• 한국전문물리치료학회지
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• 제22권2호
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• pp.1-10
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• 2015

The common features of walking in patients with stroke include decreased gait velocity and increased asymmetrical gait pattern. The purpose of this study was to identify important factors related to impairments in gait velocity and asymmetry in chronic stroke patients. The subjects were 30 independently ambulating subjects with chronic stroke. The subjects' impairments were examined, including the isokinetic peak torque of knee extensors, knee flexors, ankle plantarflexors, and ankle dorsiflexors. Passive and active ranges of motion (ROM) of the ankle joint, ankle plantarflexor spasticity, joint position senses of the knee and ankle joint, and balance were examined together. In addition, gait velocity and temporal and spatial asymmetry were evaluated with subjects walking at their comfortable speed. Pearson correlations and multiple regressions were used to measure the relationships between impairments and gait speed and impairments and asymmetry. Regression analyses revealed that ankle passive ROM and peak torque of knee flexors were important factors for gait velocity ($R^2=.41$), while ankle passive ROM was the most important determinant for temporal asymmetry ($R^2=.35$). In addition, knee extensor peak torque was the most significant factor for gait spatial asymmetry ($R^2=.17$). Limitation in ankle passive ROM and weakness of the knee flexor were major contributors to slow gait velocity. Moreover, limited passive ROM in the ankle influenced the level of temporal gait asymmetry in chronic stroke patients. Our findings suggest that stroke rehabilitation programs aiming to improve gait velocity and temporal asymmetry should include stretching exercise for the ankle joint.

• 대한의용생체공학회:의공학회지
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• 제22권6호
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• pp.543-550
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• 2001

본 연구에서는 하퇴 절단환자에서 고정형. 단축형, 다축형 인공족관절 장착시 지면반발력과 에너지 소비량을 측정하여 하퇴의지에 대한 생체역학적 평가를 하였다. 실험에는 각각 2명의 남성과 여성 하퇴 절단 환자가 3종류의 의지를 착용하고 참여하였으며. 3차원 보행분석은 7개의 기준점에 대하여 전체 입각기에 대한 지면 반발력의 체중에 대한 비율로 나타내었다. 하퇴의지 에너지 소비량은 피 실험자들이 각각 2km/h, 3km/h 그리고 가장 걷기 편한 속도로 런닝머신 위에서 보행하게 하면서 측정하였다 실험결과는 지면반발력에서 다축형 인공족관절 장착시 추진력과 후진력의 보행특성에 대하여 우위를 보이며, 고정형 인공족관절 장착시에는 보행균형과 무게중심의 이동에 대해 상대적인 우위를 보였다. 에너지 소비량은 2.3km/h 이상의 보행속도에서 단축형 인공족관절 장착시 다른 두 의지에 비해 적은량의 에너지 소비를 보였다.

• 한국전문물리치료학회지
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• 제11권2호
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• pp.27-34
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• 2004

The purpose of this study was to identify the influence of wedged insole and foot progression angle (FPG) on lateral thrust of knee in healthy subjects. Fifteen healthy male subjects were recruited from Suncheon First College, in Suncheon. The subjects randomly walked at the comfortable velocity under five conditions: bare footed, medio-lateral $10^{\circ}$ wedged insoles, toe-in and toe-out gait. The lateral thrust was measured by a accelerometer with telemeter during walking. Data was collected while each subject walked for about 10 gait cycle on a flat, level walkway at their normal speed. The middle three gait cycle were used for averaged peak value of lateral acceleration. The three averaged peak value of lateral acceleration were collected under each condition at heel strike. The results showed that averaged peak value of lateral acceleration increased significantly in medial wedged insole and toe-in gait and decreased significantly in lateral wedged insole and toe-out gait as compared with bare footed (p<.05). These results suggest that wedged insole as well as walking strategy, such as foot progression angle, may prevent progression of degenerative knee osteoarthritis.

