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The 3rd International Physical Therapy Conference

Stiffening of Joints and Hardening of Arteries: What Can Exercise Do for Us? Keynote Speaker: Professor Dr.Hirofumi Tanaka

December 14th - 16th, 2016

The 3rd International Physical Therapy Conference and the 4th Physical Therapy Mahidol University Research Symposium December 14th-16th, 2016 Twin Towers Hotel, Bangkok

Stiffening of Joints and Hardening of Arteries: What Can Exercise Do for Us? Keynote Speaker: Professor Dr.Hirofumi Tanaka

December 14th - 16th, 2016

The 3rd International Physical Therapy Conference and the 4th Physical Therapy Mahidol University Research Symposium December 14th-16th, 2016 Twin Towers Hotel, Bangkok

December 14th - 16th, 2016

The 3rd International Physical Therapy Conference and the 4th Physical Therapy Mahidol University Research Symposium December 14th-16th, 2016 Twin Towers Hotel, Bangkok

FOREWORD The 3rd International Physical Therapy Conference and The 4th Physical Therapy Mahidol University Research Symposium (PTMURS) Stiffening of Joints and Hardening of Arteries: What Can Exercise Do for Us? December 14-16, 2016, Bangkok, Thailand

Mahidol University’s academic service and research strategies are to promote international and research collaborations, Faculty of Physical Therapy therefore launches the 3rd IPTC and the 4th PTMURS 2016. The theme this year is “Stiffening of joints and hardening of arteries: What can exercise do for us?”.

We aim to emphasize the knowledge sharing and research collaborations among physical therapists and researchers from various institutes. This conference would provide a unique opportunity in sharing your professional knowledge, getting connected professionally and socially, interacting with physical therapy clinicians, educators and researchers. There will be the lectures from the keynote and invited speakers. We are very pleased to have Professor Dr.Hirofumi Tanaka and Dr.Vijj Kasemsup as our keynote and invited speakers. Professor Tanaka is from the Department of Kinesiology and Health Education, The University of Texas at Austin, USA. Dr.Vijj Kasemsup is from the Department of Community Medicine, Ramathibodi Hospital, Mahidol University. The symposium also includes 13 oral and 5 poster presentations as well as panel discussion.

We hope that everyone will gain the benefit from this symposium. May we take this moment to extend a warm welcome to all delegates, invited and keynote speakers. We wish you all a rewarding and memorable symposium.

Roongtiwa Vachalathiti, Ph.D, PT

Associate Professor Dean, Faculty of Physical Therapy Mahidol University, Thailand

The 3rd International Physical Therapy Conference and the 4th Physical Therapy Mahidol University Research Symposium December 14th-16th, 2016 Twin Towers Hotel, Bangkok

December 14 - 16 , 2016 th

th

December 14, 2016 8:00 - 9:00 am

Registration

9:00 - 9:15 am

Opening Ceremony

Stiffening of joints and hardening of arteries

What can exercise do for

Stiffening of joints and hardening of arteries:

What can exercise do for us?

(President, Mahidol University) 9:15 - 10:15 am

NCD prevention and control: Advocate for accountability

Dr. Vijj Kasemsup 10:15 - 10:45 am

Coffee break

10:45 am - 12:00 pm

Epidemiology of cardiovascular disease

Asst. Prof. Dr. Chutima Jalayondeja

12:00 - 1:00 pm

Lunch

1:00 - 2:30 pm

Resistance training and vascular function

Prof. Dr. Hirofumi Tanaka 2:30 - 2:45 pm

Coffee break

2:45 - 4:00 pm

Workshop: Vascular vs. joint stiffness screening

Prof. Dr. Hirofumi Tanaka

Asst. Prof. Dr. Wattana Jalayondeja

Dr.Nantinee Nualnim

December 15, 2016 9:00 - 10:15 am

Stiffening of joints and hardening of arteries:

What can exercise do for us?

Stiffening of joint and hardening of the arteries

Prof. Dr. Hirofumi Tanaka 10:15 - 10:45 am

Coffee break

10:45 - 12:00 pm

Utility of swimming in exercise rehabilitation

Prof. Dr. Hirofumi Tanaka 12:00 - 1:00 pm

Lunch

1:00 - 2:30 pm

Oral and poster presentation

2:30 - 2:45 pm

Coffee break

2:45 - 4:00 pm

Oral and poster presentation

Stiffening of joints and hardening of arteries:

What can exercise do for us?

s:

The 3rd International Physical Therapy Conference and the 4th Physical Therapy Mahidol University Research Symposium December 14th-16th, 2016 Twin Towers Hotel, Bangkok

r us?

December 14 - 16 , 2016 th

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December 16, 2016 9:00 - 10:30 am

Stiffening of joints and hardening of arteries

What can exercise do for

Stiffening of joints and hardening of arteries:

What can exercise do for us?

Panel discussion: Osteoarthritis from joints to vascular

Prof. Dr. Hirofumi Tanaka

Asst. Prof. Dr. Wattana Jalayondeja

Dr.Nantinee Nualnim :Moderator 10:30 - 10:45 am

Coffee break

10:45 - 11:30 am

Meet and Greet with Prof. Dr. Hirofumi Tanaka

11:30 am - 12:00 pm

Awarding Ceremony

Stiffening of joints and hardening of arteries:

What can exercise do for us?

Chairpersons: Venue: Presentation time:

Dr.Wunpen Chansirinukor, Asst.Prof.Dr.Jarugool Tretriluxana Twin Towers Hotel, Bangkok Thailand.

15 December 2016 1.00-4.00 pm (10 minutes of presentation and 2 minutes of questions and answers)

No. Presenter 1. Sopinya Pluemjai 2.

Natiyagorn Chongaonoy

3.

Soraya Sratongtean

4.

Thanwarat Junsri

5.

6.

Maturin Juntongsree Ampika Nanbancha

7.

Shambhu Prasad Adhikari

Title Hip Joint Kinetics and Gluteus Medius Muscle Activity While Performing Step Tasks in Thai Females with and Without Knee Osteoarthritis: A Pilot Study.

Development of an Android Application for Reaction Time Test and Finger Tapping Test.

Accuracy and Consistency of Observational Skill in Using Vojta Based Observational Checklist of Motor Development in Full-Term Healthy Infants.

Musculoskeletal Disorders and Physical Performance in Petroleum Workers: A CrossSectional Survey.

Corticospinal Excitability of the Muscles Controlling Ankle Joint in Athletes with Chronic Ankle Instability: A Pilot Study.

Immediate Effects of Action-Observation-Execution Combined with Task-Oriented Training on Reach-to-Grasp Actions in Individuals with Sub-Acute Stroke.

Presentation Time 1.00-1.12 pm 1.12-1.24 pm 1.24-1.36 pm 1.36-1.48 pm 1.48-2.00 pm 2.00-2.12 pm 2.12-2.24 pm

Coffee Break and Poster Presentation

8. Pisit Suwannimit 9. Made Hendra Satria Nugraha 10. Gede Parta Kinandana

Active Forward Bend Task in Asymptomatic Individuals: A Pilot Study.

The Effectiveness of Bobath Training on Walking Speed among Individuals with Subacute Stroke.

The Combined Effect of Perturbation Training and Ultrasound Treatment on Functional Ability in individual with Knee Osteoarthritis.

11. Ni Komang Ayu Juni Antari The Effectiveness of Progressive Muscle Relaxation for Decreasing Blood Pressure in Grade I Hypertension.

12. Warin Rakkamon Impaired Dexterity in Elders with Mild Cognitive Impairment 13. Supansa Tajai Volitional and Social Skills Assessment of Thai Autistic Students

3.00-3.12 pm 3.12-3.24 pm 3.24-3.36 pm 3.36-3.48 pm 3.48-4.00 pm 4.00-4.12 pm

Section Poster Presentation

No. Presenter 1. Chutima Jalayondeja 2.

3.

4.

5.

Title Health Worker’s Knowledge, Skill and Attitude towards Physical Activity Promotion Based on Thai Physical Activity Guideline (TPAG) Chutima Jalayondeja Trunk and Extremities Muscle Strength Predict Independent Supine-to-Sit in Individuals with Stroke Watesinee Kaewkhuntee Energy Expenditure Determination of Physical Activity in Thai Physical Activity Guideline Kannika Permpoonputtana Cognitive Ability in Methamphetamine Abusers Compared to Healthy Control Kannika Permpoonputtana Astrocyte Activation and Cytokine Production in Hippocampus of Aged Mice

Presentation Time 2.24-3.00 pm 2.24-3.00 pm 2.24-3.00 pm

2.24-3.00 pm

Content page I *

Stiffening of Joints and Hardening of Arteries : What Can Exercise Do for Us? Curriculum Vitae

1

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Advocate for Accountability: NCD Prevention and Control Vijj Kasemsup, M.D., Ph.D.

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Epidemiology of Cardiovascular Disease Chutima Jalayondeja, Ph.D.

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Resistance Training and Vascular Disease Risks Hirofumi Tanaka, Ph.D.

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Stiffening of Joint and Hardening of Arteries Hirofumi Tanaka, Ph.D.

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Utility of Swimming in Exercise Rehabilitation Hirofumi Tanaka, Ph.D.

87

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Arterial Stiffness Assessment Nantinee Nualnim, Ph.D.

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Oral Presentations Hip Joint Kinetics and Gluteus Medius Muscle Activity while Performing Step Tasks in Thai Females with and without Knee Osteoarthritis: A Pilot Study Sopinya Pluemjai MSc, Komsak Sinsurin PhD, Roongtiwa Vachalathiti PhD, Chanin Lamsam, MD

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Development of an Android Application for Reaction Time Test and Finger Tapping Test Natiyagorn Chongaonoy BSc, Petcharatana Bhuanantanondh PhD, Keerin Mekhora PhD, Wattana Jalayondeja PhD

137

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Accuracy and Consistency of Observational Skill in Using Vojta Based Observational Checklist of Motor Development in Full-Term Healthy Infants Soraya Sratongtean, Saipin Prasertsukdee, Sureelak Sutcharitpongsa, Ubonwon Wathanadilokul

150

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Content page 168

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Musculoskeletal Disorders and Physical Performance in Petroleum Workers: A Cross-Sectional Survey Thanwarat Junsri, Keerin Mekhora PhD, Wattana Jalayondeja PhD, Chutima Jalayondeja DrPH

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Comparison of Neurodynamic Response and Pain in Experienced and Non-Experienced Thai Dancers Maturin Juntongsree, Keerin Mekhora PhD, Petcharatana Bhuanantanondh PhD

188

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Active Forward Bend Task in Asymptomatic Individuals: a Pilot Study Pisit Suwannimit PT, MSc student, Tanatta Chaichakan PT, MEng student, Peemongkon Wattananon PT, PhD

201

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Immediate Effects of Action-Observation-Execution Combined with Task-Oriented Training on Reach-To-Grasp Actions in Individuals with Sub-Acute Stroke Shambhu Prasad Adhikari BPT, Jarugool Tretriluxana PhD, Pakaratee Chaiyawat PhD, Chutima Jalayondeja DrPH

203

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Active Forward Bend Task in Asymptomatic Individuals: a Pilot Study Pisit Suwannimit PT, MSc student, Tanatta Chaichakan PT, MEng student, Peemongkon Wattananon PT, PhD

204

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The Effectiveness of Bobath Training on Walking Speed among Individuals with Sub-Acute Stroke Made Hendra Satria Nugraha S.Ft., Ni Komang Ayu Juni Antari S.Ft, Gede Parta Kinandana S.Ft., Ari Wibawa S.ST.Ft., M.Fis Ni Luh Nopi Andayani S.ST.Ft., M.Fis.

206

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The Combined Effect of Perturbation Training and Ultrasound Treatment on Functional Ability in Individual with Knee Osteoarthritis Gede Parta Kinandana S.Ft., Made Hendra Satria Nugraha S.Ft., Ni Komang Ayu Juniantari

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The Effectiveness of Progressive Muscle Relaxation for Decreasing Blood Pressure in Grade I Hypertension Ni Komang Ayu Juni Antari, S.Ft, Gede Parta Kinandana, S.Ft, Made Hendra Satria Nugraha, S.Ft

208

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Impaired Dexterity in Elders with Mild Cognitive Impairment Warin Rakkamon MSc, Sasithorn Saengrueangrob MSc, Thanwarat Chantanachai MSc, Mantana Vongsirinavarat PhD

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Content page *

III *

Volitional and Social Skills Assessment of Thai Autistic Students Supansa Tajai MA, Winai Chatthong MEng, Supalak Khemthong PhD Poster Health Worker’s Knowledge, Skill and Attitude towards Physical Activity Promotion Based on Thai Physical Activity Guideline (TPAG) Chutima Jalayondeja DrPH, Wattana Jalayondeja PhD, Roongtiwa Vachalathiti PhD, Sunee Bovonsunthonchai PhD, Prasert Sakulsriprasert PhD, Watsinee Kaewkhuntee PhD, Tipwadee Bunprajun PhD, Rujiret Upiriyasakul MSc

211

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Trunk and Extremities Muscle Strength Predict Independent Supine-toSit in Individuals with Stroke Chutima Jalayondeja DrPH, Thitinat Pankaew MSc, Pornsiri Suvarnnato MSc

215

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Energy Expenditure Determination of Physical Activity in Thai Physical Activity Guideline Watesinee Kaewkhuntee PhD, Chutima Jalayondeja DrPH Wattana Jalayondeja PhD, Piyaporn Wichaidij MSc

217

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Cognitive Ability in Methamphetamine Abusers Compared to Healthy Control Kannika Permpoonputtana PhD., Jatuporn Namyen MSc., Piyarat Govitrapong PhD.

219

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Astrocyte Activation and Cytokine Production in Hippocampus of Aged Mice Kannika Permpoonputtana PhD., Patlada Tangweerasing B.Sc., Piyarat Govitrapong PhD.

221

Organization

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IV

Curriculum Vitae

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Advocate for Accountability: NCD Prevention and Control Vijj Kasemsup, M.D., Ph.D. Department of Community Medicine Ramathibodi Hospital, Mahidol University, Thailand

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Epidemiology of Cardiovascular Disease Chutima Jalayondeja, Ph.D. Faculty of Physical Therapy, Mahidol University, Thailand

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Resistance Training and Vascular Disease Risks Hirofumi Tanaka, Ph.D. Cardiovascular Aging Research Laboratory Department of Kinesiology & Health Education The University of Texas at Austin

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Arterial Stiffness Assessment Nantinee Nualnim, Ph.D. Faculty of Physical Therapy, Mahidol University, Thailand

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Oral Presentations

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Hip Joint Kinetics and Gluteus Medius Muscle Activity while Performing Step Tasks in Thai Females with and without Knee Osteoarthritis: A Pilot Study Sopinya Pluemjai MSc Candidate*, Komsak Sinsurin PhD*, Roongtiwa Vachalathiti PhD*, Chanin Lamsam, MD** *

Biomechanics and Sports Research Units, Faculty of Physical Therapy, Mahidol University, Thailand

**

College of Sports Science and Technology, Mahidol University, Thailand

Objective: To compare hip frontal moment (HFM), hip abductor torque (HAT), and gluteus medius muscle (Gmed) activity during performing step up and down tasks between individuals with and without knee osteoarthritis (OA).

Material and Method: All participants were evaluated and divided into two groups (OA and control). Three step up and three step down tasks were tested for each limb. Kinematics, kinetic, and muscle activity were measured by cameras (100 Hz), two force plates (1,000 Hz), and electromyographer (1,000 Hz), respectively. HAT was measured by an isokinetic machine. Peak HFM, peak HAT, and Gmed activity was averaged and reported. Independent t-test was used to compare the data between groups.

Results: Five females in each group were matched for dominant leg, body mass index and age.

The finding exhibited that average muscle activity of left Gmed during left step up was significantly different between groups (p<0.05). However, no significant HFM was observed.

Less peak HAT was noted in OA group.

Conclusion: This study supports that there is an impairment of hip function in OA group. An affected limb showed a decrease of hip abductor strength and muscle activity. Therefore, hip abductor exercise should be suggested for people with OA.

Keywords: Hip joint kinetics, Gluteus medius muscle, Knee osteoarthritis Correspondence to: Sinsurin K, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.

E-mail address: komsak.sin@mahidol.edu

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Knee osteoarthritis (OA) is a common chronic joint disease in the elders( 1, 2) . Higher incidence and prevalence in females than males has been reported( 3) . People with knee OA experience knee joint dysfunction such as joint pain, decreased joint movement, changed alignment, joint stiffness, and impairment of energy absorption( 3- 5) . These dysfunctions cause physical disability and limit capacity to perform activities of daily living(6).

Biomechanical changes of lower extremity could be observed in the progression of knee OA, such as less hip muscle forces, increased external loading, foot hyperpronation, and joint moment alteration( 7- 10) . Previous studies have shown that hip and knee moments related to muscle activities of gluteus medius muscle (Gmed) during walking and stair climbing tasks in normal participants(7, 8, 11-13). In 2005, Chang et al(7) studied the function of hip abductor muscles in people with knee OA. They reported that there was an association between hip abductor muscle weakness and knee OA. Hip abductor muscle weakness in a stance limb led to the pelvic drop of a swing limb during walking. Then, the shifting of the center of mass to the swing limb would increase external knee adduction moment and knee joint medial loading on a stance limb.

Therefore, they suggested that greater peak internal hip abduction moment could protect the progression of medial knee OA in stance limb during stance phase of walking( 7) . Besides, previous studies reported the role of hip function in people with knee OA(8,14,15).

Step and stair climbing require more muscle function of lower limb, especially hip and knee extensor groups, than overground walking( 11- 13) . Moreover, stair climbing would be difficult for elders especially people with knee OA, thereby led to compensation patterns. The common patterns included toe- out during walking and stair climbing that reduced knee adduction moment. Most biomechanical studies examined lower extremity movements during overground walking in individuals with and without knee OA( 16- 18) . To better understand the biomechanical changes, the pattern of different biomechanics between people with and without knee OA should be investigated.

Therefore, the purposes were to compare hip frontal moment (HFM), hip abductor torque (HAT), and gluteus medius muscle (Gmed) activity during performing step up and down tasks between women with and without knee OA. We hypothesized that less Gmed muscle activity

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and difference of hip frontal moment of stance limb during step tasks would be observed in patient with knee OA than control group.

Material and Method Participants This pilot study was an observational study design. Ten females participated in this study and were divided into two groups including the women with knee OA and the women without knee OA (the control) groups. All participants were over fifty years of age, able to communicate, and able to perform step tasks without assistive device.

In the knee OA group, physical examination was performed. The American College of Rheumatology Classification Criteria (ARCC) ( 19) was used to identify the individual with knee OA. At least three of six criteria according to ARCC and at least one side of knee OA symptom had to be found in each participant.

In the control group, participants had no pain and no OA symptoms of the knee according to ARCC. They were screened and matched for dominant leg, body mass index (BMI), and age with the knee OA group.

Participants were excluded from the study if they had a history of serious injury or operation of lower extremities, musculoskeletal problems that affected lower extremity function of step tasks, regular physical therapy program in the last three months before testing, a history of corticosteroid injection at the knee within three months prior to participation, and an assistive device for ambulation.

Instrumentations and measures All tests were collected in the motion analysis laboratory. All participants were asked to wear the appropriate clothes provided by the researcher. The anthropometric data including elbow width, wrist width, hand thickness, knee width, ankle width, and leg length were measured to calculate the kinematic and kinetic data according to the Plug-in-Gait model. Thirtyfive reflective makers were placed on the bony prominence of both sides. The VICON Nexus 1.8.1 software (Oxford Metries, Oxford, UK) was used to operate and process the data. Ten video cameras with sampling rate at 100 Hz were used to collect movement of all reflective markers.

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Electromyographer ( Noraxon USA Inc. ) with a sampling rate at 1,000 Hz was synchronized with the VICON system and used to record the muscle activity of Gmed. Alcohol and sand paper was used for skin preparation to reduce impedance prior to electrode placement.

Inter-electrode impedance was less than 10 kOhm. Ag/AgCI surface electrodes (diameter 34 mm and sensor area 13.2 mm2) were placed on 50% of the distance between iliac crest and greater trochanter according to the European recommendations for Surface Electromyography (SENIAM). Inter-electrode distance was 20 mm from center to center. Adhesive tape was used to minimize cable sway. After EMG preparation, maximum voluntary isometric contraction (MVIC) test of Gmed muscle was undertaken. The participants were asked to stand in front of isokinetic dynamometer (System 4 Pro, Biodex Medical Systems Inc., New York, USA). They were instructed to perform Gmed MVIC at 30ď&#x201A;° hip abduction for three trials. The MVIC test was recorded in 5 seconds. Ninety seconds resting was allowed between trials. The data were collected for both sides.

Two force platforms ( AMTI, Advance Mechanical Technologise Inc. , USA) with a sampling frequency of 1,000 Hz were synchronized with the VICON system. A force plate was embedded in the stair and another one was on the ground as shown in Figure 1. Participants were asked to perform step up and step down tasks for both legs by randomly selected order.

Before actual testing, they practiced the step tasks to familiarize with the test. Each participant was provided 2-minute resting period between trials to prevent fatigue.

Step tasks test Participants were instructed to perform naturally step tasks without holding handrail.

For step up task, participants were asked to stand on the ground (force platform 1). Then, they were asked to perform the step up with the tested limb onto the step (force platform 2) and then non-tested leg was followed. The final position was standing on both legs on the step.

For step down task, participants were asked to perform step down from the step (force platform 2). Firstly, they were instructed to perform step down with non-tested limb onto the ground (force platform 1) followed by tested limb.

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Participants were tested for a total of 12 trials including three step up and three step down for each leg.

