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BACKGROUND: Bracing is one of the oldest non-operative treatments for patients with scoliosis. However, a wide variety of braces is used, and some show no effect, while others show conflicting results. OBJECTIVE: We aimed to evaluate the effectiveness of a new orthotic device for the treatment of adult scoliosis. METHODS: Twenty adult patients who were diagnosed with scoliosis and qualified for the study were selected and all participants were treated for 12 hours/day for 12 weeks using a new orthotic device. Various efficacy assessments (Cobb’s angle, spine length, pelvic angle, shoulder angle, thoracic angle, lumbar angle, pelvic sacral angle) were performed before and after the 12-week treatment. The values at each time point were compared. RESULTS: There were significant treatment effects in a time-dependent manner on every efficacy assessment (p< 0.05) after 12 weeks of bracing. CONCLUSION: In this clinical study, it was demonstrated that a new brace that is more comfortable for the wearer reduced scoliosis and may be a useful option for non-operative treatment of scoliosis.

Background The amount of patients with muscle imbalance of the left and right side increases rapidly due to an incorrect lifestyle. Objective We investigated the optimal exercise load required to improve muscle imbalance. Methods Thirty participants were enrolled in the study. They performed squat exercises according to a whole body vibration (WBV) frequency protocol over a period of eight weeks. The exercises were performed three days a week and comprised five sets of fifteen trials per set per day. We validated muscle imbalance improvement using WBV by comparing and analyzing the results at different vibration frequencies. The participants were divided into three WBV protocol groups: no WBV, low-frequency WBV (25 Hz and 5 mm amplitude), and high-frequency WBV (50 Hz and 5 mm amplitude). We estimated the isokinetic muscle functions of the hip, knee, and ankle joints using BIODEX system 3. Ultimately, low-frequency WBV improved balance 10.2 ∼ 26.5% more than high-frequency WBV. Results Continuous load-deviation motions during low-frequency WBV were more effective at improving muscle imbalance than high-frequency WBV. WBV load variation methods improved muscle function and contractility more than external weights or loads by directly transferring kinetic energy into the body. Conclusion In this clinical study, we demonstrated that low-frequency WBV was more effective at improving muscle imbalance. The WBV protocol can be used in rehabilitation programs to improve imbalance without requiring elderly or physically decompensated patients to participate in excessive exercise.

Background and Purpose— In unilateral moyamoya disease, altered endothelial shear stress on the intact-side terminal internal carotid artery might trigger the progression to bilateral disease. We analyzed the endothelial shear stress parameters of the normally appearing terminal internal carotid artery in unilateral moyamoya disease and its association with the progression to bilateral disease. Methods— This retrospective cohort study included patients diagnosed with unilateral moyamoya disease by cerebral angiography and followed-up with regular magnetic resonance imaging/magnetic resonance angiography evaluations for >1 year. Endothelial shear stress parameters acquired were mean and maximum signal intensity gradients (SIG) and SIG SD at the vessel boundary in time-of-flight sequences in initial brain magnetic resonance imaging/magnetic resonance angiography. Contralateral disease progression defined as the detection of newly developed vessel steno-occlusion with an magnetic resonance angiography steno-occlusive stage of ≥2, in the previously intact side of the brain on follow-up magnetic resonance imaging/magnetic resonance angiography evaluation. Results— Among 146 patients (66 males [45.2%] and 80 females [54.8%]; 76 pediatric [52.1%]), contralateral disease progression was detected in 43 patients (29.5%) after a mean follow-up of 4.3±2.4 years. Multivariate analysis showed that SIG SD was significantly associated with this progression (odds ratio, 13.001 [95% CI, 1.764−95.794], P =0.012). In receiver operating characteristic curve analysis, SIG SD predicted the contralateral progression with area under the curve values of 0.803 (95% CI, 0.726−0.880, P Conclusions— Increased spatial variability of the endothelial shear stress around the normally appearing terminal internal carotid artery, as measured by SIG SD in time-of-flight sequences, may predict the contralateral progression of unilateral moyamoya disease.

