Relationship between paraspinal muscle cross-sectional area and relative proprioceptive weighting ratio of older persons with lumbar spondylosis

[Purpose] The purpose of this study was to examine the relationship between the paraspinal muscle cross-sectional area and the relative proprioceptive weighting ratio during local vibratory stimulation of older persons with lumbar spondylosis in an upright position. [Subjects] In all, 74 older persons hospitalized for lumbar spondylosis were included. [Methods] We measured the relative proprioceptive weighting ratio of postural sway using a Wii board while vibratory stimulations of 30, 60, or 240 Hz were applied to the subjects’ paraspinal or gastrocnemius muscles. Back strength, abdominal muscle strength, and erector spinae muscle (L1/L2, L4/L5) and lumbar multifidus (L1/L2, L4/L5) cross-sectional areas were evaluated. [Results] The erector spinae muscle (L1/L2) cross-sectional area was associated with the relative proprioceptive weighting ratio during 60Hz stimulation. [Conclusion] These findings show that the relative proprioceptive weighting ratio compared to the erector spinae muscle (L1/L2) cross-sectional area under 60Hz proprioceptive stimulation might be a good indicator of trunk proprioceptive sensitivity.Key words: Relative proprioceptive weighting ratio, Erector spinae muscle cross-sectional area, Older persons with lumbar spondylosis     

Effect of Muscle Vibration on Spatiotemporal Gait Parameters in Patients with Parkinson’s Disease

[Purpose] The purpose of this study was to investigate the effect of muscle vibration in the lower extremities in patients with Parkinson’s disease (PD) during walking. [Subjects] Nine patients with PD participated in this study and were tested with and without vibration (vibration at 60 Hz). [Methods] Eight oscillators of vibration were attached to the muscle bellies (tibialis anterior, gastrocnemius, biceps femoris, and rectus femoris) on both sides of the lower extremities with adhesive tape in this study. Spatiotemporal gait parameters were measured using a motion analysis system. [Results] Stride length and walking speed with vibration were significantly increased compared with those without vibration in PD patients. [Conclusion] These results suggest that the application of vibration to lower extremity muscles in patients with PD may improve the parkinsonian gait pattern.Key words: Parkinson’s disease, Muscle vibration, Spatiotemporal gait parameter     

Effect of Muscle Vibration on Postural Balance of Parkinson’s Diseases Patients in Bipedal Quiet Standing

[Purpose] The purpose of this study was to investigate the effect of muscle vibration applied to the lower extremities on static postural balance of patients with Parkinson’s disease (PD). [Subjects] Seven subjects with Parkinson’s disease participated in this study. [Methods] The oscillators of vibration were attached to the muscle bellies of the tibialis anterior, gastrocnemius, biceps femoris, and rectus femoris on both sides of the lower extremities with adhesive tape. A vibration frequency of 60 Hz was used to induce static postural reactions. Subjects’ center of pressure (COP) sway and peak ground reaction force (GRF) were measured with their eyes open with and without vibration. COP sway and peak GRF (Fx, Fy, Fz) were measured using a force plate (AMTI, Newton, USA), which provides x, y and z coordinates of body movement. [Results] The area of COP sway with vibration was significantly smaller than that with no vibration, but the length of COP sway showed no difference between two conditions. Peak medial-lateral maximum force (Fy) with vibration was significantly higher than that with no vibration, but peak anterior-posterior force (Fx) and peak vertical force (Fz) showed no differences. [Conclusion] These results suggest that vibration applied to the lower extremities can help PD patients control postural balance during quiet standing.Key words: Vibration, Postural balance, Parkinson’s disease     

Influence of pelvic position and vibration frequency on muscle activation during whole body vibration in quiet standing

