• 한국운동역학회지
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• 제20권4호
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• pp.469-477
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• 2010

The purpose of this study was to evaluate the effects of insole-equipped ankle-foot-orthoses (AFO) on gait. 10 healthy males who had no history of injury in the lower extremity participated in this study as the subjects. The foot of each subject was first scanned, and the insole fit to the plantar was made using BDI-PCO(Pedcad Gmbh, Germany). The subject then was made to walk on a treadmill under four experimental conditions: 1) normal walking, 2) walking wearing AFO, 3) walking wearing AFO equipped with the insole, 4) walking wearing pneumatic-ankle-foot-orthosis (pAFO) equipped with the insole. During walking, foot pressure data such as maximum force, contacting area, peak pressure, and mean pressure was collected using Pedar-X system (Novel Gmbh, Germany) and EMG activity of lower limb muscles such as gastrocnemius medial head, gastrocnemius lateral head, and soleus was recorded using MP150 EMG module (BIOPAC System Inc., USA). Collected data was then analyzed using paired t-test in order to investigate the effects of the insole. As a result of the analysis, when insole was equipped, overall contacting area was increased while both the highest peak pressure and the mean pressure were significantly decreased, and EMG activity of the lower limb muscles was decreased. On the contrary, the cases of wearing AFO showed the decreased contacting area and the increased pressures. Therefore, the AFO equipped with a proper insole fit well to the foot can help comfortable walking by spreading the pressure over the entire plantar.

• 대한족부족관절학회지
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• 제6권2호
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• pp.181-189
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• 2002

Purpose: We try to evaluate the functional outcomes of the ankle with isokinetic plantaflexion torque for acute achilles tendon rupture cases those treated by primary repair with the Krackow suture technique and early rehabilization. Materials and Method: The authors studied retrospectively, 15 patients of acute achilles tendon rupture treated and followed over six months, from July 1997 to May 2001. There were 12 men and 3 women, and mean age was 39.6year. The repair method of ruptured tendon was single or double Krackow suture technique. One week(5days-2weeks) after operation, early ROM with ankle-foot orthosis was started. We used Arner-Lindholm Scale for the clinical evaluation and analyzed patient's satisfaction and subjective strength deficit. We analyzed the dorsiflexion peak torque and plantarflexion peak torque of the ankle statistically with strength test with Cybex dynamometer. Result: In clinical results, we had 11 excellent cases(73%) and 3 good cases(20%). In patients satisfaction degree, 11 excellent cases(66.6%), 3 good cases(20%) and 2 fair cases(13.4%). And in strength deficit, 3 none deficit (20%), 9 minimal deficit(60%). We evaluated the isokinetic plantar flexion torque in 3months or 6months after operation. After 3 months, isokinetic test showed the mean functional deficits, 32% and 25% at $30^{\circ}$ and $120^{\circ}/sec$, in 7 cases(46.6%) of 15 cases respectively. After 6 months, the mean deficits were in 21%, 24% at 30. and $120^{\circ}/sec$, respectively. At 3 and 6 months' follow up, absolute value of isokinetic test showed increase of 25. 31bs to 421bs and 19.61bs to 271bs at $30^{\circ}$ and $120^{\circ}/sec$, respectively. Conclusion: We had good result for acute achilles tendon rupture treated by Krakow suture technique and early range of motion exercise of the ankle. After 6 months, strength deficit was 21% in all of cases but were able to return pre-injured state. This study shows Krakow suture technique was recommended method for primary repair and early rehabilization of achilles tendon ruptue.

• 한국운동역학회지
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• 제31권2호
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• pp.95-103
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• 2021

