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To identify different contributions of motor and sensory variables for independent ambulation of patients with incomplete spinal cord injury (SCI), and reveal the most significant contributors among the variables.
The retrospective study included 30 patients with incomplete SCI and lesions were confirmed by magnetic resonance imaging. Motor and sensory scores were collected according to the International Standards for Neurological Classification of Spinal Cord Injury. The variables were analyzed by plotting ROC (receiver operating characteristic) curves to estimate their differential contributions for independent walking. The most significant functional determinant was identified through the subsequent logistic regression analysis.
Motor and sensory scores were significantly different between the ambulators and non-ambulators. The majority was associated to the function of lower extremities. Calculation of area under ROC curves (AUC) revealed that strength of hip flexor (L2) (AUC=0.905, p<0.001) and knee extensor (L3) (AUC=0.820, p=0.006) contributed the greatest to independent walking. Also, hip flexor strength (L2) was the single most powerful predictor of ambulation by the logistic regression analysis (odds ratio=6.3, p=0.049), and the model fit well to the data.
The most important potential contributor for independent walking in patients with incomplete SCI is the muscle strength of hip flexors, followed by knee extensors compared with other sensory and motor variables.
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To evaluate the clinical features that could serve as predictive factors for improvement in gait speed after robotic treatment.
A total of 29 patients with motor incomplete spinal cord injury received 4-week robot-assisted gait training (RAGT) on the Lokomat (Hocoma AG, Volketswil, Switzerland) for 30 minutes, once a day, 5 times a week, for a total of 20 sessions. All subjects were evaluated for general characteristics, the 10-Meter Walk Test (10MWT), the Lower Extremity Motor Score (LEMS), the Functional Ambulatory Category (FAC), the Walking Index for Spinal Cord Injury version II (WISCI-II), the Berg Balance Scale (BBS), and the Spinal Cord Independence Measure version III (SCIM-III) every 0, and 4 weeks. After all the interventions, subjects were stratified using the 10MWT score at 4 weeks into improved group and non-improved group for statistical analysis.
The improved group had younger age and shorter disease duration than the non-improved group. All subjects with the American Spinal Injury Association Impairment Scale level C (AIS-C) tetraplegia belonged to the non-improved group, while most subjects with AIS-C paraplegia, AIS-D tetraplegia, and AIS-D paraplegia belonged to the improved group. The improved group showed greater baseline lower extremity strength, balance, and daily living function than the non-improved group.
Assessment of SCIM-III, BBS, and trunk control, in addition to LEMS, have potential for predicting the effects of robotic treatment in patients with motor incomplete spinal cord injury.
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To evaluate characteristics of static and dynamic parameters in patients with degenerative flat back (DFB) and to compare degree of their improvement between successful and unsuccessful surgical outcome groups
Forty-seven patients with DFB were included who took whole spine X-ray and three-dimensional motion analysis before and 6 months after corrective surgery. Forty-four subjects were selected as a control group. As static parameters, thoracic kyphosis (TK), thoracolumbar junction (TLJ), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured. As dynamic parameters, maximal and minimal angle of pelvic tilt, lower limb joints, and thoracic and lumbar vertebrae column (dynamic TK and LL) in sagittal plane were obtained.
The DFB group showed smaller TK and larger LL, pelvic posterior tilt, hip flexion, knee flexion, and ankle dorsiflexion than the control group. Most of these parameters were significantly corrected by fusion surgery. Dynamic spinal parameters correlated with static spinal parameters. The successful group obtained significant improvement in maximal and minimal dynamic LL than the unsuccessful group.
The DFB group showed characteristic lower limb and spinal angles in dynamic and static parameters. Correlation between static and dynamic parameters was found in spinal segment. Dynamic LL was good predictor of successful surgical outcomes.
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To compare optical motion capture system (MoCap), attitude and heading reference system (AHRS) sensor, and Microsoft Kinect for the continuous measurement of cervical range of motion (ROM).
Fifteen healthy adult subjects were asked to sit in front of the Kinect camera with optical markers and AHRS sensors attached to the body in a room equipped with optical motion capture camera. Subjects were instructed to independently perform axial rotation followed by flexion/extension and lateral bending. Each movement was repeated 5 times while being measured simultaneously with 3 devices. Using the MoCap system as the gold standard, the validity of AHRS and Kinect for measurement of cervical ROM was assessed by calculating correlation coefficient and Bland–Altman plot with 95% limits of agreement (LoA).
