Yijung Chung

Effects of treadmill training with optic flow on balance and gait in individuals following stroke: randomized controlled trials:

Objective: This study examined the effects of treadmill training with optic flow on the functional recovery of balance and gait in stroke patients. Design: Randomized controlled experimental study. Participants: Thirty patients following stroke were divided randomly into the treadmill with optic flow group (n = 10), treadmill group (n = 10) and control group (n = 10). Interventions: The subjects in the experimental group wore a head-mounted display to receive speed-modulated optic flow during treadmill training for 30 minutes, while those in the treadmill group and control group received treadmill training and regular therapy for the same time, three times a week for four weeks. Main measures: The data were collected using timed up-and-go test, functional reach test, 10-m walk test, and six-minute walk test before and after treatment. Results: The timed up-and-go test in the treadmill with optic flow group (5.55 ± 2.04) improved significantly greater than the treadmill (1.50 ± 0.93) and control (0.40 ± 0.84) groups. The functional reach test in the treadmill with optic flow group (2.78 ± 1.44) was significantly higher than the control group (0.20 ± 0.16) only. The gait velocity in the treadmill with optic flow group (0.21 ± 0.06) showed a significant decrease compared to the treadmill (0.03 ± 0.02) and control (0.01 ± 0.02) groups. Finally, the six-minute walk test in the treadmill with optic flow group (24.49 ± 11.00) showed significant improvement compared to the treadmill training (4.65 ± 3.25) and control (1.79 ± 3.08) groups. Conclusion: Treadmill using optic flow speed modulation improves the balance and gait significantly in patients with stroke who are able to participate in physical gait training.

Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy

Independent walking is an important goal of clinical and community-based rehabilitation for children with cerebral palsy (CP). Virtual reality-based rehabilitation therapy is effective in motivating children with CP. This study investigated the effects of treadmill training with virtual reality on gait, balance, muscular strength, and gross motor function in children with CP. Eighteen children with spastic CP were randomly divided into the virtual reality treadmill training (VRTT) group (9 subjects, mean age, 10.2 years) and treadmill training (TT) group (9 subjects, mean age, 9.4 years). The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks. Muscle strength was assessed using a digitalized manual muscle tester. Gross motor function was assessed using the Gross Motor Functional Measure (GMFM). Balance was assessed using the Pediatric Balance Scale (PBS). Gait speed was assessed using the 10-meter walk test (10MWT), and gait endurance was assessed using the 2-minute walk test (2MWT). After training, gait and balance was improved in the VRTT compared to the TT group (P < 0.05). Muscular strength was significantly greater in the VRTT group than the TT group, except for right hamstring strength. The improvements in GMFM (standing) and PBS scores were greater in the VRTT group than the TT group (P < 0.05). Furthermore, the VRTT group showed the higher values of 10MWT and 2MWT compared to the TT group (P < 0.05). In conclusion, VRTT programs are effective for improving gait, balance, muscular strength, and gross motor function in children with CP.

Functional electrical stimulation applied to gluteus medius and tibialis anterior corresponding gait cycle for stroke

The purpose of this study was to determine the influence of functional electrical stimulation (FES) applied to the tibialis anterior and gluteus medius muscles on the improvement of the spatiotemporal parameters of gait in individuals with a hemiparetic stroke. Thirty-six patients who had suffered a hemiparesis post stroke were enrolled in this study. The participants walked at a self-selected velocity on three different FES applications: (1) FES-triggered gait on the gluteus medius in the stance phase and the tibialis anterior in the swing phase (GM+TA), (2) FES-triggered gait on the tibialis anterior in the swing phase (TA only), and (3) gait without FES-triggered (Non-FES). FES was triggered when the heel in the affected lower limb was placed in contact with an on or off foot switch sensor. The effect of FES applications was assessed using GAITRite for spatiotemporal data. The gait speed, cadence, and stride length were significantly higher under the GM+TA condition than under the TA only and None-FES conditions. The gait speed, cadence and stride length were increased significantly in the TA only condition compared with the Non-FES condition. The double support time and gait symmetry were significantly improved in the GM+TA condition compared to the TA only and Non-FES conditions. These findings suggest that walking with FES of the gluteus medius in the stance phase and tibialis anterior in the swing phase can improve the spatiotemporal parameters of gait in individuals with hemiparetic stroke.

