into two groups: a lumbar stability group (n=45) and a lumbar instability group (n=33). They were assessed using the Korean version of the Oswestry Disability Index (KODI) to determine the level of disability of the patients with low-back pain. A 100 mm visual analog scale (VAS) was used to assess low-back pain. [Results] The limitation of hip range of motion of the lumbar instability group was significantly greater than that of the lumbar stability group. Comparisons among four groups at three weeks and six weeks after the start of hip exercises revealed that the VAS score of each group had significantly decreased. Comparisons among four groups at three weeks and at six weeks after the start of hip exercises revealed that the KODI score of each group had significantly decreased. [Conclusion] These findings suggest that the performance of hip exercises by chronic low-back pain patients with lumbar instability is more effective than conventional therapy at reducing low-back pain and levels of disability.

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.