MoCap and ARHS showed fair agreement (95% LoA<10°), while MoCap and Kinect showed less favorable agreement (95% LoA>10°) for measuring ROM in all directions. Intraclass correlation coefficient (ICC) values between MoCap and AHRS in –40° to 40° range were excellent for flexion/extension and lateral bending (ICC>0.9). ICC values were also fair for axial rotation (ICC>0.8). ICC values between MoCap and Kinect system in –40° to 40° range were fair for all motions.
Our study showed feasibility of using AHRS to measure cervical ROM during continuous motion with an acceptable range of error. AHRS and Kinect system can also be used for continuous monitoring of flexion/extension and lateral bending in ordinary range.
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To investigate the difference of range of motion (ROM) of ankle according to pushing force, gender and knee position.
One hundred and twenty-eight healthy adults (55 men, 73 women) between the ages of 20 and 51, were included in the study. One examiner measured the passive range of motion (PROM) of ankle by Dualer IQ Inclinometers and Commander Muscle Testing. ROM of ankle dorsiflexion (DF) and plantarflexion (PF) according to change of pushing force and knee position were measured at prone position.
There was significant correlation between ROM and pushing force, the more pushing force leads the more ROM at ankle DF and ankle PF. Knee flexion of 90° position showed low PF angle and high ankle DF angle, as compared to the at neutral position of knee joint. ROM of ankle DF for female was greater than for male, with no significant difference. ROM of ankle PF for female was greater than male regardless of the pushing force.
To our knowledge, this is the first study to assess the relationship between pushing force and ROM of ankle joint. There was significant correlation between ROM of ankle and pushing force. ROM of ankle PF for female estimated greater than male regardless of the pushing force and the number of measurement. The ROM of the ankle is measured differently according to the knee joint position. Pushing force, gender and knee joint position are required to be considered when measuring the ROM of ankle joint.
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To investigate whether an audible cracking sound during shoulder manipulation following distention arthrography is clinically significant in patients with adhesive capsulitis of the shoulder.
A total of 48 patients (31 women, 17 men) with primary adhesive capsulitis of the shoulder completed the study. All participants underwent C-arm-guided arthrographic distention of the glenohumeral joint with injections of a corticosteroid and normal saline. After distention, we performed flexion and abduction manipulation of the shoulder. The patients were grouped into sound and non-sound groups based on the presence or absence, respectively, of an audible cracking sound during manipulation. We assessed shoulder pain and disability based on a Numeric Rating Scale (NRS), the Shoulder Pain and Disability Index (SPADI), and passive range of motion (ROM) measurements (flexion, abduction, internal and external rotation) before the procedure and again at 3 weeks and at 6 weeks after the intervention.
The patients were divided into two groups: 21 were included in the sound group and 27 in the non-sound group. In both groups, the results of the NRS, SPADI, and ROM assessments showed statistically significant improvements at both 3 and 6 weeks after the procedure. However, there were no significant differences between the two groups except with respect to external rotation at 6 weeks, at which time the sound group showed a significant improvement in external rotation when compared with the non-sound group (p<0.05).
These findings showed that manipulation following distention arthrography was effective in decreasing pain and increasing shoulder range of motion. In addition, the presence of an audible cracking sound during manipulation, especially on external rotation, was associated with better shoulder range of motion.
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To correctly measure the knee joint angle, this study utilized a Qualisys motion capture system and also used it as the reference to assess the validity of the study's Inertial Measurement Unit (IMU) system that consisted of four IMU sensors and the Knee Angle Recorder software. The validity was evaluated by the root mean square (RMS) of different angles and the intraclass correlation coefficient (ICC) values between the Qualisys system and the IMU system.
Four functional knee movement tests for ten healthy participants were investigated, which were the knee flexion test, the hip and knee flexion test, the forward step test and the leg abduction test, and the walking test.
The outcomes of the knee flexion test, the hip and knee flexion test, the forward step test, and the walking test showed that the RMS of different angles were less than 6°. The ICC values were in the range of 0.84 to 0.99. However, the leg abduction test showed a poor correlation in the measurement of the knee abduction-adduction movement.
The IMU system used in this study is a new good method to measure the knee flexion-extension movement.
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Anterior cervical osteophytes are common and usually asymptomatic in elderly people. Due to mechanical compressions, inflammations, and tissues swelling of osteophytes, patients may be presented with multiple complications, such as dysphagia, dysphonia, dyspnea, and pulmonary aspiration. Paradoxical vocal cord motion is an uncommon disease characterized by vocal cord adductions during inspiration and/or expiration. This condition can create shortness of breath, wheezing, respiratory stridor or breathy dysphonia. We report a rare case demonstrating combined symptoms of dyspnea, dysphonia as well as dysphagia at the same time in a patient with asymptomatic anterior cervical osteophytes. Moreover, this is the first report demonstrating that anterior osteophytes can be a possible etiological factor for paradoxical vocal cord motion that induces serious respiratory symptoms.
