• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.58-62
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• 2004

Purpose: To cover the exposed tendons and bones after trauma and cure the concomitant osteomyelitis in the lower extremities, gracilis muscle free flaps are frequently preferred. 32 cases of gracilis muscle free flap we had done were analysed according to the indications, specification of flap length and width, pedicle length, vessels used in the anastomosis and final healing after at least over 1 year follow up. Materials and methods: From August 1995 through November 2002, we have performed 32 cases of gracilis muscle free flap transplantation with the general microsurgical procedures in the lower extremities. Open fracture of the middle and distal tibia were 12, exposed heel 6, crushing injury in the foot 5 cases, open fracture of the ankle 4, chronic osteomyelitis of the tibia 3 and osteomyelitis of the tarsal bones 2. Tailored flap length were ranged from 16 cm to 4 cm, width were from 5cm to 4cm. Pedicle length averaged around 4 cm. Anastomosis of one artery and two veins in both of donor and recipient were performed in 17 cases and one artery and one vein in 15 cases. Results: All flaps were survived, except 2 cases. Final flap healing was satisfactory to both of the patients and microsurgeon. Conclusion: Gracilis muscle free flaps are frequently chosen to cover the exposed components and cure the osteomyelitis in the lower extremities.

• Archives of Plastic Surgery
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• v.40 no.5
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• pp.575-583
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• 2013

Background The aim of lower-extremity reconstruction has focused on wound coverage and functional recovery. However, there are limitations in the use of a local flap in cases of extensive defects of the lower-extremities. Therefore, free flap is a useful option in lower-extremity reconstruction. Methods We performed a retrospective review of 49 patients (52 cases) who underwent lower-extremity reconstruction at our institution during a 10-year period. In these patients, we evaluated causes and sites of defects, types of flaps, recipient vessels, types of anastomosis, survival rate, and complications. Results There were 42 men and 10 women with a mean age of 32.7 years (range, 3-72 years). The sites of defects included the dorsum of the foot (19), pretibial area (17), ankle (7), heel (5) and other sites (4). The types of free flap included latissimus dorsi muscle flap (10), scapular fascial flap (6), anterolateral thigh flap (6), and other flaps (30). There were four cases of vascular complications, out of which two flaps survived after intervention. The overall survival of the flaps was 96.2% (50/52). There were 19 cases of other complications at recipient sites such as partial graft loss (8), partial flap necrosis (6) and infection (5). However, these complications were not notable and were resolved with skin grafts. Conclusions The free flap is an effective method of lower-extremity reconstruction. Good outcomes can be achieved with complete debridement and the selection of appropriate recipient vessels and flaps according to the recipient site.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.119-124
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• 2007

Purpose: We reconstructed the skin defect of lower legs exposing muscles, tendons and bone with fasciocutaneous sural artery flap and report our cases. Materials and Methods: Between March 2005 and September 2006, 8 cases of skin defect were reconstructed with fasciocutaneous sural artery flap. Defect site were 4 case of ankle and foot and 4 cases of lower leg. The average defect size was $4{\times}4\;cm^2$. There were 5 men and 3 women and mean age was 52.2 years. We evaluated the viability of flap, postoperative complication, healing time, patient's satisfaction. Results: There was no flap failure in 8 cases. But recurrent discharge in 2 cases was healed through several times adequate debridement and delayed suture without complication. Flap edema may be due to venous congestion was healed through leg elevation and use of low molecular weight heparin. Mean time to heal the skin defect was 4 weeks. No infection and recurrence in follow up period. Cosmetic results as judged by patients were that 5 cases are good and 3 cases are fair. Conclusion: Sural artery flap is good treatment method among the numerous methods in the cases of skin defect, with soft tissue exposed, which is not covered with debridment and skin graft. Sural artery flap is useful method for the skin defect of lower legs because it is simple procedure, has constant blood supply and relatively good cosmetic effect.

• Physical Therapy Rehabilitation Science
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• v.9 no.4
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• pp.318-323
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• 2020