Du-Ri Kim1,2 *, Seunghwan Song1,3 *, Gwon-Min Kim,1 Jae Hyeok Chang,1,4 Young Jin Tak,5 Up Huh,1,3 Jeong Su Cho,3 Yung Liao,6 Kap-Soo Han,7 Myoung-Hwan Ko,7,8 Jong-Hwan Park1 1Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea; 2Department of Occupational Therapy, Graduate School of Inje University, Gimhae, Korea; 3Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea; 4Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea; 5Department of Family Medicine, Pusan National University Hospital, Busan, Korea; 6Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan; 7Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea; 8Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea*These authors contributed equally to this workCorrespondence: Myoung-Hwan KoDepartment of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, KoreaTel +82-63-250-1785Email mhko@jbnu.ac.krJong-Hwan ParkHealth Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, KoreaTel +82-51-240-7071Email parkj@pusan.ac.krPurpose: Information and communication technology (ICT)-based training devices for older adults’ care related to dementia are being developed to enhance older adults’ cognitive functions. Older adults who require bicycle training devices can improve muscle strength and balance of lower limbs by continuously contracting and relaxing lower-limb muscles and improving cognitive function to prevent dementia. This study was conducted to investigate the effects of an ICT-based multicomponent program on body composition and cognitive function in older adults.Patients and Methods: In a randomized controlled intervention test on 20 people over the age of 60 (exercise group: n = 10; control: n = 10), the multicomponent program was applied to the exercise group twice per week, once per day for 12 weeks, at 30 min per session, whereas the control group was advised to maintain their usual daily activities.Results: Comparing body composition changes and cognitive function changes before and after intervention exhibited statistically significant differences in skeletal muscle mass (P=0.01) and modified Alzheimer’s disease assessment scale–cognitive score (P=0.01) between the two groups.Conclusion: It can be difficult to be engaged in a simple repetitive exercise program. Therefore, to meet older adults’ interests and expectations, a customized ICT-based multicomponent program, which can improve body composition and cognitive function in older adults and is believed to help prevent dementia, is recommended.Trial Registration: UMIN000042129 (https://www.umin.ac.jp/english/).Keywords: ICT-based multicomponent program, body composition, cognitive function, dementia, older adults

Dysphagia is the most common complication of anterior cervical discectomy and fusion (ACDF). Several studies have reported dysphagia’s incidence, severity, and prognosis after ACDF; however, few have investigated the objective effects of dysphagia management. We aimed to elucidate the efficacy of laryngeal rehabilitation therapy for dysphagia following ACDF. This prospective randomized control trial included 20 patients who underwent more than two-level ACDF. Laryngeal rehabilitation therapy was performed on 10 patients for 7 days, whereas the remaining 10 comprised the control group. Pharyngeal transit time (PTT) by videofluoroscopic swallowing study (VFSS) was performed to evaluate the objective state of swallowing. We analyzed Bazaz scale and total variance of prevertebral soft tissue swelling (PSTS) from C2 to C7 on lateral cervical radiographs during hospitalization and at 4 and 8 weeks post-surgery. The PTT of the rehabilitation group was shorter than that of the control group at 7 days and 4 weeks post-surgery (p-value; POD 7D = 0.003, POD 4W = 0.042, POD 8W = 0.097). Perioperative laryngeal rehabilitation therapy effectively reduces postoperative dysphagia after ACDF.

Whole-body vibration training (WBVT) is emerging as an alternative exercise method that be easily performed by older adults. This clinical trial investigates the efficacy of WBVT in improving muscle strength and physical performance before resistance exercise, in comparison to conventional resistance exercise after stretching exercise in older adults. The WBVT group (n = 20) performed WBVT using a vibrating platform (SW-VC15™), followed by strengthening exercises. The control group (n = 20) performed stretching instead of WBVT. Both groups underwent a total of 12 sessions (50 min per session). The primary outcome was isokinetic dynamometer. The secondary outcomes were grip strength, short physical performance battery (SPPB), a 36-Item Short Form Survey (SF-36), and body composition analysis. In all results, only the time effect was significant, and the group effect or time x group effect was not. Both groups showed a significant increase in isokinetic dynamometer. Although there was no significant group effect, the increase in mean peak torque was greater in the WBVT group. The only WBVT group showed significant improvement in SPPB. In SF-36, only the control group showed significant improvements. WBVT can be safely performed by older adults and may be an alternative exercise method to boost the effect of strengthening exercise.

In this paper, a device to analyze gait pattern was developed by using a 2-axis acceleration sensor attached to the foot. The 1st low-pass filter was adapted to limit the frequency band up to 5 Hz. An algorithm to detect the peak value exceeding the threshold voltage of an X-axis acceleration sensor and a Z-axis acceleration sensor was developed and normal and abnormal walking patterns were thus differentiated. Also, MCU and Bluetooth were combined to transfer the data to other MCUs to display on an LCD; the size of the device could then be reduced. The new algorithm and the device allowed the individual walking patterns to be easily measured at a low cost and with less restriction on activities compared to conventional multiple pressure sensors or motion camera system.