Therapeutic effect of functional electrical stimulation-triggered gait training corresponding gait cycle for stroke

The purpose of this study was to determine the therapeutic effects of functional electrical stimulation (FES) applied to the gluteus medius and tibialis anterior muscles during the gait cycle in individuals with hemiparetic stroke. Eighteen patients who had suffered a stroke were enrolled in this study. The participants were divided into either the gluteus medius and tibialis anterior (GM + TA) training group (n = 9) or the control group (n = 9). The GM + TA group received FES-triggered gait training to the gluteus medius (GM) in the stance phase and the tibialis anterior (TA) in the swing phase for 30 min, 5 session a week over a 6-week period, and control group who received only gait training without FES-triggered for the same duration of time. A foot-switch sensor was used to trigger the device in the stance (GM) and swing (TA) phases of the gait cycle reciprocally. This study measured three types of outcome measures, including spatiotemporal gait parameters, muscles activities, and balance function. After 6 weeks training, there was a significant improvement in gait velocity, cadence, stride length, and gait symmetry in the GM + TA training group compared to the control group. Dynamic balance function was significantly improved in the GM + TA training group compared to the control group. The mean changeable values of the GM was significantly greater strength in the GM + TA training group than the control group. These findings suggest that FES-triggered gait training of the GM in the stance phase and TA in the swing phase may improve the spatiotemporal parameters of gait in persons with hemiparetic stroke.

Treadmill gait training combined with functional electrical stimulation on hip abductor and ankle dorsiflexor muscles for chronic hemiparesis

The purpose of this study was to investigate the effects of treadmill training (TT) with functional electrical stimulation (FES) applied to the gluteus medius (GM) and tibialis anterior (TA) muscles on gait and balance performance in individuals with chronic hemiparetic stroke. Thirty-six participants with chronic hemiparesis were recruited to this study and randomly distributed into three groups: TT with FES applied to the GM and TA muscles (TTFES-GM+TA group, 12 patients); TT with FES applied to the TA muscle (TTFES-TA group, 12 patients); and TT only (control group, 12 patients). All participants underwent 20 sessions of TT with a harness (30min five times per week for 4 weeks). They also received regular physical therapy for 1h five times per week for 4 weeks. All participants were assessed before and after training using digital muscle testing, the Medical Research Council (MRC) scale, the 6-min walk test (6MWT), and spatiotemporal parameters. After training, the TTFES-GM+TA group showed significant improvement in hip abductor strength, Berg Balance Scale score, 6MWT result, MRC scale score grade, gait velocity, and cadence compared to the TTFES-TA group and control group. These findings show that TT with FES applied to the GM and TA muscles increased lower limb muscle strength and improved balance and gait capacities. Therefore, TT with FES applied to the GM and TA could be a beneficial intervention in clinical settings for individuals with chronic hemiparetic stroke.

Effects of gait training with a cane and an augmented pressure sensor for enhancement of weight bearing over the affected lower limb in patients with stroke: a randomized controlled pilot study

Objective: The purpose of this study was to examine the effect of gait training when using a cane with an augmented pressure sensor for enhancement of weight-bearing over the affected lower limb on the peak pressure force of the cane, muscle activation, and gait in patients with stroke. Design: Randomized controlled pilot study. Setting: Inpatient rehabilitation center. Participants: A total of 22 hemiparetic stroke patients were recruited and randomly divided into an experimental group (n = 11) and control group, which later had a drop-out (n = 10). Interventions: Subjects in the experimental group participated in gait training with auditory feedback for 30 minutes, five times a week for four weeks, whereas those in the control group received gait training without auditory feedback for the same amount of time. Main measures: The peak force of cane, muscle activation of gluteus medius, and vastus medialis oblique, single limb support phase of the affected leg, and gait speed before and after training were collected. Results: Significant improvement in the peak force of cane, muscle activation of gluteus medius and vastus medialis oblique, single limb support phase of the affected leg, and gait speed were observed in the experimental group (13.5 ±9.5 cm/s) compared with the control group (3.7 ±8.4 cm/s) (p < 0.05). Conclusion: Gait training using a cane with an augmented pressure sensor to enhance weight bearing over the affected lower limb is beneficial and effective in improving the peak force of cane, muscle activation, and gait in stroke patients.

