Purpose: This systematic review was conducted to analyze the effects of virtual reality (VR) rehabilitation therapy on functional mobility in patients with subacute stroke and to provide clinical evidence for therapeutic effectiveness. Methods: Literature searches were performed using four major electronic journal databases in medicine and health sciences. The study population consisted of patients with subacute stroke between 1 and 6 months post-onset. The intervention was a VR-based rehabilitation therapy program. For comparison, studies including VR therapy groups as experimental groups and conventional therapy or other treatment modalities as control groups were included. The outcome measures assessed functional mobility, such as static/dynamic balance and gait functions. Risk of bias assessment and meta-analysis for effect sizes were conducted, focusing on randomized controlled trials. Results: Five studies with a total of 218 participants were included in the meta-analysis. Risk of bias assessment revealed that 2 studies (40%) had a low risk of bias, 1 study (20%) showed some concerns, and 2 studies (40%) had a high risk of bias. The outcome measures primarily focused on gait and balance abilities, as assessed by the Timed Up and Go test (2 studies), the 6 min walk test, walking speed, and Tinetti gait assessment (1 study each). Using Hedges' g as the effect size measure and applying a random-effects model to account for methodological differences between studies, the pooled effect size showed a moderate to large effect (standardized mean difference 0.670, 95% confidence interval 0.184-1.156; p = 0.007). Conclusion: When VR rehabilitation therapy was applied to patients with subacute stroke, the VR therapy group showed significantly greater improvement in functional mobility than did the conventional therapy groups. Future research is needed to develop optimal VR rehabilitation therapy protocols for improving functional mobility, not only in patients with subacute stroke but also across various stages of stroke recovery.

Purpose: This study used an ergonomic evaluation framework to assess the risk of work-related musculoskeletal disorders (WMSDs) associated with patient transfers between a therapy table and a wheelchair. Methods: A manual wheelchair with a fixed seat height of 45 cm was used, and the height of the therapy table was set at 45 cm and 52.5 cm. A physical therapist performed patient transfers between the wheelchair and the therapy table, and the movement was recorded for analysis. The transfer process was segmented into three phases-initial posture, intermediate posture, and final posture-based on the sequence of movement. The risk of WMSDs was assessed using ergonomic evaluation tools, including the Rapid Entire Body Assessment (REBA) and the Rapid Upper Limb Assessment (RULA). Results: The REBA analysis revealed that the highest risk occurred during the intermediate posture, particularly in the trunk. The elevated risk level was attributed to the absence of a handle for secure coupling. Similarly, the RULA analysis indicated a significant ergonomic risk and increased load during the intermediate posture. Conclusion: The greatest risk during patient transfers by physical therapists is concentrated in the trunk region, highlighting susceptibility to lumbar WMSDs. These results underscore the necessity for preventive strategies and educational interventions aimed at modifying physical therapy postures and promoting the use of ergonomic assistive tools to mitigate WMSD risks.

Purpose: This study aimed to examine and compare the effects of two types of training on improving lung function: (1) a combination of expiratory muscle training (EMT) and pelvic floor muscle training (PFM); and (2) PFM training alone. Previous studies have examined the effects of inspiratory muscle training and PFM training, but research on the effects of combining EMT and PFM training is scarce. Methods: Forty healthy adults (15 men, 25 women) were randomly assigned to either the experimental group (20) or the control group (20). Adults in the experimental group performed EMT and PFM training for 10 minutes each, whereas those in the control group performed only PFM training for 20 minutes. Changes in lung function-measured in terms of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), and peak expiratory flow (PEF)-were evaluated using a spirometer. Results: FVC, FEV₁, and PEF increased significantly in the experimental group (p < 0.05). In the control group, FEV₁ and PEF (p < 0.05) increased significantly, but no changes were observed in FVC (p > 0.05). No significant differences were observed between the experimental and control groups (p > 0.05). Conclusion: A combination of EMT and PFM training can be more effective in improving lung function (FVC, FEV₁, and PEF) than PFM training alone. This implies that EMT can contribute to respiratory rehabilitation treatment and the improvement of lung function.

