Purpose: This study aimed to demonstrate the effectiveness of different types of exercise interventions on the balance ability of children with cerebral palsy through network meta-analysis. Methods: The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) network meta-analysis guidelines for the review of comprehensive research. The study used the PICOS framework (P - Participants; I - Intervention; C - Comparison, O - Outcome; S-Study design) for subject selection wherein P referred to children with cerebral palsy, I referred to exercise programs, C referred to general physical therapy, O referred to balance ability measured by the BBS (Berg Balance Scale), PBS (Pediatric Balance Scale), and S referred to a randomized controlled trial with experimental and control groups. In this study, the network meta-analysis used the "netmeta" package in R to estimate the comparative advantage of exercise programs for cerebral palsy. The effects of the exercise programs were compared and analyzed using the mean and standard deviation of balance ability. Results: Among the exercise programs for children with cerebral palsy analyzed in this study, the Pilates program improved BBS scores (P-score: 64.90%) and was ranked as the most effective. In terms of PBS improvement, the exercise program that was ranked as the most effective in improving the PBS was Pilates combined with conventional physical therapy (Pilates+CPT) (P-score: 67.98%), followed by game-based dual task (P-score: 59.53%), dual task training (P-score: 56.45%), and gaming balance board training (P-score: 56.02%). The Pilates+CPT program showed a larger effect size than other intervention methods, and this difference was statistically significant. Conclusion: These findings support the preferential application of Pilates-based interventions for balance rehabilitation in children with cerebral palsy, particularly suggesting that combination with conventional physical therapy may provide optimal therapeutic effects. Furthermore, game-based interventions and dual-task training also demonstrated significant effects, indicating that personalized selection of interventions, taking into account children's characteristics and preferences, is feasible.

Purpose: This study proposed a mnemonic method for therapists with limited clinical experience to evaluate shoulder girdle function in people with stroke. Methods: The mnemonic SHOULDER TEST was introduced as a model to guide clinical reasoning and decision-making in identifying shoulder girdle problems in individuals with stroke. Results: SHOULDER TEST stands for: Scapula (S), Hippocrates (H), Overhead motion (O), Upward rotation (U), Latissimus dorsi (L), Deltoid (D), and External Rotator (ER). Also, Tone (T), Emotion (E), Sensory (S), and Trunk (T). It serves as a procedural guide for evaluating upper extremity function in people with stroke. Conclusion: The SHOULDER TEST approach offers an accessible method for evaluating upper extremity function, especially for less experienced therapists or those having difficulty assessing stroke patients. However, in addition to the above, hand function, along with functional levels in daily activities such as eating, washing, and overall participation in life, should also be considered.

Purpose: The effects of a proprioceptive neuromuscular facilitation (PNF) exercise program on shoulder pain, range of motion, spasticity, and upper limb function were investigated in a stroke patient with a rotator cuff tear on the hemiplegic side. Methods: The participant was a stroke patient experiencing pain and movement limitations due to a rotator cuff tear on the hemiplegic side. A PNF exercise program based on indirect treatment using the non-paretic side was conducted for 1 hour per day, 3 times a week, over 4 weeks. The effects of the exercise were compared through evaluations conducted before and after the intervention. Results: Pain, active range of motion, shoulder functional status, spasticity, and arm function improved, whereas the level of motor recovery did not show significant changes. Conclusion: The results of this case study indicate that the PNF exercise program is an effective method for reducing pain and improving upper limb function in a stroke patient with a rotator cuff tear on the hemiplegic side.

Purpose: Physical changes, such as a decrease in balance and muscle weakness in the elderly, can affect gait and increase the risk of falls. This study aimed to evaluate the effects of wearing an elastic ankle orthosis on muscle activity, kinematics, and dynamic balance during gait of elderly individuals with ankle instability. Methods: Eighteen elderly women aged 65 years and above with ankle instability were recruited, and eight were selected for participation. Dynamic balance was assessed using the Timed Up and Go test, and muscle activity was evaluated using surface electromyography. Kinematics were recorded using an inertial measurement unit sensor. Participants performed gait tests before and after wearing the orthosis, and the Wilcoxon signed-rank test was used for statistical analysis. Results: After wearing the elastic ankle orthosis, tibialis anterior muscle activity significantly decreased during the initial swing phase. Ankle plantarflexion increased during the loading response, initial swing, and mid-swing phases, and pelvic posterior rotation increased during the pre-swing and initial swing phases. There was no significant difference in the Timed Up and Go test. Conclusion: Wearing an elastic ankle orthosis may help improve gait patterns in elderly individuals with ankle instability. However, it requires careful guidance from an expert.