Intensive gait training with rhythmic auditory stimulation in individuals with chronic hemiparetic stroke: A pilot randomized controlled study

BACKGROUND Motor relearning protocols should involve task-oriented movement, focused attention, and repetition of desired movements. OBJECTIVES To investigate the effect of intensive gait training with rhythmic auditory stimulation on postural control and gait performance in individuals with chronic hemiparetic stroke. METHODS Twenty patients with chronic hemiparetic stroke participated in this study. Subjects in the Rhythmic auditory stimulation training group (10 subjects) underwent intensive gait training with rhythmic auditory stimulation for a period of 6 weeks (30 min/day, five days/week), while those in the control group (10 subjects) underwent intensive gait training for the same duration. Two clinical measures, Berg balance scale and stroke specific quality of life scale, and a 2-demensional gait analysis system, were used as outcome measure. To provide rhythmic auditory stimulation during gait training, the MIDI Cuebase musical instrument digital interface program and a KM Player version 3.3 was utilized for this study. RESULTS Intensive gait training with rhythmic auditory stimulation resulted in significant improvement in scores on the Berg balance scale, gait velocity, cadence, stride length and double support period in affected side, and stroke specific quality of life scale compared with the control group after training. CONCLUSIONS Findings of this study suggest that intensive gait training with rhythmic auditory stimulation improves balance and gait performance as well as quality of life, in individuals with chronic hemiparetic stroke.

Immediate Effects of Rhythmic Auditory Stimulation with Tempo Changes on Gait in Stroke Patients

[Purpose] The aim of this study was to investigate the effects of tempo changes in rhythmic auditory stimulation (RAS) on gait in stroke patients. [Subjects] Forty-one chronic stroke patients who had had a stroke with more than 6 months previously were recruited for this study. [Methods] All participants were asked to walk under 5 different conditions in random order: (1) no RAS (baseline); (2) baseline-matched RAS (0%); and (3) −10%, (4) +10%, and (5) +20% of the baseline. A GAITRite system was used to evaluate the spatial and temporal parameters of gait. [Results] Compared with under the RAS 0% conditions, the gait velocity, cadence, and stride length on the affected side were significantly decreased under the RAS −10% conditions. Gait velocity and cadence were significantly improved, but gait symmetry was significantly decreased under the RAS +10% and +20% conditions compared with under the RAS 0% conditions. [Conclusion] A faster RAS tempo significantly improved gait velocity and cadence, and applying RAS significantly improved the gait symmetry of stroke patients.

The Influence of an Unstable Surface on Trunk and Lower Extremity Muscle Activities during Variable Bridging Exercises

[Purpose] The aim of this study was to investigate the influence of an unstable surface on trunk and lower extremity muscle activities during various types of bridging exercises. [Subjects] Thirty healthy female adults voluntarily participated in this study. [Methods] All subjects were asked to perform 3 different bridging exercises (bridging exercise, single leg lift bridging exercise, single leg cross bridging exercise) with and without an unstable surface. The trunk and lower extremity muscle activities were measured by using surface electromyography during bridging exercise. [Results] During the bridging exercise (BE), single leg lift bridging exercise (LBE), and single leg cross bridging exercise (CBE), the muscle activities of the external oblique muscle (EO), erector spinae (ES), and biceps femoris (BF) were significantly higher on an unstable surface than on a stable surface. The muscle activities of the EO on both sides, contralateral BF, and ipsilateral ES were significantly higher during LBE than during BE and CBE. [Conclusion] Use of an unstable surface increases muscle activity of the trunk and lower extremities, and single leg lift bridging exercise increases the muscle activity of the EO on both sides, ipsilateral ES, and contralateral BF.

Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture.

[Purpose] The purpose of this study was to investigate the effects of scapular stabilization exercise on neck posture, muscle activity, pain, and quality of life in individuals with neck pain and forward head posture. [Subjects and Methods] Fifteen participants were recruited according to the selection criteria and were randomly allocated to the scapular stabilization group (n=8) and the control group (n=7). The scapular stabilization group underwent training for 30 minutes a day, 3 times a week for 4 weeks; the control group performed relaxation exercises for 4 weeks. [Results] After training the scapular stabilization group showed significant improvement on the craniovertebral angle, upper trapezius muscle activity, serratus anterior muscle activity, Neck Disability Index scores, Visual Analog Scale scores, and World Health Organization Quality of Life Assessment-BREF scores compared to those in the control group. [Conclusion] Scapular stabilization exercise can help improve the head posture and pain in the patients with neck pain and forward head posture. Controlling the muscular activities through scapular stabilization exercise also improves the patients’ quality of life.