Force platfor

Force platfor Figure 1 Research setting in the Motion Analysis Laboratory

Data processing and analysis A low pass zero-lag, fourth order, butterworth filter was applied to filter the data. Marker coordinate and ground reaction forces were filtered at cutoff frequency of 6 Hz and 40 Hz, respectively. The current study determined the cut- off frequency with residual analysis technique( 20) . Joint kinematics and kinetics were calculated using a Plug- In Gait software.

Average peak hip moment in frontal plane was reported in the current study. For hip frontal moment, positive value represents adductor moment and negative value represents abductor moment. The joint moments were normalized with body mass.

Bandpass Butterworth filtering with cut-off frequency of 20-450 Hz was preferred to filter the raw EMG data. Average EMG 100 ms before and 500 ms after the peak hip frontal moment was collected for analyzing muscle activity during step tasks. Average EMG of Gmed muscle from three trials were reported in percentage of MVIC.

Statistical analysis SPSS version 19 (IBM Corporation, New York, USA) was used. All data in the current study was normal distribution testing with the Kolmogorov- Smirnov Goodness of Fit test.

Independent t-test was used to compare difference between the control and knee OA groups.

The level of significance was set at p-valve < 0.05.

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Results Participantâ&#x20AC;&#x2122;s demographics using mean and standard deviation (SD) are presented in Table 1. All participants have the right dominant leg. In the knee OA group, all participants had OA symptoms on the left knee. Comparison with independent t-test was analyzed. There were no significances (p > 0.05) of age and BMI between two groups.

Table 1. Participant demographics [mean (SD)] Groups

Number

Age (year)

BMI (kg/m2)

Knee OA

5

64 (8.3)

24.6 (3.8)

Control

5

65 (8.2)

26.6 (4.2)

Table 2 shows the average %MVIC of Gmed muscle activity during step up and step down tasks for both limbs. There were no significances between two groups, except of left Gmed muscle activity during step up task. A decreasing Gmed muscle activity was observed in participants with knee OA.

Table 2. Average %MVIC (SD) of Gmed muscle activity during step tasks.

Step up (%MVIC)

Step down (%MVIC)

Groups Left limb

Right limb

Left limb

Right limb

Knee OA

17.2 (9.6)*

15.4 (13.5)

13.6 (9.1)

13.6 (14.7)

Control

42.8 (29.9)

42.6 (34.4)

40.0 (39.1)

43.4 (31.0)

* Statistically significant difference compared with control group (p < 0.05)

Table 3 shows the hip adductor moment during step up and step down tasks of both limbs. There was no significant difference (p > 0.05) between two groups.

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Table 3. Mean (SD) of peak hip adductor moment Step up task (Nm)

Step down task (Nm)

Groups Left limb

Right limb

Left limb

Right limb

Knee OA

0.64 (0.25)

0.03 (0.29)

0.44 (0.36)

0.69 (0.27)

Control

0.26 (0.13)

0.25 (0.21)

0.51 (0.19)

0.55 (0.27)

Table 4 summarizes peak hip abduction torque of both sides. Participants with knee OA exhibited lower peak torque in both sides compared with the control group. However, there was no significant difference (p > 0.05) between two groups.

Table 4. Mean (SD) of peak hip abduction torque between two groups Peak hip abduction torque (Nm) Groups Left limb

Right limb

Knee OA

40.1 (11.3)

40.7 (5.3)

Control

59.4 (36.0)

57.1 (29.5)

Discussion The purpose of the pilot study was to compare HFM, HAT, and Gmed activity while performing step up and down tasks between women with and without knee OA. The results support the hypothesis that there was a significantly less Gmed muscle activity in the knee OA group compared with the control group. Moreover, there were trends of hip moments difference.

However, no statistically significant difference of hip adduction moment and peak hip abduction torque was observed.

Weakness of ipsilateral hip abductor muscles has been reported in individuals with medial tibiofemoral OA( 17, 18) . Gmed muscle works as pelvic stabilizer during walking. It helps protect contralateral pelvic drop, which could be observed in patients with knee OA. Therefore, increased loading on medial compartment of ipsilateral knee joint was a result of ipsilateral Gmed muscle weakness(7, 8, 15). These results agree with previous studies(17, 18). The average Gmed muscle activity during dynamic step up and step down tasks showed less EMG, which may result from impairment in motor unit recruitment of Gmed muscle. Moreover, hip abductor

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strength testing with isokinetic dynamometer exhibited less peak torque of isometric test in knee OA group. This weakness might be the cause of contralateral pelvic drop and ipsilateral trunk flexion during step tasks that might be observed during testing. Further study should investigate the pelvic level and trunk movement to support this phenomenon.

Normally, greater hip abductor function has been suggested as an important component to promote ipsilateral pelvic stability for clearing swing limb during overground walking and stair climbing tasks( 21) . Difference of dominant hip moment between knee OA and control groups was expected to observe in frontal plane. However, the present study showed peak frontal hip moment as adductor for both control and knee OA groups. Further study should include more parameters of trunk and lower extremity to describe the movement patterns of both groups of this study.

The limitations of the present study were that this study measured only the muscle activity of Gmed muscle, which is one of the hip abductors. Therefore, it might not represent hip abductor completely. Moreover, the number of participants and statistical power to analyze the data were small. Therefore, more participants will be included for the further study.

Conclusion There is an impairment of hip abductor function in OA group, especially gluteus muscle function. An affected limb exhibited a decrease in hip abductor strength and less Gmed muscle activity during performing step tasks. Therefore, hip abductor muscle exercise should be recommended for knee OA rehabilitation.

Acknowledgement The authors would like to thank all the participants in this study.

This study was financially supported by National Research Council of Thailand. The sponsor had no involvement in the study protocol.

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What is already known on this topic?

-

Muscle activity of gluteus medius was reduced in participants with knee OA.

-

The higher internal hip adduction moment was generated in affected limb (left limb) during left limb step up task, and right limb step down task (left limb was on the upper step).

-

Less peak torque of hip abductor was noted in participants with knee OA.

What this study adds?

This study supports that there is an impairment of hip function in knee OA group. Thus, hip abductor muscle exercise should be suggested for people with knee OA. Potential conflicts of interest None.

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21 Nadeau S, McFadyen BJ, Malouin F. Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking? Clin Biomech (Bristol, Avon). 2003 Dec;18(10):950-9.

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คิเนติกส์ข้อสะโพกและการทางานของกล้ามเนื้อ Gluteus medius ขณะก้าวขึ้นและลงบันไดในหญิงไทย ที่มีและไม่มีข้อเข่าเสื่อม: การศึกษานาร่อง โสภิญญา ปลื้มใจ, คมศักดิ์ สินสุรินทร์, รุ่งทิวา วัจฉละฐิต,ิ ชนินทร์ ล่าซา วัตถุประสงค์: เพื่อเปรียบเทียบโมเมนต์การกางและหุบข้อสะโพก ทอร์กกางสะโพก และการทางานของกล้ามเนื้อ Gluteus medius (Gmed) ขณะก้าวขึ้นและลงบันไดระหว่างผู้ที่มีและไม่มีข้อเข่าเสื่อม วัสดุและวิธีการ: ผู้ร่วมวิจัยได้รับการตรวจประเมินและแบ่งออกเป็นสองกลุ่ม (กลุ่มข้อเข่าเสื่อมและกลุ่มควบคุม) ทาการทดสอบ โดยการขึ้นบันไดสามครั้งและลงบันไดสามครั้งของขาแต่ละข้าง คิเนมาติกส์ คิเนติกส์ และการทางานกล้ามเนื้อ Gmed ถูกทา การวัดด้วยกล้อง แผ่นวัดแรงปฏิกิริยาจากพื้น และเครื่องวัดสัญญาณไฟฟ้ากล้ามเนื้อที่ความถี่ 100 Hz, 1,000 Hz และ 1,000 Hz ตามลาดับ ทอร์กกางสะโพกถูกวัดด้วยเครื่องไอโซคิเนติก ค่าสูงสุดโมเมนต์การกางและหุบข้อสะโพก ทอร์กกางสะโพก และ การทางานของกล้ามเนื้อ Gmed ถูกเฉลี่ยและรายงาน ใช้สถิติ Independent เพื่อเปรียบเทียบข้อมูลระหว่างกลุ่ม ผลการศึกษา: ผู้เข้าร่วมงานวิจัยกลุ่มละ 5 คน โดยควบคุมปัจจัยในเรื่องของขาข้างที่ถนัดเหมือนกัน ดัชนีมวลกายและอายุ ใกล้เคียงกัน การศึกษานี้แสดงให้เห็นว่า ค่าเฉลี่ยการทางานของกล้ามเนื้อ Gmed ของข้างซ้ายระหว่างการขึ้นบันไดมีความ แตกต่างอย่างมีนัยสาคัญระหว่างกลุ่ม (p<0.05) อย่างไรก็ตามไม่พบความแตกต่างของโมเมนต์การกางและหุบข้อสะโพก พบ ค่าสูงสุดของทอร์กกางสะโพกในกลุ่มข้อเข่าเสื่อมมีค่าน้อยกว่า สรุป: การศึกษานี้สนับสนุนว่า มีการทางานผิดปกติของสะโพกในกลุ่มผู้ที่มีข้อเข่าเสื่อม โดยขาที่ข้อเข่าเสื่อมมีความแข็งแรงและ การทางานของกล้ามเนื้อกางสะโพกลดลง ดังนั้นในผู้ที่มีข้อเข่าเสื่อมจึงควรได้รับคาแนะนาให้มีการออกกาลังกล้ามเนื้อกางสะโพก

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Development of an Android Application for Reaction Time Test and Finger Tapping Test Natiyagorn Chongaonoy BSc, Petcharatana Bhuanantanondh PhD, Keerin Mekhora PhD, Wattana Jalayondeja PhD Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand

Objective: The objectives of this study were to determine the test-retest reliability and users’ satisfaction of an android application for reaction time (RT) and finger tapping (FT) tests.

Material and Method: Thirty healthy volunteers aged 20-30 years participated in this study.

The test-retest reliability of an android application for RT and FT tests in three types of android tablets was assessed. Each participant performed simple RT (SRT), choice RT (CRT) and FT tests on each tablet; the order of tablets were randomized. There was a 10-minute rest period between each type of android tablets. Participants were also asked to rate their satisfaction with the android application on a scale from 1 (very dissatisfied) to 5 (very satisfied).

Results: The test-retest reliability of the application in three types of android tablet was moderate to high for the RT tests (ICC=0.67 for the SRT; ICC=0.75 for the CRT), and high for the FT tests (ICC=0.90 for right hand; ICC=0.93 for left hand). Overall participants’satisfaction with the android application was high (score 4.20 ± 0.48).

Conclusion: The developed android application was an acceptable tool to assess RT and FT. The findings also suggest that tablet specifications may affect the reliability of the application.

Keywords: Reaction time, Finger tapping test, Reliability

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Reaction time (RT) is a psychomotor performance parameter which can reflect the psychomotor and cognitive function in human(1). It is an interval between presentation of stimulus and initiation of response to that stimulus(2). The standard task for the RT test is asking participants to press a response button as immediately as a presentation of a light stimulus(3, 4).

Although the measured interval actually represents response time (summation of RT and movement time), this method is acceptable for determining RT(3). The short RT reflects the good psychomotor performances and high relationship between sensory and motor activities in the central nervous system(5). Fatigue can raise the RT because it reduces efficiency and alertness, and impairs performance and activity(6). The influential factors for the RT includes age (i.e. elders have longer RT when compared to younger adults)(7), gender (i.e. males have faster RT than females)(8, 9) and exercise (i.e. exercise can improve RT)(10) .Simple reaction time (SRT) and choice reaction time (CRT) were subtypes of RT. SRT involves making a response to a single stimuli as fast as possible. In CRT, there are multiple stimuli and the responder has to make the appropriate response for only one stimulus(4, 11, 12).

Finger tapping (FT) test is an assessment which reflects the level of alertness, ability to focus attention, or slowing of response(13). If there is reduced level of alertness, impaired ability to focus attention or slowing of responses, the number of tapping will be decreased(13, 14). The slow tapping rate demonstrates the development of physical fatigue(14, 15). For influential factors of FT, males tend to perform faster tapping than females; dominant hand obtains higher scores than non-dominant hand; and tapping rate decreases as age increases (13, 16).

Previously, to conduct the RT and FT tests, researchers must carry bulky equipment and manually record the data or use a personal computer(17). With the current technology, using the touch screen and android operation system in tablet may make the tests to be portable, practical, and easily accessible. Thus, in this study, an android application for RT and FT tests was developed to be a portable measurement tool to assess fatigue. However, the efficacy of touch screen on tablet depends on device size, age of device, and other hardware specifications such as central processing unit (CPU) and random-access memory (RAM) ( 18) . Different devices have different latencies depending on their specifications( 17) . Therefore, the aims of this study were to determine the test-retest reliability of an android application for RT and FT tests in

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three types of android tablet with different specifications and to evaluate user’s satisfaction of the android application.

Material and Method Study design This study was a measurement design aimed to determine the test-retest reliability and user’s satisfaction of an android application for RT and FT tests. This study was approved by Mahidol University Institutional Review Board (COA NO: MU-CIRB 2015/046.1604).

Study population Thirty healthy volunteers aged 20-30 years were recruited from Mahidol University. All participants had no visual problem or otherwise corrected by eye glasses or contact lens, were able to communicate in Thai language, and obtained at least seven hours of sleep the night before the test. The participants were excluded if they were diagnosed with neurological disorder or history of stroke, mental illness, and color blindness. They were excluded if they had vigorous exercise on the day before the test, took any caffeine or cigarette within three hours and alcohols within 24 hours before the test.

Measurements/Equipment An android application which consisted of the simple RT (SRT), the choice RT (CRT), and the FT tests, was developed in this study. The participants performed a series of these tests in three types of android tablets (i.e. “tablet 1” was the highest specification tablet; “tablet 2” was the medium specification tablet; and “tablet 3” was the lowest specification tablet). The details of each test in the application are as follows: For the SRT test, the participants were instructed to use the index finger of their dominant hand to press the “start” button to start the test. Then, they pressed the “stop” button as fast as possible when the red light appeared on the screen, as shown in Figure 1. For the CRT test, the participants were instructed to use the index finger of their dominant hand to press the “start” button to start the test. After that when the button with the letter “press me” and red light appeared on the screen, they pressed that button as fast as possible, as shown in Figure 2. The

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positions of the “press me” button were appeared in random fashion on the screen. For SRT and CRT tests, each participant performed the SRT test, 12 trials per session. At the end of the session, the average SRT was displayed to the participant in milliseconds.

Figure 1. Android application for simple reaction time. Use the index finger of the dominant hand press the “start” button to start the test. Press the “stop” button as fast as possible when the red light appears on the screen.

Figure 2. Android application for choice reaction time. Start the test by the using the index finger of dominant hand pressing the “start” button. Press the “press me” button corresponding to the position of the light as fast as possible when the light appears.

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For the FT test, the participants were instructed to use the index finger to press the “start” button; once the button with the letter “tap here” and green light appears, tap on that button as fast as possible within a 10- second time interval, as shown in Figure 3. Each participant performed the FT test 3 trials per session for each hand, starting with the left hand. At the end of the session, the average number of tapping for each hand was displayed to the participant.

Figure 3. Android application for finger tapping test. Start the test by pressing the “left hand start” or “right hand start” button. When the green light appears, press the “tap here” button as fast as possible continuously for 10 seconds.

In addition, a questionnaire was used to assess users’ satisfaction of the application for the RT and FT tests. The survey consists of five items, which are 1) the application is easy to access and navigate, 2) the interface of the application is easy to use, 3) the interface of the application is attractive, 4) the interface of the application is responsive, and 5) overall you satisfy with the application. T h e p articipants were asked to rate their satisfaction with the android application on a scale from 1 (very dissatisfied) to 5 (very satisfied).

Procedure All participants read and signed the informed consent before enrolling in the study.

After enrolling in the study, the participants were given the test instruction and 2-3 practice sessions were provided prior to start testing. Each participant performed a series of tests which are SRT, CRT and FT tests in three types of android tablet (i.e. tablet 1, tablet 2, and tablet 3).

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The order of the tablets was randomized and a 10-minute rest period was provided between each type of android tablet. After finishing the testing, each participant was asked to complete a questionnaire about user’s satisfaction on the android application.

Statistical analysis Statistical Package for the Social Sciences (SPSS) version 20 was used for statistical analyses. The statistical significant level was set at p-value < 0.05. Demographic data and users’ satisfaction of the android application were analyzed using descriptive statistics. The test-retest reliability of the android application for the SRT, CRT and FT tests in three types of android tablet was analyzed using intraclass correlation coefficient (ICC(3,3)).

Results Thirty healthy volunteers (7 males and 23 females, average age 21.63 ± 0.72 years) participated in this study. All of them were right-hand dominant. Table 1 presents the mean and standard deviation (SD) of each test and reliability of android application for the RT and FT tests in three types of android tablet.

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Table 1. Mean and standard deviation (SD) of each test and reliability of android application for RT and FT tests in three types of android tablet Test

Android application

ICC (3,3)

(mean ± SD) Tablet 1

Tablet 2

Tablet 3

Tablet 1 vs

Tablet 1 vs

Tablet 2 vs

Tablet 1 vs Tablet 2

Tablet 2

Tablet 3

Tablet 3

vs Tablet 3

SRT (msec)

428.97±56.30 449.95±41.09 481.79±80.09

0.76**

0.55**

0.46*

0.66**

CRT (msec)

663.74±82.80 676.57±55.35 688.04±76.10

0.71**

0.63**

0.70**

0.75**

FT of right hand

74.62±9.24

72.89±10.13

70.82±9.97

0.95**

0.82**

0.81**

0.90**

65.92±6.61

64.74±6.76

64.12±6.59

0.90**

0.92**

0.87**

0.93**

(times/10 sec) FT of left hand (times/10 sec) *Significant level set at p < 0.05, **Significant level set at p < 0.01

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The test-retest reliability of the application in three types of android tablet was moderate to high for the RT tests (ICC(3,3) = 0.67 for the SRT; ICC(3,3) = 0.75 for the CRT), and high for the FT tests (ICC(3,3) = 0.90 for right hand; ICC(3,3) = 0.93 for left hand). In addition, the results showed that there were high reliability of “tablet 1-tablet 2” for all tests of the application (ICC(3,3) = 0.710.95). However, the reliability of “tablet 1-tablet 3” and “tablet 2-tablet 3” were moderate for SRT (ICC(3,3) = 0.549 and 0.464, respectively) and CRT (ICC(3,3) = 0.63 and 0.70, respectively) test and were high for the FT tests (ICC( 3,3) = 0.81-0.92). As for user’s satisfaction, the results showed more than 3.5 scores for all questions, as shown in Table 2.

Table 2. Satisfaction of android application Item

Satisfaction level (mean ± SD)

1. The application is easy to access and navigate.

4.67 ± 0.48

2. The interface of the application is easy to use.

4.20 ± 0.81

3. The interface of the application is attractive.

3.77 ± 0.97

4. The interface of the application is responsive.

4.20 ± 0.80

5. Overall, you satisfy with the application.

4.20 ± 0.48

Discussion This study demonstrated moderate to high test-retest reliability among three applications.

There were also high reliability for all tests of the application between tablet 1 and tablet 2.

However, the reliability of “tablet 1-tablet 3” and “tablet 2-tablet 3” were at moderate level for the SRT and CRT tests.

CPU or central processing unit was similar as brain of smart phone and tablet. It could be divided by the number of core (worker) in CPU into four categories as followed: single, dual, quad, and octa (one, two, four, and eight, respectively). The more number of core CPU, the more efficient that a smartphone or tablet will be processing. RAM was the same as transmission data from CPU (high RAM reflects high efficiency) ( 18) . In this study, tablet 1, tablet 2 and tablet 3 had an octa-core CPU and RAM 3.0 GB, quad-core CPU and RAM 1.5 GB, dual-core CPU and

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RAM 1 GB, respectively. There was high reliability of tablet 1 vs tablet 2. This might be because tablet1 and tablet 2 had a high the number of core in CPU, high RAM and had a graphics processing unit ( GPU) , thus it reduces the function of CPU and leads to more efficient in processing.

In addition, in this study tablet 2 and tablet 3 had the same size and type of display, but the reliability of tablet 2 vs tablet 3 was moderate to high. This finding suggested that the efficiency of touch screen on tablet for RT and FT test depended on CPU and GPU, but was not dependent on size and type of display. Moreover, the efficiency of touch screen for RT and FT test in three types of android tablet in this study depended on version of android operating system (high version reflects the improved performance of smart phone and tablet) and number of RAM (high RAM reflects high efficiency of processing data) (18).

These findings from this study suggest that performance of android tablet depends on hardware specifications which is in line with previous studies(17-18). It should also be pointed out that the RTs in this study were greater than some studies( 19- 20) , but about the same range with other studies(21-22). The differences of RTs in various studies might be because of using different equipment. For instance, the RTs assessed by touch screen device reported to be greater than those assessed by keyboard-based device or mouse. It might be the hardware testing of mobile devices had showed variability for touch latency between of 50 to 150 msec( 23) . To date, there were no data on baseline RT for the application and no studies compared the mobile application to the validated equipment for RT assessment(24). Moreover, userâ&#x20AC;&#x2122;s satisfaction of most aspects of the application for RT test and FT test was at high satisfaction level (score more than 4). The aspect of the application that received the least satisfaction rating was the attractiveness of the interface. This suggests that further improvement of the application is needed.

There were some limitations in this study. Only three types of android tablets were studied for test-retest reliability. However, three tablets used in this study represent low to high specification of android application. In addition, the participants in this study were university students who aged 20-30 years that might not be generalized to the whole population.

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Conclusion The findings of this study indicated that the android application for RT test and FT test was an acceptable tool to assess RT and number of FT. It is portable, practical, and easily assessable. However, the application should be used with caution. If the application must be used with a touch screen device, it should be the same device for each serial testing event.