Purpose: This study aimed to investigate the effects of a four-week anterior scalene muscle stretching exercise on the craniovertebral angle (CVA) and diaphragmatic mobility in healthy adults. Methods: Thirty-eight healthy adults (33 males and 5 females) participated in the study and were randomly assigned to either the stretching group or the control group. The stretching group performed anterior scalene stretching exercises three times per week for 4 weeks, completing 3 sets of 10 repetitions per side per session. The CVA was measured before and after the intervention using a smartphone application, and diaphragmatic mobility was assessed with an ultrasound device during both quiet and deep breathing. Results: The stretching group showed statistically significant improvements in CVA and diaphragmatic mobility during both quiet and deep breathing (p < 0.05). In contrast, the control group exhibited no significant changes in any of the variables (p > 0.05). Between-group comparisons revealed significant differences in CVA and diaphragmatic mobility under both breathing conditions (p < 0.05). Conclusion: Stretching the anterior scalene muscle positively affected both the craniovertebral angle and diaphragmatic mobility. These findings suggest that incorporating anterior scalene stretching into exercise programs may be beneficial for individuals with postural misalignment or reduced respiratory function.

Purpose: This study examined the effects of changes in the movement distance of smooth pursuit eye movements on static balance, based on the movement distance of a target moving horizontally. Methods: A total of 35 participants were recruited, and after excluding two dropouts, 33 participants completed the study in a single-group design. Participants wore an eye tracker and focused on an object 3 meters in front of them. They observed and tracked an object moving horizontally up to 5 meters to the left and right. Results: Results showed significant differences in the limit of stability, center of pressure mean velocity, and COP mean distance at 0m vs 5m and 3m vs 5m during the smooth pursuit eye movement (p<.05). These results demonstrate that smooth pursuit eye movements are correlated with static balance, based on the movement distance of a target moving horizontally. Conclusion: This indicates that smooth pursuit eye movement could offer a new rehabilitation paradigm to aid static balance in patients with neurological disorders such as stroke and Parkinson's disease, as well as elderly patients with reduced balance.

Purpose: This study aimed to investigate the effect of shoulder approximation on the activation of the periscapular muscles in proprioceptive neuromuscular facilitation (PNF) arm exercises, specifically the lower trapezius and serratus anterior. Methods: This study included 18 healthy adults without musculoskeletal or neurological disorders. The activation of the lower trapezius and serratus anterior was examined using surface electromyography (Ultium EMG, Noraxon Inc., USA) during PNF arm pattern exercises with and without shoulder approximation. The exercises were performed in the seated position. The collected data were analyzed using SPSS version 21.0. Results: Muscle activation of both the lower trapezius and serratus anterior increased significantly when shoulder approximation was applied (p<0.05). However, within each condition, there was no significant difference in activation between the two muscles (p>0.05). Conclusion: The application of shoulder approximation during PNF arm pattern exercise may effectively enhance the activation of scapular stabilizing muscles. These findings highlight the effectiveness of approximation in promoting shoulder stabilizer muscle activity during rehabilitation exercises.

Purpose: This study sought to determine the test-retest reliability, standard error of measurement (SEM), and minimal detectable change (MDC) of the 2-Minute Walk Test (2MWT) and the 6-Minute Walk Test (6MWT). Additionally, it sought to evaluate the convergent validity of the 2MWT and 6MWT and investigate whether the 2MWT can serve as a suitable alternative to the 6MWT for assessing walking ability in patients with subacute stroke. Methods: This was a retrospective cross-sectional study. Data were collected from 19 stroke patients. Information was obtained on the participants' Functional Ambulation Category (FAC), 10-Meter Walk Test (10MWT), 2-Meter Walk Test (2MWT), 6-Meter Walk Test (6MWT), Berg Balance Scale (BBS), and Fugl-Meyer Assessment for the lower extremity (FMA-L/E). Reliability was assessed by comparing the test-retest agreement between the 2MWT and 6MWT, administered 5 to 10 days apart. Results: The test-retest reliability of the 2MWT was excellent, with an intraclass correlation coefficient (ICC) of 0.989. The MDC for the 2MWT was 15.40 meters, and the 95% limits of agreement (LOA) for its test-retest were -9.16 to 17.80. The 2MWT showed a very strong correlation with the 6MWT (r>0.949, p<0.001), and the 2MWT distance predicted 97% of the variance in the 6MWT total distance. Conclusion: The test-retest reliability and construct validity of the 2MWT in subacute stroke patients were excellent. The MDC, reflecting the true change in clinical decision-making, was 15.40m for the 2MWT. The test predicted over 97% of the total distance covered during the 6MWT. Therefore, the 2MWT is a clinically useful tool that can serve as a practical alternative to the 6MWT in time-limited settings.

