Traditional ankle rehabilitation procedures are tedious, repetitive, and require therapist's help. Therefore, they do not provide patients with good motivation to actively participate in the rehabilitation exercises. In addition, objective diagnosis and evaluation of the treatment progress have been difficult because records of exercise history are made by passive instruments from time to time. The virtual reality technology can make these procedures more fun so that patients can perform everyday rehabilitation exercises more actively. Moreover, haptics technology can give active resistance to the patients ankle motion to improve strength of muscles as well as can record ankle's motion and force histories for objective diagnosis and evaluation. This paper summarizes development of a virtual environment fur reforming the conventional ankle rehabilitation procedures. First of all, conventional rehabilitation procedures have been summarized. Secondly, haptic design and control, user interface design, virtual environment contents design are described. Lastly, mutual cooperation among many developers including medical doctors and therapists and future works are commented.
The purpose of this study to compare the muscle performances (peak torque (PT), relative strength (RS), average power (AP), and total work (TW)) between taping group and non-taping group after 1 hour extensive exercise. Twenty healthy male subjects were evaluated in this study. Each subject was divided with taping(n=10) and non-taping group (n=10) randomly. Muscle performances were measured at 60 degree/sec and 180 degree/sec on the Cybex 770. The PT, RS, AP, and TW were measured before and after 1 hour extensive exercise. The results showed that taping group demonstrated significantly higher PT, RS, AP, and TW during ankle dorsiflexion and plantar flexion at 60 degree/sec than those of non-taping group, except for total work during ankle plantar flexion. At the 180 degree/sec, PT and RS was significantly higher during ankle dorsiflexion and plantar flexion in taping group than in non-taping group. This results suggest that lower leg taping could be useful to maintain muscle performances during sport activities.
The purpose of this study was to investigate the effects of clinical characteristics of chronic stroke patients on physiological cost index (PCI) during walking. Fourteen stroke patients participated in this study. To investigate the clinical characteristics, Fugl-Meyer score (FMS), gait velocity (GV), muscle strength of the knee extensor, modified Ashworth scale (MAS) of ankle plantar flexor, devices, and gait patterns during walking were measured and analyzed. The results were as follows: Firstly, use of devices and high MAS of the ankle plantar flexor significantly increased PCI. Secondly, PCI was significantly correlated with the FMS and MAS of the ankle plantar flexor. In conclusion, inhibition of spasticity of the ankle plantar flexor is considered to reduce PCI during walking for chronic stroke patients.
PURPOSE: The purpose of this study was to investigate the effect of the elastic band and stretching exercise program on ankle joint maximal voluntary isometric contraction (MVIC) and plantar pressure in high-heel wearing women in their 20s. METHODS: Twenty women in their twenties were randomly assigned to the experimental group (n=10) and the control group (n=10). The experimental group (n=10) performed the elastic band exercise program, while the control group (n=10) performed the stretching exercise program. Both exercise programs were performed three times a week for a total of four weeks. The BTE Primus RS was used in order to measure the ankle joint MVIC during dorsiflexion, plantar flexion, inversion, and eversion. Maximum pressure ($N/cm^2$), average pressure ($N/cm^2$) were measured using the Pedoscan. SPSS v. 21.0 software was used for all statistical analyses in this study. RESULTS: The measurement of the ankle joint's MVIC revealed that in inversion, a significant change in both feet was seen in both the experimental and control groups. In eversion, there was a significant change in both feet only in the experimental group. In terms of the rest of the results, no significant changes were visible. With regard to the plantar pressure, no significant results were seen for either foot in the comparison between or within the groups. CONCLUSION: Exercise program using elastic band and exercise program using stretching were effective on MVIC of ankle joint muscles, although it had no effect on changes of plantar pressure.
