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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 evaluate the effects of rowing exercise on body composition, laboratory data, fitness and scoliosis in visually impaired people. The majority of visually impaired people do not participate in active sports due to efficiency and safety issues. Rowing is a safe whole-body exercise with aerobic and anaerobic components.
Twenty subjects were recruited from among those admitted to a facility for visually impaired people (16 men and 4 women). Laboratory data, body composition, physical fitness, Cobb's angle, and fall index were checked before and after 6 weeks (5 days a week) of indoor rowing using Concept2 Model E.
After the training, fat mass and total body fat percent decreased significantly. In the fitness test, back strength and trunk flexion score increased significantly. Laboratory data showed significant increases in serum protein and albumin and decreases in low-density lipoprotein (LDL) cholesterol. There were 9 subjects with scoliosis and after the training Cobb's angle decreased by 1.11°±1.55°, though this was not statistically significant.
Visually impaired people frequently have abnormal body composition, low physical fitness, and scoliosis. A rowing exercise program can be helpful, with a positive effect on body composition and physical fitness; however, with respect to scoliosis, we need an earlier intervention program in visually impaired people.
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To compare the differences of diagnostic rates, of the two widely used test positions, in measuring vestibular evoked myogenic potentials (VEMP) and selecting the most appropriate analytical method for diagnostic criteria for the patients with vertigo.
Thirty-two patients with vertigo were tested in two comparative testing positions: turning the head to the opposite side of the evaluating side and bowing while in seated position, and bowing while in supine positions. Abnormalities were determined by prolonged latency of p13 or n23, shortening of the interpeak latency, and absence of VEMP formation.
Using the three criteria above for determining abnormalities, both the seated and supine positions showed no significant differences in diagnostic rates, however, the concordance correlation of the two positions was low. When using only the prolonged latency of p13 or n23 in the two positions, diagnostic rates were not significantly different and their concordance correlation was high. On the other hand, using only the shortened interpeak latency in both positions showed no significant difference of diagnostic rates, and the degree of agreement between two positions was low.
Bowing while in seated position with the head turned in the opposite direction to the area being evaluated is found to be the best VEMP test position due to the consistent level of sternocleidomastoid muscle tension and the high level of compliance. Also, among other diagnostic analysis methods, using prolonged latency of p13 or n23 as the criterion is found to be the most appropriate method of analysis for the VEMP test.
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To compare effectiveness on correcting cranial and ear asymmetry between helmet therapy and counter positioning for deformational plagiocephaly (DP).
Retrospective data of children diagnosed with DP who visited our clinic from November 2010 to October 2012 were reviewed. Subjects ≤10 months of age who showed ≥10 mm of diagonal difference were included for analysis. For DP treatment, information on both helmet therapy and counter positioning was given and either of the two was chosen by each family. Head circumference, cranial asymmetry measurements including diagonal difference, cranial vault asymmetry index, radial symmetry index, and ear shift were obtained by 3-dimensional head-surface laser scan at the time of initiation and termination of therapy.
Twenty-seven subjects were included: 21 had helmet therapy and 6 underwent counter positioning. There was no significant difference of baseline characteristics, head circumferences and cranial asymmetry measurements at the initiation of therapy. The mean duration of therapy was 4.30±1.27 months in the helmet therapy group and 4.08±0.95 months in the counter positioning group (p=0.770). While cranial asymmetry measurements improved in both groups, significantly more improvement was observed with helmet therapy. There was no significant difference of the head circumference growth between the two groups at the end of therapy.
Helmet therapy resulted in more favorable outcomes in correcting cranial and ear asymmetry than counter positioning on moderate to severe DP without compromising head growth.
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To investigate associations between angiotensin-converting enzyme (ACE) polymorphisms and muscle fatigability in 65-year-old Koreans.
The study participants were 49 Koreans aged 65 years. ACE insertion/deletion (I/D) polymorphisms were determined by polymerase chain reaction and serum ACE activity, by spectrophotometry. Body mass index (BMI), body fat mass (BFM), and lean body mass (LBM) were determined. To evaluate muscle fatigability, dynamic Electromyography was used to measure maximum voluntary isometric contractions (MVICs) of ankle plantar flexor muscles. Patients were seated with their hips flexed at 90°, knees fully extended, and ankles at 0°. Continuous submaximal VICs (40% MVIC) were then performed, and contraction duration and EMG frequency changes during the initial 2 min were measured. A self-reported physical activity questionnaire was used to evaluate effects of ACE activity levels on muscle fatigability.