Acknowledgement We would like to express our gratitude and appreciation to all participants for their participation. We also would like to thank the PTT Exploration and Production Public Company Limited for the funding support.

Potential conflicts of interest None.

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11th Annual Symposium on Graduate Research and Scholarly Projects. Wichita, KS: Wichita State University.

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การพัฒนาโปรแกรมการทดสอบเวลาปฏิกิริยาและความเร็วในการตอบสนองบนระบบแอนดรอยด์ นติยากร ชนเก่าน้อย, เพชรรัตน์ ภูอนันตานนท์, คีรินท์ เมฆโหรา, วรรธนะ ชลายนเดชะ วัตถุประสงค์: เพื่อทดสอบความน่าเชื่อถือแบบวัดซ้าและความพึงพอใจของโปรแกรมการทดสอบเวลาปฏิกิริยาและความเร็ว ในการตอบสนองบนระบบแอนดรอยด์ วัสดุและวิธีการ: อาสาสมัครที่มีสุขภาพดีจ้านวน 30 คนมีอายุระหว่าง 20-30 ปี เข้าร่วมการศึกษาครังนี การทดสอบความ น่าเชื่อถือแบบวัดซ้าของโปรแกรมการวัดเวลาปฏิกิริยาและความเร็วในการตอบสนองในแท็บเล็ตทังหมด 3 รุ่น ผู้เข้าร่วม การศึกษาแต่ละคนท้าการวัดเวลาปฏิกิริยาและความเร็วในการตอบสนองในแท็บเล็ตทุกรุ่น โดยมีการสุ่มล้าดับของแท็บเล็ตใน การทดสอบ พัก 10 นาทีระหว่างการทดสอบในแท็บเล็ตแต่ละรุ่น ผู้เข้าร่วมการศึกษาประเมินความพึงพอใจต่อโปรแกรมบน แท็บเล็ต ข้อค้าถามมีระดับคะแนน 1 (ไม่เห็นด้วยอย่างยิ่ง) ถึง 5 (เห็นด้วยมากที่สุด) ผลการศึกษา: ผลการศึกษาพบว่าความน่าเชื่อถือ แบบวัดซ้าของโปรแกรมในแท็บเล็ต 3 รุ่น การทดสอบเวลาปฏิกิริยาอยู่ใน ระดับปานกลาง-สูง (การทดสอบเวลาปฏิกิริยาอย่างง่าย; ICC=0.666, การทดสอบเวลาปฏิกิริยาแบบซับซ้อน; ICC=0.754) และการทดสอบความเร็วในการตอบสนองอยู่ในระดับสูง (ด้านขวา; ICC=0.902, ด้านซ้าย; ICC=0.927) ผู้เข้าร่วมการศึกษา ทังหมดมีความพึงพอใจต่อโปรแกรมการทดสอบบนระบบแอนดรอยด์อยู่ในระดับสูง (4.20 ± 0.48) สรุป: โปรแกรมที่พัฒนาขึนมานีเป็นเครื่องมือที่ยอมรับได้ในการวัดเวลาปฏิกิริยาและความเร็วในการตอบสนอง ผลการศึกษานี ยังชีให้เห็นว่าข้อมูลจ้าเพาะของแท็บเล็ตอาจมีผลต่อความน่าเชื่อถือของโปรแกรมการทดสอบ

149

Accuracy and Consistency of Observational Skill in Using Vojta Based Observational Checklist of Motor Development in Full-Term Healthy Infants Soraya Sratongtean*, Saipin Prasertsukdee*, Sureelak Sutcharitpongsa** Ubonwon Wathanadilokul*** *

Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand

**Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ***

Department of Physical Medicine and Rehabilitation, Queen Sirikit National Institute of Child Health, Bangkok, Thailand

Objective: To examine how well and consistently a rater observed the quality of motor development using Vojta based observational checklist of motor development (V_OCMD).

Material and Method: The V_OCMD was developed based on Vojta concepts to assess the quality of motor development in infants aged 0-6 months. Gross motor abilities in supine, prone and rolling obtained from 10 full-term healthy infants aged 2-6 months were recorded on videotapes. One rater who is a pediatric physical therapist and one expert who has 10 years of experience in pediatric physical therapy and 5 years of experience in Vojta therapy participated in this study. They both independently viewed the videotapes of the infantsâ&#x20AC;&#x2122; motor development.

The rater viewed the same videotapes in one week apart.

Results: The agreement between the rater and the expert in observing the motor development was acceptable (>80% , kappa > 0.6) indicating that the rater had sufficient skills in observing the motor development. Moreover, the raterâ&#x20AC;&#x2122;s agreement of two times of rating the motor development was acceptable (>80% , kappa > 0.6). These results indicate that the rater was able to observe the motor development consistently.

Conclusion: The rater had sufficient observational skills of motor development using the V_OCMD.

Keywords: V_OCMD, Observational checklist, Quality of movement, Motor development, Vojta.

Correspondence to: Sratongtean S, Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Road, Salaya, Phutthamonthon, Nakhon Prathom 73170, Thailand.

Phone:+66-99-2299169 E-mail: soraya.sra@mahidol.edu

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Motor development, especially during the first year of age is very important for upcoming motoric abilities and quality(1-3). These essential movement components are described in terms of the acquisition of control and coordination movement in conjunction with the age of achievement( 1, 2, 4, 5) . At present, there are several approaches to assess the spontaneous movement of normal infants during the first year and the interest in the motor development of normal infants is widespread( 6,

7)

. Assessing the global and segmental patterns of motor

development and maturation of movement components are required for effective interventions such as Vojta therapy(8-11). Vojta therapists analyze movements regarding what and how well an infant can do and observe movement deviations from the global and partial patterns of spontaneous movements(10, 11). For completely observing the global and partial patterns of motor development in typical infants based on Vojta therapy, an observational checklist is needed( 10) .

Currently, there has been no observational checklist of motor development suitable for observing motor development based on Vojta therapy.

Therefore, we developed the

observational checklist of motor development based on Vojta concept( 8- 10) , called the Vojta observational checklist of motor development or V_OCMD. The V_OCMD is used to observe qualitative components of motor development in infants with typical development in supine, prone and rolling position. To ensure that pediatric physical therapists were able to use the V_OCMD for assessing the motor development in infants, the accuracy and consistency were needed( 12- 15) . The purpose of this study was to examine accurary and consistency of a rater in observing the motor developments in infants with 2-6 months of age using the V_OCMD. This study was a preliminary study for examining observational skill of the major observer in the main study in the topic: the quality of motor development in healthy infants with 2-6 months of age.

Material and Method This study was an observational design. Ten Thai full-term healthy infants with the age of 2-6 months participated. They were recruited from the community hospital in Salaya district, Nakhon Prathom province. The information on procedure was explained to participantsâ&#x20AC;&#x2122; parents.

The parents signed the inform consent. This study was approved by the MUIRB (COA NO : 2016/027.1202).

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All participants were screened by a pediatrician according to the following inclusion criteria for the full-term healthy infants. The criteria were 1) no complication during pregnancy and labour 2) Apgar scores â&#x2030;Ľ 8 at one minute and 10 at five minutes 3) birth weights â&#x2030;Ľ 2500 grams, 4) gestational ages range of 38-42 weeks, 5) weight, length and head circumference range of 3rd-97th percentiles based on standard growth chart. The partcipants were excluded if they had history of serious medical complications.

Vojta observational checklist of motor development (V_OCMD) (see Appendix 1 and Appendix 2 ) The V_OCMD is a checklist of quality of motor development in supine, prone, and rolling. This checklist is used when a therapist observes global patterns and segmental patterns of gross motor function as well as grasping and reaching and vision in an infant when she/he is in supine, prone, and rolling. For global patterns of gross motor function, the most mature pattern (the hightest motor development milestone) is observed. Segmental patterns of gross motor function are then observed from the selected global patterns. Segmental patterns consisted of anatomical positions of head, trunk, spine, scapula, upper and lower extremitries.

For each segmental patterns, the therapist will check what she/he can observe most frequently.

Procedure Participant preparation and videotaping. On the testing day, the participants had no illness and inreadiness state. They were fed about two hours before testing, alert and not tired confirmed by their parents. The participants were underwear or diaper or were undressed. The researcher recorded the demographic data including age, gender, weight, height, head circumference and apgar score. Each participant was observed in a quiet room with comfortable temperature. They were positioned in supine first and followed by prone and rolling positions.

For all starting positions, their spontaneous movements were encouraged with minimal handling using toys for three repetitions each. Each movement was repeated and videotaped for five minutes in three views: top view, right side, and left side.

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Scoring Two pediatric physical therapists took part in this study. The first person (SS) acting as the main observer or a rater had five years of experience in pediatric physical therapy and two years of experience in Vojta therapy. The second person (SP) acting as the expert had 10 years of experience in pediatric physical therapy and five years of experience in Vojta therapy. Both of them independently viewed the videotapes recording the participantâ&#x20AC;&#x2122;s motor development and rated scale using the V_OCMD in supine, prone and rolling. Only the rater repeated the scoring of the same videos one week later.

Data analysis The observational ratings were showed during the rater and expert in the first session were analyzed for ensuring whether the rater accurately observed the motor development using V_OCMD. The ratings by the rater for the first and second sessions were analysed for ensuring whether the rater consistently observed the motor development using V_OCMD. Percentage of agreement index (PA) and the Kappa coefficient were calculated index (K)(16-18).

PA =

numbers of agreements Ă&#x2014; 100 total observations K=

đ?&#x2018;&#x192;đ?&#x2018;&#x192; â&#x2C6;&#x2019; đ?&#x2018;&#x192;c 1 â&#x2C6;&#x2019; đ?&#x2018;&#x192;c

Po is the proportion of observed agreements Pc is the proportion of agreements expected by chance Percentage of agreement is needed to be at least 80 percent for indicating acceptable agreement. Kappa value is needed to be at least 0.6 for indicating acceptable agreement( 17, 19) .

The criteria for interpreting Kappa are as follows:

K = 0.4-0.6

Moderate agreement

K > 0.6

Substantial agreement

K > 0.8

Excellent agreement

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Results Ten infants who were videotaped for this study were covered in the age range and met the inclusion criteria required in the research. Demographic data of the participants who were videotaped for the study are shown in Table 1.

Table 1. Demographic data of infants who were videotaped for the study Demographic data of infants (n = 10)

Mean + Standard deviation

Gestational age (weeks)

35.4

+0.9

Age (months)

3.9

+4.7

Birth weight (grams)

3060.0+313.1

Birth length (centimeters)

48.4

+0.8

Head circumference (centimeters)

34.9

+0.6

Apgar score at 1 minute

9.4

+0.5

Apgar score at 5 minutes

10

Âą0

1. Agreement of observational ratings of global patterns using the V_OCMD between the rater and the expert Percentage of agreement for the global patterns of motor development between the rater and the expert are shown in Table 2. Percentage of agreement for the global patterns had 86, 88 and 100 percent in supine, prone and, rolling, respectively. All of them achieved the acceptable levels of agreement. For Kappa coefficients, the value for the global patterns of motor development in supine, prone, and rolling was 0.7, 0.7 and 1, respectively.

2. Agreement of observational ratings of global patterns using the V_OCMD of the rater between sessions 1 and 2

154

The global patterns of motor development of the rater between sessions 1 and 2 as presented in percentage of agreement and Kappa values are shown in Table 3. Percentage of agreement for the global patterns were 100 percent in supine, prone and, rolling. For Kappa coefficients, the value for the global patterns of motor development in supine, prone, and rolling was K= 1.

Table 2. Observational agreement of global patterns using the V_OCMD between the rater and the expert in supine, prone, and rolling Numbers of observation

%Agreement

Supine

7

86

Prone

8

88

0.7

100

1

Position/movement during observing the global patterns of motor development

Rolling

5

Kappa

0.7

Table 3. Observational agreement of global patterns using the V_OCMD of the rater between sessions 1 and 2 in supine, prone, and rolling

Numbers of observation

%Agreement

Supine

6

100

1

Prone

7

100

1

Rolling

5

100

1

Position/movement during observing the global patterns of motor development

Kappa

3. Agreement of observational ratings of segmental patterns using the V_OCMD between the rater and the expert

155

Percentage of agreement for the segmental patterns of motor development between the rater and the expert are shown in Table 4. All observed segmental patterns in supine, prone, and rolling had percentage of agreement at least 80 percent (80-100%). For Kappa coefficients, the value for all observed segmental patterns of motor development in supine, prone, and rolling were at least 0.6 (K=0.6-1).

4. Agreement of observational ratings of segmental patterns using the V_OCMD of the rater between sessions 1 and 2 The results of agreement of observational rating of the motor development using the VOCMD of the rater between session 1 and 2 are shown in Table 5. All observed segmental patterns in supine, prone, and rolling had percentage of agreement at least 80 percent (80-100%).

For Kappa coefficients, the value for all observed segmental patterns of motor development in supine, prone, and rolling were at least 0.6 (K=0.6-1).

156

Table 4. Observational agreement of segmental pattern by using the V_OCMD between the rater and the expert Supine (N = 10)

Segmental patterns

Prone (N = 10)

Rolling (N = 10)

No. of observation

% Agreement

Kappa

No. of observation

% Agreement

Kappa

No. of observation

% Agreement

Kappa

Position of head

6

100

1

5

80

0.6

4

100

1

Movement of head

3

100

1

7

85

0.7

-

NA

NA

Position of trunk

7

100

1

6

100

1

4

100

1

Position of scapula

7

85

0.7

15

87

0.7

14

92

0.8

Position of shoulder

16

100

1

25

96

0.9

45

93

0.8

Position of elbow

-

NA

NA

7

100

12

100

1

Position of forearm

-

NA

NA

8

100

6

100

1

Position of wrist

-

NA

NA

23

100

20

90

0.8

Position of hand

-

NA

NA

8

100

88

0.7

7

86

94

0.8

21

90

Position pelvis Position of hip Position of knee Position of ankle

(N) = numbers of participants;

157

9 18 16 26

100 92

1 0.8

NA = Not applied in the position

1 1 1 1

12

0.7 0.8

8

100

100

18

89

23

87

13

100

83 0.6

-

NA

0.8 0.7 1

1 18

1

NA

Table 5. Observational agreement of segmental pattern by using the V_OCMD of the rater between sessions 1 and 2 Supine (N = 10)

Segmental patterns

Prone (N = 10)

Rolling (N = 10)

No. of observation

% Agreement

Kappa

No. of observation

% Agreement

Kappa

No. of observation

% Agreement

Kappa

Position of head

6

100

1

5

80

0.6

4

100

1

Movement of head

3

100

1

7

85

0.7

-

NA

NA

Position of trunk

7

100

1

6

100

1

4

100

1

Position of scapula

6

100

1

14

100

1

13

85

0.7

Position of shoulder

16

94

0.8

24

92

0.8

43

93

0.8

Position of elbow

-

NA

NA

7

100

1

12

83

0.6

Position of forearm

-

NA

NA

8

100

1

6

83

Position of wrist

-

NA

NA

23

100

1

20

100

Position of hand

-

NA

NA

8

100

1

12

100

86

1

7

100

1

16

94

88

0.7

19

100

1

20

90

1

8

100

1

13

100

0.8

15

86

0.7

-

NA

Position pelvis Position of hip Position of knee Position of ankle

8 17 16 24

100 92

(N) = numbers of participants; NA = Not applied in the position

158

0.6 1 1 0.8 0.8 1 NA

Discussion The results showed that percentage of the agreement and Kappa values in observing all global and segmental patterns by the V_OCMD between the rater and the expert were acceptable (i.e., ≥ 80% , K ≥ 0.6) indicating that the rater had sufficient skills in observing the motor development using the V_OCMD. Additionally, percentage of the agreement and Kappa values in observing all global and segmental patterns by the V_OCMD between sessions 1 and 2 were acceptable (i.e., ≥ 80% , K ≥ 0.6) indicating that the rater can consistently observe the motor development using the V_OCMD. The pilot study is for ensuring that the rater in this research study had acceptable skills in collecting the data from the videos of motor development in an infants. It is important preparatory process the valid and reliable data collection(12).

Limitation of the study Numbers of observation in some global and segmental patterns of motor development in 10 infants were small (< 10) because of un-clearness or unseen of the video views were not considered by the obsevers. Therefore, the orientations of the video cameras will be developed to get the better video views of motor development. Furthermore, the locations of the therapist who encourages infants to act while videotaping will be adjusted to prevent hindering the views of infants’ posture and movement.

Conclusion According to the pilot study, the main observer had valid and reliable observational skill for motor development using the V_OCMD in healthy full term infants with 2-6 months of age.

This was a prepatory process for acceptable data collection in the research study.

Acknowledgement Special thanks are given to all infants and their parents for their valuable contribution to this study.

159

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1996;22(2):249-54.

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ความถูกต้องและความสม่​่าเสมอในการใช้แบบรายการตรวจสอบโดยการสังเกตพัฒนาการการเคลื่อนไหว ตามพื้นฐานของวอยต้าในทารกคลอดครบก่าหนดที่มีสุขภาพดี: การศึกษาขั้นต้น สรญา สระทองเทียน, สายพิณ ประเสริฐสุขดี, สุรีย์ลักษณ์ สุจริตพงศ์, อุบลวรรณ วัฒนาดิลกกุล วัตถุประสงค์ : เพื่อตรวจสอบว่าผู้ประเมินสามารถสังเกตคุณภาพของพัฒนาการด้านการเคลื่อนไหวโดยใช้แบบรายการ ตรวจสอบโดยการสังเกตพัฒนาการการเคลื่อนไหวตามพื้นฐานของวอยต้า (V_OCMD) ได้อย่างดีและสม่​่าเสมอหรือไม่ วัสดุและวิธีการ: แบบประเมิน V_OCMDถูกพัฒนาขึ้นจากแนวคิดของวอยต้าเพื่อตรวจคุณภาพของพัฒนาการการเคลื่อนไหว ในทารกแรกเกิดถึง 6 เดือน ทารกที่คลอดครบก่าหนดและมีสุขภาพดี อายุ 2-6 เดือน จ่านวน 10 คน ถูกบันทึกวิดีโอเทป ความสามารถของการเคลื่อนไหวในท่านอนหงาย และท่านอนคว่​่า นักกายภาพบ่าบัดด้านเด็กหนึ่งคนในฐานะผู้ประเมิน และ ผู้เชี่ยวชาญหนึ่งคน ที่มีประสบการณ์ด้านกายภาพบ่าบัดด้านเด็กเป็นเวลา10 ปี และมีประสบการณ์ด้านการบ่าบัดด้วยวอยต้า เป็นเวลา 5 ปี ประเมินพัฒนาการการเคลื่อนไหวของทารกผ่านวิดีโอเทป ผู้ประเมินดูวิดีโอเทปชุดเดิมซ้่าโดยเว้นช่วงระยะเวลา 1 สัปดาห์ ผลการศึกษา: ค่าความเห็นพ้องระหว่างผู้ประเมินและผู้เชี่ยวชาญในการสังเกตพัฒนาการการเคลื่อนไหวอยู่ในค่าที่ยอมรับได้ (มากกว่าหรือเท่ากับ 80% และ kappa >0.6) แปลผลว่า ผู้ประเมินมีทักษะที่เพียงพอในการสังเกตพัฒนาการการเคลื่อนไหว ยิ่งไปกว่านั้น ค่าความเห็นพ้องของผู้ประเมินในการสังเกตพัฒนาการการเคลื่อนไหว 2 ครั้งอยู่ในค่าที่ยอมรับได้ (มากกว่าหรือ เท่ากับ 80% และ kappa >0.6) แปลผลว่า ผู้ประเมินสังเกตพัฒนาการการเคลื่อนไหวได้อย่างสม่​่าเสมอ สรุป: ผู้ประเมินมีทักษะในการสังเกตพัฒนาการการเคลื่อนไหวโดยใช้ V_OCMD อย่างเพียงพอ

162

APPENDIX 1 Sample of V_OCMD THE QUALITY OF MOTOR DEVELOPMENT IN HEALTHY INFANTS WITH 0 – 6 MONTHS Subject ID…………………………...Date of observation………………………..................

Gender…………...Weight……………Length…………......Head circumference………….

Date of birth…………………………Chronological age…………………………………….

1. Supine 1.1 Gross motor Overall patterns (for observing key motor development)

Check (/) when be observed the most mature pattern should to explain the term of “the most mature pattern”

Asymmetry posture: fix his/her at objects with extension of facial limbs and flexion in occipital limbs (Fencer posture— Vojta)

Bring both hands to midline (Hand – hand coordination-- Vojta) Grasp a toy and bring to the mouth (even get it or not) (Hand-mouth-eye coordination—Vojta) Brings hand(s) to tummy (Hand-stomach coordination—Vojta Brings hand (s) to genital area/knee (Hand-genital-knee coordination--Vojta) Play feet with hand(s) ( foot – hand – eye coordination--Vojta)

163

1.1 Gross motor

Segmental patterns (for observing merged required components and deviations) 1.

Check (/) when be most frequently observed

Midline (Axial extension—Vojta)

Hyperextension (Reclination of head-Vojta)

R

L

Lateral flex to R or L Rotate to 2.

R or L

Movement of head

Turns head but not complete to ….. side(s)R / L / Both

Turns head completely to … side(s)R / L / Both 3.