[Purpose] The purpose of this study was to investigate muscle activation related to postural stability depending on the pelvic position and frequency of whole body vibration (WBV) during quiet standing, and to identify the most effective training conditions that elicit the highest neuromuscular responses. [Subjects and Methods] Eighteen healthy subjects voluntarily participated in this single-group, repeated-measures study in which surface electromyography (EMG) data for the upper trapezius, rectus abdominis, external oblique abdominis, erector spinae, gluteus maximus, rectus femoris, semitendinosus, and medial gastrocnemius were collected at three frequencies (0 Hz, 10 Hz, and 20 Hz) of WBV and three pelvic positions (neutral, anterior tilt, posterior tilt) for each subject during quiet standing. [Results] The EMG activities of all the recorded muscles showed significant differences between the three frequencies of WBV and three pelvic positions during quiet standing. [Conclusion] The study findings suggest that a higher WBV frequency (20 Hz) should be used to strengthen most muscles, and that using the posterior pelvic tilt during WBV is much more effective at strengthening and training muscles related to core stability.Key words: Whole body vibration, Frequency, Pelvic tilt     

Influence of transcutaneous electrical nerve stimulation on weight distribution in lower leg muscles

[Purpose] The purpose of this study was to compare the effects of transcutaneous electrical nerve stimulation (TENS), with and without visual input, on weight distribution following exercise-induced fatigue in the dorsiflexor and plantar flexor muscles of the ankle. [Subjects and Methods] This study had a cross-sectional design. Nineteen healthy adults (10 males, 9 females; mean age 21±0.8 years) were recruited to participate in a single group repeated measurements study lasting three days. On the first day, following exercise-induced fatigue, the standing position was maintained for 30 minutes, after which the postural sway was measured with eyes open (EO) and eyes closed (EC). On the second day, TENS was applied to the ankle dorsiflexors in the standing position for 30 minutes following exercise-induced fatigue. On the last day, TENS was applied to the plantar flexors, and the postural sway was measured with EO and EC following the same exercise-induced fatigue. [Results] On level terrain, with and without visual input, there was a significant difference between the baseline values and those following TENS on the tibialis anterior. On uneven terrain (simulated by a cushion), with and without visual input, there was a significant difference between the baseline values and those following TENS on the gastrocnemius. [Conclusion] Clinically, during walking on a flat surface for only a short period of time, TENS should be applied to the tibialis anterior. If walking training is performed on a variety of terrains for a longer time, TENS should be applied to the gastrocnemius.Key words: Transcutaneous electrical nerve stimulation (TENS), Weight distribution index (WDI), Visual input     

Effects of community-based virtual reality treadmill training on balance ability in patients with chronic stroke

[Purpose] We aimed to examine the effectiveness of a community-based virtual reality treadmill training (CVRTT) program on static balance abilities in patients with stroke. [Subjects and Methods] Patients (n = 20) who suffered a stroke at least 6 months prior to the study were recruited. All subjects underwent conventional physical therapy for 60 min/day, 5 days/week, for 4 weeks. Additionally, the CVRTT group underwent community-based virtual reality scene exposure combined with treadmill training for 30 min/day, 3 days/week, for 4 weeks, whereas the control group underwent conventional physical therapy, including muscle strengthening, balance training, and indoor and outdoor gait training, for 30 min/day, 3 days/week, for 4 weeks. Outcome measurements included the anteroposterior, mediolateral, and total postural sway path lengths and speed, which were recorded using the Balancia Software on a Wii Fit^™ balance board. [Results] The postural sway speed and anteroposterior and total postural sway path lengths were significantly decreased in the CVRTT group. Overall, the CVRTT group showed significantly greater improvement than the control group. [Conclusions] The present study results can be used to support the use of CVRTT for effectively improving balance in stroke patients. Moreover, we determined that a CVRTT program for stroke patients is both feasible and suitable.Key words: Stroke rehabilitation, Community-based virtual reality, Balance     

