Purpose: This systematic review aims to determine whether robot-assisted training is more effective in gait training for persons with subacute hemiparetic stroke. Methods: This study adopted a systematic review study design focused on subacute hemiparetic stroke, and four core academic databases were searched until June 11, 2021, for relevant studies, including PubMed, Embase, the Cochrane Library, and ProQuest Central. The review included randomized controlled trials (RCTs) evaluating the effects of robotic-assisted training on gait performance in persons with a diagnosis of subacute hemiparetic stroke. The selected RCT studies were qualitatively synthesized based on the population, intervention, comparison, outcome, settings, and study design (PICOS-SD). Results: The study selected five RCTs involving 253 subacute hemiparetic stroke patients and performing robotic-assisted gait training using the following devices: the Lokomat, Morning Walk, Walkbot, ProStep Plus, or Gait Trainer II. Five RCTs were eligible for the meta-analysis after quantitative synthesis, and the results showed that the robot-assisted gait training group had a greater gait performance than the control group based on the 10-meter walk test, Berg balance scale, Rivermed mobility index, functional ambulation category, and modified Barthel index. Conclusion: The results of this study showed that the gait performance of subacute hemiparetic stroke patients changes throughout robot-assisted gait training, but there were no indications that any of the clinically relevant effects of robot-assisted training are greater than those of conventional gait training. Further, the small sample size and different therapeutic intensities indicate that definitive conclusions could not be made.

Purpose: This study aims to compare the effects of obstacle walking training combined with cognitive tasks on balance, gait, and activities of daily living in patients with stroke. Methods: A single-subject design was used, where one stroke patient participated. Obstacle walking training combined with cognitive tasks was performed for 1 hour per day for a total of 10 times during the intervention phase. The subjects were measured five times in the baseline phase, 10 times in the intervention phase, and five times in the follow-up phase. The outcome measurements included the Berg balance scale (BBS), the 10-meter walk test (10 MWT), and the Korean modified Barthel index (K-MBI). Results: In this study, the results showed that the 10 MWT scores during the intervention period improved and that this improvement remained, even during the post-period. In addition, BBS and K-MBI values for stroke patients increased significantly after training. Conclusion: The results of this study revealed that obstacle walking training combined with cognitive task training may be helpful to improve balance, gait, and activities of daily living in stroke patients. Therefore, obstacle walking training combined with cognitive tasks is recommended for stroke patients.

Purpose: The aim of this study is to determine the effects of gastrocnemius stretching with talus-stabilizing taping on ankle dorsiflexion and subtalar joint pronation during walking. Methods: In total, 26 subjects with limited ankle dorsiflexion were equally divided into two groups: a gastrocnemius stretching with talus-stabilizing taping group (13 subjects) and a gastrocnemius stretching group (13 subjects). They were assessed according to ankle dorsiflexion and subtalar joint pronation during walking before and after an intervention, which involved two types of gastrocnemius stretches performed three times a week for six weeks. Results: Ankle dorsiflexion was significantly increased in both groups (p<0.05), though the gastrocnemius stretching with talus-stabilizing taping group showed a significantly greater improvement in ankle dorsiflexion than the gastrocnemius stretching group (p<0.05). However, subtalar joint pronation showed no difference between the two groups before and after (p>0.05), also between groups (p>0.05). Conclusion: Gastrocnemius stretching with talus-stabilizing taping is a useful stretching exercise that improves ankle dorsiflexion during walking in subjects with limited ankle dorsiflexion movement.

Purpose: Hallux valgus (HV) is one of the most common chronic foot disorders, occurring when the first toe deviates laterally toward the other toe. HV impairs muscle strength and affects gait function (postural sway and gait speed). Thus, this study aims to investigate using the FDM system the effect of wearing braces on gait while wearing a virtual reality (VR) device. Methods: This study was conducted on 28 healthy adults with HV of 15 degrees or more. To compare differences in walking, depending on whether a toe brace can be worn, the subject walked without wearing anything, walked after wearing the VR device, and walked after wearing the VR device and the toe brace, and the FDM system was used for the gait ability measurement analysis. Results: As a result of a one-way repeated analysis of variance, the walking speed-related variables (cadence, velocity, etc.) in the HV group were higher during comfortable walking. In addition, walking while wearing a VR device and walking while wearing a VR device and a toe brace demonstrated more significant values in terms of six gait parameters (double stance phase, loading response, stage, stage, stage, and stage). The maximum pressure of the forefoot was significantly reduced when walking while wearing a VR device and a toe brace compared to comfortable walking, but in all variables, there was no statistically significant difference between walking while wearing a VR device and walking while wearing a VR device and a toe brace. Conclusion: Orthosis with a VR device during gait (OVG) and gait with a VR device (GVR) affect gait in HV patients. However, there was no significant difference between GVR and OVG. Thus, it is necessary to conduct experiments on various HV angles and increase the duration of wearing the toe brace.