Position of trunk Midline (Elongation—vojta)

Hyperextension (Reclination-vojta) R Lateral flex to R or L

Rotate to R or L

164

L

APPENDIX 2 Details of overall and segmental patterns used in the V_OCMD

Overall patterns Supine position Asymmetry posture Bring both hands to midline Grasp a toy and bring to the mouth Brings hand(s) to tummy Brings hand (s) to genital area/knee Play feet with hand(s)

Segmental patterns Head +Trunk + UEs Position of head Hyperextension Lateral flex to R or L Rotate to R or L Movement of head Turns head but not complete to … side(s)R / L / Both Turns head completely to … side(s)R / L / Both Position of trunk Midline (Elongation—vojta) Hyperextension Lateral flex to R or L Rotate to R or L Position of scapula Neutral Protraction Retraction Position of Shoulder Internal rotation External rotation Position of elbow Flexion Extension Hyperextension

165

Position of forearm Pronation Mid position Supination Position of wrist Flexion Neutral Extension Ulnar deviation Radial deviation Position of hand Fisted Open

Segmental patterns LEs Position pelvis Neutral Anterior tilt Posterior tilt Upward on R Upward on L Forward on R Forward on L Position of hip Straight or flexion < 45 Flexion < 90 Flexion 90 Flexion > 90 Adduction Abduction Internal rotation Neutral rotation External rotation Position of knee Straight or flexion < 45 <45 Flexion < 90 Flexion = 90 Flexion > 90

Position of ankle DF PF Adduction Neutral Pronation Supination

Overall patterns Prone position Inert flexion of all joints, no support Forearm flopping Forearm support Forearm support with one hand reaching Hands support Swimming like posture

166

Segmental patterns Head +Trunk + UEs Head up < 45 >45 but < 90 90 >90 Hyperextension Head orientation Lateral flex to R or L Rotate to R or L Movement of Head Turns head but not complete to….

Turns head completely to …

Position of trunk Midline Hyperextension Lateral flex to R or L Rotate to R or L Position of scapula Neutral Protraction Retraction Position of Shoulder Flexion < 90 Flexion 90 Flexion > 90 Adduction Abduction Horizontal abduction Internal R Neutral External R Position of elbow Flexion Extension Hyperextension

Position of forearm Pronation Mid position Supination Position of wrist Flexion Neutral Extension Ulnar deviation Radial deviation Position of hand Fisted Open

Segmental patterns LEs Position pelvis Position of ankle Neutral DF Anterior tilt PF Posterior tilt Adduction Upward on R Neutral Upward on L Pronation Forward on R Supination Forward on L Position of hip Straight or flexion < 45 Flexion < 90 Flexion 90 Flexion > 90 Adduction Abduction Internal rotation Neutral rotation External rotation Position of knee Straight or flexion < 45 <45 Flexion < 90 Flexion = 90 Flexion > 90

Overall patterns Rolling Supine to sidelying Supine to prone Supine to prone , and can pause in sidelying Prone to supine

Segmental patterns Head +Trunk + UEs Position of head Reclination of neck neutral lateral flexion during sidelying Movement of Head Turns head but not complete toâ&#x20AC;Ś.

Turns head completely to â&#x20AC;Ś Position of trunk Flexion Neutral Extension Position of underlying arm Position of scapula Neutral Protraction Retraction Position of Shoulder Flexion Extension Position of elbow Flexion 90 Flexion >90 Position of wrist Flexion Neutral Extension Ulnar deviation Radial deviation

Segmental patterns LEs Position of hand Fisted Open Position of underlying arm Position of scapula Neutral Protraction Retraction Position of Shoulder Flexion <90 >90 but < 120 đ?&#x2018;&#x192;120 Abduction <90 >90 but < 120 đ?&#x2018;&#x192;120 Internal rotation External rotation Position of forearm Pronation Mid position Supination Position of wrist Flexion Neutral Extension Ulnar deviation Radial deviation Position of hand Fisted Open

Position of underlying leg Position pelvis Neutral Anterior tilt Posterior tilt Upward on R Upward on L Forward on R Forward on L Position of hip Straight or flexion < 45 Flexion < 90 Flexion 90 Flexion > 90 Internal rotation Neutral rotation External rotation Position of knee Straight or flexion < 45 <45 Flexion < 90 Flexion = 90

Position of upper leg Position pelvis Neutral Anterior tilt Posterior tilt Upward on R Upward on L Position of hip Straight or flexion < 45 Flexion < 90 Flexion 90 Flexion > 90 Internal rotation Neutral rotation External rotation Position of knee Straight or flexion < 45 <45 Flexion < 90 Flexion = 90

Flexion > 90 Position of ankle DF PF Adduction Neutral Pronation Supination

Flexion > 90 Position of ankle DF PF Adduction Neutral Pronation Supination

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Musculoskeletal Disorders and Physical Performance in Petroleum Workers: A Cross-Sectional Survey Thanwarat Junsri, Keerin Mekhora PhD, Wattana Jalayondeja PhD, Chutima Jalayondeja DrPH Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand Objective: This study aimed to determine the prevalence of musculoskeletal disorders (MSDs) and the association between individual, work task, and physical performance and the MSDs in petroleum workers.

Material and Method: A cross-sectional survey was conducted in a petroleum company, Kamphaeng Phet province, North of Thailand. A total of 294 workers completed a selfadministered questionnaire to report their pain in 11 body areas and factors related to the symptom. They were also tested for physical performance by physical therapists including muscle length, muscle strength, muscle endurance, and lumbar stabilization. The odds ratio (OR), 95% confident interval (CI) and the Chi-square test were used for data analysis.

Results: The prevalence of musculoskeletal disorders within seven days was found mostly in shoulder (25.9%), lower back (24.5%), neck (23.5%), knee (20.4%) and ankle/foot (15.0%). The risk of MSDs was higher in women than men in neck, shoulder and upper back (OR=2.023), (OR=5.575) and (OR=2.356). The manual materials handling workers had higher chance of MSDs in upper back (OR=2.319). Those with poor trunk forward bending had significant high risk of chest and ankle/foot (OR>2). Gender, work shift, and trunk forward bending were significantly associated with the MSDs in some certain areas (p<0.05).

Conclusion: High prevalence of MSDs in shoulder, lower back, neck, and knee in petroleum workers were reported. These findings indicate that preventive management needs to concern the associated factors to the MSDs in petroleum workers.

Keywords: Musculoskeletal disorders, Physical performance, Ergonomics, Risk assessment, Petroleum workers Correspondence to: Mekhora K, Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Road, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand.

Phone:+66-2-4415450 ext. 21603 E-mail: keerin.mek@mahidol.ac.th

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Musculoskeletal disorders (MSDs) presents one of the leading causes of occupational injury, disability, cost of medical treatment and loss of quality of life among the work force ( 1, 2).

The term MSDs refers to conditions that involve the nerves, tendons, muscles and supporting

structures of the body (3). MSDs is the most prevalent cause of work ability loss, sick leave and early retirement from work in Europe and Asia ( 5- 7) . Furthermore, the burden of MSDs on the individual and the industries is tremendous

( 8)

. It is well known that MSDs is influenced by

genetic factors ( 9 ) , socio-economic factors such as education ( 1 0 ) , lifestyle such as smoking and being overweight

( 11)

and individual factors such as age, gender, body mass index ( BMI) ,

medical history and sport activity ( 12) . In addition, high physical work demands such as heavy load lifting , repetitive movements work, awkward working postures

( 1, 6, 13, 14)

, prolonged

periods of standing or walking, long working hours per shift (15), poor working conditions (16) and manual materials handling (MMH) (6, 7) are generally considered to be one of the main causes of MSDs among workers. In these industries, physical activities such as MMH (e.g., heavy load lifting, lowering, pushing, pulling and carrying) and awkward working postures are very common.

MMH tasks may expose workers to physical risk factors or conditions, associated with the development of injuries which can lead to fatigue and discomfort. MMH tasks have long been a matter of discourse in ergonomics and other related realms because these are known to be one of the main causes of musculoskeletal overexertion injuries including low back, shoulders, hands, wrists, or other parts of the body ( 14, 17) . Study of low back pain (LBP) among Iranian industrial workers found that LBP caused the decrease of abdominal muscle strength, hip extensor muscle strength, flexibility of back extensor and hip flexor muscles (18). In addition physical capacity such as muscle strength and endurance, flexibility and aerobic fitness has been related to the risk of MSDs (19).

In industries, such as petroleum company, mining, food processing, leather tanning, rubber tappers, retail and agricultural industries, the workers may involve in specific tasks such as using power tools above shoulder level which are common in MMH tasks ( 1, 20) . They also work with computer for communication, business and document management. The previous epidemiologic evidence studies of MMH tasks and MSDs in industries used the general Nordic Questionnaire of musculoskeletal symptoms to examine reported cases of MSDs

( 24)

and the

169

Quick Exposure Check (QEC) to assess physical exposure to musculoskeletal risks ( 22, 23) . The other study modified Nordic questionnaire to use in 454 MMH workers and found the previous 12 month pain the neck, shoulders, elbows, wrists/hands, upper back, lower back, thighs, knees and legs/feet were 5.70%, 9.90%, 10.50%, 11.80%, 20.30%, 28.40%, 9.70%, 19.20%, and 15.90%, respectively (6).

From literature review, a few ergonomics study had previously conducted in the petroleum workers in Thailand to determine the prevalence of MSDs and to assess the physical examination exposure to musculoskeletal risk. There was a survey reporting an overview of the occurrence of MSDs across industries

( 21)

. Therefore, the present study conducted a cross-

sectional survey in petroleum workers in Thailand which aimed to determine the prevalence of MSDs and the association between personal factor, work description, and physical performance and the MSDs in petroleum workers.

Material and Method This study was conducted among workers in a petroleum company using a selfadministered questionnaire and physical examination tests to survey the prevalence of MSDs. This study was approved by Mahidol University Institutional Review Board (COA No. MUCIRB 2015/046.1604). A total of 295, 294 workers completed the questionnaire to report the MSDs in 11 body areas and related factors to the symptom.

The inclusion criteria were being a worker in a petroleum company, Kamphaeng Phet province, North of Thailand and having work experience of at least 1 year. The exclusion criteria were having other problems restricting physical performance at the time of testing, such as neuromuscular, unstable of cardiovascular disorders. Withdrawal criteria was u n w i l l i n g t o continue the test.

In this study, all measurements were performed by physical therapists who underwent a training by the experts. The physical examination included muscle length, muscle endurance, and lumbar stabilization.

170

Procedure Each participant was asked to complete the self-administered questionnaire and was measured vital signs to screen for the risk prior to conduct physical examination. Then, each participant underwent the physical examination. The examination took an hour per each person.

Questionnaire A structured self-administered questionnaire was applied at baseline. The questionnaire consists of four parts as follows: (a) demographic data such as gender, age, weight, height, work year, education, physical activity, medical background and exercise; (b) work characteristics such as sitting, standing, lifting, pushing and carrying; (c) work load such as duration of work, break, weight of object; and (d) musculoskeletal problems in different body regions.

Muscle length test (Trunk forward bending test) Participants were asked to stand and perform forward bending of the trunk. The participants had no current knee and hip or back pain and were not engaged in exercise programs designed to strengthen or lengthen the hamstring or low back muscles before testing.

To be started with, the participants were asked to place fingertips on the top of patella. Then they were instructed to "bend forward as far as you can while keeping your knees straight" to achieve the full forward- bending position. The normal trunk forward bending among full forward-bending position had led to the length of muscle (abdominal, erector spinae, iliopsoas, gluteal, rectus femoris, and hamstring muscles)

Muscle endurance test (Sorensen Test) Trunk extensor endurance: A standardized isometric back extension endurance test was performed

( 22)

. Participants were in prone and asked to hold their upper body in a horizontal

position with the arms folded across the chest and fixed lower body by straps. The position was held for as long as possible, but no longer than of 360 seconds (23).

171

Trunk flexor endurance: Participants were in crook lying on a sloping board and asked to hold their upper body in a horizontal position with their arms folded across the chest and with hips flexed 90° and ankle strapped (30).

Lumbar stabilization Objective measurements of lumbar stabilization for determining the coordination of the back muscles and trunk muscles by inflatable biofeedback. Participants were trained by a physiotherapist to perform abdominal hollowing maneuvers correctly (24). Starting position was in supine, the unit was placed under the lumbar spine and inflated to 40 mmHg. The pressure was maintained within five mmHg above and below 40 mmHg for 10 seconds and the participants did not allow to see the feedback. Participants were instructed to gently and slowly draw in the lower abdomen below the navel without moving the upper stomach, back or pelvis, while deliberately breathing in and out (25).

This test has a total of six levels depending on the activations of local trunk stabilizing muscles as follows: abdominal hollowing, unilateral knee extension (450 degrees), unilateral knee extension, unilateral knee raise, bilateral knee raise and bilateral knee raise together.

Data analysis The data were analyzed using the SPSS/PC for windows release version 19.0 as follows.

Descriptive statistics were used to explain mean, standard deviation, frequency and prevalence of MSDs. The Chi-square test was used to determine the association between personal factor, work description, and physical performance and the MSDs.

Results Table 1 presents demographic characteristics of all respondents in a petroleum company.

The prevalence of MSDs within seven days in different body parts is shown in Table 2. The most commonly affected regions among the workers were the shoulder (25.9%), lower back (24.5%), neck (23.5%), knee (20.4%), and ankle/foot (15.0%).

Table 3 shows the association between MSDs at upper body part and individual factors, work description and physical performance in petroleum workers. There were significant

172

between gender and areas of disorder at neck (p=0 .0 3 ), shoulder (p=0 .0 0 2 ), and upper back (p=0 .0 2). There were also significant associations between work description and upper back (p=0 .0 13) and neck (p=0 .044). Moreover, there was significant association between physical performance (flexibility) and chest area (p=0.03).

Table 4 shows the association between MSDs at lower body part and individual factors, work description and physical performance in petroleum workers. There was a marginal association between rest during the day and ankle/ foot ( p= 0 . 0 5 ) . There was a significant association between physical performance (flexibility) and ankle/foot (p=0.04).

173

Table 1. Demographic characteristic of all respondents in a petroleum company (n=294) Characteristics

%

n

Individual factors Age, (n=291) 20-30y 31-40y >40y

87 103 101

29.6 35.0 34.4

male female

240 53

81.6 18.0

Underweight (<18.5) Normal (18.5–24.9 ) Overweight (25–29.9) Obesity (≥30)

11 162 95 25

3.7 55.1 32.3 8.5

1-5 y 6-10 y >10 y

140 89 39

47.6 30.3 13.3

No 1-3 time/m 1-3 time/wk >3 time/wk

51 82 99 52

17.3 27.9 33.7 17.7

≥4 hours <4 hour

19 70

6.5 23.8

MMH Others job

49 143

16.7 48.6

Yes No

179 105

60.9 35.7

No ≥30 min >30 min

40 160 47

13.6 54.4 16.0

Gender, (n=293)

BMI, (n=293)

Years of experience, (n=268)

Exercise, (n=284)

Work description Office work, (n=89)

Other works, (n=192)

Work shift, (n=284)

Rest during the day, (n=247)

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Table 2. Prevalence of MSDs classified by body regions Body regions

n

%

Neck

69

23.5

Shoulder

76

25.9

Upper back

41

13.9

Chest

6

2.0

Elbow

7

2.4

Wrist/Hand

22

7.5

Lower back Abdomen Hip/Thigh Knee Ankle/Foot

72 2 32 60 44

24.5 0.7 10. 9 20.4 15.0

175

Table 3. Association between MSDs at upper body part and individual factors, work description and physical performance in petroleum workers Characteristics

Neck n

%

20-30 31-40 > 40 p-value

27 20 22

39.1 29.0 31.9

Male Female p-value OR 95%CI Lower Upper

50 19

Underweight Normal weight Overweight Obesity p-value

2 42 21 4

1-5 yrs.

6-10 yrs. >10 yrs. p-value

34 23 9

No 1-3 time/m 1-3 time/wk >3 time/wk p-value

15 22 20 12

Individual factors Age group

Shoulder n % 39.5 32.9 27.6

30 25 21

0.140

Musculoskeletal disorders Upper back Chest n n % %

n

%

n

Wrist/Hand %

16 17 8

0 3 4

0.0 42.9 57.1

8 6 8

36.4 27.2 36.4

0.06

39.0 41.5 19.5

1 3 2

0.115

16.7 50.0 33.3

Elbow

0.714

0.177

0.628

Gender 72.5 27.5

69.7 30.3

53 23

0.03* 2.023 1.064 3.847

68.3 31.7

28 13

0.002* 2.575 1.380 4.805

100.0 0.0

6 0

0.020* 2.356 1.124 4.939

85.7 14.3

6 1

0.236 1.027 1.005 1.049

72.3 (27.7

17 5

0.763 0.721 0.085 6.119

0.610 1.311 0.461 3.729

BMI 18.2 26.8 22.6 17.4

3 42 24 7

0.686

27.3 26.8 25.8 30.4

1 23 14 3

0.977

9.1 14.7 15.1 13.0

0 4 2 0

0.955

0.0 2.5 2.2 0.0

0 3 3 1

0.831

0.0 1.9 3.2 4.3

0 12 8 8

0.791

0.0 7.6 8.6 34.8 0.789

Years of experience 51.5 34.8 16.6

58.3 27.8 13.9

42 20 10

0.913

61.5 25.6 12.8

24 10 5

0.460

1 4 1

0.447

16.7 66.7 16.7

57.1 28.6 14.3

4 2 1

0.164

54.5 40.9 4.6

12 9 1

0.963

0.336

Exercise

176

30.0 27.5 20.4 23.5 0.552

11 22 26 16

22.0 27.5 26.5 31.4 0.765

9 17 10 5

18.0 21.3 10.2 9.8 0.126

0 0 2 4

0.0 0.0 2.0 7.8 0.013*

2 1 3 1

4.0 1.3 3.1 2.0 0.763

3 7 10 2

6.0 8.6 10.2 3.9 0.541

Table 3. Association between MSDs at upper body part and individual factors, work description and physical performance in petroleum workers (cont.)

Characteristics

Neck n

%

Office work MMH and Others job p-value OR 95%CI Lower Upper

23 46

33.3 66.7

Yes No p-value OR 95%CI Lower Upper

23 46

No Less than and 30 min.

Over 30 min. p-value Physical performance Muscle endurance normal abnormal p-value OR 95%CI Lower Upper

15 40 7

Work description Type of work

Shoulder n %

Musculoskeletal disorders Upper back Chest n n % %

n

%

n

30 46

20 21

2 5

28.6 71.4

6 16

0.787 1.083 0.607 1.934

39.5 60.5

48.8 51.2

3 3

0.013* 2.319 1.182 4.547

0.102 1.581 0.911 2.742

50.0 50.0

Elbow

0.340 2.163 0.428 10.935

Wrist/Hand %

0.843 0.846 0.161 4.447

27.3 72.7 0.619 0.782 0.295 2.070

Work shift 3.33 66.7

29 47

0.950 0.982 0.561 1.721

38.2 61.8

34.1 65.9

14 27

0.867 0.955 0.555 1.643

83.3 16.7

5 1 0.019* 0.114 0.013 0.992

0.645 1.178 0.587 2.363

42.9 57.1

3 4

40.9 59.1

9 13

0.761 0.791 0.173 3.604

0.721 0.851 0.351 2.064

Rest during the day 38.5 25.3 14.9

11 47 9

0.044*

10 13

8 25 4

0.358

43.5 56.5 0.440 1.143 0.438 2.985

28.2 29.7 19.1

9 17

0 5 1

0.281

34.6 65.4 0.780 1.143 0.438 2.985

20.5 15.8 8.5

7 10

1 4 2

0.514

41.2 58.8 0.680 0.794 0.269 2.343

0.0 3.2 2.1

3 3

3 13 3

0.818

50.0 50.0 0.340 -

2.6 2.5 4.3

0 1

0.917

0.0 100.0 0.440 0.982 0.947 1.018

7.7 8.2 6.4

1 5

16.7 83.3 0.290 3.100 0.346 27.790

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Table 3. Association between MSDs at upper body part and individual factors, work description and physical performance in petroleum workers (cont.)

Characteristics

Neck n

%

normal abnormal p-value OR 95%CI Lower Upper

60 5

92.3 7.7

normal abnormal p-value OR 95%CI Lower Upper

19 48

Physical performance Flexibility

Shoulder n %

Musculoskeletal disorders Upper back Chest n n % %

n

%

64 8

36 2

3 3

50.0 50.0

0.80 0.875 0.312 2.457

88.96 11.1 0.35 1.542 0.624 3.807

94.7 5.3

4 2

66.7 33.3

Elbow

0.03* 15.833 1.009 33.734

0.45 0.563 0.127 2.507

Wrist/Hand n % 19 2

0.07 1.300 0.330 4.944

90.3 9.5 0.86 1.153 0.251 5.292

Lumbar stability

178

28.4 71.6 0.44 1.272 0.695 2.330

23 51

31.1 69.8 0.80 1.076 0.606 1.911

14 25

35.9 64.1 0.60 0.826 0.406 1.680

1 5

16.7 83.3 0.49 2.417 0.278 21.002

1 6

1 4.3 85.7 0.30 2.916 0.346 24.599

8 14

36.4 63.6 0.66 0.819 0.330 2.031

Table 4. Association between MSDs at lower body part and individual factors, work description and physical performance in petroleum workers Characteristics Lower back n %

Individual factors Age group 20-30 31-40 > 40 p-value

21 30 19

Male Female p-value OR 95%CI Lower Upper

56 16

Underweight Normal weight Overweight Obesity p-value

2 36 28 6

1-5 yrs.