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To investigate the relationships between spinal mobility, pulmonary function, structural change of the spine, pain, fatigue, and quality of life (QOL) in patients with ankylosing spondylitis (AS).
Thirty-six patients with AS were recruited. Their spinal mobility was examined through seven physical tests: modified Schober test, lateral bending, chest expansion, occiput to wall, finger to ground, bimalleolar distance, and range of motion (ROM) of the spine. Pulmonary Function Test (PFT) was performed using a spirometer, and vertebral squaring was evaluated through the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). QOL, disease activity, functional capacity, and fatigue were evaluated by SF-36 Health Survey (SF-36), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Multidimensional Assessment of Fatigue (MAF) scale, respectively. Perceived physical condition and degree of pain were assessed using 10 cm visual analogue scale.
Participants showed reduced spinal mobility, which was negatively correlated with mSASSS. PFT results showed reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) and increased FEV1/FVC. Reduced FEV1 and FVC showed positive correlations with reduced spinal mobility and a negative relationship with mSASSS. Perceived physical condition and degree of pain were both significantly related to the SF-36, BASDAI, BASFI, and MAF scores.
This study shows that both reduced spinal mobility and radiographic changes in the vertebral body may have a predictive value for pulmonary impairment in patients with AS. Likewise, pain and perceived physical condition may play an important role in the QOL, functional capacity, and fatigue level of these patients.
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To investigate the factors affecting rehabilitation outcomes in children with congenital muscular torticollis (CMT).
We retrospectively reviewed the medical records of 347 patients who were clinically suspected as having CMT and performed neck ultrasonography to measure sternocleidomastoid (SCM) muscle thickness. Fifty-four patients met the inclusion criteria. Included were demographic characteristics as well as measurements of cervical range of motion (ROM), SCM muscle thickness, and the abnormal/normal (A/N) ratio, defined as the ratio of SCM muscle thickness on the affected to the unaffected side.
Subjects were divided into three groups depending on degree of cervical ROM (group 1A: ROM>60, n=12; group 1B: 60≥ROM>30, n=31; group 1C: ROM≤30, n=11), the SCM muscle thickness (Th) (group 2A: Th<1.2 cm, n=23; group 2B: 1.2≤Th<1.4 cm, n=18; group 2C: Th≥1.4 cm, n=13), and the A/N ratio (R) (group 3A: R<2.2, n=19; group 3B: 2.2≤R<2.8, n=20; group 3C: R≥2.8, n=15). We found that more limited cervical ROM corresponded to longer treatment duration. The average treatment duration was 4.55 months in group 1A, 5.87 months in group 1B, and 6.50 months in group 1C. SCM muscle thickness and the A/N ratio were not correlated with treatment duration.
Infants with CMT who were diagnosed earlier and had an earlier intervention had a shorter duration of rehabilitation. Initial cervical ROM is an important prognostic factor for predicting the rehabilitation outcome of patients with CMT.
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To investigate the intra- and inter-rater reliability of the Korean version of the ABILOCO questionnaire (K-ABILOCO).
The original ABILOCO questionnaire was translated into Korean and back-translated into English. Stroke patients (n=30) with hemiplegia were evaluated using the K-ABILOCO at one week interval. At each visit, the physiatrist also evaluated patient performance of the activities described in the K-ABILOCO, and the total logit scores were recorded. The total scores were used to evaluate intraclass correlation (ICC). Test-retest scores and each test scores were compared to obtain the intra- and inter-rater reliability.
The K-ABILOCO showed good intra-rater correlation at one week interval in both patient and physiatrist evaluations (ICC=0.81, 0.91), respectively. It also showed a high inter-rater correlation between the patient and physiatrist at both the first and second visits (ICC=0.76, 0.84), respectively.
The K-ABILOCO is a useful tool that may reliably evaluate the locomotion ability in hemiplegic stroke patients.
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To investigate the changes of ankle strength and range of motion with aging and which of the ankle strength and range of motion are contributed to balance.
Sixty healthy people (24 men and 36 women) have undergone tests for ankle strength and range of motion, using Biodex System 4 Pro; a one-leg balance, including postural sway and stability index using a Balance System; in which data were collected in a self-reported Desmond fall risk questionnaire.
