Purpose: The purpose of this study was to investigate the difference in the dynamic balance and leg muscle activity of adults in their 20s with or without shoes. Methods: In this study, seven male and 11 female university students in their 20s were randomized to determine the order of being with or without shoes, and the dominant foot was supported on the central platform of dynamic balance according to the order procedure. Using the opposite foot, the distance of leg stretching in the anterior, posterior medial, and posterior lateral directions and the muscle activity of the supporting leg were measured. Muscle activity measurement sites were attached to the dominant vastus medialis oblique muscle, vastus lateral oblique muscle, tibialis anterior muscle, peroneus longus muscle, and lateral gastrocnemius muscle. Results: As a result of this study, the distance of leg stretching was significantly increased in the anterior, posterior medial, and posterior lateral directions when barefoot rather than when wearing shoes (p < 0.05). The muscle activity of the vastus medial and lateral oblique muscles was significantly increased in all three directions when barefoot rather than when wearing shoes (p < 0.05). The muscle activity of the tibialis anterior was significantly increased in the anterior direction when barefoot (p < 0.05), the peroneus longus muscle was significantly increased when it was barefoot in the posterior medial direction (p < 0.05), and the lateral gastrocnemius muscle activity significantly increased when barefoot in the posterior direction (p < 0.05). Conclusion: The movement of the legs is freed when barefoot as compared to when wearing shoes, and being barefoot can effectively activate muscle activity and improve balance ability.

Purpose: This study investigated the correlation between physical function and forward head posture in spastic diplegia. Methods: The subjects of this study were 10 spastic diplegia patients. We took pictures of the subjects' craniovertebral angle with a digital camera to determine the degree of forward head posture and then analyzed them using the NIH image J program. The physical function test used the TCMS, the BBT, and a spirometer. The data in this study were measured using SPSS version 23.0, and the statistical significance level α was 0.05. A Pearson correlation coefficient analysis was performed to identify the correlation between the degree of the subject's head forward position and physical function. Results: When we performed the BBT and spirometer tests, the subjects' forward head postures were not correlated (p < 0.05). However, with the TCMS, there was a strong correlation between the forward position of the head and balance, with balance decreasing as the head position increased (p < 0.05). Conclusion: Spastic diplegia patients with severe forward head posture showed problems with static balance, dynamic balance, and equilibrium reaction when sitting. Intervention on the right posture and preventive activities will be needed to improve the health of spastic diplegia patients and prevent future problems with physical function.

Purpose: The purpose of this study was to compare the effects of underwater and ground-based diagonal pattern exercises on the balance confidence and respiratory functions of chronic stroke patients. Methods: Thirty chronic stroke patients were assigned randomly to an experimental (n = 15) or control (n = 15) group. The experimental group performed an underwater diagonal pattern exercise. The control group performed a ground-based diagonal pattern exercise. Training was conducted once a day for 30 minutes, five days per week for six weeks. Balance confidence was measured using the Activities-Specific Balance Confidence Scale-Korea version. Respiratory function was measured using a spirometer. Results: In a comparison within groups, the experimental and control groups showed significant differences in balance confidence after the experiment (p < 0.05). In a comparison between the two groups, the experimental group showed a more significant difference in balance confidence than the control group (p < 0.05). In a comparison within groups, the experimental group showed a significant difference in respiratory functions after the experiment (p < 0.05). In a comparison between the two groups, the experimental group showed a more significant difference in respiratory functions than the control group (p < 0.05). Conclusion: Based on these results, underwater diagonal pattern exercises effectively improved the balance confidence and respiratory functions of chronic stroke patients.

Purpose: The purpose of this research was to investigate the effects of performing Pilates exercises for eight weeks on the isokinetic trunk strength and balance of female middle school students with lumbago. Methods: Twenty-four female students who met the test requirements were recruited and randomly divided into a control group (CG, n = 16) and a Pilates exercise group (Pilates group; PG, n = 8). The PG performed a Pilates program, which consisted of lumbar muscle strengthening exercises, for 60 minutes three times a week for eight weeks. Data analysis was conducted by two-way repeated ANOVA, and a Bonferroni test was carried out when significant differences appeared. The alpha level was set at 0.05. Results: Following the experimental treatment, the PG showed an increased trunk flexion peak torque of 17% and 13% at angular velocities of 180°/sec and 300°/sec, respectively. The intergroup comparison showed no significant difference at pre-measurement, while the PG increased about 31% (180°/sec) and 15% (300°/sec) higher than the control group at post-measurement. Following the experimental treatment, the PG showed an increased trunk extensor peak torque of approximately 29% and 21% at angular velocities of 180°/sec and 300°/sec, respectively. The intergroup comparison showed no significant difference at pre-measurement, while the PG increased approximately 27% (180°/sec) and 15% (300°/sec) higher than the control group at post-measurement. Both the CG and the PG showed a 20% and 50% decrease in pain index after the experimental treatment, respectively. After the experimental treatment, the PG had about 50% lower pain than the CG. The average error rate of static balance in the PG reduced by 19% from 3.28±0.45 to 2.65±0.36, confirming a significant improvement. Conclusion: Regular Pilates exercise for eight weeks improved the isokinetic trunk muscle strength of female middle school students with lumbago and relieved their pain. Pilates was also shown to be effective in improving balance.