Objective: The aim of this study was to investigate the differences in spatiotemporal gait performance, function, and pain of lower-extremity according to foot morphological characteristics. Method: This case-control study recruited 42 adults and they were classified into 3 groups according to foot morphology using navicular-drop test: pronated (≥ 10 mm), normal (5~9 mm), and supinated (≤ 4 mm) feet. Spatiotemporal gait analysis and questionnaires including Foot and Ankle Ability Measure activities of daily living / Sports, Western Ontario and McMasters Universities Osteoarthritis Index, Lower Extremity Functional Scale, International Physical Activity Questionnaire, and Tegner activity score were conducted. One-way analysis of variance was used for statistical analysis. Results: The pronated feet group showed longer loading response and double limb support in both feet and increased pre-swing phase in non-dominant feet. The supinated feet group demonstrated a longer swing phase in non-dominant feet and single limb support in dominant feet. However, there was no significant group difference in function and pain of knee joint and lower-extremity between groups. Conclusion: Our results indicated that abnormal spatiotemporal gait performance according to foot morphology. Although there was no difference in lower extremity dysfunction and pain according to the difference in foot morphology, they have the possibility of symptom occurs as a result of continuous participation in activities of daily living and sports. Therefore, individuals with pronated or supinated foot should be supplemented by utilizing an orthosis or training to restore normal gait performance.

• 한국전문물리치료학회지
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• 제20권1호
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• pp.18-27
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• 2013

The purpose of this study was to compare the ring lock type knee-ankle-foot orthosis (KAFO) with newly developed 4-bar linkage KAFO on the gait characteristics of persons with poliomyelitis clinically. This 4-bar linkage is the stance control type KAFO which provide the stability during stance phase and knee flexion during swing phase. Two subjects participated in this study voluntarily. We provided the customized 4-bar linkage KAFO then asked the subjects to walk in level surface and stairs under the two different KAFO conditions. The characteristics of gait in the persons with poliomyelitis were evaluated using a 3D motion analysis system and force plate. Additionally 6 minute walk test for physiological cost index were conducted using pulse oximeter to measure the energy consumption. In the results of this study, the differences of 4-bar linkage KAFO compared with ring lock type KAFO are as follows: (1) Walking speed, stride length, and step length on level increased in subjects, (2) The gait symmetry was improved by generated knee flexion and decreased pelvic external rotation on level and stairs walking, (3) Decreased vertical excursion of center of mass and pelvic elevation during swing phase was decreased on level, (4) Knee extension moment, hip flexion moment, hip and knee internal rotation moment of non-braced limb were decreased on level walking, (5) Walking speed in 6-minute walk test was increased and physiological cost index was decreased. These findings indicate that 4-bar linkage KAFO compared with ring lock type KAFO is effective in enhancing pattern, endurance, and energy consumption in level surface and stairs walking.

• 대한물리치료과학회지
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• 제28권2호
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• pp.30-39
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• 2021

Background: The purpose of this study was to compare the differences in gait and mobility according to the types of assistive device for ankle joint including ankle foot orthosis (AFO), non-elastic tape, elastic tape, and high ankle shoes in chronic hemiplegic stroke survivors. Design: A cross-over design. Methods: Twelve hemiplegic stroke survivors participated in this study, and they walked under 5 different conditions including bare feet, wearing a AFO, wearing a non-elastic tape, wearing a elastic tape, and wearing a high ankle shoes. During the participants walked, the spatio-temporal gait analysis and mobility examinations were performed. For the spatio-temporal gait analysis (gait velocity and cadence, step length, stride length, and single and double leg support time) and mobility examinations, the gait mat, TUG and TUDS were used. Results: As s results, on the AFO, non-elastic tape, elastic tape, and high ankle shoes, there were significantly differences in the all spatio-temporal gait parameters, TUG, and TUDS compared to barefoot (p<0.05). In particular, all spatio-temporal gait parameters, TUG, TUDS were significantly improved with AFO compared to barefoot. TUG was significantly improved with AFO compared to non-elastic tape, TUG and TUDS were significantly improved with AFO compared to elastic tape, gait velocity was significantly improved with non-elastic tape compared to high ankle shoes, gait velocity and TUG were significantly improved with elastic tape compared to high ankle shoes, and TUDS was significantly improved with non-elastic tape compared to elastic tape. Conclusion: The AFO, non-elastic tape, elastic tape, and high ankle shoes showed a positive effect on gait and mobility compared to barefoot, and among them, wearing AFO was most effective for improving gait and mobility of chronic hemiplegic stroke survivors.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2002년도 춘계학술대회 논문집
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• pp.132-135
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• 2002