Muscle strength may vary depending on the pathological issues and static life habits. These conditions lead to abnormal spinal loads and change muscle strength as well as activation patterns, thereby causing spinal disorders. In this study, the effects of muscle strength on the spine stabilization exercise were analyzed using a whole-body tilt device. Musculoskeletal modeling was performed and the results were validated through a comparison with the electromyography (EMG) analysis results. Based on the validated basic model, modeling was performed for the whole-body tilt device. To examine the exercise effect and muscle activation while the maximum muscle force capacity (MFC) was varied from 30[Formula: see text]N/cm2 to 60[Formula: see text]N/cm2 and 90[Formula: see text]N/cm2, the muscle force was predicted through inverse dynamics analysis. When MFC was 30[Formula: see text]N/cm2, the posterior direction of the tilt could not be analyzed (no solution found). When MFC was 60[Formula: see text]N/cm2, it could be analyzed, but the muscle force was predicted to be higher compared to when MFC was 90[Formula: see text]N/cm2. It was confirmed that muscle strength is a very important element for maintaining postural activities and performing exercise. Therefore, for rehabilitation patients and elderly people with weak muscle strength, hard or extreme exercise may cause musculoskeletal injuries.

We aimed to investigate the effect of basic fitness function according to whole-body vibration (WBV) stimulus with slope during deadlift in adults. A total of 15 subjects performed deadlift exercise with a sound-wave vibrator. The subjects consisted of three groups: no slope and WBV group (control), WBV only group (group 1), and slope and WBV group (group 2). Slope was set at [Formula: see text], and the frequency and amplitude of WBV were 10[Formula: see text]Hz and 5[Formula: see text]mm, respectively. The participants performed Romanian deadlift 2 days a week for 4 weeks, including 10 trials per set and five sets a day. We measured basic fitness function factor including the isokinetic muscle contraction test using biodex system3. All groups showed an increase in strength of approximately [Formula: see text]%. Group 2 showed the highest increase. Moreover, maximal peak torque of the lumbar joint showed an increase trend similar to that of back muscle strength. An increase of 15.72%, 24.86%, and 51.44% was noted in the control, group 1, and group 2, respectively. The findings indicate that WBV exercise with slope is the most efficient exercise protocol for improving muscle function of the trunk. WBV with slope could help stimulate trunk muscles more and efficiently, could result in a more positive effect on muscle function compared with WBV only, and could be included in an exercise program for efficient patient rehabilitation.

Core spinal muscles are related to trunk stability and assume the main role of stabilizing the spine during daily activities; strengthening of core muscles around the spine can therefore reduce the chance of back pain. The objective of the study was to investigate the effect of core muscle strengthening in the spine during spine stabilization exercise using a whole body tilt device. To achieve this, a validated musculoskeletal (MS) model of the whole body was used to replicate the input motion from the whole body tilting exercise. An inverse dynamics analysis was executed to estimate spine loads and muscle forces depending on the tilting angles of the exercise device. The activation of long and superficial back muscles such as the erector spinae (iliocostalis and longissimus) were mainly affected by the forward direction (-40°) of the tilt, while the front muscles (psoas major, quadratus lumborum, and external and internal obliques) were mainly affected by the backward tilting direction (40°). Deep muscles such as the multifidi and short muscles were activated in most directions of the rotation and tilt. The backward directions of the tilt using this device could be carefully applied for the elderly and for rehabilitation patients who are expected to have less muscle strength. In this study, it was shown that the spine stabilization exercise device can provide considerable muscle exercise effect.

It is known that muscle strength of human body can alter or deteriorate as aging. In this study, we present an inverse dynamics simulation to investigate the effect of muscle strength on performing the daily activities. A 3D musculoskeletal model developed in this study includes several segments of whole body, long and short muscles, ligaments and disc stiffness. Five daily activities such as standing, flexion, finger tip to floor, standing lift close and lifting flexed were simulated with varying the maximum muscle force capacities (MFC) of each muscle fascicles from 30 to 90 N/cm 2 with an increment of 30 N/cm 2 . In the result, no solution can be obtained for finger tip to floor and lifting flexed with 30 N/cm 2 . Even though the solution was available for standing lift close activity in case of 30 N/cm² capacity, many of muscle fascicles hit the upper bound of muscle strength which means that it is not physiologically possible to perform the acvities in reality. For lifing flexed, even the case of 60 N/cm 2 capaciy, represents the moderate healthy people, was not able to find the solutions, showing that 18 muscles among 258 muscle fascicles reached 100% of muscle capacity. The estimated results imply that people who have low muscle strength such as elders or rehabilitation patients were required higher muscle work to perform and maintain the same daily activities than healthy one.