Purpose: Neurodynamic tests are used to examine neural tissue in patients with neuro-musculoskeletal disorders, although this has not yet been established in the intensity of nerve tension application. This study aimed to investigate the acute effects of neural stretching intensity on nerve excitability using the latency and amplitude of nerve conduction velocity test (NCV) analysis. Methods: Thirty young, healthy male and female subjects (mean age = 21.30 years) voluntarily participated in this study. Nerve excitability was assessed using the median sensory NCV test. The latency and amplitude of the NCV test were measured under four different conditions: reference phase (supra-maximal stimulus, without neural stretching), baseline phase (2/3 of the supra-maximal stimulus, without neural stretching), weak stretch phase (2/3 of the supra-maximal stimulus, with weak neural stretching), and strong stretch phase (2/3 of the supra-maximal stimulus, with strong neural stretching). Results: The NCV latency was significantly delayed after one minute of neural stretching at the baseline, weak phase, and strong phase in comparison with the reference phase. The NCV latency was significantly delayed by increasing the strength of neural stretching. Furthermore, the NCV amplitude was significantly increased at the weak and strong phases, which were under neural stretching, in comparison with the baseline phase. The NCV amplitude was significantly increased by increasing the strength of the neural stretching. Conclusion: Transient neural stretching as a neurodynamic test can increase the sensitivity of the nerve without negatively affecting the nervous system. However, based on the results of this study, strong neural stretching in the neurodynamic test may delay the transmission of nerve impulses and hypersensitivity.

Purpose: This study investigated the immediate effects of a figure-8 shoulder brace and taping intervention on round shoulder posture, thoracic kyphosis, and chest expansion mobility in forward head posture. Methods: Thirty patients with forward head posture were assigned randomly to the figure-8 shoulder brace group (n = 15) or the taping intervention group (n = 15). Patients were assessed for forward head posture, shoulder posture, thoracic kyphosis, and chest expansion. Results: The figure-8 shoulder brace and taping intervention groups showed a significant difference for forward head posture, shoulder posture, and thoracic kyphosis after the experiment (p < 0.05). There was no significant difference between the groups (p > 0.05). Conclusion: These results suggest that a figure-8 shoulder brace and taping intervention has a positive effect on rounded shoulder posture, thoracic kyphosis, and chest expansion in patients with forward head posture.

Purpose: This study aimed to compare the contraction ratios of the abdominal muscles and the preferential activation ratios of the transversus abdominis muscle (TrA) during the abdominal drawing-in maneuver (ADIM) in the hook-lying, sitting, and standing positions. Methods: This study included 30 healthy participants. The thicknesses of the TrA, internal oblique muscle (IO), and external oblique muscle (EO) were measured at rest and during the ADIM in the hook-lying, sitting, and standing positions using B-mode ultrasound imaging. The contraction ratios of these muscles and the preferential activation ratios of the TrA were calculated for each position. Results: The contraction ratio of the TrA and preferential activation ratio of the TrA during the ADIM in the hook-lying position were significantly higher than those in the sitting and standing positions (p < 0.05). The contraction ratio of the TrA during the ADIM in the sitting position was significantly higher than that in the standing position (p < 0.05). Conclusion: The hook-lying position tended to facilitate TrA activity better than the sitting position. Furthermore, the sitting position tended to facilitate TrA activity better than the standing position. These findings suggest that the ADIM in the hook-lying position should be implemented before that in the sitting position and that the ADIM in the sitting position should be implemented before that in the standing position.