In the present study, an electro-mechanical KAFO (knee-ankle-foot orthosis) which satisfies both the stability in stance and the knee flexion in swing was developed and evacuated in eight polio patients. A knee joint control algorithm suitable for polio patients who are lack of the stability in pre-swing was also developed and various control systems and circuits were also designed. In addition, knee flexion angles and knee moments were measured and analyzed for polio patients who used the developed KAFO with the three-dimensional motion analysis system. Energy consumption was also evaluated for the developed KAFO by measuring the movement of the COG (center of gravity) during gait. From the present study, the designed foot switch system successfully determined the gait cycle of polio patients and controlled knee joint of the KAFO, resulting in the passive knee flexion or foot clearance during swing phase. From the three-dimensional gait analysis for polio patients, it was found that the controlled-knee gait with the developed electro-mechanical KAFO showed the knee flexion of 40$^{\circ}$∼45$^{\circ}$ at an appropriate time during swing. Vertical movements of COG in controlled-knee gait (gait with the developed electro-mechanical KAFO) were significantly smaller than those in looked knee gait(gait with the locked knee Joint). and correspondingly controlled-knee gait reduced approximately 40% less energy consumption during horizontal walking gait. More efficient gait patterns could be obtained when various rehabilitation training and therapeutic programs as well as the developed electro-mechanical KAFO were applied for polio patients.

• 한국전문물리치료학회지
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• 제30권2호
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• pp.110-119
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• 2023

Background: Osteoarthritis is a common condition with an increasing prevalence and is a common cause of disability. Osteoarthritic pain decreases the quality of life, and simple gait training is used to alleviate it. Knee osteoarthritis limits joint motion in the sagittal and lateral directions. Although many recent studies have activated orthotic research to increase knee joint stabilization, no study has used patellar tendon straps to treat knee osteoarthritis. Objects: This study aimed to determine the effects of patellar tendon straps on kinematic, mechanical, and electromyographic activation in patients with knee osteoarthritis. Methods: Patients with knee osteoarthritis were selected. After creating the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), leg length difference, Q-angle, and thumb side flexion angle of the foot were measured. Kinematic, kinetic, and muscle activation data during walking before and after wearing the orthosis were viewed. Results: After wearing the patellar tendon straps, hip adduction from the terminal stance phase, knee flexion from the terminal swing phase, and ankle plantar flexion angle increased during the pre-swing and initial swing phases. The cadence of spatiotemporal parameters and velocity increased, and step time, stride time, and foot force duration decreased. Conclusion: Based on the results of this study, the increase in plantar flexion after strap wearing is inferred by an increase due to neurological mechanisms, and adduction at the hip joint is inferred by an increase in adduction due to increased velocity. The increase in cadence and velocity and the decrease in gait speed and foot pressure duration may be due to joint stabilization. It can be inferred that joint stabilization is increased by wearing knee straps. Thus, wearing a patellar tendon strap during gait in patients with knee osteoarthritis influences kinematic changes in the sagittal plane of the joint.

• 대한물리치료과학회지
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• 제9권3호
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• pp.129-140
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• 2002

This study intended to find out how the handicapped use medical aid, their satisfaction at using it and so on. First a preliminary survey(Apr. 20$\sim$24, 2002) was made for the handicapped who had been cured for rehabilitation by wearing medical aid at hospitals and welfare center in Jeonbuk region. Then total 120 subjects were asked to fill out a standardized questionnaire from May 15$\sim$22, 2002. Out of total 95 questionnaires collected, 84 questionnaires were analyzed except for 11 cases unsuitable for the intention of this study. The results can be outlined as follows: 1. In general characteristic, it was found that the causes of disability included disease(35 respondents; 41.7%), traffic accident(23 respondents, 27.4%) and so on. In addition, 1st handicap comprised the majority(32 respondents; 58.2%) in handicap grade and ankle foot orthosis(or b-k orthosis) was most often used as medical aid(28 respondents: 33.3%) 2. In particular, it was also shown that the 1st handicap mainly resulted from traffic accident(15 respondents, 27.3%) and post-disease disability (11 respondents, 20.0%). They wore medical aid for 1 year or less on the average, because they were hospitalized for cure, which showed statistically significant level(P<0.05). 3. It was found that total 69 respondents(82.1%) were more or less satisfied with their medical aids depending on the causes of disability, and total 46 respondents(83.6%) were satisfied with their aids according to their handicap grade, but there were no statistical significance. 4. Total 56(66.7%) respondents answered that they would purchase medical aid on their own expenses, when they became handicapped. And the price of medical aid ranged from $\300,000{\sim}400,000$(25 respondents: 29.8%) to \ 500,000 or more(24 respondents: 28.6%). It means that they purchased more or less expensive medical aid on their own expenses, which showed statistical significance(P<0.05). 5. If there was any failure of medical aid, 9 respondents(37.5%) answered that they would be serviced from medical companies, and 7 respondents(29.2%) would be serviced from medical aid manufacturers. Most respondents were serviced for their medical aids from related companies. For the question about the causes of dissatisfaction upon repair service, 11 respondents(45.8%) answered that existing service company provided unskilled repair services and other respondents answered that there was no spare part or higher service expenses than they thought. These answers had the statistical significance(P<0.05). However, 20 respondents(79.2%) answered that they were satisfied with the repair service, which means that most respondents are satisfied with the service. In view of the results as described above, it can be concluded that their handicap or disability results from disease or sequelae after traffic accident and most of the affected wear their own medical aid. In the future, it is required that the medical insurance should cover those medical aids, and the service for failed medical aids should be commissioned by technical serviceman to realize customized manufacture and repair service according to different causes so that the handicapped can enjoy more or less comfort and convenience in their daily lives without any extreme difficulty.