Association between Muscle Synergy and Stability during Prolonged Walking

[Purpose] The purpose of this study was to examine whether changes in muscle synergy could affect gait stability or muscle activity by comparing muscle activity before and after prolonged walking. [Subjects and Methods] Twelve healthy male subjects walked on a treadmill for 10 min as a warm-up. Data were recorded from the participants during the first and last 1 min during 90 min of walking at 4.5 km/h. Electromyographic (EMG) activity was recorded for 7 leg muscles, and patterns of coordination were determined by principal component analysis (PCA). The patterns of activity within the anatomic muscle groups were additionally determined by repeating PCA. iEMG was calculated using the mean EMG for each cycle step during the 1 min walking periods. The largest Lyapunov exponent was calculated to quantify each subject’s inherent local dynamic stability. [Results] The patterns for each of the 7 muscles showed no change between the start and end periods. However, the end period showed a higher co-activation of the triceps surae, lower iEMG of the medial gastrocnemius, and a smaller largest Lyapunov exponent of the mediolateral and anteroposterior directions than those observed during the start period. [Conclusion] The increase in triceps surae co-activation may be associated with gait stability.Key words: Muscle synergy, Muscle activity, Gait stability     

Kinematic effects of different gait speeds during gait initiation movement

[Purpose] We investigated the influence of gait speed on the movement strategy during gait initiation. [Participants and Methods] This study included 21 young healthy individuals (11 males and 10 females; mean age, 21.7 ± 0.5 years; mean height, 166.1 ± 9.8 cm; and mean weight, 57.3 ± 11.2 kg). A three-dimensional motion analyzer and strain gauge force platform were used in this study. The measurement task consisted of gait initiation from the quiet stance; the two measurement conditions were normal gait and the highest speed. The analysis interval was from the start of the center of pressure migration to the heel contact at the first step of the swing limb. The center of gravity, center of pressure, joint movements, step length, and step time during the anticipatory postural control (from the start of center of pressure migration to swing leg-heel off) and swing (swing leg-heel off to swing leg-heel contact) phases were analyzed. [Results] Significant differences were observed in the center of gravity, center of pressure, hip flexion, abduction movement, stance-limb ankle dorsiflexion movement during the anticipatory postural control phase, and step time during the anticipatory postural control and swing phases. The stance-limb ankle plantar flexion movement and step length did not differ significantly in the swing phase. [Conclusion] When the gait speed increases, fluctuations in the joint movements increase as the center of pressure displacement increases, thus requiring complex control.     

Effect of the Intrinsic Foot Muscle Exercise Combined with Interphalangeal Flexion Exercise on Metatarsalgia with Morton’s Toe

[Purpose] This study examined the effects of the intrinsic foot muscle exercise combined with interphalangeal flexion exercise on metatarsalgia with Morton’s toe. [Subject] A 38-year-old male with Morton’s toe, who complained of pain in his left metatarsophalangeal joints was the subject. [Methods] The pressure pain threshold, peak contact pressure of the metatarsophalangeal region during gait, and the navicular drop were measured before and after the intrinsic foot muscles exercises combined with interphalangeal flexion exercise. [Results] After exercising for 2 weeks, the pressure pain threshold increased from 1 to 1.5 kg, while the peak contact pressure decreased from 0.63 to 0.50 kg/cm², and the navicular drop improved from 5 to 8 mm. [Conclusion] The results show that the combined exercises alleviated the pain while walking by reducing the excessive pressure on the metatarsophalangeal region, and the improvement of gait with Morton’s toe.Key words: Contact pressure, Interphalangeal flexion, Metatarsalgia     

Tactile and proprioceptive sensory stimulation modifies estimation of walking distance but not upright gait stability: a pilot study

[Purpose] Recently, there has been growing interest in the somatosensory system, but little data exist on the interaction between dynamic postural control and the somatosensory system. The purpose of this study was to determine whether a training program, based on tactile and proprioceptive sensory stimulation of the trunk with the use of perceptual surfaces, improved the estimation of walking distance by healthy subjects, the ability to walk toward a memorized distance without vision, and whether it increases upright gait stability. [Subjects and Methods] Ten healthy subjects with a mean age of 31.9 ± 2.5 years were enrolled and participated in 10 daily sessions of perceptive training using perceptual surfaces, for 45 minutes each session. An experimental indoor test measured the subjects’ ability to perceive walking distances to a memorized target in an indoor environment. [Results] After treatment, the distances that were traversed were closer to the target than before treatment. Trunk acceleration did not differ significantly between pre- and post-training and did not increase significantly after training. [Conclusion] Treatment with perceptual surfaces stimulating the trunk midline improves the estimation of walking distance and modifies proprioceptive gait patterns, allowing various corrective strategies to be implemented during ambulation.Key words: Trunk midline, Perceptual surfaces, Gait patterns     