Purpose: This study aimed to compare the effects of a manual lymphatic drainage (MLD) intervention combined with the hold-relax (HR) technique with those of an MLD intervention alone on lymphedema and arm function in patients with breast cancer-related lymphedema (BCRL). Methods: The study participants were diagnosed with stage two lymphedema in one arm after undergoing treatment for breast cancer. They were diagnosed by a medical specialist and volunteered to participate in the study. A total of 14 subjects were randomly assigned to seven experimental and seven control groups. The experimental group received MLD combined with the hold-relax technique, while the control group received only MLD. The experimental group received 40 minutes of MLD and 20 minutes of HR, while the control group received only MLD for 60 minutes. All interventions were performed once or twice a week for a total of four weeks. The volume of lymphedema and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were measured before and 4 weeks after the intervention in both groups. Results: The lymphedema volume (effect size = 1.81) and DASH score (effect size = 0.54) decreased significantly in the experimental group after the intervention compared with before (p < 0.05). Additionally, the change in lymphedema volume was significantly greater in the experimental group than in the control group (p<0.05). Conclusion: A four-week MLD intervention combined with HR was more effective than an MLD intervention alone in reducing lymphedema volume and improving arm function. For patients with BCRL, a combination of MLD and other interventions, rather than MLD alone, is recommended to improve lymphedema and arm function.

Purpose: This study aimed to compare and analyze the effects of proprioceptive training and self-myofascial release on gait, balance, and ankle range of motion (ROM) in adults with chronic ankle instability (CAI). Methods: Adults with CAI were identified using the Chronic Ankle Instability Questionnaire and the Cumberland Ankle Instability Tool. Ten participants were randomly assigned to either a proprioceptive training group or a self-myofascial release group. Both interventions were conducted twice a week for four weeks, with each session lasting approximately 30 minutes. Gait and balance abilities were assessed using the Y-Balance Test (anterior, posteromedial, and posterolateral directions), the Figure-of-8 Walk Test (F8WT), and the Functional Reach Test (FRT). Ankle ROM was evaluated in dorsiflexion, plantarflexion, inversion, and eversion. Results: The proprioceptive training group demonstrated significant improvements in all directions of the Y-Balance Test. The self-myofascial release group showed significant improvements in F8WT and FRT. Both groups exhibited increased ankle ROM in certain movements. These findings suggest that proprioceptive training contributes to improvements in balance and postural control, while self-myofascial release enhances mobility and flexibility in adults with CAI. Conclusion: Proprioceptive training and self-myofascial release can be practical and accessible interventions for improving balance and mobility in individuals with chronic ankle instability. Selection between the two methods may be tailored based on the patient's functional goals and clinical condition.

Purpose: The study aimed to identify the effect of static stretching and self-myofascial release on the muscular frequency, stiffness, and decrement of the single and multi-joint hip flexor. Methods: Thirty young adults volunteered to participate and were randomly assigned to one of two groups (SS; static stretching, SMFR; self-myofascial release). The properties of the iliopsoas muscle for single joint and rectus femoris for multi-joint of the hip during static stretching and self-myofascial release were measured by Myoton PRO (Myoton AS, Tallinn, Estonia). Statistical analysis used an independent t-test to determine the effect of static stretching and self-myofascial release on the muscular frequency, stiffness, and decrement of the single- and multi-joint hip flexor. The level of statistical significance was set at α=0.05. Results: The comparison of muscular properties revealed that muscle stiffness and muscle decrement of the rectus femoris in the SMFR group were significantly lower than those in the SS (p<0.05). Conclusion: It was concluded that SMFR is more effective in enhancing muscle elongation when applied to multi-joint muscles (e.g., rectus femoris) compared to single-joint muscles (e.g., iliopsoas).

Purpose: This study compared the effects of proprioceptive neuromuscular facilitation (PNF) and task-oriented training (TOT) on balance, gait, activities of daily living, and quality of life in stroke patients. Methods: Thirty chronic stroke patients (onset 1-2 years) were randomly allocated to the PNF group (n=15) and the TOT group (n=15). Both groups received their respective interventions in addition to conventional physical therapy, five times per week for six weeks. Outcome measures included the Berg Balance Scale (BBS), Timed Up & Go (TUG), 10-Meter Walking Test (10MWT), Korean version of the Modified Barthel Index (K-MBI), and EuroQoL five-dimension three-level (EQ-5D-3L). Data were analyzed using paired t-tests and ANCOVA. Results: Both groups showed significant within-group improvements in all measures (p < 0.05). Between-group comparisons revealed that the PNF group had significantly greater improvement in TUG (p < 0.05), while the TOT group showed greater improvement in 10MWT (p < 0.05). No significant between-group differences were found for the BBS, K-MBI, and EQ-5D-3L. Conclusion: Both PNF and TOT effectively improve functional outcomes in patients with chronic stroke, with specific advantages for each approach. PNF appears more effective for improving dynamic balance, while TOT is more beneficial for enhancing gait speed. Treatment selection should thus be individualized based on the patients' specific functional goals.