Objective: Reacquisition of motor functions following stroke depends on interhemispheric neural connections. The intervention highlighted in the present case is an insight for augmenting motor recovery by stimulating the lesioned area and adjacent areas governing the motor behaviour of an individual. The purpose of this study was to determine the changes in the motor and cognitive outcomes through multi target stimulation of cortical areas by application of multichannel transcranial direct current stimulation (M-tDCS) in a stroke survivor. Design: A case report. Methods: The patient was a participant of a trial registered with the clinical trial registry of India (CTRI/2020/01/022998). The patient was intervened with M-tDCS over the left primary motor cortex i.e. C3 point and left dorsolateral prefrontal cortex i.e. F3 point with 0.5-2 mA intensity for the period of 20 minutes. SaeboFlex-assisted task-oriented training, functional electrical stimulation over the lower extremity (LE) to elicit dorsiflexion at the ankle and eversion of the foot, and conventional physiotherapy rehabilitation including a tailored exercise program were performed. Outcome assessment was done using the Fugl-Meyer assessment scale (FMA) for the upper and lower extremity (UE and LE), Montreal Cognitive Assessment (MOCA), Wisconsin Gait Scale (WGS) and the Stroke Specific Quality of Life (SSQOL) measures. Assessment was taken at Day 0, 15 and 30 post intervention. Results: Improvement was observed in all the outcome measures i.e FMA (UE and LE), MOCA, SSQOL and WGS across the span of 4 weeks. Conclusions: M-tDCS induced improvement in motor functions of the UE and LE, gait parameters and cognitive functions of the patient.

• Physical Therapy Korea
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• v.9 no.3
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• pp.77-91
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• 2002

Asymmetrical stance posture, balance, and gait disturbance are common problems in hemiplegic patients. Posterior leaf springs (PLS) are frequently prescribed to correct these problems. Recently, anterior leaf springs (ALS) have also been prescribed, but only limited studies have been performed to investigate the effects of ALS. The purpose of this study was to compare the effects of three conditions, i.e., wearing an ALS, wearing a PLS, and not wearing an AFO (ankle foot orthosis),: on 1) the distribution of weight bearing on the affected side, 2) standing balance, and 3) the gait patterns of hemiplegic patients. Eleven hemiplegic patients (10 men and 1 woman) participated in this study. The data were analyzed by the Friedman test. The results were as follows: 1) More weight bearing on the affected leg was observed in the ALS and PLS conditions than in the condition without an AFO. No significant difference between the ALS and PLS conditions was found. 2) There were statistically significant differences in the composite equilibrium scores (CES) among the three conditions. The CES in the PLS condition was significantly higher than in the ALS condition or the condition without an AFO. 3) Gait patterns improved significantly in the ALS and PLS conditions. No statistically significant difference between the ALS and PLS conditions was found. These results suggest that both ALS and PLS effectively improve the distribution of weight bearing on the affected side, standing balance, and gait patterns of hemiplegic patients. Further study using three-dimensional kinematic analysis and dynamic electromyography is needed to support these findings.

• Journal of Korean Medicine Rehabilitation
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• v.23 no.3
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• pp.55-68
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• 2013

Objectives This study was to investigate the effects of Yuhyangjeongtong-san on the carrageenin-induced acute inflammation and adjuvant-induced arthritis in rats. Methods Acute inflammation was induced by injection of 2% carrageenin 0.15 ml into right hind foot of rats. Control group was carrageenin injected and taken distilled water, treated group was carrageenin injected and taken Yuhyangjeongtong-san by orally once. 2 hours after injection, plantar temperature and paw volume were measured. 3 hours after, counts of white blood cell (WBC) were performed. Arthritis was induced by injection of complete freund's adjuvant (CFA) into base of tail. Control group was CFA injected and taken distilled water, treated group was CFA injected and taken Yuhyangjeongtong-san by orally for 10 days. 0,5,10 day, body weight, thickness of ankle joint and paw edema were measured. 10 day, counts of WBC, $interleukin-1{\beta}$ ($IL-1{\beta}$) and tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$) level were analysed. Histochemical study of NADPH-d and immunohistochemical study of c-fos were performed. Results In the carrageenin-induced acute inflammation, neutrophils of treated group were significantly decreased compared with control group. In the adjuvant-induced arthritis, paw edema, total counts of WBC and TNF-${\alpha}$ level in paw exudates were significantly decreased compared with control group, and the number of c-fos positive neurons of treated group was significantly decreased compared with control group. Conclusions On the basis of these results, we concluded that Yuhyangjeongtong-san have anti-arthritic and anti-inflammatory effects.