Acute Effects of 5 Min of Plantar Flexor Static Stretching on Balance and Gait in the Elderly

[Purpose] The purpose of this study was to examine the acute effects of five minutes of plantar flexor static stretching (PSS) on the balance and gait of the elderly. [Subjects and Methods] Twenty-five subjects aged 65 years and above performed 5 min of PSS in the form of wedge board standing. The sway length of each subject’s center of mass was measured to examine the subject’s static balance. It was measured by one minute of quiet standing with the eyes closed. Functional reach tests (FRTs), timed up and go tests (TUGs), and 10-meter walk tests (10MWTs) were performed to examine dynamic balance and gait before and after PSS. [Results] The outcome showed significant increases in sway distances (6.55 ± 5.03 cm) after stretching. However, in the FRTs, TUGs, and 10MWTs, the reach distance and time did not show any significant changes. [Conclusion] These results suggest that the elderly subjects temporarily experienced difficulties in maintaining balance immediately after the PSS but that their dynamic balance and gait were not adversely affected after a short period of time. Therefore, to prevent falls and perform exercises in a safe way, it is recommended to allow patients to rest after performing PSS.Key words: Elderly, Static stretching, Postural balance     

Relationship between gait speed and trunk muscles in frail elderly individuals

[Purpose] The external and internal abdominal muscles may be related to gait speed; however, this has not yet been elucidated. In this study, we aimed to clarify the relationship between gait speed and trunk muscle thickness in elderly individuals. [Participants and Methods] The participants were 12 elderly individuals (4 males and 8 females, mean age 83.4 years old, SD ± 0.5) that attend a day service center. We measured the 5 m free gait speed, the 5 m fastest gait speed, and the thickness of five trunk muscles (the rectus abdominis [divided into three parts: upper, central, and lower], external oblique, internal oblique, transverse abdominis, and iliopsoas muscles). [Results] There were positive correlations between the free gait speed and the thickness of the lower rectus abdominis, internal oblique, and transverse abdominis muscles. There were also positive correlations between the fastest gait speed and the thickness of the lower rectus abdominis, internal oblique, and transverse abdominis muscles. [Conclusion] Incorporating muscle strength training of the lower rectus abdominis, internal oblique, and transverse abdominis muscles into existing lower limb muscle training protocols is important to effectively maintain the gait speed of elderly individuals.Key words: Gait speed, Trunk muscles, Frail elderly individuals     

Effects of orthosis on balance and gait in healthy adults

[Purpose] This study evaluated the effects of an oral orthosis that can change body alignment on the balance ability and gait of healthy adults. [Subjects and Methods] The subjects of this study were 21 University students. A gait analyzer was used to analyze the subjects’ balance ability and gait quality. Two walking speeds were used: 2 km/h, a comfortable speed, and 4 km/h, a slightly faster walking speed. [Results] The step length, and base of gait at 2 km/h differed significantly after the intervention. The total step time and step length increased significantly after the intervention. Furthermore, the total base of gait decreased significantly after the intervention. The step times of the left lower limb at 4 km/h differed significantly after the intervention. [Conclusion] The oral orthosis tested positively affects the balance ability and gait of healthy adults.Key words: Orthosis, Balance, Gait     

Effects of Various Gait Speeds on the Latissimus Dorsi and Gluteus Maximus Muscles Associated with the Posterior Oblique Sling System

[Purpose] This study investigated the effect of different gait speeds on the muscle activities of the latissimus dorsi and gluteus maximus muscles in relation to the posterior oblique sling system. [Subjects] We recruited 14 young adult males. [Methods] We measured the left latissimus dorsi muscle activity and right gluteus maximus muscle activity of all subjects while they walked on a treadmill at speeds of 1.5 km/h, 3.5 km/h and 5.5 km/h. [Results] There was a significant increase in latissimus dorsi muscle activity with a treadmill speed of 5.5 km/h compared with 1.5 km/h and 3.5 km/h. The gluteus maximus muscle activity significantly increased in the order of 1.5 km/h < 3.5 km/h < 5.5 km/h. [Conclusion] The present results indicate that arm swing connected to increasing gait speed influences the muscle activity of the lower limbs through the posterior oblique sling system.Key words: Electromyography, Gait speed, Posterior oblique sling system     