The purpose of this study was to evaluate muscle function and basal physical fitness in relation to muscle balance pattern using rowing machines. Twenty four subjects participated in this study, using three different rowing machines. Rowing exercises were performed for twenty-five times a set, four sets a day, 3 days a week, for 8 weeks. Biodex system 3(Biodex Medical Systems Co., New York, USA) was used to measure joint torques in the elbow, shoulder, lumbar and knee of subjects, for analyzing muscle function. The evaluation of basal physical fitness included body composition, muscle strength, muscle endurance, muscle reaction, agility, flexibility and explosive power. Before the experiment, significant differences of joint torques in the elbow, shoulder, lumbar and knee were present between subjects in the group. After the rowing exercise, significant improvement in every joint was witnessed. All aspects of basic fitness increased significantly, and the most improvement was observed in muscle strength from the joint torque results. As shown in the following results, every joint it was evident to have improved by more than 30% with the use of dependent load deviation type over the previously used water load method. This means that it is more effective for enhancing muscle strength and endurance to keep the muscle balance using dependent load deviation. The human body maintains motor coordination of muscle contraction during exercise. The muscle balances in the upper-lower and left-right arms could assist with effective activation of motor coordination. In this paper, an exercise method using dependent load deviation was demonstrated to be more efficient for improving muscle imbalance and strengthening muscles.

The aim of the study was to calculate the arterial wall signal intensity gradient (SIG) from time-of-flight MR angiography (TOF-MRA) and represent arterial wall shear stress. We developed a new algorithm that uses signal intensity (SI) of a TOF-MRA to directly calculate the signal intensity gradient (SIG). The results from our phantom study showed that the TOF-MRA SIG could be used to distinguish the magnitude of blood flow rate as high (mean SIG ± SD, 2.2 ± 0.4 SI/mm for 12.5 ± 2.3 L/min) and low (0.9 ± 0.3 SI/mm for 8.5 ± 2.6 L/min) in vessels (p<0.001). Additionally, we found that the TOF-MRA SIG values were highly correlated with various flow rates (β=0.96, p<0.001). Remarkably, the correlation coefficient between the WSS obtained from the computational fluid dynamics (CFD) analysis and the TOF-MRA SIG was greater than 0.8 in each section at the carotid artery (p<0.001 for all β values). This new technique using TOF-MRA could enable the rapid calculation of the TOF-MRA SIG and thereby the WSS. Thus, the TOF-MRA SIG can provide clinicians with an accurate and efficient screening method for making rapid decisions on the risk of vascular disease for a patient in clinical practice.

This study investigated the characteristics of dynamic postural responses when subjects attempted to maintain an upright standing position on a support plate during continuous sinusoidal perturbation in the anterior-posterior direction. Fif- teen healthy young subjects participated in the experiment. Body movement patterns during the perturbation were captured and analyzed using a 3D motion analysis system (APAS 3D motion analysis, Ariel Dynamics Inc.). Seven markers were at- tached on the subject's body to measure and analyze the motion patterns. The markers were positioned at the head, chest, hip, right knee, left knee, right ankle, and left ankle. Five different frequencies of motion were applied to the support surface: 0.1, 0.5, 1.0, 1.5, and 2.0 Hz with a 4-cm path of motion at the base. The experiments measured dynamic postural responses in a condition were subjects had their eyes open. The results showed that the median frequency of the knee and ankle increased in all frequency bands. Following an increase in the frequency of the perturbation, the postural control strategy was changed from the ankle strategy to a combined strategy. These experimental results could be applied to the dynamic postural training for the elderly and to rehabilitation training for patients to improve their ability for postural control.

This study investigated that the spinal MFs can create compressive follower loads (CFLs) in the lumbar spine in a dynamic state. Three-dimensional optimization and finite element (FE) models of the spinal system were developed and validated using reported experimental data. An optimization analysis was performed to determine the MFs that create CFLs in the lumbar spine in various sagittal postures from 10° extension to 40° flexion. Optimization solutions for the MFs, CFLs, and follower load path (FLP) location were feasible for all studied postures. The FE predictions demonstrated that MFs which created CFLs along the base spinal curve connecting the geometrical centers or along a curve in its vicinity (within anterior or posterior shift by 2 mm) produced stable deformation of the lumbar spine in the neutral standing and flexed postures, whereas the MFs which created the smallest CFLs resulted in unstable deformation. For extended postures, however, finding CFLs creating MFs that produce stable deformation of the extended spine was not possible. The results of this study support the hypothesis that the spinal muscles may stabilize the spine via the CFL mechanism.