Participants are classified into 3 groups by age (group 1, 20-40 years; group 2, 40-65 years; group 3, over 65 years). Stability index and postural sway is significantly increased with aging. Ankle plantarflexor strength and ankle eversion range of motion is significantly decreased with aging. Pearson's correlation revealed that ankle plantarflexor strength is significantly correlated with anterior/posterior sway, and ankle eversion range of motion is significantly correlated with medial/lateral sway in the aged group (over 65 years).
Stability, ankle plantarflexor strength, and eversion range of motion is declined with aging. In addition, strength of ankle plantarflexor and eversion range of motion is significantly correlated with balance stability. Further studies are needed for programs to improve the strength of plantarflexor, and range of motion of eversion of the ankle are beneficial in improving balance, stability, and prevention of falling in the elderly.
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To investigate the effect of Comprehensive Hand Repetitive Intensive Strength Training (CHRIST) on upper limb function in children with cerebral palsy using motion analysis.
The subjects in this study included 19 children (10 males, 9 females, mean age=8.8 years) with cerebral palsy. The experimental group (n=10) received CHRIST and general rehabilitation therapy. The control group (n=9) received a home program as well as general rehabilitation therapy. Both groups received 30 sessions of CHRIST or home program training for 60 minutes per session 3 times a week during the 10-week period. The reaching movements were captured by a motion analysis system. Kinematic variables including movement time (MT), mean velocity (MV), normalized jerk score (NJS), mean angular velocity (MAV) and normalized jerk score of the shoulder, elbow and wrist joint with comfortable and fast speed were analyzed between groups and the pre-post training group.
After pre- and post-training experimental group, MT, MV, NJS, MAV of shoulder, elbow, wrist and NJS of elbow and wrist improved significantlyin reaching movement of both comfortable and fast speed (p<0.05). However, After pre- and post-training control group, MV improved significantlyin reaching movement of only comfortable speed (p<0.05). Between two groups, MT and MAV of the elbow at comfortable speed and NJS of the elbow at fast speed were statisticallysignificant (p<0.05).
CHRIST proved to be an effective intervention for improving upper limb extremity function of reaching movement in children with cerebral palsy.
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Method: A cross sectional study in 155 type II diabetic patients was done. The presence of LJM and shoulder adhesive capsulitis was sought. The diseases closely related to diabetes were recorded. The patients were assessed for retinopathy, nephropathy, and neuropathy.
Results: The prevalence of LJM and shoulder adhesive capsulitis in type II diabetic patients was 32.3% and 29.7%, respectively. Development of LJM and shoulder adhesive capsulitis was correlated with age and duration of diabetes. Higher blood HbA1c level was noticed in mild and moderate degree of LJM. The prevalence of shoulder adhesive capsulitis was shown association with LJM. The prevalence of LJM was associated with a history of myocardial infarction and chronic diabetic compli cations. The prevalence of shoulder adhesive capsulitis was associated with retinopathy, carpal tunnel syndrome, and autonomic neuropathy.
Conclusion: According to the results, around 30% of type II DM patients could have hand LJM and should adhesive capsulitis, which suggested more attention and effort to prevent the LJM and shoulder adhesive capsulitis were needed.
Method: Ten healthy adult volunteers were included. We attached surface markers at the corresponding skin surface of each lumbar vertebral bodies and measured lumbar segmental ROM in flexion-extension, right bending, left bending, axial rotation with 3-D motion analysis. We compared some of the results with radiologic segmental ROM measurements.
Results: In 3-D motion analysis, segmental ROM of flexion and extension, right bending, left bending, right rotation, left rotation were, respectively: 10.1o, 45o, 3.5o, 1.7o and 1.9o (L1-L2); 17.9o, 6.2o, 5.1o, 1.4o and 1.1o (L2-L3); 15.0o, 7.2o, 4.9o, 2.1o and 1.1o (L3-L4); 14.9o, 5.8o, 4.6o, 1.7° and 1.6° (L4-L5); 10.6o, 4.9o, 3.8°, 2.6° and 0.8° (L5-S1). There was no statistically significant difference in segmental ROM between 3-D motion analysis measurements and radiologic measurements except L5-S1 right bending, L2-L3 and L5-S1 left bending. No statistical significant difference in lumbar flexion and bending ROM was found between two methods.