Purpose: This study was conducted to investigate the type of physical therapist response work and its intensity, along with the prolonged prevalence of COVID-19, to determine the impact on physical therapists' occupational stress and occupational burnout. Methods: An online survey was conducted with 118 physiotherapists and collected the participants' gender, final educational background, clinical work experience, workplace type, additional workload, and fatigue associated with COVID-19. After excluding one participant who submitted an incomplete questionnaire, 117 respondents were included in the final data. Results: Additional COVID-19-related workloads and response reliability for fatigue, occupational burnout, and occupational stress were shown to have Cronbach's alpha measures of 0.76, 0.89, and 0.87, respectively. Groups who had experienced a new epidemic in the past showed higher fatigue levels (3.06±0.94) than those groups who had no such experience (2.49±0.84; p < 0.05). Correlation analysis of COVID-19 work fatigue and occupational burnout scales showed a positive correlation (r = 0.19; p < 0.05). The regression of occupational burnout and occupational stress showed a regression model of Y = 20.00+0.43X₁ (X₁: job stress; p< 0.05) and an explanatory power of 24.8% with an adj.R² = 0.25. Conclusion: Based on the results, it is suggested that various institutions, such as medical institutions, educational institutions, and physiotherapists' associations, should seek ways to manage and alleviate physiotherapists' stress.

Purpose: The purpose of this study was to determine the changes in foot contact area and pressure when walking with a functional insole that emphasizes the Hallux point as compared to a general insole. Methods: In this study, an experiment was conducted to investigate changes in plantar pressure and contact area for a functional insole that emphasized the Hallux point as compared to a general insole. A lower extremity robot was used for walking reproduction. First, the gait sequence according to the two insoles was determined through a randomized controlled trial comparison. According to the sequence procedure, the insole was attached to the shoe and then worn on the right side of the lower extremity robot for gait reproduction at a normal gait speed of 20 steps per minute. After programming the robot to walk, the experiment was carried out. The result value was determined by averaging the pressure and area data of the fore and rear foot measures after walking at 20 steps per minute. Results: The functional insole that emphasized the hallux point significantly increased the forefoot and rearfoot contact area (p < 0.05) and significantly decreased the forefoot and rearfoot contact pressure (p < 0.05) compared to the general insole. Conclusion: A functional insole that emphasizes the hallux point does not collapse the medial longitudinal arch during gait, increasing foot stability and reducing fatigue. Thus, this functional insole needs to be widely used clinically.

Purpose: The purpose of this study was to observe office workers' postural behaviors during computer work to identify the risk factors for head and thorax postural behaviors. Methods: The participants included 57 office workers who worked longer than 20 hours on a computer. Postural behaviors during computer work were measured using 3-D wearable motion sensors on the forehead and sternum. A multivariate linear regression model evaluated the association between various risk factors (neck pain, demographics, and environmental factors) and non-head and thorax postural behaviors. Results: The participants maintained their head and thorax in neutral postures (defined as 10° extension~10° flexion and 5° extension~10° flexion, respectively) for 24.7% and 39.3% of the total recorded time. Those who reported neck pain at the measurement of postural behaviors showed less time spent in thorax postures. Current neck pain, high desk height, and the distance between the keyboard and the edge of the desk (cm) were found to be related to less time spent in a neutral thorax posture. Conclusion: Office environment factors and current neck pain might affect workers' thorax postures, which might also determine the orientation of head postures during computer work.

Purpose: This study aimed to adjust the craniovertebral angle and shoulder alignment through shoulder and abdominal stabilization exercises in adults with a forward head posture. Methods: The study participants were 29 adults with a forward head posture, and they were randomly divided into the following groups: 14 participants in a combined exercise group that used shoulder and abdominal stabilization exercises and 15 participants in a shoulder exercise group that used just shoulder stabilization exercises. The participants performed the stabilization exercises for 30 minutes per day, three times a week for five weeks. Results: There were significant differences in the craniovertebral angle after intervention in the shoulder stabilization exercise group (p < 0.05). There were significant differences in the craniovertebral angle and location of the right root of the spine and both inferior angles before and after intervention in the shoulder and abdominal stabilization exercise group (p < 0.05). There was a significant difference in the location of the right root of the spine and the left inferior angle between the groups at the post-test (p < 0.05), and there was a larger change in the shoulder and abdominal stabilization exercise group. Conclusion: There was a significant difference in the craniovertebral angle and a partially significant difference in shoulder alignment before and after intervention in both groups.

Purpose: This study aimed to investigate changes in gait variables depending on whether a task was performed using a smartphone while walking on a ramp. Methods: The participants of this study were 41 college students attending U University located in Gyeongju City, Gyeongsangbuk-do. In this study, gait variables were measured during ramp gait while using a smartphone to perform a task and during ramp gait without performing such tasks. In other words, four walking conditions were used: 1) walking up a ramp, 2) walking up a ramp while using a smartphone to perform a task, 3) walking down a ramp, and 4) walking down a ramp while using a smart phone to perform a task. Gait variables were measured using a gait analysis tool (Legsys; BioSensics, USA), and stride time, stride length, stride velocity, cadence, and double support were analyzed. The order of measurements was randomized to control for order effects due to repeated measurements. Results: The comparative analysis of gait variables according to the presence or absence of smartphone use during ramp gait showed that there were significant differences in stride time, stride length, and stride velocity during both ramp ascent and ramp descent (p < 0.05). In both ramp ascent and ramp descent, stride time increased when walking using a smartphone, compared to when walking without using a smartphone (p < 0.05). However, in both ramp ascent and ramp descent, stride length and stride velocity were decreased when walking using a smartphone compared to when walking without using a smartphone (p < 0.05). Conclusion: The study results showed that the use of a smartphone during walking can affect safety. Therefore, it is necessary to improve the awareness of risks associated with walking while using a smartphone, and further research needs to be conducted in various environments and with different ramps.