Purpose: Lower limb coordination plays a vital role in determining balance, walking speed, and functional mobility in individuals with stroke. This study aimed to evaluate the inter-rater and test-retest reliability, as well as measurement error indices-including the standard error of measurement (SEM) and minimal detectable change (MDC)-of the Lower Extremity Motor Coordination Test (LEMOCOT) in patients with subacute stroke. Additionally, the study examined the construct validity of LEMOCOT. Methods: A cross-sectional study was conducted with 30 individuals in the subacute phase of stroke recovery. Inter-rater and test-retest reliability were assessed using the intraclass correlation coefficients (ICC2,1 and ICC3,1, respectively). Measurement error was calculated using SEM, MDC, and MDC (%). Bland-Altman plots were used to analyze the 95% limits of agreement between paretic and nonparetic limb scores. The construct validity of LEMOCOT was determined by correlating performance with scores from the Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Berg Balance Scale (BBS), modified Four Square Step Test (mFSST), 10-Meter Walk Test (10mWT), Timed Up and Go Test (TUG), and 6-Minute Walk Test (6MWT) using Spearman's correlation coefficient. Results: LEMOCOT demonstrated excellent inter-rater reliability (ICC = 0.925, paretic; 0.880, nonparetic) and high test-retest reliability (ICC = 0.906, paretic; 0.808, nonparetic). MDC values indicated minimal measurement error. Strong correlations were found between LEMOCOT performance and functional outcomes, such as FMA-LE (r = 0.734-0.749) and BBS (r = 0.587-0.593), as well as moderate to strong correlations with mobility tests, including the 10mWT, TUG, and 6MWT. Conclusion: LEMOCOT is a reliable and valid clinical tool for assessing lower extremity coordination in patients with subacute stroke. Its simplicity and efficiency support its use in routine rehabilitation settings.

Purpose: Structural changes in the foot, particularly pes planus, lead to internal rotation of the tibia and femur, subsequently increasing pelvic anteversion. This biomechanical adaptation in the pelvis and lower extremities affects the lumbar spine, resulting in an increase in lumbar lordotic curvature. This study aimed to analyze whether lumbar spinal alignment changes occur in asymptomatic flexible pes planus and to evaluate the corrective effects of low-Dye taping and modified Mulligan taping, which are commonly used in the treatment of flexible pes planus, by examining their potential to induce changes in lumbar lordotic curvature. Methods: This study was conducted with 30 voluntarily participating individuals who exhibited bilateral flexible pes planus. Improvement in flexible pes planus following taping application was assessed using the navicular drop test, while changes in lumbar lordotic curvature were analyzed using a flexible curve ruler. The corrective effects of each taping method on pes planus and the degree of lumbar lordotic curvature alteration were examined through one-way repeated measures ANOVA and contrast tests. Results: Application of low-Dye taping and modified Mulligan taping resulted in a significant increase in the height of the navicular tuberosity compared to the pre-taping condition. However, no significant abnormality in lumbar lordotic curvature was observed in individuals with asymptomatic flexible pes planus, and neither taping intervention induced a significant change in lumbar lordotic curvature. Conclusion: In asymptomatic flexible pes planus, both low-Dye taping and modified Mulligan taping were effective in correcting flexible pes planus. However, neither intervention induced significant changes in lumbar lordotic curvature.

Purpose: This study aimed to investigate the effects of proprioceptive neuromuscular facilitation (PNF) pattern exercises performed on an unstable support surface under visual occlusion on static balance and gait performance in college students. Methods: A total of 19 college students (9 males and 10 females) who did not report any lower extremity pain or balance-related edema voluntarily participated. Participants were randomly assigned to two groups: (1) PNF exercise performed on an unstable support surface under visual occlusion and (2) PNF exercise under visual input conditions. Both groups underwent a 6-week intervention program. Static balance and gait parameters were assessed pre- and post-intervention. The Wilcoxon signed-rank test was used for within-group comparisons, while appropriate nonparametric tests were used to analyze between-group differences. Results: The experimental group showed significant improvements in the stability index during the normal eyes open (NO) and head back (HB) conditions. The control group improved significantly in the NO and head forward (HF) conditions, with additional enhancement in the weight distribution index under head left. Between-group comparisons revealed significant differences in stability indices under the HB and HF conditions. Regarding gait, the experimental group improved in both swing phase and gait analysis duration, whereas the control group improved only in the swing phase. Significant differences in overall gait stability were found between groups. Conclusion: PNF pattern exercises on an unstable surface under visual occlusion effectively enhance static balance and gait performance, supporting their use in clinical balance and gait training.