Purpose: Whiplash-associated disorder is often caused by external impact, such as a car accident, and it involves acceleration and deceleration of the flexion and extension of the neck. The purpose of this study is to determine whether the combination of cyrotherapy and a joint mobilization intervention in patients with acute whiplash-associated disorder is effective for pain, cervical range of motion (ROM), and muscle tone in the neck muscles. Methods: In this study, 20 patients with acute whiplash-associated disorder were randomly assigned to two groups. Group A was treated with cyrotherapy for 5 minutes, while group B was treated with cyrotherapy and a joint mobilization intervention. In both groups, visual analogue scale (VAS), neck disability index (NDI), cervical ROM, and muscle tone values were measured pre- and post-intervention. Results: According to the VAS values, both groups showed significant differences pre- and post-intervention (p<0.05), and in both groups, NDI was significantly decreased pre- and post-intervention (p<0.05). Finally, in terms of muscle tone, both groups showed significant changes before and after the intervention (p<0.05). Conclusion: These results showed that cryotherapy and joint mobilization can be effective interventions in patients with whiplash-associated disorder. In addition, to improve the ROM of the cervical joint and reduce NDI, the combination of cryotherapy and joint mobilization is considered more effective than the single intervention of cryotherapy.

Purpose: This study aims to examine the functional difference in the long and short heads of the biceps brachii by investigating the onset time of muscle contractions in the biceps brachii in the supination motion according to whether the flexor of the elbow joint is excluded. Methods: This study was conducted with 21 healthy men aged in their 20s. While performing forearm pronation at an elbow flexion angle of 90 degrees, the onset time of muscle contractions in the long and short heads of the biceps brachii was measured and compared in a posture where the humerus is placed on a table and the posture is lifted against gravity. Using an independent samples t-test, the difference in the onset time of muscle contractions in the long and short heads of the biceps brachii was analyzed. Results: The onset time of the long head was shorter if the flexor activity of the elbow joint was excluded, while that of the short head of the biceps brachii was shorter if it was not excluded. Conclusion: It is noted that the long head of the biceps brachii mainly functions as a supinator muscle, while the short head of the biceps brachii plays a role in stabilizing and maintaining flexion of the elbow joint.

Purpose: The study aims to examine the effects of the proprioceptive neuromuscular facilitation pattern exercise and scrambler therapy on pain, range of motion (ROM), and shoulder dysfunction in breast cancer patients. Methods: In total, 30 breast cancer patients were recruited and randomized to group I (n = 10), group II (n = 10), and group III (n = 10). Pain was measured using a visual analogue scale, ROM was measured using a goniometer, and shoulder dysfunction was measured using a shoulder pain and disability index. Group I practiced the proprioceptive neuromuscular facilitation pattern exercise and underwent scrambler therapy, group II underwent scrambler therapy only, and group III practiced the proprioceptive neuromuscular facilitation pattern exercise only. Results: A within-groups comparison showed that all groups demonstrated significant differences in pain, ROM, and shoulder dysfunction after the experiment (p<0.05). Further, according to a comparison of the three groups, group I showed a more significant difference in effectiveness than groups II and III in terms of pain, ROM, and shoulder dysfunction before and after the experiment (p<0.05). Conclusion: This study showed that the proprioceptive neuromuscular facilitation pattern exercise and scrambler therapy are effective in treating pain, ROM issues, and shoulder dysfunction in breast cancer patients.

Purpose: This study aims to compare hamstring flexibility and pressure pain threshold (PPT) after an intervention with proprioceptive neuromuscular facilitation contract-relax (PNF CR) technique, myofascial release (MFR), and a massage gun (MG), as well as to verify the effectiveness of the MG. Methods: This study recruited 36 participants (22 males and 14 females) with shortening of less than 70 degrees upon a straight leg raise (SLR) test, and they were randomly assigned to one of the PNF, MG, and MFR groups, each of which underwent its own protocol for 30 minutes. Flexibility of the hamstring was measured after the intervention using the active and passive knee extension (AKE and PKE) test, the sit and reach test, and PPT. Results: The AKE and PKE angles significantly decreased, as well as significantly increased in flexibility when each of the PNF, MFR, and MG interventions was performed (p<0.05). In addition, there was no significant difference among groups. However, according to the Cohen's D effect size, the MG demonstrated the largest effect size in AKE (d = 1.41) and PNF demonstrated the largest effect size in PKE (d = 1.66) and flexibility (d = 0.63). Conclusion: All interventions used in our study are effective in increasing hamstring flexibility. Based on the Cohen's D effect size, an MG is beneficial to increase the AKE, whereas PNF CR technique is recommended for increasing PKE and flexibility.