Among the 49 volunteers, 15 showed II genotype; 22, ID genotype; and 12, DD genotype. Serum ACE activity levels were significantly higher in DD genotype subjects than in II genotype subjects (p<0.05). Furthermore, the duration of submaximal isometric contractions was longer in II and ID genotype subjects than in DD genotype subjects (p<0.05). Dynamic EMG showed significantly lower mean frequency changes in II genotype subjects than in DD genotype subjects (p<0.05). However, LBM, BFM, and BMI were independent of ACE genotypes.
ACE II genotype subjects showed significantly higher resistant to muscle fatigue than that by DD genotype subjects. However, body composition and BMI showed no correlations with ACE I/D polymorphisms.
Citations
Objective: The purpose of this study was to know the correlation between resting calcaneal stance position (RCSP) and height-length (H/L) ratio of foot.
Method: Both feet of 173 persons who visited the Department of Rehabilitation Medicine, Chungnam National University Hospital were included in the study. Their mean age was 23.6 years old. H/L ratio, RCSP and navicular angle of 346 feet were measured. All people were divided into 3 groups, such as, normal foot (2o≤RCSP≤2o), rear foot valgus (RCSP＜2o) and rear foot varus (RCSP＞2o) according to the angle of RCSP. And the relationship between RCSP and H/L ratio were evaluated. Independent T-test, ANOVA and Pearson correlation of SPSS was used for statistical data processing.
Results: The mean H/L ratio of rear foot valgus was 0.2206, noraml foot 0.2440 and rearfoot varus 0.2625. H/L ratio and navicular angle showed significant increase in each RCSP groups in order of rear foot angle.
Conclusion: H/L ratio and RCSP showed strong positive correlation and the value of H/L ratio in normal group was 0.2440⁑0.0114 (Mean⁑S.D.). H/L ratio is easily acceptable parameter in human mechanics or orthotic field of rehabilitation. (J Korean Acad Rehab Med 2002; 26: 591-597)
The reference values of motor unit action potentials(MUAP) of first dorsal interosseous and tibialis anterior muscles were measured in 50 healthy subjects. The MUAPs were recorded with a concentric needle electrode and extracted with a decomposition method. Sixty six patients with neuropathy were also studied in the same way with a count of outliers and measurement of mean values.
The mean values of amplitude, area, duration and thickness were 667.74±204.34 ՌV, 992.26±253.18 ՌVms, 9.75±1.95 ms and 1.49±0.26 ms, respectively in the first dorsal interosseous muscles, and 612.88±140.13 ՌV, 1172.84±199.21 ՌVms, 11.41±2.48 ms and 1.93±0.34 ms respectively in the tibialis anterior muscles. There was no significant difference in age and gender of normal subjects. The amplitude was the most sensitive parameter to detect abnormality in a count of outliers and measurement of mean values. The outliers count in duration showed a higher sensitivity than the measurement of mean values(p＜0.05), but not in amplitude, area or thickness.
Based on the results of this study, the count of outliers was more sensitive than the measurement of mean values in the diagnosis of patients with neuropathy. Further more, less numbers of MUAPs were needed for the evaluation of the outliers count. Through this method we could save the evaluation time and the patients felt more comfortable.
Objective: This study was designed to investigate the effect of forearm position on the maximal isometric voluntary supination and pronation strengths and EMG activities in the related muscles.
Method: The maximal isometric supination and pronation strengths were measured in 14 normal male subjects using Work simulatorⰒ at 4 different forearm rotation position. EMG activities were simultaneously measured in supinator and biceps brachii during supination and pronator quadratus and pronator teres during pronation.
Results: The maximal isometric supination strength and EMG activities of biceps brachii and supinator were significantly higher as the forearm was more pronated (p＜0.05). The maximal isometric pronation strength and EMG activi-ties of pronator teres were significantly higher as the forearm was more supinated (p＜0.05). The maximal isometric supination and pronation strengths were higher in the dominant side than those of the nondominant side (p＜0.05) and EMG activities of pronator teres and supinator were higher in the dominant side than in the nondominant side (p＜0.05).
Conclusion: The supination and pronation strengths and EMG activities of related muscles were influenced by the forearm rotation position. Therefore the forearm position should be considered in evaluation of upper limb strength and function, and rehabilitation of upper extremity for improving strength and minimizing the overuse of supination and pronation. (J Korean Acad Rehab Med 2002; 26: 432-438)
Objective: The purpose of this study is to analyze the distribution of plantar pressure in six balletpositions and to compare those between the skilled and unskilled ballet dancers.