Purpose: This study aimed to investigate the effects of a combined intervention of proprioceptive neuromuscular facilitation (PNF) neck pattern and balance training on balance and gait abilities in adults aged 65 years and older. Methods: Thirty adults aged 65 years and older participated in this study and were divided into an experimental group (n = 15) receiving combined PNF neck pattern and balance training, and a control group (n = 15) receiving balance training only. The sample size was calculated using G^*Power 3.1.9.7 software. Balance assessment was conducted using the PhysioSensing platform to measure the weight distribution ratio, sway area, and limits of stability. Gait assessment was performed using the G-Walk system to measure cadence, gait speed, and step length. Within-group comparisons were analyzed using paired t-tests, while between-group comparisons were conducted using analysis of covariance, with pre-intervention values as covariates. The intervention was implemented five times per week for a total of 4 weeks. Results: Within-group comparison results showed significant differences in all parameters for both groups. Between-group comparison results revealed that the experimental group demonstrated significantly greater improvements than the control group in all parameters, except for weight distribution ratio and step length. Conclusion: The combination of PNF neck pattern and balance training is effective in improving balance and gait abilities in older adults.

Purpose: This study aimed to investigate awareness of AI-based rehabilitation services among future rehabilitative professionals, specifically university students majoring in rehabilitative therapy. It also sought to provide a rationale for integrating artificial intelligence (AI) education into the rehabilitative therapy curriculum to develop professionals who can drive AI technology in clinical practice. Methods: The study included 179 students from universities located in the Chungcheong and Honam regions. The survey questionnaire consisted of 47 items: 4 items on the common characteristics of the participants, 18 items on the general aspects of AI-based rehabilitation services, and 25 items on the Intelligent Rehabilitation Service Awareness Scale (IRSRS). Results: Students with higher awareness showed significantly greater recognition of the value of intelligent rehabilitation services (IRS) than those with moderate and low awareness (p < 0.05). However, no significant difference was found in the ability to distinguish IRS types between the group that perceived them as important and the group that did not (p > 0.05). The Cronbach's alpha coefficients for the IRSRS ranged from 0.608 to 0.667. The respondents demonstrated an IRSRS mean score of 16.39, falling short of the cut-off score of 19. Analysis of the IRSRS subdomains indicated that, although education (3.63 points) and efficiency (3.69 points) were elevated, experience (1.31 points), understanding (2.12 points), application (3.16 points), and effectiveness (2.48 point) remained low. Conclusion: Students in the field of rehabilitation therapy need a solid understanding of machine-learning-based services to firmly establish the role of rehabilitation professionals in clinical settings.

Purpose: This study aimed to investigate differences in muscle activity of the medial and lateral hamstrings based on hip joint position during the Good Morning exercise, as well as the effects on muscle activity of synergist muscles, with implications for hamstring injury prevention and rehabilitation. Methods: Nineteen healthy males with no history of hamstring injury participated in the study. They performed the Good Morning Exercise under four hip rotation conditions. Muscle activity of the erector spinae, gluteus maximus, semitendinosus, and biceps femoris was measured during eccentric and concentric contractions. Results: During the concentric phase, the muscle activity of the erector spinae was significantly higher in conditions of hip internal rotation (p < 0.001), while the muscle activity of the gluteus maximus was significantly lower in conditions of internal rotation (p = 0.011). During the eccentric and concentric phases, the muscle activity of the semitendinosus was higher with internal rotation (p < 0.001), and the muscle activity of the biceps femoris was higher with external rotation (p < 0.001). Conclusion: Rotating the hip joint during the Good Morning exercise can induce selective activation of the hamstrings.

Purpose: This study aimed to investigate the effects of ultrasound-assisted static stretching and post-isometric relaxation, a type of muscle energy technique, on hamstring flexibility and muscle stiffness in healthy adults. Methods: Thirty-three healthy adults were randomly assigned to three groups: ultrasound only (US), ultrasound-assisted static stretching (US+SS), and ultrasound-assisted post-isometric relaxation (US+PIR). All interventions were conducted three times per week over a period of 6 weeks. Hamstring flexibility was assessed using the sitting trunk flexion test and the active knee extension (AKE) test. Muscle stiffness was measured objectively using the MyotonPRO device, which evaluates mechanical muscle properties. Statistical analyses included paired t-tests to assess within-group changes and one-way ANOVA with LSD post hoc tests to determine between-group differences, with the level of significance set at α = 0.05. Results: All groups exhibited statistically significant improvements in hamstring flexibility and reductions in muscle stiffness (p < 0.05). Notably, the US+SS and US+PIR groups demonstrated significantly greater gains in AKE and reductions in stiffness than the US-only group did. However, there were no significant differences between the US+SS and US+PIR groups. Conclusion: Both ultrasound-assisted static stretching and PIR effectively improved hamstring flexibility and reduced stiffness. The absence of significant differences between US+SS and US+PIR suggests that static stretching can achieve effects comparable to PIR when combined with ultrasound. These findings support the use of combined thermal and stretching interventions to enhance muscle extensibility in clinical practice.