Conclusion: 3-D motion analysis is a useful method when measuring the lumbar segmental range of motion and it has an advantage to analyze segmental lumbar motion with three directions simultaneously. (J Korean Acad Rehab Med 2003; 27: 424-432)
Methods: Thirty nine patients who underwent cervical decompression and fusion for cervical myelopathy were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated with Nurick classification, Functional Independence measure (FIM) score and gait analysis using three dimensional motion analyzer before surgery, 1 week and 3 months after surgery.
Results: In the Nurick classification there was statistically significant change but no significant change in FIM score after surgery. In the gait analysis there were statistically significant improvements in all the linear parameters, kinetic (ankle plantarflexion moment) and kinematic (knee range of motion in swing phase) parameters (p＜0.05).
Conclusion: This study suggests that gait analysis can be used as a quantitative tools of postoperative gait improvement in patient with cervical myelopathy. (J Korean Acad Rehab Med 2003; 27: 58-62)
Objective: This study is designed for comparison of the clinical usefulness between computerized and manual inclinometer and to find out more reliable and acceptable method in measuring spinal ROM (range of motion).
Method: Twenty healthy volunteers (mean age 23⁑4) were selected. Spinal ROM was measured by computerized and manual inclinometer twice a week. Data was analyzed with paired t-test and Pearson's correlation test.
Results: There was no significant difference between the measured value of two methods. In the repeated measurement by computerized inclinometer, there was significant reliability of spinal ROM except right rotation of the lumbar spine, and by manual inclinometer, there was significant reliability of spinal ROM except cervical left lateral bending, thoracic lateral bending, and lumbar right rotation (p＜0.05). In cases of computerized inclinometer, estimated times to measuring ROM were 8 min 46 sec in cervical spine, 10 min 22 sec in thoracic spine, 9 min 50 sec in lumbar spine, and of manual inclinometer, those were 3 min 27 sec in cervical spine, 5 min 8 sec in thoracic spine, 4 min 35 sec in lumbar spine.
Conclusion: In the measurement of spinal ROM, computerized inclinometer is more reliable than manual inclinometer for its higher reliability, but has a limitation of long measurement time. This study suggest that computerized inclinometer can be acceptable tool for accurate measuring spinal ROM. (J Korean Acad Rehab Med 2002; 26: 456- 460)
Objective: Shoulder pain in hemiplegia is common and serious problem, but is not completely understood and somewhat controversial. This preliminary study attempt to evaluate the effect and usefulness of subacromial massage in the management of hemiplegic shoulder.
Method: In this ramdomized controlled trial, twenty nine hemiplegic patients with shoulder pain and limitation of motion were treated with either subacromial massage (treatment group) or massage on the supra-acromial area (control group). Outcome measurement of pain intensity, and range of motion were obtained by blinded assessment.
Results: After massage, in treatment group, mean active range of shoulder motion was increased by 14.3o in abduction, 9.0o in flexion, 10.3o in external rotation and 13o in internal rotation versus 3.9o in abduction, 7.5o in flexion, 4.3o in external rotation and 6.4o in internal rotation in control group. The mean pain intensity decreased from VAS 5.47 to 3.8 in treatment group and from VAS 4.57 to 3.71 in control group. This result was statistically significant, except in increment of active range of motion of flexion and external rotation of shoulder joint.
Conclusion: Subacromial massage was used in an effort to increase shoulder motion and to reduce shoulder pain in hemiplegic patients. There were increase in shoulder motion especially abduction, and decrease shoulder pain in study group compared with control group. Further investigation in the form of long term follow up studies is needed. (J Korean Acad Rehab Med 2002; 26: 385-390)
Objective: The purpose of this study was to examine the change of heart rate, mean arterial pressure, respiration rate, and spasticity at passive leg range of motion exercise for one month in hemiplegic patients.
Method: Subjects were composed of twenty hemiplegic patients who had spasticity above two grade in modified Ashworth scale. Passive leg range of motion exercise was performed with passive cycle leg exerciser (Autocybex) at the speed of 40 rpm. Training program consisted of two sessions a day, and each session was done for twenty minutes. The heart rate, mean arterial pressure, and respiration rate were checked for each subject before and after passive leg range of motion exercise at initial state and after one month. Spasticity was measured at knee joint of the affected side at initial state and after one month.
Results: The resting heart rate, mean arterial pressure and respiration rate were significantly decreased after one month (p＜0.05). The changes of heart rate, mean arterial pressure, and respiration rate after passive leg range of motion exercise were significantly decreased after one month (p＜0.05). The grade of spasticity was decreased after one month (p＜0.05).
Conclusion: We concluded that passive leg range of motion exercise during one month stabilized heart rate, mean arterial pressure, and respiration rate, and reduced spasticity.