• Annals of Rehabilitation Medicine
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• v.42 no.6
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• pp.872-883
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• 2018

Objective To replace camera-based three-dimensional motion analyzers which are widely used to analyze body movements and gait but are also costly and require a large dedicated space, this study evaluates the validity and reliability of inertial measurement unit (IMU)-based systems by analyzing their spatio-temporal and kinematic measurement parameters. Methods The investigation was conducted in three separate hospitals with three healthy participants. IMUs were attached to the abdomen as well as the thigh, shank, and foot of both legs of each participant. Each participant then completed a 10-m gait course 10 times. During each gait cycle, the hips, knees, and ankle joints were observed from the sagittal, frontal, and transverse planes. The experiments were conducted with both a camera-based system and an IMU-based system. The measured gait analysis data were evaluated for validity and reliability using root mean square error (RMSE) and intraclass correlation coefficient (ICC) analyses. Results The differences between the RMSE values of the two systems determined through kinematic parameters ranged from a minimum of 1.83 to a maximum of 3.98 with a tolerance close to 1%. The results of this study also confirmed the reliability of the IMU-based system, and all of the variables showed a statistically high ICC. Conclusion These results confirmed that IMU-based systems can reliably replace camera-based systems for clinical body motion and gait analyses.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.4
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• pp.163-171
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• 2019

PURPOSE: This study examined the incidence, location, and characteristics of sports injuries according to the position in Korean female national field hockey athletes. METHODS: Eighteen female national field hockey athletes (two goal keepers, five forwards, six midfielders, and five defenders) who trained at the national training center between January 2018 and December 2018 were enrolled. The event, position, and location of injury were recorded per IOC's daily injury reports form. The incidence of sports injuries was examined with the 95% confidence interval (CI), and the difference in the incidence of injury according to the position was presented as the rate ratio (RR). Moreover, differences in the location of sports injury according to the position were examined using χ2 tests. RESULTS: A total of 92 sports injuries occurred among field hockey players, with an incidence of 6.47 cases per 1,000 hours of training (95% CI 4.98-7.96). In addition, 29.12 cases of injuries occurred per 1,000 exposures (95% CI 23.17-35.07), and the incidence of injury was highest among the defenders, followed by forwards, midfielders, and goal keepers. The most common location of sports injury was the lower extremity, followed in order by the trunk, upper extremity, head, and neck, and there were significant differences in the location of the sports injury according to the position (p=.046). In addition, lumbar spine/lower back, thigh, ankle, lower leg, knee, and foot/toe were common sites of sports injury among female field hockey players. CONCLUSION: These results provide a baseline for predicting sports injuries in athletes during games, and would provide useful information for developing performance enhancement and injury prevention programs.

• Journal of Biomedical Engineering Research
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• v.28 no.5
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• pp.647-656
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• 2007

The purpose of this study was to analyze the effects of vibratory stimulus as somatosensory inputs on the postural control in human standing. To study these effects, the center of pressure(COP) was observed while subjects were standing on a stable and an unstable support with co-stimulated mechanical vibrations to flexor ankle muscles(tibialis anterior tendon, achilles tendon) and two plantar zones on both foot. The COP sway measurement was repeated twice in four conditions: (1) with visual cue and vibration, (2) without visual cue and vibration, (3) with visual cue and without vibration, (4) without visual cue and with vibration. The calculated parameters were the COP sway area and the distance, the median frequency and the spectral energy of COP sway in three intervals $0.1{\sim}0.3,\;0.3{\sim}1,\;1{\sim}3Hz$. The results showed that vibratory stimulus affect postural stability. The reduction rate of the COP sway with vibratory stimulus were higher on the unstable support because the effect of postural stability increases when afferent nervous flow is more activated by vibration on unstable support. If unclear visual or vibratory information is received, one type of information is compared with the other type of sensory information. Then the input balance between visual and vibratory information is corrected to maintain postural stability. These findings are important for the rehabilitation system of postural balance control and the use of vibratory information.

• Physical Therapy Rehabilitation Science
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• v.7 no.1
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• pp.35-40
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• 2018

Objective: The purpose of this study was to investigate the immediate effect of applying self-myofascial release (SMR) to the plantar fascia using a foam roller on hamstring and lumbar spine superficial back line (SBL). Design: Randomized controlled trial. Methods: Thirty-one healthy adults agreed to the method and purpose of the study. Selection and exclusion criteria were screened, and baseline measurements for the Toe Touch test and passive straight leg raise (PSLR) test were obtained. The participants were then randomly assigned to the SMR group or the sham group. After group assignment, the SMR group rolled the surface of the foot from the heel to the metatarsal head using a foam roller for 5 minutes. The sham group received passive mobilization of the ankle joint in the supine position. Afterwards, the Toe Touch test and the passive straight leg-raise test were re-assessed. Results: In the SMR group, the Toe Touch test results showed significant improvement (p<0.05). Left and right PSLR test results showed a significant increase (p<0.05). In the sham group, there was no significant difference between pre and post-test results. The SMR group showed a significant difference in the PSLR test and Toe Touch test compared to the sham group (p<0.05). Conclusions: The results of this study showed that SMR on the plantar fascia was immediately effective for improving the flexibility of the SBL of the lumbar spine and hamstring.