Purpose: Although various conservative treatments have been proposed for managing lateral epicondylitis of the elbow (LE), the clinical effectiveness of Mulligan taping as a standalone intervention remains insufficiently explored. This study aims to assess the impact of two distinct Mulligan taping techniques-wrist extensor lateral glide Mulligan taping (WE-MT) and forearm lateral glide Mulligan taping (FA-MT)-on grip strength and forearm muscle activity in patients with LE. Methods: Fourteen individuals diagnosed with LE participated in this study. A single-group repeated measures design was employed, and each participant received both WE-MT and FA-MT interventions in randomized order, with a 20 min washout period between applications. Grip strength was measured using a Jamar dynamometer, and surface electromyography was used to assess the muscle activity of the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), and extensor digitorum communis (EDC). Differences based on the presence of taping were analyzed using one-way repeated measures ANOVA, and contrast tests were conducted to compare the effects of each taping technique. Results: Both taping methods significantly improved grip strength compared to the pre-taping condition (p < 0.05), with WE-MT demonstrating a greater improvement than FA-MT (p < 0.05). Electromyographic analysis showed that WE-MT significantly increased muscle activity in the ECRL, ECRB, and EDC (p < 0.05), whereas FA-MT resulted in limited or no improvement in muscle activity (p < 0.05). Conclusion: Compared to FA-MT, WE-MT had a greater effect on grip strength and muscle activation in patients with LE. These findings suggest that WE-MT may serve as a more effective Mulligan taping strategy for the management of LE.

Purpose: This study attempted to determine the influence of proprioceptive neuromuscular facilitation training on walking ability and pain in patients who underwent total knee arthroplasty patients. Methods: The participants were 60 total knee replacement patients, randomly assigned to three groups of 20: a general physical therapy group, a proprioceptive neuromuscular facilitation group, and a general physical therapy + proprioceptive neuromuscular facilitation group. Both exercises were performed 6 days per week, for 60 min a day, for a period of 4 weeks. Results: After the intervention was conducted, the following test results for walking ability and pain were obtained. In the walking ability test, a comparison of walking velocity within groups showed a significant difference between groups 2 and 3 (p < .05) (p < .001), and a comparison between groups also showed a significant difference (p < .001). Cadence comparison within groups revealed a significant difference between groups 2 and 3 (p < .001), as did the comparison between groups (p < .001). For the timed up and go test, a significant within-group difference was found in group 3 (p < .001), and a significant difference was also observed between groups (p < .001). A comparison of pain within groups showed a significant difference between groups 2 and 3 (p < .001), as well as a significant difference between groups (p < .001). Conclusion: Proprioceptive neuromuscular facilitation training improves walking ability and reduces pain in patients with total knee arthroplasty. It could be suggested as an effective therapeutic intervention for improving walking function and pain, particularly when applied according to the patient's recovery stage in clinical practice.

Purpose: This study aimed to investigate the characteristics of lower extremity muscle activity, isokinetic strength, range of motion, and balance in ballet dancers with chronic ankle instability (CAI) to provide fundamental data for injury prevention and rehabilitation strategies. Methods: Female ballet dancers were divided into the CAI (n = 20) and control (n = 10) groups. EMG analysis evaluated muscle activity in the tibialis anterior, peroneus longus, and gastrocnemius during four ballet movements: arabesque relevé, passé relevé, first position relevé, and first position jump. Isokinetic ankle strength was measured at three angular velocities (60°/sec, 120°/sec, and 180°/sec) for inversion, eversion, plantar flexion, and dorsiflexion movements. The ankle range of motion (ROM) was assessed using goniometry. Results: The CAI group showed significantly decreased ankle strength at 60°/sec across all motions. Notably, plantar flexion strength was 50.8% lower than that in the control group. ROM analysis revealed increased inversion ROM (9.11°) and decreased eversion ROM (10.5°) in the CAI group. EMG analysis demonstrated 34% higher peroneus longus activation during arabesque relevé in CAI dancers than in the controls. Conclusion: Ballet dancers with CAI demonstrate specific neuromuscular adaptations, including decreased isokinetic strength at low velocities, directional ROM imbalances, and compensatory muscle activation patterns. Rehabilitation programs should focus on low-velocity strength training, correcting frontal plane ROM imbalances, and functional peroneus longus training integrated with ballet-specific movements.