Purpose : Using a smartphone while walking districts attention and increases the risk of losing balance or falling. Ankle instability is caused by decreased muscle strength and decreased neuromuscular ability leading to postural control problems. Dual tasks increases the risk of falls by reducing postural control in adults with ankle instability. This study aimed to investigate the effect of performing a dual task on balance and muscle activity in adults with ankle instability using a smartphone. Methods : Forty-nine individuals with ankle instability participated in this study. A game of finding the wrong picture was performed using a smartphone in the dual task, and only looking at the blank screen of a smartphone was evaluated in the single task. The participants randomly performed single and dual task to evalutate balance and muscle atcitivy. Balance was evaluated using the Biodex balance system (BBS), and muscle activity was evaluated using surface EMG. Muscle activity of the gastrocnemius and tibialis anterior was measured at the same time as balance. Results : The results of this study showed that overall, anteior/posterior, and medial/lateral balance indices all showed significant differences when performing the dual task compared with those during the single task (p<.05). The muscle activity results showed a significant difference compared with that of the gastronemius muscle on the nondominant side during the dual task (p>.05). Conclusion : The results of this study showed that maintaining balance is more difficult when performing the dual task than during the single task, and only the muscle activity of the nondominant gastrocnemius muscle decreased. The dual task causes a decrease in concentration for postural control, which negatively affects postural stability. Individuals with ankle ankle instability should refrain from performing dual tasks, such as using smartphones, to prevent ankle damage.
Objective: The purpose of this study was to investigate the difference in muscle strength, kinematics, and kinetics between injured and non-injured sides of the leg after Achilles Tendon Rupture surgery during walking and running. Method: The subjects (n=11; age = 30.63 ± 5.69 yrs; height = 172.00 ± 4.47 cm; mass = 77.00 ± 11.34 kg; time lapse from surgery = 29.81 ± 10.27 months) who experienced Achilles Tendon Rupture (ATR) surgery participated in this study. The walking and running trials were collected using infrared cameras (Oqus 300, Qualisys, Sweden, 100 Hz) on instrumented treadmill (Bertec, U.S.A., 1,000 Hz) and analyzed by using QTM (Qualisys Track Manager Ver. 2.15; Qualisys, U.S.A). The measured data were processed using Visual 3D (C-motion Inc., U.S.A.). The cutoff frequencies were set as 6 Hz and 12 Hz for walking and running kinematics respectively, while 100 Hz was used for force plate data. Results: In ATR group, muscle strength there were no difference between affected and unaffected sides (p> .05). In kinematic analysis, subjects showed greater ROM of knee joint flexion-extension in affected side compared to that of unaffected side during walking while smaller ROM of ankle dorsi-plantar and peak knee flexion were observed during running (p< .05). In kinetic analysis, subjects showed lower knee extension moment (running at 2.2 m/s) and positive ankle plantar-flexion power (running at 2.2 m/s, 3.3 m/s) in affected side compared to that of unaffected side (p< .05). This lower positive ankle joint power during a propulsive phase of running is related to slower ankle joint velocity in affected side of the subjects (p< .05). Conclusion: This study aimed to investigate the functional evaluation of the individuals after Achilles tendon rupture surgery through biomechanical analysis during walking and running trials. Based on the findings, greater reduction in dynamic joint function (i.e. lower positive ankle joint power) was found in the affected side of the leg compared to the unaffected side during running while there were no meaningful differences in ankle muscle strength and walking biomechanics. Therefore, before returning to daily life and sports activities, biomechanical analysis using more dynamic movements such as running and jumping trials followed by current clinical evaluations would be helpful in preventing Achilles tendon re-rupture or secondary injury.
In this paper, we designed and tested an ankle joint mechanism for a gait rehabilitation robot. Gait rehabilitation programs are designed to improve the natural leg motion of patients who have lost their walking capabilities by accident or disease. Strengthening the muscles of the lower-limbs and stimulation of the nervous system corresponding to walking helps patients to walk again using gait assistive devices. It is an obvious requirement that the rehabilitation system's motion should be similar to and as natural as the normal gait. However, the system being used for gait rehabilitation does not pay much attention to ankle joints, which play an important role in correct walking as the motion of the ankle should reflect the movement of the center of gravity (COG) of the body. Consequently, we have designed an ankle mechanism that ensures the safety of the patient as well as efficient gait training. Also, even patients with low leg muscle strength are able to operate the ankle joint due to the direct-drive mechanism without a reducer. This safety feature prevents any possible adverse load on the human ankle. The additional degree of freedom for the roll motion achieves a gait pattern which is similar to the normal gait and with a greater degree of comfort.