The effects of ramp gait exercise with PNF on stroke patients’ dynamic balance

[Purpose] This study examined the effects of ramp gait training using lower extremity patterns of proprioceptive neuromuscular facilitation (PNF) on chronic stroke patients’ dynamic balance ability. [Subjects and Methods] In total, 30 stroke patients participated in this study, and they were assigned randomly and equally to an experimental group and a control group. The experimental group received exercise treatment for 30 min and ramp gait training with PNF for 30 min. The control group received exercise treatment for 30 min and ground gait training for 30 min. The interventions were conducted in 30 min sessions, three times per week for four week. The subjects were assessed with the Berg balance scale test, timed up and go test, and functional reach test before and after the experiment and the results were compared. [Results] After the intervention, the BBS and FRT values had significantly increased and the TUG value had significantly decreased in the experimental group; however, the BBS, FRT, and TUG values showed no significant differences in the control group. In addition, differences between the two groups before the intervention and after the intervention were not significant. [Conclusion] In conclusion, ramp gait training with PNF improved stroke patients’ dynamic balance ability, and a good outcome of ramp gait training with PNF is also expected for other neurological system disease patients.Key words: Stroke, Proprioception, Ramp gait     

Acute effects of unilateral whole body vibration training on single leg vertical jump height and symmetry in healthy men

[Purpose] The aim of the present study was to investigate the acute effects of unilateral whole body vibration training on height and symmetry of the single leg vertical jump in healthy men. [Subjects] Thirty males with no history of lower limb dysfunction participated in this study. [Methods] The participants were randomly allocated to one of three groups: the unilateral vibratory stimulation group (n=10), bilateral vibratory stimulation group (n=10), and, no vibratory stimulation group (n=10). The subjects in the unilateral and bilateral stimulation groups participated in one session of whole body vibration training at 26 Hz for 3 min. The no vibratory stimulation group subjects underwent the same training for 3 min without whole body vibration. All participants performed the single leg vertical jump for each lower limb, to account for the strong and weak sides. The single leg vertical jump height and symmetry were measured before and after the intervention. [Results] The single leg vertical jump height of the weak lower limb significantly improved in the unilateral vibratory stimulation group, but not in the other groups. The single leg vertical jump height of the strong lower limb significantly improved in the bilateral vibratory stimulation group, but not in the other groups. The single leg vertical jump symmetry significantly improved in the unilateral vibratory stimulation group, but not in the other groups. [Conclusion] Therefore, the present study found that the effects of whole body vibration training were different depending on the type of application. To improve the single leg vertical jump height in the weak lower limbs as well as limb symmetry, unilateral vibratory stimulation might be more desirable.Key words: Single leg vertical jump, Symmetry, Whole body vibration     

Reliability of the Good Balance System? for Postural Sway Measurement in Poststroke Patients

[Purpose] The purpose of this study was to examine test-retest reliability of the Good Balance system^® for measurement of postural sway in poststroke patients. [Subjects] Sixty chronic stroke patients (40 men and 20 women; age 63.08 years; stroke duration 16.45 months) participated in this study. [Methods] Postural sway was evaluated using a force platform system (Good Balance system, Metitur Oy, Jyvaskyla, Finland). Two examiners measured postural sway for all participants during two separate testing sessions. The second measurement was performed one week after the first measurement. Intraclass correlation coefficients [ICC_(2,1)] were used for estimation of reliability. [Results] The ICC (95% CI) for intra-examiner reliability was good to very good, ranging from 0.69 to 0.93 (0.53–0.96), and the ICC for inter-examiner reliability was good to very good, ranging from 0.85 to 0.98 (0.77–0.99). [Conclusion] The results of the current study indicated that the intra- and inter-examiner reliability of the Good Balance system^® for measurement of postural sway was good to very good. Therefore, we suggest that measurement of postural sway using the Good Balance system^® would be useful for clinical assessment in poststroke patients.Key words: Postural sway, Reliability, Stroke     