Purpose: This study aimed to investigate the comparability and consistency of walking speed measurements obtained using different testing protocols in individuals with subacute stroke. Specifically, it aimed to compare walking speeds measured using the flying start method over 5 m, 8 m, and 10 m segments of a walkway, with speeds measured by both static start and flying start methods across a full 10 m walkway using the 10 m Walk Test (10mWT). By examining these variations, the study sought to determine the methodological impact of starting technique and walkway length on gait assessment outcomes in clinical settings. Methods: A retrospective observational study analyzed walking speeds in individuals with subacute stroke using the flying start method, which incorporated a 2 m acceleration zone and a 2 m deceleration zone across 5 m, 8 m, and 10 m walkway distances. Both comfortable walking speed (CWS) and fast walking speed (FWS) were recorded. Additionally, CWS and FWS values obtained from the static start method over the entire 10 m walkway were compared with those obtained from the flying start method, including the acceleration and deceleration zones. Results: There were no significant differences in CWS and FWS across different walkway distances (5 m, 8 m, and 10 m), indicating that walkway distance did not affect walking speed. In CWS, the flying start (0.69m/s) was significantly faster by 0.05m/s compared to the static start (0.63m/s) (p = .018). Similarly, in FWS, the flying start (0.79m/s) was significantly faster by 0.07m/s compared to the static start (0.72m/s) (p = .009). Conclusion: Walkway distance (5 m, 8 m, and 10 m) did not significantly affect CWS or FWS. However, the static start method over the full 10 m walkway had a significant influence on 10MWT outcomes compared to the flying start method, which included acceleration and deceleration zones. When space is limited, a 5mWT using the flying start method can be proposed as a practical alternative protocol to the 10MWT.

Purpose: This study aimed to investigate the effects of vibration swing exercise performed on an unstable surface on balance, gait, and depression in patients with chronic stroke. Methods: A total of 24 patients with chronic stroke participated in the study and were randomly assigned to two groups: the unstable surface vibration swing exercise group (experimental group) and the stable surface vibration swing exercise group (control group). The experimental group performed vibration swing exercises on an unstable surface, while the control group performed the same exercises on a stable surface. Balance was assessed using the Berg Balance Scale, gait was measured with the 10-Meter Walking Test, and depression was evaluated using the Beck Depression Inventory. Paired t-tests were used to analyze within-group differences, and independent t-tests were used to compare outcomes between the two groups. Results: Both groups showed significant improvements in balance, gait, and depression after the intervention (p < 0.05). However, the experimental group that performed the vibration swing exercise performance on an unstable surface showed significantly greater improvements in all three measures compared to the control group (p < 0.05). Conclusion: Vibration swing exercise performed on an unstable surface is more effective than on a stable surface for improving balance, gait, and depression in patients with chronic stroke.

Purpose: Although industrial safety shoes are an important form of workplace protection, they can lead to musculoskeletal diseases involving the foot and ankle. This study was conducted to validate the effectiveness of an industrial safety shoe designed to prevent musculoskeletal diseases. Methods: The sample size for this study was determined based on the results of a pilot study, with an effect size of 0.8, a statistical power of 0.8, and a significance level of 0.05. A total of 12 participants were recruited and randomly assigned to test both N company and D company industrial safety shoes. Measurements were taken under three different work conditions. First, we measured the mobility of the sole flexion point and the number of times the little toe struck the toecap, along with peak and mean pressure during a half-kneeling position. Second, we measured the same factors, excluding sole flexion point mobility, during a 10-meter slope walk test. Finally, we measured these same factors during stair walking. Results: N Company industrial safety shoes featuring Wide-den technology demonstrated significantly higher sole flexion point mobility than D company industrial safety shoes. N industrial safety shoes showed significantly fewer instances of little toe contact with the toecap and lower peak and mean pressures under all conditions. Conclusion: Industrial safety shoes featuring Wide-den technology were effective in increasing the sole flexion point mobility, reducing little toe contact with the toecap, and decreasing peak and mean pressures.