Immediate effects of the activation of the affected lower limb on the balance and trunk mobility of hemiplegic stroke patients

[Purpose] The purpose of this study was to determine the effects of the activation of the affected lower limb on balance and the trunk hemiplegic mobility of stroke patients. [Subjects] The gait group (GG) consisted of 6 subjects with hemiplegia and the non-gait group (NGG) consisted of 6 hemiplegic subjects. [Methods] The subjects in both groups were given foot facilitation training once for 30 min. The Spinal Mouse was used to measure the spinal alignment and the Berg balance scale (BBS) and sensory tests were also performed. [Results] In the GG, the sacral hip in upright to flexion, the lumbar spine in upright to extension, and the sacral hip and lumbar spine in flexion to extension showed significant increases in their angles after the intervention. In addition, there was a significant increase in the angle of the lumbar spine during extension from an upright position in the NGG. The BBS scores of both groups also increased significantly. [Conclusion] The intervention resulted in improvements in the angle of anterior pelvic tilt in the GG, and subjects in the NGG showed more extension of the thorax, which was regarded as compensation to avoid falling forward when flexing from an upright position. However, when extending backward from an upright position, both groups tended to control balance by using more lumbar flexion to keep the center of mass (COM) within the base of support (BOS). Both groups had better BBS scores.Key words: Balance, Stroke, Trunk     

Immediate effects of dynamic sitting exercise on the lower back mobility of sedentary young adults

[Purpose] The aim of this study was to investigate the effects of dynamic sitting exercises during prolonged sitting on the lower back mobility of sedentary young adults. [Subjects and Methods] Seventy-one subjects aged between 18–25 years participated in this study. Following a randomized crossover study design, subjects were randomly assigned to two groups: sitting only and dynamic sitting exercise. The dynamic sitting exercise was a combination of lower back hyperextension and abdominal drawing-in movements which were repeated 6 times in a 1-minute period and performed every 20 minutes during a 2-hour sitting session. Lumbar range of movement was measured with the modified-modified Schober test, and the pain intensity was evaluated using the visual analog scale. [Results] After the experiment, the lumbar range of movement was significantly impaired in the sitting only group; however, it was significantly improved in the dynamic sitting exercise group. There were significant differences in lumbar range of movement of both flexion and extension between the groups. No significant difference in pain intensity between the groups was found. [Conclusion] These results suggest that dynamic sitting exercises during prolonged sitting can prevent decreases in lumbar range of movement in both back flexion and extension following a 2-hour sitting period.Key words: Back exercise, Flexibility, Long sitting     

Comparison of the Lumbar Flexion Angle and EMG Activity in Trunk Muscles in Individuals with and without Limited Hip Flexion Range of Motion during Visual Display Terminal Work with Cross-Legged Sitting

[Purpose] The purpose of this study was to compare the lumbar flexion angle and electromyography (EMG) measurements of trunk muscle activity in individuals with and without limited hip flexion range of motion (ROM) during visual display terminal (VDT) work with cross-legged sitting. [Subjects] The 15 participants included a control group with sufficient hip flexion ROM (n = 7) and an experimental group with limited hip flexion ROM (n = 8). [Methods] All subjects performed VDT work with cross-legged sitting. The lumbar flexion angle was measured using a three-dimensional motion capture system, and the trunk muscle activity was recorded using a surface EMG system during VDT work with cross-legged sitting. The differences in trunk flexion angle and trunk muscle activity between the two groups were analyzed using independent t-tests. [Results] The lumbar flexion angle was significantly greater in the experimental group than the control group, although trunk muscle activity did not differ between the two groups. [Conclusion] These findings suggest that limited hip flexion leads to greater lumbar flexion during cross-legged sitting.Key words: Cross-legged sitting, Electromyography, Lumbar flexion     

Lumbar spine side bending is reduced in end range extension compared to neutral and end range flexion postures