• Physical Therapy Rehabilitation Science
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• 제3권2호
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• pp.134-141
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• 2014

Objective: The purpose of this study was to compare with different distance across three conditions in stroke survivors with the grading of cognitive state. Design: Cross-sectional study. Methods: Twelve stroke patients who agreed to active participation were included. Participants were allotted to normal cognitive (CN) group (n=7) and cognitive impairment (CI) group (n=5) and then walked on a self-paced walkway at three conditions on the Time Up and Go (TUG) test and the 6 minute walk test (6MWT): 1) walking with your comfortable speed, 2) walking while carrying a tray with glasses, 3) walking with a verbal cognitive task. The TUG test was repeated three successful times on each condition. For the 6MWT, participants were tested one time. Results: The CI group walked slower than the CN group at the three conditions on the TUG test. However, there was no significant difference between two groups to each condition. A significant effect of dual tasking was found only in error of verbal cognitive task condition for the TUG test (p<0.05). On the 6MWT, the participants in the CI group walked short distance rather than the CN group (p<0.05). There were significant differences between two groups not only at all conditions but also at error of verbal cognitive task condition as well (p<0.05). Conclusions: To consider the results of different distances such as the TUG test and the 6MWT, we think that exercises in long distance would be more effective to patients with CI. Those would be improved patient's endurance in cognitive problem.

• The Journal of Korean Physical Therapy
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• 제20권1호
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• pp.41-47
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• 2008

Purpose: This study aimed to assess the effectiveness of gait training with the use of an electromechanical gait trainer with functional electrical stimulation (FES) for patients that had undergone subacute stroke. Methods: The study subjects included nine subacute stroke patients of the Korea National Rehabilitation Center in Seoul, Korea. Outcome was measured using the timed Up and Go test, Fugl-Meyer-L/E assesment, with determination of the comfortable maximal gait speed, composite spasticity score, functional ambulatory category and Berg balance scale. All measured scores were recorded before, during, and after rehabilitation and at an eight-week follow-up. Results: Patients who received electromechanical-assisted gait training in combination with FES after subacute stroke were more likely to achieve independent walking, functional activities, balance and gait speed. Conclusion: The outcome of our gait-training program demonstrates that it may be practical to integrate FES into electromechanical gait training without any adverse effects. However, further randomized controlled studies are needed to evaluate if patient outcome after combined training is superior to outcome after the use of electromechanical gait trainer treatment alone or conventional gait training alone.

• 인터넷정보학회논문지
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• 제21권6호
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• pp.41-50
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• 2020

The consequences of wearing high heels can be different according to the heel height, gait speed, shoe design, heel base area, and shoe size. This study aimed to focus on the knee extension and flexion range of motion (ROM) during gait, which were challenged by wearing five different shoe heel types and two different self-selected gait speeds (comfortable and fast) as experimental conditions. Measurement standards of knee extension and flexion ROM were individually calibrated at the time of heel strike, mid-stance, toe-off, and stance phase based on the 2-minute video recordings of each gait condition. Seven healthy young women (20.7 ± 0.8 years) participated and they were asked to walk on a treadmill wearing the five given shoes at a self-selected comfortable speed (average of 2.4 ± 0.3 km/h) and a fast speed (average of 5.1 ± 0.2 km/h) in a random order. All of the shoes were in size 23.5 cm. Three of the given shoes were 9.0 cm in height, the other two were flat shoes and sneakers. A motion capture software (Kinovea 0.8.27) was used to measure the kinematic data; changes in the knee angles during each gait. During fast speed gait, the knee extension angles at heel strike and mid-stance were significantly decreased in all of the 3 high heels (p<0.05). The results revealed that fast gait speed causes knee flexion angle to significantly increase at toe-off in all five types of shoes. However, there was a significant difference in both the knee flexion and extension angles when the gait in stiletto heels and flat shoes were compared in fast gait condition (p<0.05). This showed that walking fast in high heels leads to abnormal knee ROM and thus can cause damages to the knee joints. The findings in this preliminary study can be a basis for future studies on the kinematic changes in the lower extremity during gait and for the analysis of causes and preventive methods for musculoskeletal injuries related to wearing high heels.

• Physical Therapy Rehabilitation Science
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• 제5권1호
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• pp.9-14
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• 2016