Purpose: This study sought to comprehensively examine the correlations among spatiotemporal gait variables according to age, sex, and physical characteristics across the life cycle, using a foot pressure sensor-based gait assessment system in conditions resembling real walking. Methods: Participants were instructed to maintain their usual walking speed and practice walking three times during the preparation phase. Subsequently, using the Gait Checker device, they walked a total distance of 4.4 m, and gait data were collected over the middle 2.4 m, excluding the first and last 1 m, to ensure accurate measurement of steady-state walking. Results: In the comparison of gait parameters between males and females, significant differences were observed in stride length, step length of each foot, and stance time (p<0.05). In the age-group comparison, significant differences were found only in stride length and step length, which were identified as the key indicators showing change (p<0.05). Correlation analysis between the key gait parameters and general characteristics revealed that height showed a moderate correlation (r≈0.35) with the stride and step lengths of each foot. In contrast, weight showed a moderate correlation with the step length of each foot. In contrast, weight showed only a weak correlation (r≈0.10). Stepwise regression analysis of the physical and gait-related indicators of stride length indicated that the step length of each foot and height were the major determinants of stride length. Conclusion: This study analyzed gait indicators in 2,156 community-dwelling healthy adults with independent ambulation to examine differences by sex and age group across the life cycle and to investigate correlations among gait parameters and determinants of stride length. The findings on sex- and age-related differences in gait parameters are expected to provide valuable evidence for the future development of gait assessment devices and the establishment of related health policies.

Purpose: This study aimed to examine the impact of active vibration swing exercises performed on unstable surfaces on balance, walking ability, and lower limb muscle strength in elderly individuals with sarcopenia. Methods: Twenty-six elderly participants with sarcopenia were randomly assigned to two groups: an unstable-surface active-vibration swing exercise group (experimental group) and a stable-surface group (control group). The experimental group performed the exercises on an unstable surface, whereas the control group performed the same exercises on a stable surface. Balance was measured using the Functional Reach Test, walking ability was assessed with the Timed Up and Go Test, and lower limb muscle strength was evaluated using the Five Times Sit-to-Stand Test. Paired t-tests were conducted to examine the changes within each group, and independent t-tests were used to assess the differences between the groups. Results: Both groups demonstrated significant improvements in balance, gait, and lower extremity muscle strength following the intervention (p < 0.05). The experimental group showed significantly greater improvements across all three variables compared with the control group (p < 0.05). Conclusion: Performing active vibration swing exercises on an unstable surface is more beneficial than on a stable surface for improving balance, walking ability, and lower-limb muscle strength in elderly individuals with sarcopenia

Purpose: This study aimed to examine the effects of a Pilates-aerobic combined program and a Pilates-pelvic floor combined program on pelvic floor function, quality of life, and functional movement in postpartum women. Methods: Twenty-one women, 6-48 weeks postpartum, were randomly assigned either to a Pilates-aerobic group (n=11) or a Pilates-pelvic floor group (n=10). Each group participated in 60-minute sessions twice weekly for six weeks. Assessments included pelvic floor displacement, vaginal pressure, the Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7), and functional movement tests (deep squat, hurdle step). Results: Both groups showed significant improvements in pelvic floor function and quality of life, with increased pelvic floor displacement and vaginal pressure and decreased PFDI-20 and PFIQ-7 scores. However, only the Pilates-aerobic group demonstrated significant gains in deep-squat and hurdle-step performance, indicating superior functional movement improvement. Conclusion: The Pilates-aerobic combined program was more effective than the Pilates-pelvic floor combined program for enhancing pelvic floor function, quality of life, and physical functional movement in postpartum women. These findings suggest that integrating aerobic exercise with Pilates may be an efficient and comprehensive rehabilitation approach for postpartum recovery.

Purpose: This study aimed to examine the effects of head turn and surface conditions on gait parameters in elderly adults. Methods: Twenty community-dwelling adults aged 60 years or older from City D participated in the study. Gait parameters were assessed using a wearable gait analysis system (Legsys; BioSensics, USA). Each participant performed two gait tasks-head-oriented gait and head-turn gait-on two surfaces: a firm surface and a foam surface. The four resulting gait conditions were administered in a randomized order. Participants completed one familiarization trial prior to testing, and the mean of three subsequent trials was used for analysis. A two-way analysis of variance (ANOVA) was conducted to evaluate the effects of head turn and surface condition on gait parameters, with the statistical significance set at α = 0.05. Results: A significant main effect of head turn was observed for two gait parameters. Compared with the head-oriented gait, the head-turn gait resulted in a significantly shorter stride length according to the height ratio and a slower stride velocity (p < 0.05). Conclusion: The findings indicate that a head turn during gait alters key gait parameters-specifically, stride length and stride velocity-in elderly adults. These results suggest that head movement may impose additional challenges to gait stability in elderly adults.