Lumbar side bending movements coupled with extension or flexion is a known low back pain (LBP) risk factor in certain groups, for example, athletes participating in sports such as hockey, tennis, gymnastics, rowing and cricket. Previous research has shown that sagittal spinal postures influence the degree of spinal rotation, with less rotation demonstrated at end of range extension and flexion. To date it is unknown whether sagittal spinal postures influence side bending. The aim of this study was to determine whether side bend range of motion (ROM) of the lumbar spine is decreased in end-range flexion and extension postures compared to a neutral spine. Twenty subjects between 18 and 55 years of age [mean age = 22.8 yrs (6.8)] with no history of LBP were recruited for this study. Upper (L1–L3) and lower (L3–L5) lumbar side bend, were measured utilising a 14 camera system (Vicon, Oxford metrics, inc.) in end-range flexion, extension and neutral postures, in both sitting and standing positions. The results revealed no statistically significant difference in upper and lower lumbar side bend ROM in an end-range flexion posture compared to a neutral spinal posture. A reduction was found in the range of upper and lower lumbar side bend ROM in an end-range extended posture (p < 0.05), compared to neutral and end range flexion postures. This ROM reduction was found in sitting and standing. These findings allow clinicians to better interpret combined movements involving side bending of the lumbar spine in clinical and real life settings.     

Lumbar Extension during Stoop Lifting is Delayed by the Load and Hamstring Tightness

[Purpose] This study investigated the relationship between lumbar pelvic rhythm and the physical characteristics of stoop lifting. [Subjects and Methods] Participants performed a stoop lifting task under two conditions: with and without load. We assessed the lumbar kyphosis and sacral inclination angles using the SpinalMouse^® system, as well as hamstring flexibility. During stoop lifting, surface electromyograms and the lumbar and sacral motions were recorded using a multi-channel telemetry system and flexible electrogoniometers. [Results] In the initial phase of lifting, lumbar extension was delayed by load; the delay showed a negative correlation with sacral inclination angle at trunk flexion, whereas a positive correlation was observed with electromyogram activity of the lumbar multifidus. Additionally, a positive correlation was observed between sacral inclination angle and hip flexion range of motion during the straight leg raise test. [Conclusion] We found that a disorder of the lumbar pelvic rhythm can be caused by both load and hamstring tightness. In the initial phase of stoop lifting, delayed lumbar extension is likely to lead to an increase in spinal instability and stress on the posterior ligamentous system. This mechanism shows that stoop lifting of a load may be harmful to the lower back of people with hamstring tightness.Key words: Lifting, Lumbar pelvic rhythm, Hamstring flexibility     

Comparison of the Forward Head Angle and the Lumbar Flexion and Rotation Angles of Computer Workers Using Routine and Individually Fixed Computer Workstations

[Purpose] This study compared the forward head angle and the lumbar flexion and rotation angles of computer workers using routine and fixed computer workstations. [Subjects] Ten male workers voluntarily consented to participate in the study. [Methods] A 3-D motion analysis system was used to measure the angles of the forward head and lumbar flexion. All subjects performed computer work for 30 minutes using both types of workstation. [Results] When working at the fixed workstation, the forward head angle was less than that observed when the routine workstation was used. At the fixed workstation, the lumbar flexion and rotation angles were less than that at the routine workstation. [Conclusion] The computer workstation individually fixed for standard posture may have prevented poor sitting posture.Key words: Computer workstation, Forward head angle, Sitting posture     

Effects of activation of the foot on trunk mobility of patients with hemiplegia

[Purpose] The purpose of this study was to determine the effects of activation of the foot on the trunk mobility of patients with hemiplegia. [Subjects] Sixteen subjects with hemiplegia took part in the immediate group (IG), and 14 subjects with hemiplegia participated in the 2-month group (2MG). [Methods] The subjects in IG were given one leg stance training through activation of the foot only once, and 2MG received the same intervention for 30 minutes 3 times a week for, 8 weeks. The Spinal Mouse was used to collect spinal alignment data. Also, the trunk Impairment Scale (TIS) and Sensory test were used as functional tests. [Results] Sacral hip (SH), lumbar spine (LS) and thoracic spine (TS) angles in IG improved significantly, but not inclination (I), and 2MG showed increased angles of SH, LS and I, but not TS. Also, TIS Dynamic, TIS Coordination and Sensory test results of 2MG increased significantly. [Conclusion] One leg stance training through activation of the foot was effective at improving sensory input and alignment of the spine, therefore trunk mobility was improved.Key words: Alignment, Stroke, Trunk     