Methods: Thirty eight feet of healthy ballerina were evaluated by EMED-SF (Novel GMBH Inc. Ger.) system to analyze six positions of ballet. At each position, we estimated the static and dynamic positions. The forefoot was divided into 6 different zones on the basis of head of metatarsal bones. The degree of discipline was assessed by 3 expert ballerina.
Results: In each position, there were significant peak pressure distribution areas. In the skilled ballerina, there was less difference in peak pressure between the static and dynamic positions in comparision with the unskilled ballerina. In the skilled ballerina, more forces are distributed to M6 area in releve position and to M3 and M6 areas in turnout positions.
Conclusion: Six basic ballet positions could be analyzed by plantar pressure measurement. There were some differences in the distribution of planter pressure in some ballet positions between the skilled and unskilled ballet dancers.
Method: 20 hemiplegic patients (right: 10, left: 10) were evaluated LSST in resting position at three different points (T2-Superior Angle, T3-Scapular Spine, T7-Inferior Angle) in three times of the both shoulder. Muscle power of shoulder, Brunnstrom stages, spasticity, subluxation degrees using X-ray studies and ROM pain degrees using Visual Analog Scale (VAS) were also evaluated to examine the clinical correlation.
Results: This study showed the evidence of positive correlation with LSST and shoulder subluxation, ROM pain degrees using VAS at T7-inferior angle (p＜0.05), and negative correlations with LSST with shoulder abduction muscle power and Brunnstrom stage. But, there were no correlations with shoulder spasticity and hemiplegic side.
Conclusion: This study provided LSST can be a useful predictor of shoulder subluxation and it supposed that the glenoid fossa on the affected side was upward rotated compared to the unaffected side. (J Korean Acad Rehab Med 2003; 27: 819-823)
Method: 15 healthy adults were recruited as subjects. We applied two hot packs to the lumbar region for two consecutive days. On the first day, the body part was on the top of hot pack and on the second day, the hot pack was placed over the body part. We measured peak skin temperature, skin temperature elevation, time required to peak skin temperature, skin temperature after 20 minutes and visual analogue scale(VAS) of subjective feeling of heat (hot).
Results: In the peak skin temperature, the means were 44.4⁑0.70oC and 42.7⁑ 0.99oC in the supine and prone position, respectively. In the skin temperature elevation, the means were 11.2⁑1.1oC and 9.5⁑1.6oC, respectively. In the time required to peak skin temperature elevation, the means were 6'49"⁑15" and 10'33"⁑ 15", respectively. In the skin temperature after 20 minutes, the means were 42.4⁑ 0.7oC and 41.6⁑0.8oC, respectively. In the VAS of subjective feeling of heat (hot), the means were 8.66⁑1.11 and 5.72⁑1.48, respectively.
Conclusion: The patient's position is one of the important factors in determining temperature elevation. Therefore, it should be considered during application of the hot pack.
Method: Ulnar motor nerve conduction studies were performed bilaterally in twenty healthy adult volunteers. For each limb, nerve conduction study was carried out in two different positions. In the first position, shoulder were abducted, elbow and wrist flexed to 90o. For the second position, all joints were kept constant except for the wrist where it was extended. Routine conduction study was performed in both wrist positions. All data were statistically analyzed.
Results: The average conduction velocities in the wrist flexed position were 61.6 m/sec for the forearm segment and 62.3 m/sec across elbow. With the wrist extended, the average was 62.6 m/sec and 64.1 m/sec, respectively. The differences in conduction velocities between two different wrist positions were statistically significant (p＜0.05). In the wrist flexed position, the average measured latencies were 2.3 msec with wrist, 5.4 msec below elbow, and 7.4 msec above elbow stimulation, compared to wrist extended which showed 2.4, 5.4 and 7.2 msec, respectively. The difference of latencies at wrist between the two wrist positions was statistically significant (p＜0.05).
Conclusion: The authors conclude that wrist position affect ulnar nerve conduction velocity.
Objective: The purpose of this study was to evaluate the incidence of inability to flex proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint in normal Koreans. The opposition palm ratio and thumb index ratio was also of interest.
Method: Randomly selected eighty nine normal Korean adults of 48 men and 41 women, with ages 20 to 79 years. The finger flexion was measured using the standard flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) screening tests. Thumb index ratio and opposition palm ratio was also assessed additionally.