Purpose: This study aims to determine the effect of proprioceptive neuromuscular facilitation (PNF) pectoralis minor stretching and lower trapezius strengthening exercise on posture change, shoulder range of motion (ROM), and pain in rotator cuff repair patients with a rounded shoulder posture (RSP). Methods: Following baseline measurements, the subjects (n = 25) with rotator cuff repair were randomized into two groups: the PNF group (n = 13), which engaged in PNF pectoralis minor stretching and lower trapezius strengthening exercise, and the control group (n = 12), which received traditional physical therapy. Each group participated in the intervention five times per week for two weeks. The RSP values for the postural changes, flexion and abduction ROM, and visual analogue scales (VASs) of both groups were recorded at both pre- and post-intervention. In addition, before and after the intervention, a paired t-test was conducted to compare the within-group changes and an independent t-test to compare the between-group differences. Results: After the two-week intervention, both groups experienced significantly decreased RSP and VAS values (p < 0.05) and a significantly increased ROM (p < 0.05). Meanwhile, the PNF group showed greater improvements in RSP, ROM, and VAS than the control group (p < 0.05). Conclusion: These results suggest that PNF pectoralis minor stretching and lower trapezius strengthening exercise reduce posture and shoulder pain and enhance ROM in rotator cuff repair patients with RSP.

Purpose: The present study aims to investigate the effects of a diagonal exercise pattern on selective activation of the upper extremity muscles using both normalization and isolation methods. Methods: In total, 17 asymptomatic subjects participated in this study. During the two diagonal patterns of exercise (diagonals 1 and 2), muscular activities of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), anterior deltoid (AD), and infraspinatus (IS) were measured. The collected data were analyzed in two ways, according to the dominance of muscle activities (%Isolation) and according to normalized activities (%MVIC). Results: There were significant differences in LT, SA, AD, and IS between %MVIC and %Isolation (p<0.05), and the diagonal 1 pattern of exercise showed significantly more LT activities compared with the diagonal 2 pattern (p<0.05). Further, except for LT, there were no significant differences in muscle activities between the diagonal 1 and 2 exercises. Conclusion: The present study suggests that a diagonal pattern of exercise is advantageous for strengthening shoulder muscles, but caution is needed when applying to patients requiring selective strengthening. Regarding both the concentric and eccentric phases of exercise, there was no significant difference in muscular activation, except in LT, between the two diagonal patterns of exercises.

Purpose: The study aims to determine the effect of a breathing exercise on shoulder pain, range of motion (ROM), and forward head posture in patients with rotator cuff repair. Methods: In total, 25 patients with rotator cuff repair were included in this study. The experimental group (n = 13) underwent a breathing exercise, while the control group (n = 12) received traditional physical therapy. The visual analogue scales (VASs) for pain, flexion and abduction ROM, and the craniovertebral angle (CVA) of both groups were recorded at both pre- and post-intervention. Paired t-tests were used to determine significant changes in the post-intervention compared with the pre-intervention period, and independent t-tests were used to analyze differences in dependent variables between the two groups. Results: After the two-week intervention, the experimental group experienced a significantly decreased VAS (p < 0.05) and significantly increased ROM and CVA (p < 0.05), while the control group experienced a significantly decreased VAS (p < 0.05). Further, the experimental group that underwent the breathing exercise showed greater improvements in flexion and abduction ROM and in the CVA than the control group (p < 0.05). Conclusion: The results suggested that a breathing exercise can reduce shoulder pain and enhance ROM and posture in patients with rotator cuff repair.