Rate and range of knee motion during ambulation in healthy and arthritic subjects

The purpose of this study was to determine the relationship between gait velocity and rate and range of knee motion, during ambulation, for healthy and arthritic subjects. The arthritic subjects had either rheumatoid arthritis or osteoarthritis, and all were tested before and after total knee replacement. Healthy subjects ambulated at an average velocity of 80 m/min and demonstrated knee flexion and extension rates of 344 degrees/sec and a range of knee motion of 60 degrees. Gait velocity correlated with rates of knee flexion and extension and range of knee motion. Arthritic subjects ambulated at velocities less than those of healthy subjects ambulating at free speed. Arthritic subjects accordingly demonstrated reduced knee flexion and extension rates and range of knee motion. When compared with healthy subjects ambulating over a comparable gait-velocity range, the arthritic subjects demonstrated reduced rates and range of motion in most instances. We discuss implications for therapeutic intervention to increase gait velocity for arthritic subjects.     

Gait patterns of transtibial amputee patients walking indoors barefoot

OBJECTIVE: To evaluate the gait patterns of lower limb amputee patients walking with and without shoes and to identify differences in barefoot gait patterns when using different prosthetic feet. DESIGN: Optoelectronic three-dimensional motion analysis of gait was performed on six transtibial amputees using a solid ankle cushion heel foot and a single-axis foot, both with and without shoes. RESULTS: Gait abnormalities were observed during barefoot walking when the solid ankle cushion heel foot was used. These included knee joint hyperextension of 9.9 +/- 2.0 degrees and the loss of ankle plantar flexion in the early stance phase. When the single-axis foot was used, knee flexion thrust declined from 9.9 +/- 3.7 degrees to 7.2 +/- 3.8 degrees and ankle plantar flexion decreased from 9.9 +/- 2.8 degrees to 7.0 +/- 2.1 degrees during the early stance phase. CONCLUSIONS: In transtibial amputees, significant gait abnormalities were observed during barefoot walking using the solid ankle cushion heel foot. These gait patterns improved, however, with use of a single-axis prosthetic foot, which permits a further plantar flexion after the initial contact.     

The effects of lumbar stabilization exercises on foot pressure of older individuals while walking

[Purpose] The purpose of this study was to examine the effect of lumbar stabilization on pressure distribution in old women. [Subjects] The subjects of this study were 14 women aged 65 or older who agreed to participate in this study. They had a sufficient range of motion and muscle strength to perform the postures in this study’s program and were without gait problems, congenital deformity, orthopedic disorder, or neurological disorder. [Methods] The participants performed a group exercise program that promotes lumbar stabilization for 50 minutes per session by following the instructions of a physical therapist. Gait Analyzer was used to measure the foot pressure of individual participants from three measurements for each lumbar stabilization exercise, and the mean values were used. The mean values were then compared between before and after the exercises by paired t-test. [Results] Pressure in F3 and F6 statistically significantly decreased from 2.06±1.23% N/cm² to 1.55±1.02% N/cm² and from 7.40±1.52% N/cm² to 5.95±1.76% N/cm², respectively, after the intervention, but no significant differences were found in the other foot areas. [Conclusion] The lumbar stabilization exercises affected the pressure evenly over the entire foot and, in particular, in the inner area of the forefoot.Key words: Lumbar stabilization exercise, Foot pressure, Gait Analyzer     

Changes of kinematic parameters of lower extremities with gait speed: a 3D motion analysis study