6-10 yrs. >10 yrs. p-value

43 16 10

No 1-3 time/m 1-3 time/wk >3 time/wk p-value

8 24 25 14

30.0 42.9 27.1

Abdomen n

%

1 0 1

50.0 0.0 50.0

0.351

Musculoskeletal disorders Hip/Thigh n % 8 10 14

0.558

25.0 31.3 43.7

Knee n

%

17 20 23

28.3 33.3 38.3

0.413

Ankle/Foot n % 15 17 12

0.648

34.1 38.6 27.3 0.635

Gender 77.8 22.2

50.0 50.0

1 1

0.369 1.351 0.699 2.612

84.4 15.6

27 5

0.254 4.423 0.272 71.875

80.0 20.0

48 12

0.640 0.787 0.288 2.149

84.1 15.9

37 7

0.767 1.116 0.544 2.287

0.616 0.798 0.334 1.903

BMI 18.2 22.9 28.6 26.1

0 1 1 0

0.593

0.0 0.6 1.0 0.0

1 22 8 1

0.933

9.1 14.0 8.2 4.3

1 32 24 3

0.392

9.1 20.4 24.5 13.0

1 22 15 6

0.372

9.1 14.0 15.3 26.1 0.456

Years of experience 62.3 23.2 14.5

0.0 50.0 50.0

0 1 1

0.105

43.3 33.3 23.3

13 10 7

0.232

53.8 26.9 13.5

28 14 7

0.333

53.5 34.9 11.6

23 15 5

0.948

0.812

Exercise 16.0 30.0 25.5 27.5 0.343

1 0 0 1

2.0 0.0 0.0 2.0 0.314

6 6 12 8

12.0 7.5 12.2 15.7 0.531

11 17 22 10

22.0 21.3 22.4 19.6 0.982

7 10 20 7

14.0 12.5 20.4 13.7 0.474

179

Table 4. Association between MSDs at lower body part and individual factors, work description and physical performance in petroleum workers (cont.)

Characteristics

Lower back n %

n

%

4 hours and over MMH and others job p-value OR 95%CI Lower Upper

26 45

0 2

0.0 100.0

Yes No p-value OR 95%CI Lower Upper

21 51

No Less than and 30 min.

Over 30 min. p-value Physical performance Muscle endurance normal abnormal p-value OR 95%CI Lower Upper

12 35 13

Work description Type of work

36.6 63.4

Abdomen

0.335 1.321 0.750 2.327

Musculoskeletal disorders Hip/Thigh n % 12 20

0.330 1.011 0.996 1.026

37.5 62.5

Knee n

%

16 44

26.7 73.3

0.480 1.317 0.613 2.829

Ankle/Foot n % 16 28

0.316 0.722 0.382 1.367

36.4 63.6 0.500 1.260 0.643 2.472

Work shift 29.2 70.8

100.0 0.0

2 0

0.095 1.632 0.915 2.911

43.7 56.3

14 18

0.066 1.019 0.993 1.047

36.7 63.3

22 38

0.428 0.741 0.352 1.559

34.1 65.9

15 29

0.899 1.039 0.575 1.877

0.625 1.184 0.602 2.328

Rest during the day

180

30.8 22.2 27.7

0 2 0

0.461

20 7

4 18 7

0.578

74.1 25.9 0.16 2.041 0.749 5.559

0.0 1.3 0.0

0 2

6 36 9

0.763

0.0 100.0 0.78 -

10.3 13.4 14.9

4 6

5 33 3

5 16

23.8 76.2 0.16 2.215 0.725 6.774

12.8 20.9 6.4 0.050*

0.393

40.0 60.0 0.82 0.857 0.223 3.299

15.4 22.8 19.1

9 6

60.0 40.0 0.06 0.313 0.100 0.984

Table 4. Association between MSDs at lower body part and individual factors, work description and physical performance in petroleum workers (cont.)

Characteristics

Lower back n %

Physical performance

Abdomen n %

Musculoskeletal disorders Hip/Thigh n %

Knee n

%

53 6

89.8 10.2

Ankle/Foot n %

Flexibility 65 94.2 normal 5.8 abnormal 4 0.56 p-value 95%CI

OR Lower Upper

2 0

100.0 0.0

25 4

0.67 1.008 0.997 1.019

0.596 0.195 1.817

86.2 13.8 0.27 1.886 0.594 5.985

36 7

83.7 16.3 0.04* 2.589 0.995 6.732

0.49 1.305 0.490 3.474

Lumbar stability normal abnormal p-value 95%CI

OR Lower Upper

23 48

22.4 67.6 0.97 0.990 0.555 1.765

1 1

50.0 50.0 0.59 0.473 0.029 7.648

10 20

33.3 66.7 0.89 0.945 0.423 2.116

17 41

30.5 69.5 0.75 1.107 0.594 2.065

13 30

30.2 69.8 0.76 1.117 0.551 2.264

181

Discussion The self-reported questionnaire showed that symptoms from the musculoskeletal system were common among petroleum workers. The majority of the workers (54.1%) had MSDs within seven days.

The prevalence of MSDs within seven days in different body parts were found in shoulder (25.9%), lower back (24.5%), neck (23.5%), knee (20.4%), and ankle/foot (15.0%), respectively. The results of this study are consistent with previous study (6). This indicates that the petroleum company should be considered as a high-risk for developing the MSDs (28, 29).

The findings in this study also support the results from previous studies

(6, 7)

which

suggested that individual factors (i.e. age and gender) were associated with MSDs in different body regions. There were, however, no association between BMI, years of experience, and exercises and MSDs. Furthermore, there was an association between type of work (i.e. computer and MMH) and MSDs in the upper back region. The period of rest during the day was also associated with MSDs in the neck and ankle/foot. The results regarding the association between work description and MSDs supported the previous studies (6, 8, 27) which suggested that above problems have led to MSDs. In addition, flexibility was found to be associated with MSDs in the upper back and ankle/foot. Thus, poor flexibility may contribute to MSDs. Unlike previous studies that found the poor flexibility of hamstring muscle was led to MSDs because individuals with "flat" backs (reduced lumbar curvature) while standing tended to have short hamstring muscle (29).

The limitation of this study was that participants had to undergo a series of physical examination tests which were taking a long time. These may cause fatigue in the participants and may affect the results. Another limitation was that most of participants work multitask, thus it was difficult to clearly classify their jobs.

Conclusion High prevalence of MSDs in shoulder, lower back, neck and knee in petroleum workers were reported. These findings indicate that preventive management needs to concern the

182

associated factors to the MSDs in petroleum workers. This study may potentially improve the scientific evidence for preventive strategies towards MSDs. The results of this study could be useful for planning and implementing interventional ergonomics programs in the workplace and improving workersâ&#x20AC;&#x2122; health in the petroleum works in Thailand.

Acknowledgement We would like to thank all participants and staff at a petroleum company in Kamphaeng Phet province, North of Thailand and Faculty of Physical Therapy, Mahidol University, for their support.

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การสารวจความผิดปกติทางระบบกระดูกกล้ามเนื้อและสมรรถภาพทางกายในพนักงานปิโตรเลียม ธัญวรัตน์ จันทร์ศรี, คีรินท์ เมฆโหรา, วรรธนะ ชลายนเดชะ, ชุติมา ชลายนเดชะ วัตถุประสงค์: เพื่อศึกษาความชุกของความผิดปกติทางระบบกระดูกและกล้ามเนื้อ และความสัมพันธ์ระหว่างปัจจัยส่วนบุคคล ลักษณะการทางาน และสมรรถภาพทางกาย กับความผิดปกติดังกล่าว ในพนักงานอุตสาหกรรมปิโตรเลียม วัสดุและวิธีการ: การศึกษาในครัง้ นี้เป็นการศึกษาแบบตัดขวางในอุตสาหกรรมปิโตรเลียม จังหวัดกาแพงเพชร ภาคเหนือของ ประเทศไทย โดยมีพนักงานทั้งหมด 294 คน ได้ตอบแบบสอบถามด้วยตนเองที่เกี่ยวกับอาการทางระบบกระดูกและกล้ามเนื้อ ที่พบในส่วนต่าง ๆ ของร่างกายทั้งหมด 11 ตาแหน่ง และปัจจัยที่เกี่ยวข้องกับอาการ พนักงานทุกคนได้รับการทดสอบ สมรรถภาพทางกาย ได้แก่ ความยาวของกล้ามเนื้อ ความแข็งแรงของกล้ามเนื้อ ความทนทานของกล้ามเนื้อ และการทรงท่า เพื่อเพิ่มความมั่นคงของกระดูกสันหลัง การทดสอบทั้งหมดถูกประเมินโดยนักทางกายภาพบาบัด ผลการศึกษา: ผลการศึกษาพบว่าความชุกของความผิดปกติทางระบบกระดูกและกล้ามเนื้อที่พบมากที่สุด ภายใน 7 วัน ก่อน การทดสอบ ได้แก่ ความผิดปกติของไหล่ (25.9%), หลังส่วนล่าง (24.5%), คอ (23.5%) หัวเข่า (20.4%) ข้อเท้า/เท้า (15.0%) หากแบ่งการทางานและกลุ่มอายุของพนักงานเป็นหมวดหมู่ก็ไม่พบความแตกต่างของความชุกมากไปจากนี้ จากการวิเคราะห์ เพื่อหาค่าอัตราเสีย่ งที่จะเกิดการบาดเจ็บทางระบบกระดูกและกล้ามเนื้อพบว่า เพศหญิงมีความเสี่ยงมากกว่าเพศชายที่บริเวณ คอ, ไหล่ และหลังส่วนบน พนักงานที่ทางานเกี่ยวกับการยก ดึง ดัน มีความเสี่ยงมากกว่าพนักงานที่ทางานเกี่ยวกับคอมพิวเตอร์ ที่บริเวณหลังส่วนบน

และผู้ทมี่ ีความยืดหยุ่นในการก้มงอตัวได้นอ้ ยมีความเสี่ยงมากกว่าผู้ที่มีความยืดหยุ่นในการงอตัวปกติ

(OR>2) นอกจากนี้ ยังพบว่าปัจจัยส่วนบุคคล (อายุและเพศ) ลักษณะงานที่ทา (คอมพิวเตอร์และการทางาน ยก ดึง ดัน) และ สมรรถภาพทางกาย (การก้มงอของลาตัว) มีความสัมพันธ์กับอาการผิดปกติดังกล่าวในบางตาแหน่งของร่างกาย (p <0.05) สรุป: ความชุกของความผิดปกติทางระบบกระดูกและกล้ามเนื้อทีพ่ บมากบริเวณข้อไหล่ หลังส่วนล่าง คอ และเข่า ของ พนักงานที่ทางานในอุตสาหกรรมปิโตรเลียม

แสดงให้เห็นว่าต้องให้ความสนใจในการบริหารจัดการและการป้องกันการ

บาดเจ็บทางระบบกระดูกและกล้ามเนื้อ และจัดการปัจจัยที่ส่งผลให้เกิดการบาดเจ็บดังกล่าว

187

Comparison of Neurodynamic Response and Pain in Experienced and Non-Experienced Thai Dancers Maturin Juntongsree, Keerin Mekhora PhD, Petcharatana Bhuanantanondh PhD Faculty of Physical Thearapy, Mahidol University, Nakhon Pathom, Thailand

Objective: To compare median nerve neurodynamic response and pain outcomes between experienced and non-experienced Thai dancers.

Material and Method: Two groups of subjects, 22 experienced Thai dancers and 22 nonexperienced Thai dancers, with age range 20-30 years participated in the study. They were assessed for the Upper Limb Neurodynamic Test 1 (median bias). Elbow ranges of motion were recorded at pain as responded by subjects and resistance as felt by the examiner. The pain was measured by visual analogue discomfort scale (VADS) at neck and upper extremity and pressure pain threshold (PPT) at upper trapezius muscle.

Results: The VADS in shoulder, wrist, and hand regions of experienced Thai dancers were significantly lesser than those of non-experienced Thai dancers (p-value < .011 - .048).

Moreover, the median nerve tension (MNT) and PPT were significantly greater for the experienced Thai dancers than the non-experienced ones. These findings indicate that the experienced Thai dancers were less sensitive to the pain (p-value < .003 for MNT and .022 for PPT).

Conclusion: Experienced Thai dancers have nerve tension, discomfort and pain sensitivity lesser than non-experienced ones. Thai dance might help improve MNT and pain. Studies to determine the effect of Thai dance on preventing work-related musculoskeletal disorders are required.

Keywords: Discomfort, Median nerve tension, Neurodynamic, Pressure Pain Threshold, Thai dancer

188

Work-related musculoskeletal disorders (WMSDs) are common injuries among computer users(1) and sedentary workers(2). Discomfort, pain, limitation of joints, tension of muscle and nerve are symptoms of the disorders(3, 4). Sedentary workers whose work involve computer use for a long period of time, would have increased nerve tension and discomfort of upper body(5) and those with less exercise would have an increased risk of WMSDs(6).

Consequently, the disorders can interrupt ability and efficiency of working and can lead to absence from work, increasing request of sick leave, increasing tension at work, initially long-term disability and a possibility of leaving from the profession at an early age(7).

To reduce the risk of WMSDs, prevention is said to be the best strategy rather than treatment(8). The study about discomfort prevention showed that one with more exercise such as jogging, fast walking or easy walking more than 15 minutes would have less scale of pain and fatigue than one without exercise(9). Moreover, stretching exercise at least 3 times per day can prevent and decrease pain in the upper body(10). This can apply for one with nerve tension since neurodynamic exercise such as flamingo dance, Tichi, yoga and Thai dance can reduce nerve tension of upper limb such as median nerve, radial nerve or ulnar nerve(11, 12).

Therefore, physical activity, stretching exercise and neurodynamic exercise can prevent discomfort and nerve tension.

Thai dance is a traditional dance that requires smooth and rhythmic movement of body parts, particularly the upper limbs. It has been recommended as an exercise to relieve nerve tension and discomfort in upper body(12). Prom See Na (figure 1a), Lor Knaew (figure 1b) and Cha nee Rai mai (figure 1c) are famous forms of Thai dance considered to be similar to nerve tension test as described by Butler(11, 12). It was reported that Thai dance can decrease symptoms of carpal tunnel syndrome among participants who performed Thai dancing every day for three weeks(13). Moreover, performing 5 minutes of Thai dancing during a 10-minute break of 4-hour computer use can decrease nerve tension and pain(12).

Figure 1a. Prom See Na (Mekhora, 2010) 189

Figure 1b. Lor Kaew (Mekhora, 2010)

Figure 1c. Cha nee Rai mai (Mekhora, 2010)

However, those previous studies investigated effects of Thai danceâ&#x20AC;&#x2122;s intervention in short term from subjects without experience of Thai dance. Therefore, it was interesting to determine the effect of Thai dance from subjects who have practiced Thai dancing regularly.

To be started with, this study intended to study in subjects who were classified as experienced Thai dancer and compared the nerve tension and pain scale with subjects with no experience of Thai dance.

Material and Method Study design: The study was a comparative design between 2 groups of subjects without follow-up.

The study was approved by the Mahidol University Institutional Review Board (MU-IRB. COA2015/092.2107).

Study setting:

190

For the experienced Thai dancers, the subjects were recruited by direct contact from three settings: the Faculty of Fine and Applied Arts Program in performing Arts at Suan Sunandha Rajabhat University, the Faculty of Fine Arts Program in Thai drama at Bunditpatanasilpa Institute, and Club of Thai drama at Mahidol University.

For the non-experienced Thai dancers, the subjects were recruited by direct contact to be volunteers from Suan Sunandha Rajabhat University, Thammasat University, and Rajamangala University of Technology Thanyaburi.

Study population: The subjects were healthy subjects aged between 20-30 years old. For the experienced Thai dancers, they must have experience with regular Thai dance at least 30 minutes/day, more than 3 days per week, for more than 1 year. For non- experience Thai dancers, they must not have involved with any exercise similar to Thai dance more than 30 minutes/day for more than 3 days per week. All subjects were screened for musculoskeletal disorders and by a questionnaire and examined for sensation and range of motion of the upper extremities by a physical therapist.

The inclusion criteria were 1) having ability to understand and follow verbal instruction and 2) being independent living without any assistive devices or person. All subjects had experience of computer use more than 3 days per week and more than 4 hours/day.

The exclusion criteria were using drug for pain relief within 1 day before the test, unable to communicate and explain feeling of pain and tension, communication disorders, impaired sensory and perception, limitation of upper limb range of motion, moderate or severe pain at upper limb, and history of neck injury.

Measurements/Equipment: Visual analogue discomfort scale (VADS) was used to analyze the current discomfort of neck and upper extremities. The line of VADS was 10 centimeters. The scale ranges from no discomfort to severe discomfort(14).

Pressure pain threshold (PPT) was used to record pain thresholds or tenderness(15).

When a particular site of the body is pressed with a rubber disk having an area of 1 cm2, the device displays the pressure. The PPT was applied at a constant rate of 40 kPa/sec on the trapezius muscle until the subject felt the sensation changing from the pressure to pain. The reliability of the measurement using (ICC 3,1) was over 0.9 for all scale.

191

Upper limb neurodynamic test 1 (median bias) was performed using modified table according to Kanchanomai(16). It is used to detect median nerve tension via elbow extension range of motion (degree). The angles were recorded and digitized from videography via Scion image program at P1 (tension threshold) and P2 (submaximal pain limit) as determined by subjects, and R1 (first resistance) and R2 (end of resistance) as determined by the researcher. The reliability of the measurement using ICC (3,1) was over 0.9 for all angles.

Before assessment, all subjects were required to rest for 10 minutes to reduce some unexpected symptoms. Then, they were asked to report the VADS in neck and upper extremities. After that, they were assessed for PPT on trapezius muscles. Lastly, ULNT1 was assessed by the researcher. The test was begun with subjects lying supine on the testing table.

Then they were attached with adhesive markers at medial epicondyle of the humerus, styloid process of ulna and midline of coracoid process to the medial epicondyle. Their shoulders were depressed with weight of 4 kg indicated by spring sensor. After that, the shoulder was passively abducted to 110 degrees with external rotation. Finally, extension of elbow with full wrist extended was performed. During this movement of elbow, the videography was recorded to detect P1, P2, R1 and R2.

Statistical analysis: The data were analyzed using the independent samples t-test if the normal distribution was assumed. For non-normal distribution data, the Mann-Whitney U test was used.

Results The results showed that the ROM of elbow extension for the experienced Thai dancers was significantly greater than that for the non-experienced Thai dancers (p< 0.05) (Table 1).

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Table 1 Comparison of neurodynamic response (by ROM of elbow extension )Figure 1c. Cha nee Rai mai (Mekhora, 2010) Elbow range of motion from ULNT1â&#x20AC;&#x2122;s testing tension thresholda

submaximal pain first resistance end of resistancea

Std. Group N Mean Deviation non- 44 145.32 10.53 experienced Thai dancer experienced 44 156.21 18.19 Thai dancer G 1 44 160.82 10.66 G 2 44 178.98 5.93 G 1 44 145.23 15.95 G 2 44 160.75 15.74 G 1 44 156.32 12.91 G 2 44 176.80 5.20

Mean Sig. (2- difference tailed) < 0.05 10.89

< .005 **

18.16

< .005 **

15.52

< .005

20.48

** = significant difference at p < 0.05 by parametric test a

= significant difference at p < 0.05 by non-parametric test

G 1 = non-experienced Thai dancer group, G 2 = experienced Thai dancer group

The results showed significant differences of VADS of both shoulders, right elbow and hand between the experienced and non-experienced Thai dancers (p< 0.05) (Table 2).

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Table 2. Comparison of visual analogue discomfort scale Visual analogue discomfort scale Neck shoulder in left side shoulder in right side elbow left side elbow right side hand left side hand right side

Group G1 G2 G1 G2 G1 G2 G1 G2 G1 G2 G1 G2 G1 G2

N 22 22 22 22 22 22 22 22 22 22 22 22 22 22

Mean (cm) 0.00 0.00 0.57 0.00 0.78 0.00 0.38 0.00 0.77 0.00 0.41 0.00 0.49 0.00

Std. Deviation 0.00a 0.00a 1.25 0.00a 1.46 0.00a 1.03 0.00a 1.01 0.00a 1.16 0.00 1.00 .00

Sig. (2-tailed) 0.04** 0.02** 0.09 < 0.05** 0.11 0.03**

a. t cannot be computed because the standard deviations of both groups are 0. ** = significant difference at p < 0.05 by parametric test ++ = significant difference at p < 0.05 by non-parametric test G 1 = non-experienced Thai dancer group, G 2 = experienced Thai dancer group

There were significant differences of PPT at upper trapezius muscle of both sides between the experienced and non-experienced Thai dancers (p < 0.05) (Table 3).

Table 3 Comparison of pressure pain thresholds Pressure pain threshold upper trapezius muscle in left side upper trapezius muscle in right side

1 2

Mean (N) Std. Deviation 22 23.00 9.61 22 31.40 13.21

1 2

22 22

Group

N

22.94 31.10

8.37 13.78

Sig. (2-tailed) < 0.05** < 0.05++

** = significant difference at p < 0.05 by parametric test ++ = significant difference at p < 0.05 by non-parametric test G 1 = non-experienced Thai dancer group, G 2 = experienced Thai dancer group

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Discussion The result showed that the experienced Thai dancer group had less median nerve tension than the non-experienced Thai dancer group as indicated by greater elbow range of motion in the experienced group. This significant difference may be from that the experienced Thai dancer group had higher physical activity than the non-experience group.

Previous study showed that the subjects with higher physical activity would have toleration of tension threshold and submaximal pain during the nerve tension being tested. This evidence was explained by the previous study reporting that motor nerve conduction velocity would be greater as a result of physical exercise(17). Moreover, some forms of Thai dance such as Prom See na , Lor Knaew and Cha nee Rai mai had movement similar to ULNT 1(12), which was recommended by Butler that such movement could decrease nerve tension(11).

Prom See Na is lifting up the arm at the body's side (Figure 1a). Let the elbow be high in the shoulder's level. Bend the elbow to let the lower arm fold to the body and be in vertical shape to the upper arm. Open palm up with the finger's end pointing to the body's side.

Therefore this Thai dance maneuvers is similar to some component of the upper limb neurodynamic testing 1 position, which is shoulder abduction 90 degree, arm flexion 90 degree and wrist full flexion.