Objective: This study was to investigate the effects of Task-oriented training for Gross Motor Function Measure (GMFM), gait and balance function in cerebral palsy. Design: Randomized controlled trials. Methods: Twenty four subjects were recruited by means of a convenience sampling from Kangseo-Gu G rehabilitation center. Subjects were 24 inpatients and were randomly divided into a task-oriented training group and a conventional group. Twelve patients were experimental group who executed the task-oriented training (5 times/wk) for 4 weeks. The task-oriented program mainly focused on the capabilities of independent walking, with the angle of inclination set at 0 degrees and walking at a self-selected comfortable speed. In addition, balance training included the one-legged standing with weight-shifting and task-oriented training. Twelve patients were control group who executed only general conventional therapy (5 times/wk) for 4 weeks. All subjects were evaluated about the motor function, gait and balance function. Subjects have conducted the measured variables, GMFM, GAITRite, PDM Multifunction Force Measuring Plate after treatment. Results: There was statistically significant increase of Gross Motor Function Measure scores of the experimental group and control group after 4 weeks (p<.05). There was statistically significant increase of gait and balance function of the experimental group after 4 weeks of task-oriented training (p<.05). The experimental group showed a significantly improvement in GMFM, gait, and balance compared to the control group (p<0.05). Conclusions: This study proved that task-oriented training after stroke can improve Gross Motor Function Measure, gait and balance. Thus this study can suggest that task-oriented training for gross motor function, gait and balance be effective on the cerebral palsy.

• 한국전문물리치료학회지
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• 제8권1호
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• pp.89-96
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• 2001

This study addresses the effects of treadmill training on hyperextended knee and cadence in patients with hemiplegia. A single subject research design with multiple baselines across individuals was used for the study. Two patients with hemiplegia participated in the experiment. The experiment consisted of interventions where the patients were asked to ambulate for 15 minutes at a comfortable walking speed on the treadmill with 11% slope grade and were allowed to rest for 10 minutes. Patients, then, were asked to ambulated 20 meters at walkway. The number of occurrences of knee hyperextension and the total number of steps were recorded. The results showed that the occurrence of knee hyperextension decreased by approximately 30% after the first session of the treadmill training and continued to gradually decrease during the following sets of treadmill training. Meanwhile, there was a slight increase in the cadence to a negligible extent. These results suggest that the gait training on the sloped treadmill may be helpful for correcting the knee hyperextension in patients with hemiplegia.

• The Journal of Korean Physical Therapy
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• 제21권1호
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• pp.41-48
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• 2009

Purpose: The examine the Reliability and Validity of the modified Emory Functional Ambulation Profile (mEFAP), Tinetti. Gait (TG), Timed Up & Go Tes t (TUG), Comfortable Gait Speed (CGS), Berg Balance Scale (BBS) in assessing gait function and balance in elderly person. Methods: The 45 community-dwelling subjects were participated in this study. Reliability was determined by intra-class correlation coefficient (ICC$_{3,1}$), Bland and Altman method (Standard Error of Measurement (SEM), Smallest Real Difference (SRD)). Results: Validity was examined by correlation the mEFAP, TG, TUG, CGS, BBS. The intra-rater reliability were High (ICC$_{3,1}$ : mEFAP=0.95, TG=0.96, TUG=0.94, CGS=0.96, BBS=0.92) and Absolute reliability were excellent (SEM: mEFAP=1.90, TG=0.21, TUG=0.28 CGS=0.25, BBS=0.52), (SRD: mEFAP=5.26, TG=0.58, TUG=0.77, CGS=0.69, BBS=1.44). There were significant correlations between assessment tool (r=.0.58$\sim$0.78, p<0.01) indicating good validity. Our results provide strong evidence that the assessment tool has good reliability, validity for assessing elderly person undergoing rehabilitation. Conclusion: The gait assessment tool is a useful scale for measuring walking function and recovery in elderly person.

• The Journal of Korean Physical Therapy
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• 제22권3호
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• pp.49-53
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• 2010

Purpose: The purpose of this study was to investigate the plantar pressure distribution between the affected and unaffected side in adult hemiplegia during gait with the use of a quad-cane. Methods: Thirty-four stroke patients from 34 to 83 years of age were enrolled in this study, and in random order, all patients were asked to walk at their most comfortable speed three times along a walkway with the use of quad-cane over a period of three days. Plantar pressure distribution was measured with regard to foot contact pattern and center of pressure (CoP) trajectories during the stance phase, progressing from heel-strike to toe-off. The F-scan system was used to compare the foot pressure of the affected and unaffected sides. Results: A significant reduction in the total contact area, the width of fore foot (FF) and hind foot (HF), and anterior/posterior (AP) CoP trajectory of the affected side was found. However, contact pressure of the hind foot on the affected side during walking increased when compared to that on the unaffected side. Conclusion: We demonstrated that plantar pressure distribution on the affected side of adult hemiplegia patients was generally poorer than that on the unaffected side when these patients walked with cane assistance. However, the use of a quad-cane was shown to increase contact pressure of the hind foot on the affected side because weight can be borne on the affected side during heel-strike with use of the cane.