[Purpose] The purpose of this study was to investigate the changes in hip, knee and ankle kinematic variables of the lower extremities at different gait speeds. [Subjects and Methods] Forty healthy subjects who had no previous history of neurological, musculo-skeletal or other medical conditions that could affect gait were recruited. The subjects were asked to walk 10 m down a walkway at three different gait speeds: normal gait speed, and self-selected fast, and slow speeds. The experimental order was randomly chosen across these gaits. The hip, knee and ankle kinematic data were evaluated using a VICON 3D motion analysis system and force plates. [Results] The flexion peak and external rotation peak of the knee joint significantly increased with the increase of gait speed. The plantarflexion peaks of the ankle joint significantly increased with increase of gait speed. However, none of the kinematic data of the hip joint were significantly dependent on increase of gait speed. [Conclusion] The relationship of the knee and ankle joint can be described as coupling motion which is dependent on gait speed. Our present findings suggest that coupling motion of the knee joint and plantarflexion of the ankle joint significantly increase with increase of gait speed. These results will provide important insight into gait mechanisms for the evaluation of pathological populations.Key words: Gait speed, 3D motion analysis, Lower extremity     

The kinematics of the lower leg in the sagittal plane during downward squatting in persons with pronated feet

[Purpose] This study aimed to examine changes in lower extremity kinematics in the sagittal plane during downward squatting by subjects with pronated feet. [Subjects and Methods] This study selected 10 subjects each with normal and pronated feet using a navicular drop test. The subjects performed downward squatting, in which the knee joints flex 90° in a standing position. We recorded the angles of the hip, knee, and ankle joint in the sagittal plane through motion analysis. For the analysis, the squatting phase was divided into phase 1 (initial squat), phase 2 (middle squat), and phase 3 (terminal squat) according to the timing of downward squatting. [Results] In the pronated foot group comparison with the normal group, the hip joint flexion angle decreased significantly in phases 2 and 3. The dorsiflexion angle of the ankle joint increased significantly in phase 3. The flexion angle of the knee joint did not differ between groups in any of the phases. [Conclusion] The pronated foot group utilized a different squat movement strategy from that of the normal foot group in the sagittal plane.Key words: Pronated foot, Kinematics, Squat     

Characteristics of thoracic and lumbar movements during gait in lumbar spinal stenosis patients before and after decompression surgery

BackgroundAlthough gait analysis has been previously conducted for lumbar spinal stenosis patients, the vertebral segmental movements, such as of the thoracic and lumbar regions, and whether the spinal movement during gait changes after decompression surgery remain unclear.MethodsTen patients with lumbar spinal stenosis and 10 healthy controls participated. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Visual Analogue Scale. Spinal kinematic data of the participants during gait were acquired using a three-dimensional motion analysis system. The trunk (whole spine), thoracic, and lumbar flexion and pelvic tilting values were calculated. Spinal kinematic data and clinical outcomes were collected preoperatively and 1 month postoperatively for the patients.FindingsCompared to that observed preoperatively, the clinical outcomes significantly improved at 1 month postoperatively. In the standing position, the preoperative lumbar extension of the patients was significantly smaller than that of the controls. Moreover, during gait, the lumbar flexion relative to the standing position of the patients was smaller than that of the controls preoperatively, and increased at 1 month postoperatively. The sum of the thoracic and lumbar flexion values during gait negatively correlated with the score for leg pain.InterpretationThe epidural pressure of lumbar spinal stenosis patients is known to be higher than that of normal subjects during gait, and to decrease during walking with lumbar flexion. Preoperatively, smaller thoracic and lumbar flexion movements during gait relative to the standing position cannot decrease epidural pressure; as a result, severe leg pain might be induced.     

The effect of ankle–foot orthosis plantarflexion stiffness on ankle and knee joint kinematics and kinetics during first and second rockers of gait in individuals with stroke

BackgroundStiffness of an ankle–foot orthosis plays an important role in improving gait in patients with a history of stroke. To address this, the aim of this case series study was to determine the effect of increasing plantarflexion stiffness of an ankle–foot orthosis on the sagittal ankle and knee joint angle and moment during the first and second rockers of gait.MethodsGait data were collected in 5 subjects with stroke at a self-selected walking speed under two plantarflexion stiffness conditions (0.4 Nm/° and 1.3 Nm/°) using a stiffness-adjustable experimental ankle–foot orthosis on a Bertec split-belt fully instrumented treadmill in a 3-dimensional motion analysis laboratory.FindingsBy increasing the plantarflexion stiffness of the ankle–foot orthosis, peak plantarflexion angle of the ankle was reduced and peak dorsiflexion moment was generally increased in the first rocker as hypothesized. Two subjects demonstrated increases in both peak knee flexion angle and peak knee extension moment in the second rocker as hypothesized. The two subjects exhibited minimum contractility during active plantarflexion, while the other three subjects could actively plantarflex their ankle joint.InterpretationIt was suggested that those with the decreased ability to actively plantarflex their ankle could not overcome excessive plantarflexion stiffness at initial contact of gait, and as a result exhibited compensation strategies at the knee joint. Providing excessively stiff ankle–foot orthoses might put added stress on the extensor muscles of the knee joint, potentially creating fatigue and future pathologies in some patients with stroke.     