Lor Kaew is abduction 90 degree, external rotation, elbow flexion, wrist slightly extension and fingers extension (Figure1b). Contra lateral side is shoulder abduction 90 degree with external rotation, elbow full extension, wrist slightly flexion and fingers extension with middle finger flexion.

Cha Nee Rai Mai is abduction 90 degree, external rotation, elbow flexion, wrist slightly extension and fingers extension(14). (Figure 1c). Contra-lateral side is shoulder abduction 90 degrees with external rotation, elbow full extension, wrist extension and fingers extension.

In addition, regular Thai dance was recommended by Mekhora as an exercise to decrease nerve tension(12). Therefore, people who have involved Thai dance regularly would have high physical activity and less nerve tension.

Moreover, the results showed significant differences of VADS of both shoulders, right elbow and hand between the experienced and non-experienced Thai dancers. These differences may be due to regular stretching exercise for preventing injury and flexibility during dance for the experienced Thai dancers. Previously, a study about effect of stretching exercise showed reduced pain and improved shoulder function in workers with shoulder pain 195

after stretching exercise(18). Moreover, after stretching exercises based on neurodynamic principles in sessions of 20 minutes in 3 months, subjects could relieve pain in wrist and hand(19). This reduction of symptoms can be from that capsule and muscle would decrease tightness, relax tense muscles, improve blood circulation, increase ROM and decrease pain after regularly stretching exercise(20, 21).

A previous study has shown that there was an increase of trapezius activation related with pain in computer users(22). Moreover, it was also indicated that an increase of trapezius activation was found during nerve tension (ULNT1) was performed(23). Thus there is a need for stabilizing shoulder when abducting the tested arm during performing the neural tension test. In the case with such higher neural tension, there may have higher activation of trapezius as well.

In addition, the result showed significant difference of PPT of all data. The experienced Thai dancer group had PPT more than non-experienced Thai dancer because the former group had physical activity more than the latter one.

In summary, Thai dance can encourage higher physical activity and more movement of neural tissue. As a consequence, the pain was reduced and the tension was less as well as the PPT confirmed less sensitivity to pain. Therefore, people who have Thai dance would gain more benefit than those without Thai dance or similar exercises and it should be further studied more on its benefit with some control groups.

The clinical implication of this finding is that clinicians should consider Thai dance as an exercise improvement of nerve tension, pain reduction and WMSD prevention.

The strength of this study is that this study was conducted in real regularly Thai dancers who have had experienced Thai dancers for more than 1 year. However, our study has some limitations that we did not train subjects to perform Thai dance and determine the effect of training over time. For further suggestion, longitudinal studies are needed to compare effects of Thai dance with other exercise. Future study should analyze other effect of Thai dance which relate to the WMSDsâ&#x20AC;&#x2122; symptom such as nerve conductive velocity and other physiological function of nerve.

Conclusion This study found that people who have danced regularly had less neural tension, pain and less pain sensitivity than those without the dance. This suggested that the benefit of Thai 196

dance and it should be recommended as one form of exercise for workers who have risk of WMSDs.

Acknowledgements We thank the Faculty of Physical Therapy, Mahidol University for their facilitation of the study. Besides, we appreciated Suan Sunandha Rajabhat University, the Faculty of Fine Arts Program in Thai drama at Bunditpatanasilpa institute and club of Thai drama at Mahidol University for their participation.

What is already known on this topic?

In short term, Thai dancing has similar pattern to upper limb neurodynamic technique.

Performing Thai dance can help improve the nerve tension relief of WMSDs’symptom.

What this study adds?

People who have regular Thai dancing for more than 1 year have lesser nerve tension and pain than those without dancing.

Potential conflicts of interest None.

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การเปรียบเทียบทางประสาทพลศาสตร์และความเจ็บปวด ในผู้ที่มีประสบการณ์และไม่มีประสบการณ์ใน การราไทย

มธุริน จันทร์ทองศรี, คีรินท์ เมฆโหรา, เพชรรัตน์ ภูอนันตานนท์

วัตถุประสงค์: เพื่อเปรียบเทียบผลของประสาทพลศาสตร์ และความเจ็บปวด ระหว่างผู้ที่มปี ระสบการณ์และไม่มีประสบการณ์ ในการราไทย วัสดุและวิธีการ: ผู้เข้าร่วมงานวิจยั กลุ่มที่มีประสบการณ์การราไทย 22 คน กลุ่มทีไ่ ม่มีประสบการณ์การราไทย 22 คน อายุ ระหว่าง 20 – 30 ปี จะได้รับการทดสอบประสาทพลศาสตร์ของเส้นประสาทมีเดียน (upper limb neurodynamic test 1) บันทึกผลเป็นองศาการเคลื่อนไหวของข้อศอก จะถูกบันทึกผลขณะที่ผู้เข้าร่วมงานวิจยั รูส้ ึกเจ็บ และเมื่อผู้วัดรับรู้ถึงแรงต้าน ระหว่างการเคลื่อนไหวของข้อศอก ในส่วนของความเจ็บปวดจะถูกบันทึกโดยแบบประเมินความรูส้ ึกไม่สบาย (visual analogue discomfort scale: VADS) ที่บริเวณคอและรยางค์ส่วนบน และวัดแรงกดที่เริ่มรู้สึกเจ็บ (pressure pain threshold: PPT) ที่กล้ามเนื้อ upper trapezius ผลการศึกษา: พบว่าในกลุ่มที่มีประสบการณ์การราไทย ผลของ Elbow range of motion ทั้งหมด และผลของ VADS ที่ ไหล่, ข้อมือและมือ มีคา่ ที่น้อยกว่าอย่างมีนัยสาคัญทางสถิติกว่ากลุม่ ที่ไม่มีประสบการณ์การราไทย (p-value < .011 - .048 สาหรับ VADS) ขณะทีผ่ ลของ PPT พบว่ากลุ่มที่มีประสบการณ์การราไทย มีคา่ ที่มากกว่าอย่างมีนัยสาคัญทางสถิติ เป็นข้อ บ่งชี้ว่ากลุ่มที่มีประสบการณ์การราไทยมีความไวในการรับความรู้สึกที่น้อยกว่า (p-value < .003 สาหรับ MNT และ .022 สาหรับ PPT) สรุป: การราไทยอาจช่วยทาให้ความตึงตัวของเส้นประสาทมีเดียนและอาการเจ็บดีขึ้น จึงเป็นทีต่ ้องการในการศึกษาผลของรา ไทยต่อการป้องกันการบาดเจ็บทางกระดูกและกล้ามเนื้อที่เกี่ยวข้องกับการทางาน

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Active Forward Bend Task in Asymptomatic Individuals: a Pilot Study Pisit Suwannimit PT, MSc student*, Tanatta Chaichakan PT, MEng student**, Peemongkon Wattananon PT, PhD* * **

Faculty of Physical therapy, Mahidol University, Thailand

Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Thailand

Objective: Presence of aberrant movement pattern during trunk forward bending can be used to identify the impaired trunk neuromuscular control in low back pain (LBP) patients. In healthy individuals, they should be able to consistently perform trunk forward bend. However, evidence to support this statement is still limited. Therefore, this study aimed to determine consistency of subject’s performance during trunk forward bending.

Material and Method: Three asymptomatic individuals (age=23 ± 1 years, body mass index=20.19 ± 1.68 kg/m2, 1 female) participated in this study. Motion sensors were placed on lumbar spine (L1), pelvis (S2), and lateral epicondyle of right femur. Participants were asked to perform two sets of three repetitions of forward bend task with motion data simultaneously collected. Lumbar, pelvic, and combined lumbar and pelvic angular motions were derived.

Coefficient of multiple determination (CMD) was used to determine consistency of subject’s performance.

Results: CMD demonstrated excellent intra-session pattern consistency (R2=0.81-1.00) of lumbar, pelvic, and combined lumbar and pelvic angular motions among three repetitions of active forward bend task in sagittal plane.

Conclusion: The finding indicates that asymptomatic individuals select and consistently perform a movement pattern during this task. Further study should investigate whether patients with LBP would be able to consistently perform active forward bend task.

Keywords: Low back pain, Aberrant movement, Pattern consistency, Forward bend

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ผู้ที่ไม่มีอาการปวดหลังมีรูปแบบการเคลื่อนไหวที่คงที่ในท่าก้มตัว: การศึกษานาร่องจากข้อมูลการ เคลื่อนไหว พิสิฐ สุวรรณนิมิตร, ธนัฏฐา ชัยฉกรรจ์, พีร์มงคล วัฒนานนท์ วัตถุประสงค์: การเคลื่อนไหวที่ผิดปกติในระหว่างการก้มตัวสามารถใช้บ่ งชี้ค วามผิดปกติใ นการควบคุมระบบประสาท กล้ามเนื้อของล้าตัวในผู้ป่วยที่มีอาการปวดหลังส่วนล่างได้ ในทางทฤษฎี ผู้ที่ไม่มีอาการปวดหลังน่าจะเคลือ่ นไหวในท่าก้มตัวซ้า้ ๆ ได้โดยไม่มีการเปลี่ยนแปลงรูปแบบการเคลื่อนไหว อย่างไรก็ตาม ผลการวิจัยที่สามารถยืนยันข้อมูลการเคลื่อนไหวดังกล่าว ยังมีอยู่ไม่เพียงพอ ดังนั้นงานวิจัยนี้มีวัตถุประสงค์เพื่อศึกษาการเปลี่ยนแปลงรูปแบบการเคลื่อนไหวในท่าก้มตัวในผู้ที่ไม่มี อาการปวดหลัง วัสดุและวิธีการ: ผู้เข้าร่วมการวิจยั ในครั้งนี้เป็นผู้ทไี่ ม่มีอาการปวดหลังจ้านวน 3 คน (เพศหญิง 1 คน ชาย 2 คน อายุเฉลี่ย 23 ± 1 ปี ดัชนีมวลกายเฉลี่ย 20.19 ± 1.68 กิโลกรัม/ตารางเมตร2) โดยติดอุปกรณ์ตรวจจับสัญญาณการเคลื่อนไหวไว้ที่กระดูกสัน หลังระดับเอวที่ 1 กระดูกสันหลังระดับเชิงกรานที่ 2 และปุ่มกระดูกแลทเทอรัล อีพิคอนไดล์ของกระดูกต้นขาข้างขวา โดยจะ เก็บข้อมูลการเคลื่อนไหวระหว่างที่ผู้เข้าร่วมการวิจัยก้มหลังทั้งหมด 2 รอบ รอบละ 3 ครั้ง ซึ่งจะท้าให้ได้ข้อมูลการเคลื่อนไหว เชิงมุมของหลังส่วนล่าง เชิงกรานและหลังส่วนล่างร่วมกับเชิงกราน และใช้ Coefficient of Multiple Determination (CMD) ในการวิเคราะห์ความสอดคล้องของการเคลื่อนไหวทั้ง 3 ครั้ง ในผู้เข้าร่วมการวิจยั แต่ละคน ซึ่งค่าความสอดคล้องนี้จะใช้เป็นตัว วัดระดับการเปลี่ยนแปลงของรูปแบบการเคลื่อนไหว ผลการศึกษา: การวิเคราะห์ความสอดคล้องการเคลื่อนไหวจากค่าการเคลื่อนไหวเชิงมุมของหลังส่วนล่าง สะโพก และหลัง ส่วนล่างร่วมกับเชิงกราน ในแนวระนาบซ้ายขวาระหว่างการก้มตัวทั้ง 3 ครั้ง พบว่าอยู่ในเกณฑ์ดีมาก (R2 = 0.81-1.00) สรุป: จากผลการศึกษาแสดงให้เห็นว่าผู้เข้าร่วมวิจัยที่ไม่ มีอาการปวดหลังสามารถเคลื่อนไหวโดยมีรูปแบบการเคลื่อนไหวที่ คงที่จากการก้มตัวทั้ง 3 ครั้ง การศึกษาต่อไปควรจะท้าการศึกษาในผู้ป่วยที่มีอาการปวดหลังส่วนล่างว่าสามารถท้าการ เคลื่อนไหวได้อย่างสอดคล้องกันในขณะก้มตัวหรือไม่

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Immediate Effects of Action-Observation-Execution Combined with Task-Oriented Training on Reach-To-Grasp Actions in Individuals with Sub-Acute Stroke Shambhu Prasad Adhikari BPT*, Jarugool Tretriluxana PhD**, Pakaratee Chaiyawat PhD**, Chutima Jalayondeja DrPH** *

Department of Physiotherapy, Kathmandu University School of Medical Sciences, Nepal **

Faculty of Physical Therapy, Mahidol University, Thailand

Objective: To investigate the immediate effects of action-observation-execution (AOE) combined with task-oriented training (TOT) based on the Accelerated Skill Acquisition Program (ASAP) on Reach-to-grasp actions (RTG) in sub-acute stroke.

Material and Method: This was a double-blinded experimental matched-pair design. Individuals with 1-6 months post-stoke (six per group) underwent 30 minutes of AOE. In addition, experimental group received 60 minutes of task-oriented training based on the concept of ASAP, whereas control group received dose-equivalent usual care. Seven hand-items of Wolf Motor Function Test (WMFT) were used to evaluate the RTG at baseline and after each intervention. The dependent measures were movement time (MT) and functional ability (FA) of the WMFT. Results: Significant group-by-time interactions were found for the WMFT-total MT, and MT of pencil lifting item. For experimental group, there were significant differences for total and lifting pencil on MT, grip strength and all FA items except flipping cards across evaluations. Post-hoc analysis demonstrated significant differences just between post-TOT and baseline in experimental group for total and pencil lifting items on MT and total, lifting pencil and lifting paper clip on FA. Conclusion: The TOT based on the ASAP when primed with the AOE resulted in faster and improved movements. The findings indicate that the combined effects enhance hand recovery at sub-acute stroke. Further study is undergoing to determine if the immediate gains in the skilled RTG last for one week.

Keywords: Task-oriented training, Mirror neurons, Dexterity, Motor learning, Stroke 203

Active Forward Bend Task in Asymptomatic Individuals: a Pilot Study Pisit Suwannimit PT, MSc student*, Tanatta Chaichakan PT, MEng student**, Peemongkon Wattananon PT, PhD* *

Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand **

Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Thailand

Objective: Presence of aberrant movement pattern during trunk forward bending can be used to identify the impaired trunk neuromuscular control in low back pain (LBP) patients. In healthy individuals, they should be able to consistently perform trunk forward bend. However, evidence to support this statement is still limited. Therefore, this study aimed to determine consistency of subject’s performance during trunk forward bending.

Material and Method: Three asymptomatic individuals (age=23 ± 1 years, body mass index=20.19 ± 1.68 kg/m2, 1 female) participated in this study. Motion sensors were placed on lumbar spine (L1), pelvis (S2), and lateral epicondyle of right femur. Participants were asked to perform two sets of three repetitions of forward bend task with motion data simultaneously collected. Lumbar, pelvic, and combined lumbar and pelvic angular motions were derived.

Coefficient of multiple determination (CMD) was used to determine consistency of subject’s performance.

Results: CMD demonstrated excellent intra-session pattern consistency (R2=0.81-1.00) of lumbar, pelvic, and combined lumbar and pelvic angular motions among three repetitions of active forward bend task in sagittal plane.

Conclusion: The finding indicates that asymptomatic individuals select and consistently perform a movement pattern during this task. Further study should investigate whether patients with LBP would be able to consistently perform active forward bend task.

Keywords: Low back pain, Aberrant movement, Pattern consistency, Forward bend

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ผู้ที่ไม่มีอาการปวดหลังมีรูปแบบการเคลื่อนไหวที่คงที่ในท่าก้มตัว: การศึกษานาร่องจากข้อมูล การเคลื่อนไหว พิสิฐ สุวรรณนิมิตร, ธนัฏฐา ชัยฉกรรจ์, พีร์มงคล วัฒนานนท์

วัตถุประสงค์: การเคลื่อนไหวที่ผิดปกติในระหว่างการก้มตัวสามารถใช้บ่ งชี้ค วามผิดปกติใ นการควบคุมระบบประสาท กล้ามเนื้อของล้าตัวในผู้ป่วยที่มีอาการปวดหลังส่วนล่างได้ ในทางทฤษฎี ผู้ที่ไม่มีอาการปวดหลังน่าจะเคลือ่ นไหวในท่าก้มตัวซ้า้ ๆ ได้โดยไม่มีการเปลี่ยนแปลงรูปแบบการเคลื่อนไหว อย่างไรก็ตาม ผลการวิจัยที่สามารถยืนยันข้อมูลการเคลื่อนไหวดังกล่าว ยังมีอยู่ไม่เพียงพอ ดังนั้นงานวิจัยนี้มีวัตถุประสงค์เพื่อศึกษาการเปลี่ยนแปลงรูปแบบการเคลื่อนไหวในท่าก้มตัวในผู้ที่ไม่มี อาการปวดหลัง วัสดุและวิธีการ: ผู้เข้าร่วมการวิจยั ในครั้งนี้เป็นผู้ทไี่ ม่มีอาการปวดหลังจ้านวน 3 คน (เพศหญิง 1 คน ชาย 2 คน อายุเฉลี่ย 23 ± 1 ปี ดัชนีมวลกายเฉลี่ย 20.19 ± 1.68 กิโลกรัม/ตารางเมตร2) โดยติดอุปกรณ์ตรวจจับสัญญาณการเคลื่อนไหวไว้ที่กระดูกสัน หลังระดับเอวที่ 1 กระดูกสันหลังระดับเชิงกรานที่ 2 และปุ่มกระดูกแลทเทอรัล อีพิคอนไดล์ของกระดูกต้นขาข้างขวา โดยจะ เก็บข้อมูลการเคลื่อนไหวระหว่างที่ผู้เข้าร่วมการวิจัยก้มหลังทั้งหมด 2 รอบ รอบละ 3 ครั้ง ซึ่งจะท้าให้ได้ข้อมูลการเคลื่อนไหว เชิงมุมของหลังส่วนล่าง เชิงกรานและหลังส่วนล่างร่วมกับเชิงกราน และใช้ Coefficient of Multiple Determination (CMD) ในการวิเคราะห์ความสอดคล้องของการเคลื่อนไหวทั้ง 3 ครั้ง ในผู้เข้าร่วมการวิจยั แต่ละคน ซึ่งค่าความสอดคล้องนี้จะใช้เป็นตัว วัดระดับการเปลี่ยนแปลงของรูปแบบการเคลื่อนไหว ผลการศึกษา: การวิเคราะห์ความสอดคล้องการเคลื่อนไหวจากค่าการเคลื่อนไหวเชิงมุมของหลังส่วนล่าง สะโพก และหลัง ส่วนล่างร่วมกับเชิงกราน ในแนวระนาบซ้ายขวาระหว่างการก้มตัวทั้ง 3 ครั้ง พบว่าอยู่ในเกณฑ์ดีมาก (R2 = 0.81-1.00) สรุป: จากผลการศึกษาแสดงให้เห็นว่าผู้เข้าร่วมวิจัยที่ไม่ มีอาการปวดหลังสามารถเคลื่อนไหวโดยมีรูปแบบการเคลื่อนไหวที่ คงที่จากการก้มตัวทั้ง 3 ครั้ง การศึกษาต่อไปควรจะท้าการศึกษาในผู้ป่วยที่มีอาการปวดหลังส่วนล่างว่าสามารถท้าการ เคลื่อนไหวได้อย่างสอดคล้องกันในขณะก้มตัวหรือไม่

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The Effectiveness of Bobath Training on Walking Speed among Individuals with Sub-Acute Stroke Made Hendra Satria Nugraha S.Ft.*, Ni Komang Ayu Juni Antari S.Ft*, Gede Parta Kinandana S.Ft. *, Ari Wibawa S.ST.Ft. *, M.Fis* Ni Luh Nopi Andayani S.ST.Ft., M.Fis. * *

Physiotherapy Department, Faculty of Medicine, Udayana University, Bali-Indonesia

Objective: To determine the effectiveness of Bobath training and conventional method in walking speed among individuals with sub-acute stroke.

Material and Method: An experimental study has been done using non-probability sampling (consecutive sampling). Twenty-two individuals with stroke were allocated into two groups: treatment (Bobath training; n=11) and control (conventional training; n=11) groups. The inclusion criteria were as follows: age 35-70 years, first stroke onset less than 180 days, and ability to follow instructions. Each training program was 40 minutes per visit, three visits per week for eight weeks.

The time was recorded during the 10 meters walk test and then used to calculate the walking speed.

The measurement was done at pre-and post-treatment. Paired t-test was used to compare walking speed between pre- and post-treatment. The difference of walking speed (pre-post different) between the treatment and control groups were tested using independent t-test.

Results: The average ages of the subjects in the control and treatment groups were 54.50 Âą 8.20 and 55.06 Âą 7.97 years respectively. Seven males and four females were in the control group, while seven males and four females were in the treatment group. In the control group, six subjects had lesions on the right side and five subjects on the left side of the body part. In the treatment group, seven subjects had lesions on the right side and four subjects on the left side. There was an increase of walking speed 0.03 m/s (p=0.004) and 0.21 m/s (p<0.001) for the control and treatment groups respectively. Comparison test result showed a significant difference in walking speed between both control and treatment groups (p<0.001).

Conclusion: Our findings suggested that the Bobath training is more effective than conventional training for increasing the walking speed among individuals with stroke.

Keywords: Bobath training, Walking speed, Gait, Stroke

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The Combined Effect of Perturbation Training and Ultrasound Treatment on Functional Ability in Individual with Knee Osteoarthritis Gede Parta Kinandana S.Ft., Made Hendra Satria Nugraha S.Ft., Ni Komang Ayu Juniantari Physiotherapy Departement, Udayana University, Bali, Indonesia

Objective: to determine the effectiveness of perturbation training on functional ability in individuals with knee osteoarthritis (OA).