Purpose: This study aimed to investigate effective cueing methods for selective muscle activation of the serratus anterior. Methods: Based on the inclusion criteria, 26 healthy adults, both males and females, were recruited for the measurement of muscle activation of the upper trapezius and serratus anterior muscles while performing basic movements in knee push-up plus (KPP) and dynamic hug (DH) positions using five different cueing methods. An electromyogram was used to measure muscle activation, and both muscle activation and muscle ratio (serratus anterior/upper trapezius) were compared during the basic movements and different cueing methods. The cueing methods were trapezius verbal cueing, trapezius verbal cueing + trapezius tactile cueing, emphasis verbal cueing, serratus anterior tactile cueing, and trapezius verbal cueing + trapezius tactile cueing + serratus anterior tactile cueing. Results: The results of the study showed that there was a significant difference in the muscles for the two exercises (p < 0.05). There was also a significant difference between the cueing methods (p < 0.05). The correlative effect between the muscles and cueing methods was also significant (p < 0.05). The muscle ratio in trapezius verbal cueing + trapezius tactile cueing + serratus anterior tactile cueing during KPP and DH was higher than in basic movements and other cueing methods. This confirms that trapezius verbal cueing + trapezius tactile cueing + serratus anterior tactile cueing is an effective cueing method for selective activation of the serratus anterior during KPP and DH. This study also demonstrated that cueing by a therapist may both increase and decrease selective muscle activation. Conclusion: Through this study, an effective cueing method to selectively activate the serratus anterior may be suggested, and the results of this study may provide basic information regarding future studies and clinical practice.

Purpose: This study aimed to develop new digital navicular drop test (ND-NDT) equipment and to determine its validity and reliability. Methods: A total of 24 healthy male and female adults, who fully understood the purpose of the study and gave consent to participate in the study, were selected as participants. The NDT and ND-NDT were conducted in the dominant foot of the participants in a random order. For the NDT, the position of the navicular bone was marked with a pen first; then, the height of the navicular bone from the ground was measured in both sitting and standing positions. For the ND-NDT, after the sticker-type reflection markers were attached to the position of the navicular bone, the height of the navicular bone from the ground was measured in both sitting and standing positions. To assess the validity of the diagnostic tests, the same examiner measured the height of the medial longitudinal arch (MLA) three times in both the sitting and standing positions. To assess the inter-rater reliability of the ND-NDT, three examiners, in a random order, attached the sticker-type reflection markers to the position of the navicular bone and then measured the height of the MLA in both positions. Results: In the sitting position, the Pearson correlation coefficient (r) between the two diagnostic tests was very high (r = 0.97) and statistically significant. In the standing position, the Pearson correlation coefficient (r) between the two tests was 0.95, which was also statistically significant. The ICC_2,1 values in the sitting and standing positions were 0.93 and 0.95, respectively, indicating significantly high inter-rater reliability. Conclusion: The ND-NDT equipment showed very high diagnostic validity, as well as excellent inter-rater reliability, indicating the clinical usefulness of the equipment as a diagnostic system for confirming pes planus.

Purpose: Gait training for stroke patients focuses on adjusting to new environments to facilitate outdoor walking. Therefore, the purpose of this study was to identify the effects of various ground obstacle walking combined with treadmill walking on the gait parameters and functional gait ability of chronic stroke patients. Methods: Twenty-four chronic stroke patients were divided into two groups: an experimental group (n = 12) and a control group (n = 12). The experimental group received a combined gait training using various ground obstacle walking and treadmill walking (VGOW) five times/week for four weeks. The control group received traditional treadmill training (TW) five times/week for four weeks. Patients were evaluated using the figure-8 walk test (F8WT) and the Functional Gait Assessment (FGA) before and after each intervention. Results: The ANCOVA results showed that both treatments significantly influenced F8WT steps, F8WT time, and FGA score. The paired t-test results showed a significant improvement in F8WT steps, F8WT time, and FGA score in the experimental group compared to those in the control group. Conclusion: Combined gait training using various ground obstacle walking and treadmill walking can improve gait ability in chronic stroke patients.