• 대한물리의학회지
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• 제6권2호
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• pp.127-133
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• 2011

Purpose: 본 연구는 단하지 보조기를 사용하는 뇌졸중환자의 시-거리 보행변수에 대한 청각신호 효과에 대한 알아보고자 하는 것이다. Methods: 9명의 뇌졸중환자가 본 연구에 참여하였으며 대상자는 보조기 착용이 없는 경우, 기존 보조기 착용의 경우 그리고 청각신호 보조기 착용의 경우에 각각 시-거리 보행 변수에 대해 측정하였다. 8대의 동작분석 카메라 시스템(Motion Analysis Corporation, Santa Rosa, USA)을 사용하여 시-거리 보행 변수를 측정하였으며 Wilcoxon rank sum test을 이용하여 양하지의 대칭성을 분석하였고 Friedman test를 사용하여 다른 보조기 사용에 따른 효과를 알아보았다. Results: 청각 신호 보조기의 경우, 손상측과 비손상측의 보행속도, 활보장 그리고 분속수가 대칭적으로 되었다. 손상측의 경우, 단하지 보조기를 착용하였을 때가 착용하지 않았을 때보다 대체적으로 보행 변수들이 증가하였다. 청각 신호 단하지 보조기를 착용하였을 때 손상측 하지의 보행 속도, 활보장, 보장, 양하지 지지 시간이 증가하였고 단하지 지지 시간은 감소하였다. Conclusion: 청각 신호 단하지 보조기 착용 시 보행 속도, 활보장, 보장은 보조기를 착용하지 않았을 때보다는 증가하였으나 청각 신호 단하지 보조기와 기존 단하지 보조기 착용 사이에는 차이가 없었다. 하지만, 본 연구의 결과는 청각 신호 단하지 보조기가 뇌졸중 환자의 시-거리 보행 변수를 개선할 수 있음을 보여주었고 앞으로 다양한 보행 변수들에 대한 연구가 필요하다고 생각한다.

• The Journal of Korean Physical Therapy
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• 제30권5호
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• pp.199-203
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• 2018

The number of reported cases with dual disability is increasing for the past few decades. Currently, dual disability of lower limb amputation and motor weakness after stroke became a strong issue in public concern. The functional levels of patients have shown in the wide range from independent community ambulation to non-ambulation. Thus, it indicates that favorable outcomes for dual disability may depend upon adopted rehabilitative strategies. We present the case of a man with left below-knee amputation and severe right-sided weakness following a huge putaminal hemorrhage. He had suffered from extreme pain and misfit of the prosthetic socket and the complicated residual limb for three years prior to the stroke. Forty days post-stroke, we performed a revision surgery to resolve the complications of bony overgrowth, verrucous hyperplasia, and neuroma and applied an ankle foot orthosis (AFO). Two years post-stroke, he was able to ambulate outside his home and negotiate stairs using a cane. This is the first case with the dual disability of lower limb amputation and contralateral hemiplegia to undergo revision surgery. The results suggest that an early revision surgery and use of an AFO are crucial for achieving a higher level of mobility in such cases.