脑卒中患者步行能力与下肢三维运动学及动力学相关性分析

目的:通过对脑卒中偏瘫患者下肢三维运动学和动力学的分析,寻找偏瘫患者步态特点,比较分析步行能力与运动学和动力学之间的关系,从运动力学角度探讨偏瘫患者异常步行的原因,寻找康复治疗中需解决的关键问题。方法:选择首次脑卒中后可以独立步行10m以上的右侧偏瘫患者20例为实验组,正常健康中老年人16例为对照组。采用Vicon和AMTOR6-7进行三维步态运动学和动力学检测和分析。结果:实验组与正常对照组比较,脑卒中患者与健康中老年人在步频、跨步时间、双腿支撑时间、步时、离地比率、步长、跨步长和步速同侧比较差异有显著性意义(P<0.05),患侧离地占步态周期百分比和健侧单腿支撑时间实验组与对照组比较差异有显著性意义(P<0.05)。矢状面上同侧髋关节伸展角度、膝关节屈曲角度和踝关节背伸及跖屈角度比较差异都有显著性意义(P<0.05)。同侧髋关节屈伸力矩、同侧膝关节伸直力矩和患侧踝关节背伸力矩实验组和对照组相比差异有显著性意义(P<0.05),步行能力(步速)与患侧髋关节伸展、健侧膝关节屈曲、双侧膝关节伸展、双侧踝关节背伸和跖屈角度相关,均有显著性意义(P<0.05);同时也和双侧髋关节屈伸、膝关节伸展和踝关节背伸力矩相关(P<0.01)。结论:①步长是脑卒中偏瘫患者步态异常的重要参考指数;②髋关节和膝关节伸展,踝关节背伸和跖屈是步态异常的重要表现;③下肢髋关节和膝关节屈伸肌群和踝关节背伸肌群的力量是影响步行能力的重要因素。     

Effects of Progressive Resistance Training Integrated with Foot and Ankle Compression on Spatiotemporal Gait Parameters of Individuals with Stroke

[Purpose] The purpose of this study was to investigate the effect of progressive resistance training (PRT) integrated with foot and ankle compression on the gait ability of post-stroke patients. [Subjects and Methods] Participants were randomly allocated to two groups: the PRT group (n=14) and the control group (n=14). Subjects in the PRT group received training for 30 minutes, five days per week, for a period of six weeks. Gait ability was evaluated using the RsScan system. [Results] Use of PRT integrated with foot and ankle compression resulted in significant improvements in temporal parameters (gait velocity, step time, and double limb support) and spatial parameters (step length, stride length, and heel-to- heel base of support). [Conclusion] Progressive resistance training integrated with foot and ankle compression improved the gait ability of stroke patients. These results suggest the feasibility and suitability of integration of PRT with foot and ankle compression for individuals with stroke.Key words: Progressive resistance training, Stroke, Gait     

Effect of joint mobilization using KEOMT and PNF on a patient with CLBP and a lumbar transitional vertebra: a case study