Improvement in lower extremity hemiplegia in a post-operative brain tumor patient by applying an integrated volitional control electrical stimulator

[Purpose] This study aimed to evaluate the improvement in lower extremity hemiplegia following brain tumor operation with an integrated volitional control electrical stimulator (IVES). [Participant and Methods] A 40 year-old male with anaplasic oligodendroglioma in the right frontal lobe underwent IVES in the rectus femoris and tibialis anterior muscles using the power-assist and sensor-trigger modes. Lower extremity motor function was assessed before and after the therapy sessions. An assessment was conducted using various techniques, including static posturography and surface electromyography. [Results] Static posturography showed an improvement in the center of pressure and sway area after IVES gait training. Based on a time-series statistical parametric mapping analysis, the activation pattern of each muscle after the treatment was different. Muscle synergy analysis revealed decreased total variance accounted for by a single synergy in the affected and normal sides after the treatment. [Conclusion] Patients with chronic hemiplegic lower extremity impairment responded well to IVES gait training. Electromyography-triggered functional electrical stimulation may enhance sensory-motor integration. Proprioceptive feedback plays a crucial role in improving motor control.     

The effects of stair gait training using proprioceptive neuromuscular facilitation on stroke patients’ dynamic balance ability

[Purpose] This study aims to examine stroke patients’ changes in dynamic balance ability through stair gait training where in proprioceptive neuromuscular facilitation (PNF) was applied. [Subjects and Methods] In total 30 stroke patients participated in this experiment and were randomly and equally allocated to an experimental group and a control group. The experimental group received exercise treatment for 30 min and stair gait training where in PNF was applied for 30 min and the control group received exercise treatment for 30 min and ground gait training where in PNF was applied for 30 min. For the four weeks of the experiment, each group received training three times per week, for 30 min each time. Berg Balance Scale (BBS) values were measured and a time up and go (TUG) test and a functional reach test (FRT) were performed for a comparison before and after the experiment. [Results] According to the result of the stroke patients’ balance performance through stair gait training, the BBS and FRT results significantly increased and the TUG test result significantly decreased in the experimental group. On the contrary, BBS and FRT results did not significantly increase and the TUG test result did not significantly decrease in the control group. According to the result of comparing differences between before and after training in each group, there was a significant change in the BBS result of the experimental group only. [Conclusions] In conclusion, the gait training group to which PNF was applied saw improvements in their balance ability, and a good result is expected when neurological disease patients receive stair gait training applying PNF.Key words: Proprioceptive neuromuscular facilitation, Stroke, Balance ability     

The effects of ageing on functional capacity and stretch-shortening cycle muscle power

[Purpose] To examine the effects of age and gender in an ageing population with respect to functional decline and the relationship between muscle power and functional capacity. [Participants and Methods] The cohort (N=154) was subdivided into youngest-old (65–70 years.; n=62), middle-old (71–75 years.; n=46), and oldest-old (76–81 years.; n=46). Measures of mechanical muscle function included countermovement jump height, muscle power, leg strength and grip strength. Functional performance-based measures included heel-rise, postural balance, Timed Up and Go, and gait speed. [Results] The oldest-old performed significantly worse than the middle-old, whereas the youngest-old did not outperform the middle-old to the same extent. Increased contribution of muscle power was observed with increasing age. Males had consistently higher scores in measures of mechanical muscle function, whereas no gender differences were observed for functional capacity. [Conclusion] The age-related decline in functional capacity appears to accelerate when approaching 80 years of age and lower limb muscle power seems to contribute to a greater extent to the preservation of functional balance and gait capacity at that stage. Males outperform females in measures of mechanical muscle function independent of age, while the findings give no support for the existence of gender differences in functional capacity.Key words: Stretch-shortening cycle muscle power, Physical function, Ageing