Objective: This study is aimed at the pathoanatomic correlates of emotional problem in the patients with stroke.
Method: Thirty patients with single, unilateral hemispheric lesion and no predisposing factors for psychiatric disorder were selected. Several neuropsychological assessments such as Mini- mental status examination-Korean (MMSE-K), Minnesota multiphasic personality inventory (MMPI), Symptom checklist-90-Revision (SCL-90-R) and Functional independence measure (FIM) were performed on all patients by a clinical psychologist and an occupational therapist.
Results: There were statistically significant differences between right and left hemisphere lesion group in emotional problems. Right hemispheric lesion group showed significantly higher scores of psychasthenia (MMPI), Obsessive-compulsive (SCL-90-R) and self care (FIM) than left hemispheric lesion group did. But there were no statistically significant differences between cortical and subcortical lesion group. Groups of left cortical lesion, right cortical lesion, left subcortical lesion and right subcortical lesion were not significantly different in their neuropsychological assessments and FIM except self care.
Conclusion: Obsessive-compulsive and anxious emotional problems are more closely related with right hemispheric lesion. Therefore patients with right hemispheric lesion need more careful psychological and psychiatric evaluation. However, because of the small numbers of subjects involved in the study, the role of lesion location remains unclear so that consecutive follow-up studies are needed.
Objective: This study is aimed to evaluate a sit-to-stand (STS) pattern in the children with spastic diplegic cerebral palsy in comparison with the normal children.
Method: Fifteen young children with spastic diplegic cerebral palsy and 21 normally developed children were recruited as subjects. A motion analysis system using a Motion analyzer (Vicon 370 M.A. with 6 infrared cameras) was used to examine the STS task. The changes in joint angle, moment, and power of each joints in lower limbs, total duration of STS transfer and each transitional points were assessed.
Results: Total duration of STS in patients was 2.44 sec, which was significantly prolonged in comparing with 1.10 sec in normal control. The major prolongation of STS occurred in the phase of vertical movement of center of mass (CoM). Cerebral palsied children showed more anterior pelvic tilting and hip flexion throughout STS transfer than normal control. Asymmetries in initial angle of ankle and maximal momentum of knee extension were shown in spastic diplegic children with cerebral palsy, but not in normal control. Less extension momentum and power of knee joint and more plantar flexion momentaum of ankle joint were observed in cerebral palsy in comparing with those of normal children.
Conclusion: This study showed that STS pattern in spastic diplegic cerebral palsy was quite different from that of normal children. The characteristics of STS pattern in these children was slowness of speed; mainly from slowness of vertical displacement of CoM, and more anterior
pelvic tilt, hip flexion and earlier abrupt change of knee extension. As well, the major moments required for this task in these patients occurred at hip and ankle joints instead of knee joint.
Objective: The purpose of this study was to determine the usefulness of manual medicine therapy in adhesive capsulitis of shoulder.
Method: Twelve patients with adhesive capsulitis of shoulder were treated with the muscle energy technique of Greenman in manual medicine therapy. The muscle energy technique of Greenman was repeated 6 times for each subject. The therapeutic effect of manual medicine therapy was assessed by the shoulder range of motion (ROM) and visual analogue scale (VAS) before and after the treatment. Two patients took the fluoroscopic examination before and after the treatment.
Results: After the manual medicine therapy, active range of shoulder motion were increased by 30.0o in forward flexion, by 21.2o in abduction, by 11.2o in external rotation, and by 18.7o in internal rotation, respectively. The visual analogue scale was decreased after treatment. None of the subjects complained pain during treatment. The mobility of shoulder joint was improved and the rhythm of scapulohumeral joint was restored.
Conclusion: The manual medicine therapy is an effective, tolerable and noninvasive treatment method for the painful adhesive capsulitis of shoulder.
Objective: To identify psychological disturbance occurring in Duchenne Muscular Dystrophy (DMD) children.
Method: Fifty one DMD children aged from 5 up to 14 years and 51 age matched healthy children were evaluated. Korean child behavioral cheak list (K-CBCL) was used to evaluate psychological problems in DMD and healthy control children. Korean Wechsler Intelligence Scale for children were performed in DMD children to evaluate cognitive function. To evaluate children's functional level, Brooke's scale for upper extremities and Vignos' scale for lower extremities were used. A correlational analysis was performed between age and total IQ score and K-CBCL subscales.