[Purpose] The purpose of this case study was to identify the effects of joint mobilization using Kaltenborn-Evjenth orthopedic manual therapy (KEOMT) and proprioceptive neuromuscular facilitation (PNF) techniques on a patient with chronic low back pain (CLBP) and a lumbar transitional vertebra. [Methods] The intervention methods were joint mobilization using KEOMT and PNF techniques. The program consisted of 40-min sessions 3 days a week for 4 weeks. The spinal motion (thoracic and lumbar vertebrae), pain, and thickness of the multifidus were measured. [Results] The angle of spinal curvature increased, and the range of motions (ROMs) flexion and extension increased in the thoracic and lumbar vertebrae. The pain score as measured on a visual analogue scale (VAS) and the Oswestry disability index (ODI) score decreased. The thickness of the multifidus (L4) increased on the left and right sides. [Conclusion] These results suggest that joint mobilization using KEOMT and PNF techniques had a positive effect on the spinal motion, pain, and thickness of the multifidus of a patient with chronic low back pain and a lumbar transitional vertebra.Key words: Lumbar transitional vertebra, Joint mobilization, Proprioceptive neuromuscular facilitation     

Comparison of lumbar repositioning error according to different lumbar angles in a flexion pattern (FP) subgroup of patients with non-specific chronic low back pain

[Purpose] This study determined the change in lumbar position sense according to lumbar angles in a flexion pattern (FP) subgroup of patients with non-specific chronic low back pain (NCSLBP). [Subjects] Thirteen subjects with FP low back pain participated. [Methods] The lumbar repositioning error (RE) of subjects was measured between a neutral starting position and re-position phases at three angles, in sitting and standing upright positions. [Results] Lumbar RE was significantly greater during lumbar flexion at a 30° angle in the sitting position than in the other tasks. [Conclusion] In the flexion-related subgroup, the lumbar RE measurement may be a more sensitive evaluation method using a lumbar flexion angle of 30° while in the sitting position, compared with other angles in sitting or standing positions.Key words: Flexion pattern, Low back pain, Repositioning error     

A Sloped Seat Wedge Can Change the Kinematics of the Lumbar Spine of Seated Workers with Limited Hip Flexion

[Purpose] The purpose of this study was to determine whether a wedge type seat decreases the lumbar flexion angle of seated workers with limited hip flexion. [Subjects] Twelve sedentary workers with limited hip flexion were recruited. [Methods] Three seat surfaces were used: a level surface, a forward-inclining wedge, and a backward-reclining wedge. The angles of lumbar flexion and pelvic tilt were measured using a three-dimensional motion analysis system. Differences in kinematic data of the subjects seated on the three seat surfaces were analyzed using repeated one-way analysis of variance. [Results] The degree of lumbar flexion decreased significantly when using the forward-inclining wedge compared with the level surface and backward-reclining wedge. [Conclusion] These findings suggest that sitting on a forward-inclining wedge may be useful for minimizing the compensatory lumbar flexion of individuals with limited hip flexion who work in a seated position.Key words: Kinematics, Limited hip flexion, Seat wedge     

Effects of Robot-assisted Gait Training Combined with Functional Electrical Stimulation on Recovery of Locomotor Mobility in Chronic Stroke Patients: A Randomized Controlled Trial

[Purpose] The purpose of the present study was to investigate the effects of robot-assisted gait training combined with functional electrical stimulation on locomotor recovery in patients with chronic stroke. [Subjects] The 20 subjects were randomly assigned into either an experimental group (n = 10) that received a combination of robot-assisted gait training and functional electrical stimulation on the ankle dorsiflexor of the affected side or a control group (n = 10) that received robot-assisted gait training only. [Methods] Both groups received the respective therapies for 30 min/day, 3 days/week for 5 weeks. The outcome was measured using the Modified Motor Assessment Scale (MMAS), Timed Up-and-Go Test (TUG), Berg Balance Scale (BBS), and gait parameters through gait analysis (Vicon 370 motion analysis system, Oxford Metrics Ltd., Oxford, UK). All the variables were measured before and after training. [Results] Step length and maximal knee extension were significantly greater than those before training in the experimental group only. Maximal Knee flexion showed a significant difference between the experimental and control groups. The MMAS, BBS, and TUG scores improved significantly after training compared with before training in both groups. [Conclusion] We suggest that the combination of robot-assisted gait training and functional electrical stimulation encourages patients to actively participate in training because it facilitates locomotor recovery without the risk of adverse effects.Key words: Robot-assisted gait training, Functional electrical stimulation, Chronic stroke