Purpose: The aim of this study is to compare the immediate effects of weight-assisting methods on vastus medialis oblique (VMO) and vastus lateralis (VL) muscle activation, on the VMO/VL muscle activation ratio, and on muscle onset time in healthy subjects when ascending stairs. Methods: Healthy participants were randomly assigned to the belt group (n = 11), hand group (n = 11), and control group (n = 11). In the belt group, a belt was wrapped around the sacrum and pulled forward with both hands, moving the center of weight forward, while ascending stairs. The hand group grasped the hips with both hands and climbed stairs, assisting their weight from the rear and moving the center of weight backward, and the control group climbed the stairs without any intervention. Results: Muscle activation of the VMO decreased significantly after the intervention in the belt and hand groups, and activation of the VL muscle in both groups showed a greater decrease than that of the VMO muscle. Further, the VMO/VL muscle activation ratio increased significantly, with an improvement shown in the order of the belt group, hand group, and control group, while muscle onset time also improved in the order of the belt group, hand group, and control group. Conclusion: The belt group demonstrated the greatest effect across all dependent variables, confirming that in clinical practice, these two weight-assisting methods are more effective interventions during stair ascent for patients with knee joint instability, pain, and imbalance than no assistance.

Purpose: Obstacle crossing training is being used to improve the walking ability of stroke patients, but studies on which method is more effective when performing obstacle crossing training with an unaffected limb lead (OCT-ULL) and an affected limb lead (OCT-ALL) are not well known. As such, this study aims to compare the intervention effects of obstacle crossing training using unaffected limb leads (OCT-ULL) and obstacle crossing training using affected limb leads (OCT-ALL). Methods: In total, 25 patients with chronic stroke were studied and assigned randomly to the obstacle crossing training with unaffected limb leads (OCT-ULL) group or the obstacle crossing training with affected limb leads (OCT-ALL) group. A lower extremity strength test, balance and gait test, and fall efficacy test were conducted as preliminary tests, and all patients participated in the intervention for 30 minutes a day, five days a week for four weeks, and the same preliminary tests were conducted post-intervention. Results: Compared with the OCT-ALL group, the OCT-ULL group showed a significant improvement in the strength of the affected hip abductor muscle and in balance and gait, as well as in fall efficacy (p<.05). Conclusion: This study suggested that applying the OCT-ULL training method in the obstacle crossing training of stroke patients is more effective for improving balance and gait functions than OCT-ALL.

Purpose: The physical therapy diagnosis process requires high-level background knowledge, the ability to obtain added information from patients, accurate examination skills, and a framework for transforming thoughts into a diagnostic decision. Thus, the physical therapy diagnostic process is highly complicated and difficult work. To function as autonomous professionals, physical therapists must develop effective clinical diagnosis skills. As such, mobile application aids can help with accurate and scientific diagnoses. Therefore, this study aims to develop and evaluate the usability of a mobile application for physical therapy diagnoses. Methods: In this study, a diagnostic application was developed using App Inventor, the development environment was the Chrome web browser for Windows 10, and the mobile application was run on a Google Pixel 5. The developed application was evaluated for usability by 20 physical therapists with more than 5 years of clinical experience in the musculoskeletal physical therapy field, and a usability evaluation was conducted using a 5-point Likert scale for accuracy, convenience, satisfaction, and usability. The collected Likert scores were converted into percentages and analyzed as descriptive statistics. Results: The graphical user interface consisted of an initial screen with program guidance, 18 screens presenting the algorithm, and 12 screens presenting the estimated diagnosis based on the algorithm. As such, the usability evaluation of the developed application was as follows: accuracy 100%, convenience 90%, satisfaction 91%, and usability 88%. Conclusion: The newly developed mobile application for physical therapeutic diagnoses has a high accuracy, and it will aid in building an easy and reliable physical therapy diagnosis system.

Purpose: The aim of this study is to provide basic information to create an efficient training program to improve shoulder stability and function in patients with injuries and in patients having undergone surgery of the supraspinatus and infraspinatus muscles, which have a relatively high incidence of injury in shoulder joint disease. Further, independent activities of the supraspinatus and infraspinatus muscles were investigated according to forearm rotation and the neutral and lateral rotation postures. Methods: The activities of the supraspinatus and infraspinatus muscles were measured using surface electromyography in 22 healthy adults in Busan, and isokinetic muscle strength measurement equipment was used to measure muscle strength during shoulder lateral rotation. The subjects performed lateral rotation of the shoulder in three different forearm postures (neutral, supine, prone) to measure shoulder muscle activity and lateral rotation strength. Results: The independent activity ratio (% Isolation) of the supraspinatus and infraspinatus muscles during lateral rotation of the shoulder joint demonstrated a significant difference (p<0.05) according to the change in forearm posture. Conclusion: The supraspinatus muscle showed independent activity ranging from highest to lowest in the order of pronation, neutral, and supination of the forearm, while the independent activity of the infraspinatus muscle ranged from highest to lowest in the order of neutral, supination, and pronation of the forearm. Therefore, the most active forearm positions for the supraspinatus and infraspinatus muscles are pronation and neutral, respectively.