Results: K-CBCL profiles of the DMD children and control group revealed that DMD children obtained significantly lower scores on social, school, total social competence scales (P＜0.01) and significantly higher scores on withdrawn, somatic complaints, anxious/depressed, immaturity, attention problems, internalizing problem, total behavior problems and emotional ability (P＜0.01). Correlations of the age and functional level of the DMD group with each social scale of the CBCL resulted in significant negative relationship on social, school, and total social competence scales (P＜0.01) and significant positive relationship on withdrawn, somatic complaints, anxious/depressed, immaturity, internalizing problems and total behavior problems (P＜0.01). Correlational analysis of IQ score of the DMD group and each scale of the CBCL revealed no significant relationships except school (P＜0.05) and total behavioral problem (P＜0.05).
Conclusion: We concluded that DMD children suffer from wide spectrum of psychological disturbance such as somatic complaints, attention and emotional problems in addition to expected psychological problems due to chronic disease and its progression. Thus, for the successful rehabilitation, these various emotional disturbances need proper treatment.
Objective: Rising from a sitting position is a very common, yet essential activity in daily life. The activity to perform the sit-to-stand (STS) transfer is a prerequisite for upright mobility. This study aims to provide fundamental data concerning the execution of the STS, and in particularly the followings: 1) how do the angles of the lower limbs change throughout the process of rising from a chair; 2) how much motion torque and power in each joint are required per kilogram of body weight to complete the STS transfer?
Method: Twenty-one children who have developed normally and could understand the command requested are involved as subjects. Their age ranged from 3 to 5 years old. Motion analysis of STS transfer were assessed with the Vicon 370 M.A (Oxford Metrics Limited, United Kingdom). The changes in joint angle, maximal moment and power in lower limb were calculated throughout the STS transfer.
Results: A series of transition points was observed in the angles of the hip, knee and ankle joints throughout the sit-to-stand movements, which was classified into five stages. The first stage is trunk and hip flexion phase; second stage, buttock take-off; third stage, ankle dorsiflexion and knee extension; forth stage, just-standing; fifth stage, stabilizing phase. The extension moment of each joint is 0.65 Nm/kg on right, 0.71 Nm/kg on left in hip, 0.41 Nm/kg on right, 0.38 Nm/kg on left in knee and 0.21 Nm/kg on right, 0.22 Nm/kg on left in ankle joint. The extension power is 0.60 watt/kg on right, 0.68 watt/kg on left in hip, 0.59 watt/kg on right, 0.50 watt/kg on left in knee and 0.15 watt/kg on right, 0.15 watt/kg on left in ankle joint.
Conclusion: A consistent pattern was observed throughout the sit-to-stand transfer and six transition points were observed in the angles of the hip, knee and ankle joints throughout the STS transfer. By these 6 points, the movement of the STS transfer was classified into 5 stages. Major changes in angle, moment, and power of each joint were observed in sagittal plane. There were no side to side difference during the STS transfer.
Objective: The aim of this study is to present the basic reference data of age and sex specific gait parameters for Korean adults.
Method: The basic gait parameters were extracted from 70 healthy adults, 38 men and 32women, 21 to 69 years of age using VICON 340 Motion Analyzer.
Results: The temporal gait parameters and kinematic parameters of Korean adults were similar to other western reference data.
Conclusion: Significant sex differences exist in the maximal pelvic tilting, pelvic internal rotation and foot internal rotation and plantar flexion. There is a statistically significant age variability for the hip and knee flexion at stance phase.
Currently the evaluations of upper extremity motion have relied on a task-oriented approach to gain an accurate clinical picture of the functional capacities. As it is, an adequate and objective system to estimate upper extremity function is yet to be developed.
Authors used the virtual reality motion analysis system(VRMAS) which was developed by us for the purpose of investigating the kinematics of upper extremity motion during drinking a cup of water. Four healthy male adult subjects were recruited from the hospital personnels. After each subject sat down on a chair resting against the backrest in a neutral position, in front of a table he was instructed to drink the content of the cup from the table.
The data was analized and showed the following results. While drinking, the hand movements were smooth and linear. There were six distinct stages during drinking a cup of water; a reaching for the cup(stage 1), picking up the cup and carrying the cup to the mouth(stage 2), extending neck and drinking from the cup(stage 3), flexing neck(stage 4), replacing the cup to the table(stage 5), and returning to the start position(stage 6). During the stage 1 and 2, of all joint motions, the shoulder adduction and elbow flexion were most prominent. The stage 3 showed the most complex movements in shoulder flexion, forearm pronation, and wrist extension which were simultaneous. Remaining stages were the reversal of the first three stages. We could observe the ranges of motion of neck, shoulder, elbow, and wrist joint as well as the relationships of these joints at the same time.