The purpose of this study was to investigate changes in kinetic and kinematic variables associated with an increase in upper body weight. Eighteen healthy male university students($175.96{\pm}4.19\;cm$, $70.79{\pm}8.26\;kg$) participated. Eight motion analysis cameras(Qualysis Oqus 500) and 2 force AMTI platforms(Advanced Mechanical Technologies Inc. OR6-7, US) were used to record motion and forces during the drop landing at a frequency of 120 Hz and 1200 Hz, respectively. QTM software(Qualisys Track Manager) was used to record the data, and the variables were analyzed with Visual 3D and Matlab 2009. For the drop landing, a box of $4{\times}2{\times}0.46\;m$ was constructed from wood. Knee and ankle maximum flexion angle, knee flexion angle, knee and ankle angle at landing, time for maximum ankle flexion after landing, and time for maximum knee flexion after landing were calculated. There was a significant change in the time for maximum and minimum ground force reaction and the time for maximum dorsal flexion after landing(p<.05) with increasing weight. There was no significant change for the hip, knee, and ankle ROM, whereas there was an increase in the angle ROM as the weight increased, in the order of ankle, knee, and hip ROM. This result shows that the ankle joint ROM increased with increasing weight for shock attenuation during the drop landing. There was a trend for greater ankle ROM than knee ROM, but there was no clear change in the ROM of the hip joint with increasing weight. In conclusion, this study shows the importance of ankle joint flexibility and strength for safe drop landing.
The purpose of this study was to test the effectiveness of a prototype KAFO (Knee-Ankle-Foot Orthosis) powered by two artificial pneumatic muscles during walking. We had previously built powered AFO (Ankle-Foot Orthosis) and KO (Knee Orthosis) and used it effectively in studies on assistance of plantaflexion and knee extension motion. Extending the previous study to a KAFO presented additional challenges related to the assistance of gait motion for rehabilitation training. Five healthy males were performed gait motion on treadmill wearing KAFO equipped with artificial pneumatic muscles to power ankle plantaflexion and knee extension. Subjects walked on treadmill at 1.5 km/h under four conditions without extensive practice: 1) without wearing KAFO, 2) wearing KAFO with artificial muscles turned off, 3) wearing KAFO powered only in plantaflexion under feedforward control, and 4) wearing KAFO powered both in plantaflexion and knee extension under feedforward control. We collected surface electromyography, foot pressure and kinematics of ankle and knee joint. The experimental result showed that a muscular strength of wearing KAFO powered plnatarfexion and knee extension under feedforward control was measured to be lower due to pneumatic assistance and foot pressure of wearing KAFO powered plnatarfexion and knee extension under feedforward control was measured to be greater due to power assistance. In the result of motion analysis, the ankle angle of powered KAFO in terminal stance phase was found a peak value toward plantaflexion and there were difference of maximum knee flexion range among condition 2, 3 and 4 in mid-swing phase. The current orthosis design provided plantaflexion torque of ankle jonit in terminal stance phase and knee extension torque of knee joint in mid-swing phase.
Purpose: To find out the priority of which procedure has had a better outcome both clinically and radiographically between the two groups, one is treated by primary repair and the other by modified Brostr$\ddot{o}$m's procedure, by comparing the postoperative ankle joint stability and the patient's degree of satisfaction. Material and methods: 16 cases were taken into consideration whose number of severed ligaments were at least two or more of the lateral collateral ligaments of the ankle, and also were confirmed intraoperatively. Among them, 8 cases were treated with primary repair and the other 8 cases were treated with primary repair and the other 8 cases by modified Brostr$\ddot{o}$m's procedure. Results: There was no distinguishable difference for the patient's degree of satisfaction between the two procedures above mentioned. In 3 cases treated with primary repair, functional instability was observed. In case of postoperative ankle joint stability, 7 of 8 cases treated by modified Brostr$\ddot{o}$m's procedure has revealed increased joint stability. And 3 of 8 cases which were treated by primary repair have showed postoperative residual instability. Conclusion: Actually, the severed ligament can not maintain its normal strength though several months has elapsed, and possible residual instability could be remained. Therefore, it can be expected that modified Brostr$\ddot{o}$m's procedure also would be a .good method in obtaining suitable ankle joint stability as well as subtalar joint stability because of its reinforcement using extensor retinaculum.
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