Results: In the sample population, 2 subjects (2.2%) were unable to bilaterally flex their fifth PIP joints independently. Four subjects (4.4%) were unable to flex one or both of their fourth or fifth DIP joints. These results show far less incidence of FDS dysfunction comparing with 52% of FDS dysfunction rate in Americans. The opposition palm ratio in men were 63.6% and in women 69.9%, indicating lower ratio in men. The thumb index ratio was not different statistically between the men and women.
Conclusion: These data suggest that the different incidences of FDS and FDP dysfunction should be considered in interpretation. The opposition palm ratio and thumb index ratio might be useful in the hand rehabilitation.
Objective: The purpose of this study is to find the proper feeding posture for the safe liquid meal in the patients with neurogenic dysphagia.
Method: Fifty patients of neurogenic dysphagia with tracheal aspiration diagnosed with the videofluoroscopic swallowing test (VFST) were evaluated. VFST using 5 cc of barium solution was done for each patient in the sitting and supine position. The results of VFST of supine position were analyzed and compared with those of sitting position for the tracheal aspiration, laryngeal penetration, premature leakage, and laryngeal spillage.
Results: The incidence of premature leakage, tracheal aspiration, and laryngeal penetration is significantly decreased in the supine position (56%, 14% and 46%) compared to the sitting position (96%, 100% and 100%) (p＜0.001). The incidence of laryngeal penetration referable to the swallowing reflex is significantly decreased in the supine position (0%, 46%, 0%) compared to the sitting position (14%, 96%, 44%) (p＜0.001). The incidence of nasal regurgitation is 2% in the sitting position and 30% in the supine position.
Conclusion: The incidence of tracheal aspiration of liquid diet is significantly decreased in the supine position compared to the sitting position. The supine position would be safer than the sitting position in the feeding of liquid diet.
Objective: The purpose of this study is to determine the proper hand position during driving by measuring of the wheel rotation strength according to the wheel angle and hand position to the wheel.
Method: BTE Work Simulator was used to measure the clockwise and counter clockwise static wheel rotation force of twenty healthy men in three different hand position (2∼10 spot, 3∼9 spot, and 4∼8 spot) and two different wheel angle (45o and 60o, average and peak force were measured during maximal isometric contraction.
Results: The average and peak force was significantly different by the wheel angle, and hand position (p＜0.01), but the direction of rotation didn't an effect on the rotation force. The hand position was the most significant factor, especially wheel rotation force at 2∼10 spot hand position was significantly lower than that of 3∼9 spot and 4∼8 spot (p＜0.05). The rotation force by the wheel angle was influenced by hand position, and lower in 60o wheel angle in the 2∼10 spot (p＜0.05).
Conclusion: The rotation force of wheel was influenced by the hand position. Therefore proper hand position is recommended during driving to reduce muscle fatigue.
Objective: To determine whether flexion and extension of the wrist joint produce the change in the conduction study of the median nerve in the normal and diabetic patients, and to compare the susceptibility of median nerve compression injury in two groups.
Method: Thirty healthy adults as control and thirty diabetic patients without carpal tunnel syndrome were studied. The wrist joint was maintained in flexion or extension position for 5 minutes before performing conduction study. The variables used for statistical analysis included the mean difference of amplitude and latency in median motor and sensory responses in neutral, flexion, and extension positions.
Results: The results showed that significant differences in the latency and amplitude of median motor and sensory responses between neutral, extension, and flexion of wrist within each group (p＜0.01). The differences in the median sensory latency (p＜0.01), amplitude (p＜0.05) and the change of wrist-palm segmental conduction velocity (p＜0.01) were statistically significant between the diabetes and the normal control.
Conclusion: The results of this study suggest that median nerves are susceptible to compression pressure in diabetic patients. Therefore, the position of the wrist joint should be considered in the median nerve conduction study.
In diagnosis of carpal tunnel syndrome, there are many techniques with high sensitivity. Among them, the median-radial latency difference(MRLD) is one of the most useful technique in screening mild carpal tunnel syndrome with high sensitivity, no painful discomfort to patients and no motor artifact.
In this study, we examined the effect of the thumb position(radial abduction and adduction) on the MRLD. Because the stimulation sites of the median sensory and superficial radial nerves are different from each other, the free movement of the thumb in this examination is not avoidable.
The results are 1) there is no significant effect of the thumb position on median sensory latency. 2) There is no significant effect of the thumb position on superficial radial latency. 3) There is significant effect of the thumb position on MRLD(P<0.01). Therefore, if we diagnose the mild carpal tunnel syndrome with MRLD, the thumb position must be maintained in neutral position through the examination.
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