Materials and Method: This is an experimental research design. Twenty-six individuals with knee OA were allocated into two treatment groups: group1 and 2. Group 1 received ultrasound treatment using 0.3 W/cm2 of intensity, 1 MHz of frequency for five minutes and perturbation training two times per week for 12 times, which was done using three types of exercises, three sets for each type and 30 seconds for each set, followed by 60 seconds rest per set. Group 2 received ultrasound treatment with the same dosage and closed chain exercise three times per week for six times, which was done using wall-slides exercise with three sets and 10 repetitions for each set and held for five seconds for each repetition. The functional ability was measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at pre-and post-treatment.

Within group comparison was analyzed using paired sample t-test. To compare the mean difference between two groups, the independent sample t-test was used.

Results: Four women and 7 men were distributed in group 1, while 3 women and 8 men were in group 2. The average ages in group 1 and group 2 were 58.91 ± 5.30 and 59.18 ± 8.24 years respectively. For body mass index (BMI), two persons with normal BMI were in the group 1, and nine persons considered as overweight were in the group 2. There were three persons for normal and eight persons for overweight. The KOOS increased by 40.8 ± 2.7 and 13.1 ± 1.5 in group 1 (p<0.001) and group 2 (p<0.001), respectively. Additionally, there was significant difference between two groups (p<0.001).

Conclusion: In addition to ultrasound treatment, the perturbation training resulted in the better functional ability in individuals with knee OA compared to the closed chain exercise.

Keywords: Knee osteoarthritis, Ultrasound, Perturbation training, Closed chain exercise, Knee Injury and Osteoarthritis Outcome Score (KOOS)

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The Effectiveness of Progressive Muscle Relaxation for Decreasing Blood Pressure in Grade I Hypertension Ni Komang Ayu Juni Antari, S.Ft, Gede Parta Kinandana, S.Ft, Made Hendra Satria Nugraha, S.Ft. Physiotherapy Department, Faculty of Medicine, Udayana University, Bali-Indonesia

Objective: To determine whether progressive muscle relaxation could decrease blood pressure level for individual with grade I hypertension.

Material and Method: This study was a pre- and post-test control group design. The inclusion criteria were: age < 60 years, able to communicate, and diagnosed with grade I hypertension without complications. Twenty-four individuals were allocated into treatment and control groups. Both groups received an angiotensin-converting-enzyme inhibitors (ACE inhibitors). Only the treatment group received additional progressive muscle relaxation consisting of 15 movements, three times a week for one week. Patients did these movements for five seconds followed by 10-second deep breathing for relaxation. The data were tested by Wilcoxon signed rank test and paired sample t-test.

The interval average of blood pressure reduction in both groups were tested using Mann-Whitney U test.

Results: Each group, six subjects took CCB regularly and six subjects took ACE inhibitors. Mean age for the treatment and control groups were 49.8 years. A significant blood pressure reduction on the treatment group was found. The interval average systolic pressure reduction for the treatment and control groups was 10.78 ± 0.59 mmHg and 0.03 ± 0.52 mmHg, (p=0.000) respectively.

Such average diastolic pressure reduction for both groups was 7.22 ± 0.39 mmHg and 0.08 ± 0.14 mmHg, p=0.000 respectively.

Conclusion: Progressive Muscle Relaxation effectively decreased blood pressure for people with grade I hypertension.

Keywords: Progressive muscle relaxation, Hypertension, Blood pressure

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Impaired Dexterity in Elders with Mild Cognitive Impairment Warin Rakkamon MSc, Sasithorn Saengrueangrob MSc, Thanwarat Chantanachai MSc, Mantana Vongsirinavarat PhD Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand Objective: To compare the dexterity of elders with and without mild cognitive impairment (MCI).

Material and Method: This study was a cross-sectional design. Two hundred and seventeen elders with age of 60-80 years were screened in this research. Sixty-one people (n=61) passed the research criteria with the Thai version of Miniâ&#x20AC;&#x201C;Mental State Examination scores (MMSEThai) â&#x2030;Ľ 23. MCI was screened using Montreal Cognitive Assessment (MoCA). Participants were categorized into two groups: MCI ( n= 34) and non- MCI ( n= 27) groups. Grip strength and recorded time of 15 dexterity tasks of Wolf Motor Function Test (WMFT) were obtained from all participants. The data were analyzed by the independent sample t-test.

Results: Age, body mass index, educational background, MMSE-Thai scores, Thai Hospital Anxiety and Depression Scale (Thai-HADS) were not different between two groups. There were significant differences in total time of 15 dexterity tasks (p<0.001), time of each task (p<0.05), and grip strength test (p=0.035) between the elders with and without MCI groups.

Conclusion: Our results indicate that MCI group spend more time on the dexterity tasks and have less grip strength than the non- MCI group. This study provides the information for treatment planning to improve upper extremity functions, especially for the elders with MCI.

Keywords: Elders, Mild Cognitive Impairment, Dexterity, Grip strength, Wolf Motor Function Test

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ความบกพร่องของการทางานละเอียดอ่อนในผู้สูงอายุที่มีภาวะความบกพร่องทางการรับรู้ระดับน้อย วรินทร์ รักกมล, ศศิธร แสงเรืองรอบ, ธัญวรัตน์ จันทนชัย, มัณฑนา วงศ์ศิรินวรัตน์ วัตถุประสงค์: เพื่อเปรียบเทียบการทางานละเอียดอ่อนของรยางค์แขนระหว่างกลุ่มผู้สูงอายุที่มีและไม่มีภาวะความบกพร่อง ทางการรับรู้ระดับน้อย วัสดุและวิธีการ: การศึกษานี้เป็นการศึกษาแบบภาคตัดขวาง ผู้สูงอายุเข้าร่วมงานวิจัย จานวน 217 คน อายุระหว่าง 60-80 ปี ผ่านเข้าเกณฑ์งานวิจัย 61 คน โดยมีคะแนนแบบทดสอบสภาพสมองเสื่อมฉบับภาษาไทย (MMSE) ≥ 23 การประเมินระดับ ความบกพร่องทางการรับรู้ด้วย Montreal Cognitive Assessment (MoCA) ผู้เข้าร่วมวิจัยแบ่งเป็น 2 กลุ่ม: กลุ่มผู้สูงอายุที่ มี (34 คน) และไม่มีภาวะความบกพร่องทางการรับรู้ ระดับน้อย (27 คน) การทดสอบแรงบีบมือ และการจับเวลาการทางาน ละเอียดอ่อนของรยางค์แขนจานวน 15 งาน ของ Wolf Motor Function Test วิเคราะห์ข้อมูลด้วย Independent sample t-test ผลการศึกษา: ไม่มีความแตกต่างอย่างมีนัยสาคัญทางสถิติระหว่างกลุ่มผู้สูงอายุที่มีและไม่มีภาวะความบกพร่องทางการรับรู้ ระดับน้อย ของอายุ ดัชนีมวลกาย ระดับการศึกษา คะแนนของแบบทดสอบสภาพสมองเสื่อม และคะแนนแบบสอบถาม อาการวิตกกังวลและอาการซึมเศร้าฉบับภาษาไทย มีความแตกต่างอย่างมีนัยสาคัญทางสถิติระหว่าง 2 กลุ่ม ในเวลารวมของ การทดสอบทั้ง 15 งาน (p<0.001) และเวลาแต่ละงานของการทางานละเอียดอ่อน (p<0.05) และแรงบีบมือ (p=0.035) สรุป: ผลการศึกษาแสดงว่ากลุ่มผู้สูงอายุที่มีภาวะความบกพร่องทางการรับรู้ระดับน้อยใช้เวลาการทางานละเอียดอ่อนมากกว่า และมีแรงบีบมือน้อยกว่า เมื่อเปรียบเทียบกับกลุ่มผู้สูงอายุที่ไม่มีภาวะความบกพร่องทางการรับรู้ ระดับน้อย งานวิจัยนี้เอื้อ ข้อมูลในการวางแผนการรักษาเพื่อปรับปรุงการทางานของแขนโดยเฉพาะอย่างยิ่งในผู้สูงอายุที่มี ภาวะความบกพร่องทางการ รับรู้ระดับน้อย

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Volitional and Social Skills Assessment of Thai Autistic Students Supansa Tajai MA, Winai Chatthong MEng, Supalak Khemthong PhD Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand

Objective: Impaired volitional and social skills are commonly found among autistic children and adolescents. The Individualized Education Program (IEP) is a holistic approach by designing an interactive collaboration among teachers, students, and their parents. It is expected to improve life skill among autistic students. To assess the effectiveness of the IEP, volitional and social skills should be evaluated. This study aimed to evaluate Volitional and Social Skills assessments of Thai autistic students from Two Thai schools.

Material and Method: Thirty- five autistic students aged 5-16 years participated. All of them underwent the IEP, mostly involving teachers and students, on the daily basis at schools.

Measurement tools consisted of the Volitional and the Social Skills Profile assessments. These skills were evaluated by two occupational therapists (OT) while the participants performed OTâ&#x20AC;&#x2122;s activities. Two OT spent 5-10 minutes per one assessment group (2-6 students/group).

Descriptive statistics were used for statistical analysis.

Results: At school 1, one student showed a good level of intention for volitional skills and six of total 23 students (26.09%) showed a good level of interest for social skills. At school 2, no students showed good level of volitional and three of total 12 students showed a good level of interest for social skills (25%).

Conclusion: There were few students with good level of volitional and social skills in participating schools. These findings suggested that both schools should increase levels of intention and interest by establishing the collaboration among teachers, students, and their parents.

Keywords: Social Skills, Intention, Interest, Volition, Autistic

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การประเมินเจตจานงและทักษะทางสังคมของนักเรียนออทิสติกไทย สุพรรษา ตาใจ, วินัย ฉัตรทอง, ศุภลักษณ์ เข็มทอง วัตถุประสงค์: ความบกพร่องด้านเจตจานงและทักษะทางสังคมพบได้ทั่วไปในเด็กและวั ยรุ่นออทิสติก แผนการศึกษาเฉพาะ บุคคล คือการออกแบบและการสร้างความร่วมมือร่วมกันแบบองค์รวมระหว่างครู นักเรียน และผู้ปกครอง เพื่อเป้าหมายใน การพัฒนาทักษะชีวิตของนักเรียนออทิสติก ในการประเมินประสิทธิภาพของแผนการศึกษาเฉพาะบุคคลควรมีการประเมิน เจตจานงและทักษะทางสังคมร่วมด้วย การศึกษาครั้งนี้มีจุดมุ่งหมายเพื่อประเมินเจตจานงและทักษะทางสังคมของนักเรียน ออทิสติกไทยจากสองโรงเรียนในประเทศไทย วัสดุและวิธีการ: นักเรียนออทิสติก จานวน 35 คน อายุระหว่าง 5-16 ปี เข้าร่วมงานวิจัย นักเรียนทั้งหมดได้รับแผนการศึกษา เฉพาะบุคคล โดยส่วนใหญ่จดั การร่วมกันระหว่างครูและนักเรียนทุกวันที่โรงเรียน เครื่องมือที่ใช้ประกอบด้วย แบบประเมิน เจตจานงในการทากลุ่มกิจกรรมบาบัดและแบบประเมินทักษะทางสังคม

ทักษะเหล่านี้จะถูกประเมินขณะผู้เข้าร่วมวิจัยทา

กิจกรรมกลุ่มกิจกรรมบาบัดโดยนักกิจกรรมบาบัดจานวน 2 คน ใช้เวลา 5-10 นาทีต่อหนึ่งกลุ่มการประเมิน (นักเรียน 2-6 คน ต่อกลุ่ม) วิเคราะห์ข้อมูลด้วยสถิติเชิงพรรณนา ผลการศึกษา: โรงเรียนที่ 1 มีนักเรียน 1 คนแสดงระดับดีของความตั้งใจสาหรับแบบประเมินเจตจานงและนักเรียน 6 ใน 23 คน (26.09 %) แสดงระดับดีของความสนใจสาหรับทักษะทางสังคม โรงเรียนที่ 2 ไม่มีนักเรียนแสดงแสดงระดับดีของความ ตั้งใจสาหรับแบบประเมินเจตจานงและนักเรียน 3 ใน 12 คน (25%) แสดงระดับดีของความสนใจสาหรับทักษะทางสังคม สรุป: มีนักเรียนจานวนน้อยที่แสดงระดับดีของความตั้งใจสาหรับแบบประเมิน เจตจานง และแสดงระดับดีของความสนใจ สาหรับทักษะทางสังคมทั้งสองโรงเรียน ผู้วิจัยเสนอว่าทั้งสองโรงเรียนควรเพิ่มระดับความตั้งใจและความสนใจของนักเรียนโดย สร้างความร่วมมือระหว่าง ครู นักเรียน และผู้ปกครอง

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Health Worker’s Knowledge, Skill and Attitude towards Physical Activity Promotion Based on Thai Physical Activity Guideline (TPAG) Chutima Jalayondeja DrPH, Wattana Jalayondeja PhD, Roongtiwa Vachalathiti PhD, Sunee Bovonsunthonchai PhD, Prasert Sakulsriprasert PhD, Watsinee Kaewkhuntee PhD, Tipwadee Bunprajun PhD, Rujiret Upiriyasakul MSc Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand Objective: To assess the knowledge, skill and attitude (KSA) of health workers after receiving training-of-trainer (TOT) program for physical activity (PA) promotion based on Thai Physical Activity Guideline (TPAG).

Material and Method: We conducted before-and after-design among health workers at Nakhon Pathom province, Thailand. They were invited to participate the TOT program for PA promotion based on TPAG. We assessed the KSA using the 20-item multiple choices for objective scoring and one open-ended question at before and after 1-day of training. The benefit and barrier of using TPAG for PA promotion in community were collected using the focus group technique at two weeks after training. The paired t-test and content analysis were used for data analysis.

Results: A total of 80, of which 54 subjects (67.5%) completed the test. The KSA scores after training were significantly improved (score11.0 ± 3.3 at before and 15.4 ± 2.1 at after, p<0.001).

Group discussion showed that health workers did not have experience for individually PA coaching and lacked skill to calculate calories expenditure. However, most of them (95%) had positive attitude toward PA promotion using TPAG. Conclusion: Although the usefulness of PA promotion based on TPAG was accepted, the individually-tailored PA might be time-consuming. Our findings found that health workers needed adequate practicing and team support to ensure the achievement of PA promotion in community. The future study of long time follow-up needs to conduct for determining the effectiveness of PA promotion using TPAG.

Keywords: Community, Health worker, Health promotion, Physical activity, Thailand

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ความรู้ ทักษะและทัศนคติของคนทางานด้านสุขภาพต่อการส่งเสริมกิจกรรมทางกายตามแนวทางกิจกรรม ทางกายของไทย (ทีแพค) ชุติมา ชลายนเดชะ, วรรธนะ ชลายนเดชะ, รุ่งทิวา วัจฉละฐิติ, สุนีย์ บวรสุนทรชัย, ประเสริฐ สกุลศรีประเสริฐ, เวทสินี เขื่องศิริกุล, ทิพย์วดี บรรพระจันทร์, รุจิเรศ เอื้อพิริยะสกุล วัตถุประสงค์: เพื่อประเมินความรู้ ทักษะและทัศนคติของคนทางานด้านสุขภาพ หลังจากได้รับโปรแกรมการฝึกอบรมผูส้ อน (TOT) สาหรับการส่งเสริมกิจกรรมทางกายตามแนวทางกิจกรรมทางกายของไทย (ทีแพค) วัสดุและวิธีการ: รูปแบบการวิจัย ก่อนและหลังการศึกษาในคนทางานด้านสุขภาพ จังหวัดนครปฐม ประเทศไทย ผู้เข้าร่วมวิจัยได้รับ เชิญเข้าร่วมโปรแกรมฝึกอบรมผู้สอน เพื่อส่งเสิรมกิจกรรมทางกายตามแนวทางของกิจกรรมทางกายของไทย การประเมินความรู้ ทักษะและทัศนคติด้วยแบบทดสอบอัตนัย 20 ข้อ ให้คะแนนตามวัตถุประสงค์ และ 1 ข้อคาถามปลายเปิด ประเมินที่ก่อนและหลัง การฝึกอบรม 1 วัน การรวบรวมข้อดีและอุปสรรคในการนาทีแพคไปใช้เพื่อส่งเสริมกิจกรรมทางกายในชุมชน ด้วยการเทคนิคการ สนทนากลุ่มที่ระยะ 2 สัปดาห์หลังการฝึกอบรม สถิติ Paired t-test และการวิเคราะห์เนื้อหานามาใช้ในการวิเคราะห์ข้อมูล ผลการศึกษา: จากทั้งหมด 80 คน ผู้เข้าร่วมวิจยั 54 คน (ร้อยละ 67.5) ทาแบบทดสอบเสร็จสมบูรณ์ คะแนนความรู้ ทักษะและเจตคติ หลังจากการฝึกอบรมมีค่ามากกว่าก่อนฝึกอย่างมีนัยสาคัญทางสถิติ (11.0 ± 3.3 คะแนนก่อนอบรม และ 15.4 ± 2.1 คะแนนหลังอบรม p<0.001) การสนทนากลุม่ แสดงว่าคนทางานด้านสุขภาพไม่มีประสบการณ์โค้ชกิจกรรมทางกายเป็นรายบุคคลและขาดทักษะคานวณค่า การใช้พลังงาน อย่างไรก็ตาม ผู้เข้าร่วมวิจัยส่วนใหญ่ (ร้อยละ 95) มีทัศนคติเชิงบวกต่อการใช้ทีแพคเพื่อการส่งเสริมกิจกรรมทางกาย สรุป: ถึงแม้ว่าประโยชน์ของการส่งเสริมกิจกรรมทางกายตามทีแพคถูกยอมรับ การออกแบบกิจกรรมทางกายเป็นรายบุคคลอาจต้องใช้ เวลานาน คนทางานด้านสุขภาพต้องการการฝึกซ้อมที่เพียงพอและทีมสนับสนุนเพื่อให้แน่ใจถึงความสาเร็จของการส่งเสริมกิจกรรมทาง กายในชุมชน ในอนาคตต้องการการศึกษาติดตามระยะยาวเพื่อศึกษาประสิทธิผลของการส่งเสริมกิจกรรมทางกายด้วยทีแพค

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Trunk and Extremities Muscle Strength Predict Independent Supine-to-Sit in Individuals with Stroke Chutima Jalayondeja DrPH*, Thitinat Pankaew MSc**, Pornsiri Suvarnnato MSc** *

Faculty of Physical Therapy, Mahidol University, Thailand **

Prasat Neurological Institute, Thailand

Objective: To determine whether trunk and extremities muscle strength could predict independent supine-to-sit in individuals with stroke.

Materials and Methods: Subjects with unilateral first stroke were recruited from the stroke rehabilitation unit of Prasat Neurological Institute. The inclusion criteria were: a) cognition measured by the modified Thai Mental State Examination > 18 and b) muscle tone measured by the modified Ashworth Scale ≤ 2. The independent transfer from supine-to-sit was defined using the Motor Assessment Scale grade 4-6. Muscle strength of trunk, shoulder, elbow, hand grip, hip and knee was measured using the hand held dynamometer. The odds ratio (OR) with 95% confident interval (95%CI) and multiple logistic regression were used for statistical analysis.

Results: 68 subjects aged 60.6±11.8 years with 19.4±44.6 days of time post-stroke were enrolled.

Twenty-five subjects performed independent supine-to-sit and took 3.9±2.1 minutes. The percentages of affected to unaffected muscle strength were 98% for trunk lateral flexor muscles, 60%-67% for shoulder and elbow muscles, 30% for grip strength, and 72%-83% for hip and knee muscles. After adjustment for age and muscle tone, the potential predictors of independent supine-to-sit in individuals with stroke were flexor muscle strength at hip (OR=1.05, 95%CI=1.01-1.08, p=0.005) and elbow (OR=1.04, 95%CI=1.01-1.07, p=0.004).

Conclusion: To achieve independent supine-to-sit in individuals with stroke who had good trunk muscle strength, our findings suggest to strengthen flexor muscles of affected hip and elbow.