In conclusion, VRMAS could be a very useful evaluation tool for the upper extremity motion and for obtaining the kinematic data from the upper extremity motion analysis.
The pendulum test, recognized as a reliable measure of spasticity, has been replaced in this study by a video-based two dimensional motion analysis system. Using twenty five patients with spasticity(21 males, 4 females; mean age 46.6 year-old) in their lower legs due to lesions affecting the central nervous system and twenty two persons without any evidence of hypertonia(all males; mean age 23.4 year-old), five parameters such as relaxation index(RI), amplitude ratio(AR), torque at maximal acceleration velocity, number of swing and swing time were obtained for the purpose of documenting the reliability of the video-based two dimensional motion analysis system for the evaluation of spasticity.
The values of RI(P＜0.05), AR(P＜0.01), and swing time(P＜0.05) in patients with spasticity were significantly lower than control, whereas the value of torque in patients was significantly higher than control(P＜0.01). Spearman's correlation coefficients of the RI(r=0.70894, P＜0.001), AR(r=0.71832, P＜0.001), number of swing(r=0.59037, P＜0.05) and swing time(r=0.59648, P＜0.01) showed a statistically significant negative correlation with the modified Ashworth scale, whereas that of torque(r=0.59037, P＜0.01) showed a significant positive correlation.
In conclusion, a pendulum test using a video-based two dimensional motion analysis system is a simple, and a reliable method for the quantitative evaluation of spasticity.
Measurement of spinal range of motion(ROM) can be effectively used in guiding the direction of therapy, determining the patient's response to rehabilitation treatment and functional assessment. However for a method of measurement to be commonly used in clinical and research settings, it must be easy to perform, rapid and highly reliable. The purpose of this study was to determine the possibility of clinical application of 2-dimensional motion analysis system to measure spinal ROM in patients with low back pain(LBP).
Subjects included 10 healthy males and 10 patients with LBP. Using Electronic Digital Inclinometer (EDI 320) and 2-dimensional motion analysis system, thoracic, lumbar and pelvic ROMs were measured for trunkal flexion, extension, lateral flexion and rotation. Also proportions of decreased ROMs in LBP patients relative to healthy subjects and movement patterns of each spinal segment according to time sequence were investigated.
LBP patients compared to normal subjects showed significantly low spinal ROM(P＜0.05) except thoracic and pelvic ROM for extension. When looking at the change of each spinal ROM in respect to time with motion analysis system, normal subjects showed synchronized and sigmoid motion curve time from the initiation to the end of motion in all areas of spine during 4 motions. LBP patients took longer time from the initiation to the end of each motion, and showed smaller initial change and fluctuation in spinal ROM during each motion compared to normal subjects.
The results of this preliminary study suggest that 2-dimensional motion analysis system can be effectively used for measuring spinal ROM in patients with LBP.
Isotonic exercise occurs when the tension or torque generated by a muscle is constant throughout the movement. In practice it is very difficult to maintain the tension constant. Evaluation of isotonic exercise should include the works of concentric and eccentric contraction and the changes in tension and torque during joint motion. However, optimal evaluation tools for isotonic exercise has yet to be developed.
We authors, used virtual reality motion analysis system(VRMAS) which was codeveloped by us and EMG system(Cardwell Excel). Healthy male adult subjects(n=10) were recruited from hospital personnel. After dominant upper arm and trunk of each subject was fixed with velcro, he was instructed to repeat flexion and extension of his dominant elbow grasping dumbell (9 kg) in hand with maximal velocity as possible as can until the point of exhaustion. We measured the elbow angle, the angular velocity, torque, power, total work and the work of concentric and eccentric contraction during exercise.
The results were as follows: there were four distinct elbow flexor muscle contractions during flexion and extension of the elbow with the first and the second contractions during concentric contraction and the third and the fourth contractions during eccentric contraction. Between the peaks of contraction, motion was maintained due to the momentum that was generated. Of the ten subjects, seven had higher concentric work than eccentric work with the eccentric work being higher in the remaining three. But there was no statistic significance between the works of concentric contraction and eccentric contraction(p>0.05). The biggest work was observed in the fourth contraction, while the third contraction showed the least work(p<0.05).
In conclusion, there were four distinct muscle contractions during elbow isotonic exercise and the works of each muscle contraction were different. This result is contrary to the definition of isotonic exercise. This study also shows that the VRMAS could be a very useful evaluation tool for several types of isotonic exercise.
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