Keyword: Motor assessment scale, Muscle strength, Stroke, Supine-to-sit, Trunk

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ความแข็งแรงของกล้ามเนื้อทานายการลุกขึ้นนั่งจากท่านอนหงายด้วยตัวเองในผู้ป่วยโรคหลอดเลือดสมอง ชุติมา ชลายนเดชะ, ธิตินาจ ปานเขียว, พรสิริ สุวรรณโท วัตถุประสงค์: เพื่อศึกษาว่าความแข็งแรงของกล้ามเนื้อลาตัวและรยางค์สามารถทานายการลุกขึ้นนั่งจากท่านอนหงายด้วย ตนเองในผู้ป่วยโรคหลอดเลือดสมองได้หรือไม่ วัสดุและวิธีการ: ผู้เข้าร่วมวิจัยมาจากหน่วยฟื้นฟูโรคหลอดเลือดสมองของสถาบันประสาทวิทยา เกณฑ์คัดเข้าคือ ก) เป็นโรคหลอด เลือดสมองข้างเดียวครั้งแรก ได้รับการวินิจฉัยจากแพทย์และภาพถ่ายรังสี, ข) การรับรู้ วัดโดยแบบทดสอบภาวะสมองเสื่อมฉบับ ภาษาไทย (คะแนน>18) และความตึงตัวของกล้ามเนื้อวัดด้วย modified Ashworth Scale≤2 การลุกขึ้นนั่งจากท่านอนหงายด้วย ตนเองวัดด้วย Motor Assessment Scale (MAS) เกรด 4-6 ความแข็งแรงของกล้ามเนื้อวัดด้วย hand held dynamometer ทีล่ าตัว ไหล่ ศอก การกามือ สะโพก และเข่า ค่า odds ratio (OR), 95% ช่วงความเชื่อมั่น (95%CI) และสมการถดถอยหลายตัวแปรแบบโลจิ สติก ผลการศึกษา: ผู้เข้าร่วมวิจัย 68 คนมีอายุ 60.6±11.8 ปี และเป็นโรคหลอดเลือดสมอง 19.4±44.6 วัน คัดเข้าการศึกษานี้ ผู้เข้าร่วม วิจัย 25 คนสามารถลุกขึ้นนั่งจากท่านอนหงายด้วยตนเองและใช้เวลา 3.9±2.1 นาที ค่าร้อยละของความแข็งแรงกล้ามเนื้อข้างอ่อนแรง ต่อข้างแข็งแรง เท่ากับ 98%, ของกล้ามเนื้อเอียงลาตัว 60-67%, ของกล้ามเนื้อไหล่และศอก, 30% ของการกามือ, และ 72-83% ของ กล้ามเนื้อสะโพกและเข่า ความแข็งแรงของกล้ามเนื้อไหล่และศอก กามือและกล้ามเนื้องอสะโพกสามารถทานายการลุกขึ้นนั่งจากท่า นอนหงายด้วยตนเอง หลังจากคานึงถึงอายุและความตึงตัวกล้ามเนื้อ ปัจจัยที่สาคัญในการทานายการลุกขึ้นนั่งจากท่านอนหงายด้วย ตนเองในผู้ป่วยโรคหลอดเลือดสมอง คือ ความแข็งแรงของกล้ามเนื้องอสะโพก (OR=1.05, 95%CI 1.01, 1.08, p=0.005) และงอศอก (OR=1.04, 95%CI 1.01, 1.07, p=0.004) สรุป: สาหรับการฝึกผู้ป่วยโรคหลอดเลือดสมองที่มีกล้ามเนื้อลาตัวแข็งแรง ผลการศึกษานี้แนะนาให้เพิ่มความแข็ งแรง กล้ามเนื้องอสะโพกและศอกเพื่อให้ผู้ป่วยสามารถลุกขึ้นนั่งจากท่านอนหงายด้วยตนเอง

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Energy Expenditure Determination of Physical Activity in Thai Physical Activity Guideline Watesinee Kaewkhuntee PhD, Chutima Jalayondeja DrPH Wattana Jalayondeja PhD, Piyaporn Wichaidij MSc Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand Objective: Of total 836 activities in Thai Physical Activity Guideline (TPAG), the intensity of 92 new additional Thai activities were not estimated. Oxygen consumption (VO2) is standard parameter to calculate the metabolic equivalence of task (MET) representing the intensity level of activity. Therefore the objectives were to measure the VO2 during performing six selected activities in TPAG and to compare the intensity of each activity between males and females.

Material and Method: Thirty-two subjects with age range of 20-40 years (16 males, 74.4 ± 10.8 kg and 16 females, 56.0 ± 7.5 kg). Their VO2 was measured at rest and during six following activities with random: playing tablet/smart phone in sitting, sitting on gym ball for computer work, swinging arms at slow (60 times/minute) and fast speed in standing (120 times/minute), marching, and cycling on stationary bicycle at 30- 50 watts. The VO2 was monitored using indirect calorimetry in five minutes for each activity performance. Descriptive statistics and independent t-test were used for data analysis. The MET value was calculated from the VO2 during activity divided by resting.

Results: The VO2 of six activities ranged 210.7-1048.2 ml.kg- 1.min- 1. Five activities were mild intensity (1.0-2.0 METs) except marching (4.6 ± 1.3 METs). There were significant difference of the MET value between male and female performing tablet/smart phone in sitting (1.0 ± 0.2 vs 0.8 ± 0.2 METs, p=0.03), swinging arms at slow speed (1.6 ± 0.2 vs 1.4 ± 0.3 METs, p=0.03) and at fast speed (2.3 ± 0.5 vs 1.7 ± 0.4 METs, p=0.01) in standing.

Conclusion: The intensity of six activities was estimated and added into the TPAG. High energy expenditure indicates high body’s metabolism during activities in males.

Keywords: Arms swing, Metabolic equivalent of task, Oxygen consumption, Physical activity, Thailand

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ค่าพลังงานของกิจกรรมในหัวข้อกิจกรรมทางกายของไทย เวทสินี แก้วขันตี, ชุติมา ชลายนเดชะ, วรรธนะ ชลายนเดชะ, ปิยาภรณ์ วิชัยดิษฐ์ วัตถุประสงค์: จากกิจกรรมทั้งหมด 836 กิจกรรมในหัวข้อกิจกรรมทางกายของไทย มี 92 กิจกรรมที่เพิ่มเติมเข้ามาและยังไม่ได้ ประเมินระดับความหนักของกิจกรรม ซึ่งค่าการใช้ออกซิเจน (VO2) ขณะทากิจกรรมเป็นค่ามาตรฐานที่ใช้คานวณค่าการใช้ พลังงานในหน่วย MET เพื่อจาแนกระดับความหนักของกิจกรรม ดังนั้น วัตถุประสงค์ของการศึกษานี้ เพื่อวัดค่า VO2 และ จาแนกความหนักของ 6 กิจกรรมซึ่งเลือกจากหัวข้อกิจกรรมทางกายของไทยที่เพิ่มเข้ามา และเพื่อเปรียบเทียบค่า VO2 ขณะทา กิจกรรมระหว่างเพศชายและหญิง วัสดุและวิธีการ: วัดค่า VO2 ในเพศชาย (n=16, 74.4 ± 10.8 กิโลกรัม.) และเพศหญิง (n=16, 56.0 ± 7.5 กิโลกรัม) อายุ 2040 ปี ขณะท ากิ จกรรมทางกาย 6 ชนิ ดโดยท าการสุ่ มล าดั บของกิ จกรรม: นั่ งเล่ นแท็ ปเล็ ต /มื อถื อ นั่ ง บนยิ มบอลท างาน คอมพิวเตอร์ ยืนแกว่งแขนช้า (60 ครั้งต่อนาที) ยืนแกว่งแขนเร็ว (120 ครั้งต่อนาที) ยืนแกว่งแขนเร็วย่าเท้าแบบมาร์ช ปั่น จักรยานอยู่กับที่ 30-50 วัตต์ โดยใช้เครื่องวัดพลังงานแบบเคลื่อนที่ขณะพักและทากิจกรรมทั้ง 6 ชนิดเป็นเวลา 5 นาที จากนั้น ใช้ สถิ ติ เชิ งพรรณาและ Independent t-test วิ เคราะห์ ข้ อมู ล ค่ า METs ของแต่ ละกิ จกรรมค านวณจากค่ า VO2 ขณะท า กิจกรรมหารด้วยขณะพัก ผลการศึกษา: ค่า VO2 ของทั้ง 6 กิจกรรมอยู่ระหว่าง 210.7-1048.2 มิลลิลิตร/กิโลกรัม/นาที โดย 5 กิจกรรมมีระดับความหนัก อยู่ในระดับเบา (1.0-2.0 METs) ยกเว้นยืนแกว่งแขนเร็วย่ าเท้ าแบบมาร์ช (4.6 ± 1.3 METs) และมีความแตกต่างอย่ า งมี นัยสาคัญทางสถิติของค่าพลังงานระหว่างเพศชายและหญิงในขณะทากิจกรรมนั่งเล่นแท็ปเล็ต/ มือถือ (1.0 ± 0.2 vs 0.8 ± 0.2 METs, p=0.03) ยืนแกว่งแขนช้า (1.6 ± 0.2 vs 1.4 ± 0.3 METs, p=0.03) และยืนแกว่งแขนเร็ว (2.3 ± 0.5 vs 1.7 ± 0.4 METs, p=0.01) สรุป: ระดับความหนักของทั้ง 6 กิจกรรมได้รับการประเมินและเพิ่มเติมในกิจกรรมทางกายของไทย และการใช้พลังงานขณะทา กิจกรรมที่สูงกว่าในเพศชาย บ่งชี้ว่าเพศชายมีการเผาผลาญที่สูงกว่าเพศหญิง

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Cognitive Ability in Methamphetamine Abusers Compared to Healthy Control Kannika Permpoonputtana PhD.*, Jatuporn Namyen MSc.**, Piyarat Govitrapong PhD.** * Faculty of Physical Therapy, Occupational Therapy Division, Mahidol University, Nakhon Pathom, Thailand ** Institute of Molecular Biosciences, Research Center for Neuroscience, Mahidol University, Nakhon Pathom, Thailand Objective: This study examines cognitive functioning in the methamphetamine abusers compared to the healthy adults.

Material and Method: One hundred and thirteen methamphetamine abusers and 60 healthy adults were recruited into this study. Cognitive function was measured with the Montreal Cognitive Assessment Battery Screening (MoCA), the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the Thai Mini-Mental State Examination (MMSE-Thai 2002). One way analyses of variance were performed, with subject group as the between subjects factor.

Results: The mean age of methamphetamine abuser is 27.5 years old and 27.3 years old for the healthy control. The mean scores of MoCA, MMSE and LOTCA in healthy control are 27.98 ± 0.1981, 28.95 ± 0.2078 and 116.6 ± 0.2435, respectively. The mean scores of 3 tests are in methamphetamine abuser are 19.14 ± 0.2594, 24.96 ± 0.2786 and 99.85 ± 0.6025, respectively.

The results showed that the cognitive scores by MoCA, MMSE and LOTCA of methamphetamine abusers were significant lower than the healthy control (p < 0.0001).

Conclusion: Methamphetamine can caused cognitive dysfunction is related to the dependent mechanisms associated with certain brain structures. The scores of MoCA, MMSE and LOTCA in methamphetamine abusers are considered to be more sensitive for cognitive dysfunction and this could be utilize to better understanding of demographic and clinical attributes associated with cognitive impairment among methamphetamine users.

Keywords: Methamphetamine, cognitive ability, MoCA, MMSE, LOTCA

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ความสามารถด้านการรู้คิดของผู้เสพติดยาบ้า กันนิกา เพิ่มพูนพัฒนา, จตุพร นามเย็น, ปิยะรัตน์ โกวิตรพงศ์ วัตถุประสงค์: การศึกษาเพื่อทดสอบระดับการรู้คดิ ในผู้เสพติดยาบ้าเปรียบเทียบกับผู้ที่มสี ุขภาพแข็งแรง วัสดุและวิธีการ: ผู้เสพติดยาบ้า 133 คน และผู้ที่มีสุขภาพแข็งแรง 60 คน ได้รับการประเมินระดับการรู้คิดโดยใช้แบบประเมิน Montreal Cognitive Assessment Battery Screening (MoCA), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) และ Thai Mini-Mental State Examination (MMSE-Thai 2002) ข้อมูลวิเคราะห์โดยใช้ One way analysis of variance ผลการศึกษา: ผูเ้ สพติดยาบ้ามีอายุเฉลีย่ 27.5 ปีและผู้ที่มสี ุขภาพแข็งแรงอายุเฉลี่ย 27.3 ปี ระดับคะแนนเฉลี่ยของคะแนน MoCA, MMSE และ LOTCA ในผู้ที่มีสุขภาพแข็งแรงเท่ากับ 27.98 ± 0.1981, 28.95 ± 0.2078 and 116.6 ± 0.2435 ตามลาดับ ส่วนในผู้ที่ผู้เสพติดยาบ้าของทั้ง 3 แบบทดสอบเท่ากับ 19.14 ± 0.2594, 24.96 ± 0.2786 และ 99.85 ± 0.6025 ตามลาดับ เมื่อเปรียบเทียบระดับความรู้คิดระหว่างกลุ่มผู้เสพติดยาบ้าเปรียบเทียบกับผู้ทมี่ ีสุขภาพแข็งแรงพบว่าระดับการรู้คดิ ของผู้เสพติดยาบ้ามีคะแนนต่ากว่าอย่างมีนัยสาคัญทางสถิติทั้ง 3 แบบทดสอบ (p < 0.0001). สรุ ป : ยาบ้ า เป็ น เหตุ ข องการบกพร่ อ งของการรู้ คิ ด อาจจะมี ค วามสั ม พั น ธ์ กั บ การท างานสมอง โดยระดั บ คะแนนจาก แบบทดสอบ MoCA, MMSE และ LOTCA มีความไวในการวัดระดับการรู้คิดในผู้ติดยาเสพ

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Astrocyte Activation and Cytokine Production in Hippocampus of Aged Mice Kannika Permpoonputtana PhD.*, Patlada Tangweerasing B.Sc.**, Piyarat Govitrapong PhD.** *Faculty of Physical Therapy, Occupational Therapy Division, Mahidol University, Nakhon Pathom, Thailand ** Institute of Molecular Biosciences, Research Center for Neuroscience, Mahidol University, Nakhon Pathom, Thailand Objective: In the present study we examined the alteration in glial cell population and neuroinflammation status in hippocampal aged-mice.

Material and Method: Mice were divided into the three treatment groups: (i) control young adult mice (2 months of age), (ii) aged group (22 months old mice), and (iii) aged mice + melatonin. The melatonin-treated mice received melatonin (10 mg/kg) in the drinking water for a period of 6months. Significance was assessed using a one-way analysis of variance (ANOVA) followed by Tukey–Kramer test.

Results: Our study in hippocampus of aged mice showed that the protein levels of microglia, astrocyte, and major pro-inflammatory cytokines include IL-1β, IL-6, and TNF-α were significantly increased when compared with young adult mice. Melatonin administration significantly decreased these protein levels.

Conclusion: Aged mice associated with the induction of inflammation while melatonin could reverse the increase of neuroinflammatory state in hippocampus of aged mice. These brain areas important related with learning and memory. Thus, the present study supports the advantage roles of melatonin in the aspect of anti-aging by anti-inflammation and potentially prevents the risk of memory impairment such as Alzheimer's disease.

Keywords: Aging, imflammation, Cytokines, Melatonin

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การกระตุ้นของเกลียเซลล์และการสร้างไซโตไคน์ในสมองส่วนฮิปโปแคมปัสของหนูชรา กันนิกา เพิ่มพูนพัฒนา, ภัทร์ลดา ตังวีระสิงห์, ปิยะรัตน์ โกวิทตรพงศ์ วัตถุประสงค์: การศึกษาครั้งนี้ทดสอบการเปลี่ยนของระดับเซลล์เกลีย และภาวะการอักเสบในสมองส่วนฮิปโปแคมปัสของหนู ชรา วัสดุและวิธีการ: การศึกษาครั้งนี้แบ่งหนูออกเป็น 3 กลุ่ม คือ กลุม่ หนูวัยผู้ใหญ่ หนูชราและหนูชราทีบ่ ริโภคเมลาโทนิน โดย หนูกลุ่มชราที่บริโภคเมลาโทนิน(10 mg/kg) ในน้​้าดื่มเป็นระยะเวลา 6 เดือน เปรียบเทียบความแตกต่างระหว่างกลุ่มโดยใช้ สถิติ one-way analysis of variance (ANOVA) ตามด้วย Tukey–Kramer test ผลการศึกษา: การศึกษาพบว่าฮิปโปแคมปัสในหนูชรามีระดับโปรตีนของเกลียเซลล์และระดับไซโตไคน์ ซึ่งได้แก่ IL-1β, IL-6, และ TNF-α เพิ่มขึ้นอย่างมีนัยส้าคัญ เมื่อเปรียบกับหนูกลุม่ วัยผู้ใหญ่ หนูชราที่บริโภคเมลาโทนินพบว่ามีระดับของโปรตีน เหล่านีล้ ดลงอย่างมีนัยส้าคัญ สรุป: ความชรามีความสัมพันธ์กับการเพิ่มขึ้นของภาวะอักเสบและปริมาณของเกลียเซลล์ที่เกี่ยวข้องกับระบบภูมิคุ้มกันของ สมอง โดยเมลาโทนินสามารถระงับอาการอักเสบที่เกิดขึ้นเองจากการชราในสมองส่วนฮิปโปแคมปัส ซึ่งเป็นสมองที่เกี่ยวของ กับการรู้คดิ และความจ้า การศึกษาสนับสนุนบทบาทของเมลาโทนินในด้านของการต้านการอักเสบและป้องกันความบกพร่อง ด้านความจ้า เช่น โรคอัลไซเมอร์

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Organization

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Organization Operations Committee 1. Assoc.Prof. Sopa Pichaiyongwongdee 2. Asst.Prof. Chompunoot Suwanasri 3. Asst.Prof.Dr. Jithvaree Khamdej 4. Assoc.Prof.Dr. Roongtiwa Vachalathiti 5. Assoc.Prof.Dr. Vimonwan Hiengkaew 6. Asst.Prof.Dr. Wattana Jalayondeja 7. Asst.Prof.Dr. Mantana Vongsirinavarat 8. Asst.Prof.Dr. Raweewan Lekskulchai 9. Asst.Prof.Dr. Jarugool Tretriluxana 10. Asst.Prof.Dr. Chutima Jalayondeja 11. Asst.Prof.Dr. Pakaratee Chaiyawat 12. Asst.Prof.Dr. Prasert Sakulsriprasert 13. Lect.Dr. Wunpen Chansirinukor 14. Lect.Dr. Nantinee Nualnim 15. Ms. Phornrat Phongkeha Subcommittee Secretary and Registration 1. Asst.Prof.Dr. Chutima Jalayondeja 2. Lect. Sasithorn Saengrueangrob 3. Lect. Thanwarat Chantanachat 4. Lect. Pairoj Suraprapapich 5. Ms. Rungtip Pongakasira 6. Undergraduate and graduate students Public Relations 1. Asst.Prof.Dr. Pakaratee Chaiyawat 2. Lect.Dr. Wanalee Klomjai 3. Lect.Dr. Peemongkon Wattananon 4. Lect.Dr. Suweena Khacharern

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Consultants Consultants Consultants Committee chairman Committee Committee Committee Committee Committee Committee Committee Committee Committee Committee and Secretary Committee and Assistant Secretary

Subcommittee Chairman Subcommittee Subcommittee Subcommittee and Secretary Subcommittee and Assistant Secretary

Subcommittee Chairman Subcommittee Subcommittee Subcommittee

Public Relations (cont.)

5. Lect.Dr. Komsak Sinsurin 6. Lect. Tosawan Upachit 7. Mrs. Ratchaporn Rachapattayakhom 8. Mr. Khajornyod anuraktam 9. Mr. Aviruth Pinkaew 10. Ms. Jutharat Hasjumphol

Subcommittee Subcommittee Subcommittee Subcommittee Subcommittee Subcommittee and Secretary

Certified Trainers 1. Lect.Dr. Nantinee Nualnim 2. Lect.Dr. Komsak Sinsurin 3. Lect.Dr. Peemongkon Wattananon 4. Ms. Rungtip Pongakasira

Subcommittee Chairman Subcommittee Subcommittee Subcommittee and Secretary

Exhibition and Souvenir 1. Asst.Prof.Dr. Prasert Sakulsriprasert 2. Asst.Prof.Dr. Jithvaree Khamdej 3. Ms. Datchanee Nampairoj 4. Ms. Ladawan Panya

Subcommittee Chairman Subcommittee Subcommittee Subcommittee and Secretary

Party Place 1. Asst.Prof.Dr. Wattana Jalayondeja 2. Lect. Sasithorn Kong-oun 3. Mr. Nopparud Chunsamran 4. Mrs. Ratchaporn Rachapattayakhom 5. Mr. Akenarin Chocknakawaro

Subcommittee Chairman Subcommittee Subcommittee Subcommittee Subcommittee and Secretary

Finance and Procurement 1. Asst.Prof.Dr. Prasert Sakulsriprasert 2. Mrs. Lanchana Narkraiking 3. Ms. Phattaravadee Phumeesat

Subcommittee Chairman Subcommittee Subcommittee and Secretary

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Research Editorial Committee and Award 1. Asst.Prof.Dr. Raweewan Lekskulchai 2. Asst.Prof.Dr. Jarugool Tretriluxana 3. Lect.Dr. Wunpen Chansirinukor 4. Assoc.Prof.Dr. Vimonwan Hiengkaew 5 Asst.Prof.Dr. Chutima Jalayondeja 6. Asst.Prof.Dr. Saipin Prasertsukdee 7. Asst.Prof.Dr. Mantana Vongsirinavarat 8. Lect.Dr. Nantinee Nualnim 9. Asst.Prof.Dr. Sunee Bovonsunthonchai 10. Lect.Dr. Komsak Sinsurin 11. Lect.Dr. Petcharatana Bhuanantanondh 12. Lect.Dr. Wanalee Klomjai 13. Lect.Dr. Tipwadee Bunprajun 14. Lect.Dr. Jatuporn Suttiwong 15. Lect.Dr. Watesinee Kaewkhuntee 16. Lect.Dr. Peeradech Thichanpiang 17. Lect.Dr. Kannika Permpoonputtana 18. Lect.Dr. Peemongkon Wattananon Editorial Department 1. Asst.Prof.Dr. Jarugool Tretriluxana 2. Lect.Dr. Wunpen Chansirinukor 3. Lect.Dr. Komsak Sinsurin 4. Asst.Prof.Dr. Chutima Jalayondeja 5. Ms. Wanida Kaewchaaum 6. Ms. Ploychanokporn Phoemsangsuwan

Subcommittee Chairman Subcommittee Subcommittee Subcommittee and Secretary Subcommittee and Assistant Secretary Subcommittee and Assistant Secretary

The Proceedings 1. Lect.Dr. Wunpen Chansirinukor 2. Lect. Warin Rakkamon 3. Ms. Jutharat Hasjumphol 4. Ms. Ploychanokporn Phoemsangsuwan

Subcommittee Chairman Subcommittee Subcommittee Subcommittee and Secretary

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December 14th - 16th, 2016

and the 4 Physical Therapy Mahidol University Research Symposium December 14th-16th, 2016 Twin Towers Hotel, Bangkok

December 14th - 16th, 2016