• Physical Therapy Rehabilitation Science
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• 제9권4호
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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.

• 대한정형도수물리치료학회지
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• 제28권3호
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• pp.51-59
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• 2022

Background: This study aimed to investigate the effect of mobilization with movement (MWM) applied to the ankle joint, on the craniovertebral angle (CVA), pressure pain threshold, and neck disability index (NDI) in asymptomatic adults with a forward head posture (FHP). Methods: A total of 32 subjects with FHP were assigned to either the MWM group (N=16) or the cranio-cervical flexion exercise (CCFE) group (n=16). The CVA, pressure pain threshold and NDI were measured before and 4 weeks after the intervention. Results: A significant improvement in the CVA was observed in the MWM group (p<.05), whereas no significant changes (p>.05) were observed in the CCFE group. Both groups showed significant differences in the pressure pain threshold and NDI before and after the intervention (p<.05). Conclusion: The results of the study suggest that MWM applied to the ankle joint can effectively improve the CVA, pressure pain threshold, and NDI of adults with a forward head posture. Based on this study, the ankle MWM technique for dorsiflexion can be used as an objective research method for additional studies targeting FHP patients in the future.

• 한국융합학회논문지
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• 제13권5호
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• pp.307-312
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• 2022

본 연구에서는 종아리 근육에 기능성 의류를 착용한 것이 종아리의 근기능에 어떤 영향을 미치는지 규명하고 기능성 의류가 종아리 근기능 증가에 활용가치가 있는지 검증하고자 하는데 그 목적이 있다. 연구의 대상은 하지에 이상이 없는 B 대학교의 남학생 21명을 대상으로 측정 하였다. 측정방법은 등속성근기능측정기인 CSMI사의 Humac Norm을 이용하여 오른쪽, 왼쪽 종아리에 기능성 의류 착용 전, 후 각속도 30°/sec, 120°/sec로 측정하였다. 피실험자들이 기능성 의류를 착용했을 때와 착용하지 않았을 때를 측정 해본 결과 발목 배측굴곡(Dorsi flexion)에서는 기능성 의류를 착용했을 때와 착용하지 않았을 때 유의한 차이가 나타나지 않았으나, 발목 저측굴곡(Plantar flexion)에서는 기능성 의류를 착용하였을 때 근력, 근파워, 근지구력이 유의하게 증가하는 것으로 나타났다. 따라서 종아리의 기능성 의류 착용이 운동기능 향상에 긍정적 효과가 있으며, 향후 연구에서는 대회를 앞두고 훈련을 하는 선수에게 기능성 의류를 착용한 인원과 착용하지 않은 인원의 근기능 향상정도를 비교해보는 연구를 제시하는 바이다.

• 대한족부족관절학회지
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• 제27권1호
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• pp.12-16
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• 2023

Purpose: Postoperative exercise for acute Achilles tendon rupture is important for a patient's return to daily life and sports. On the other hand, the protocol requires considerable effort to educate patients and continuous checking. This study evaluated the outcome of a new simple and delayed rehabilitation protocol after Achilles tendon rupture repair. Materials and Methods: From July 2014 to November 2020, one hundred eighty-three patients were operated on by one surgeon. The exercise protocol was classified into two methods. One group (immediate protocol, control group) started immediate full weight bearing with a 20° plantar flexion range of motion from two days postoperatively. Ankle dorsiflexion was restricted to 0°. The other group (delayed protocol, case group) started full weight bearing with a controlled ankle motion boot from two weeks postoperatively. No range of motion exercise was allowed until six weeks postoperatively. Age, sex, body mass index, ankle range of motion, muscle power, time to return to previous physical activity, functional score, and complication rate were evaluated. The results of the two groups were compared using a Mann-Whitney test. Statistical significance was set as p<0.05. Results: The range of motion, double heel rising, and one-leg standing were achieved faster in the control group (p<0.05). However, single-heel rising, repeated single-heel rising, return to previous activity (work, run, and sport), and functional scores showed no statistical difference (p>0.05). Conclusion: Simple and delayed postoperative rehabilitation of acute Achilles tendon rupture without active range of motion exercises showed satisfactory functional results and a low complication rate.

• 한국운동역학회지
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• 제33권2호
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• pp.62-72
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• 2023

Objective: Although balance training has been used as an effective ankle injury rehabilitation program to restore neuromuscular deficits in patients with chronic ankle instability, it is not effectively used in terms of motor learning. Attentional focusing can be an effective method for improving ankle kinematics to prevent recurrent ankle injuries. This study aimed to 1) evaluate the effects of attentional focus, including internal and external focus, and 2) determine a more effective focusing method for patients with chronic ankle instability to learn balance tasks. Method: Twenty-four patients with chronic ankle instability were randomly assigned to three groups (external focus, internal focus, and no feedback) and underwent four weeks of progressive balance training. The three-dimensional ankle kinematics of each patient were measured before and after training as the main outcomes. Ensemble curve analysis, discrete point analysis, and post hoc pairwise comparisons were performed to identify interactions between groups and time. Results: The results showed that (1) the external focus group was more dorsiflexed and everted than the internal focus group; (2) the external focus group was more dorsiflexed than the no feedback group; and (3) the no feedback group was more dorsiflexed than the internal focus group. Conclusion: Because dorsiflexion and eversion are ankle motions that oppose the mechanism of lateral ankle sprain, using the external focus method during balance training may be more effective in modifying these motions, thereby reducing the risk of ankle sprain.

• 대한족부족관절학회지
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• 제28권1호
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• pp.8-14
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• 2024

Purpose: Ankle fracture fixation is the gold standard of treatment but it does have its own complications. There is inadequate data regarding the comparative effectiveness of early vs. delayed fixation for open ankle fracture outcomes. This study compares the clinical and functional outcomes of open ankle fractures treated by early or delayed definitive fixation and identifies the limitations of both methods. Materials and Methods: All 73 patients enrolled in the study underwent surgical intervention within 24 hours of injury. The early fixation group (group A) consisting of 39 patients underwent definitive fixation as an index procedure, while the delayed fixation group (group B) consisted of 34 patients who underwent debridement and external fixator application as an index procedure and definitive fixation when soft tissue condition was conducive. All patients were evaluated at 2, 6, and 12 weeks postoperatively and then three monthly for a year. Results: Enneking and American Orthopaedic Foot and Ankle Society scores were markedly higher in the early fixation group at 6 months postoperatively (p-values <0.001 and 0.011, respectively). However, no discernible intergroup difference was evident at 12 months postoperatively. Between 6 and 12 months, group functional outcome scores were significantly different. At 6 months, there was a substantial difference in dorsiflexion between the two groups (p-values 0.001 and <0.001, respectively), but no difference was observed at 12 months postoperatively. At 6 and 12 months, group average plantar flexions were non-significantly different. Conclusion: Early definitive fixation of complex ankle fractures using a targeted approach produced promising results for lower grade open fractures (grades 1 and 2), and delayed definitive fixation, after initial external fixation to allow for soft tissue stabilization, produced promising results for higher grade open fractures (grades 3A and 3B). At 12-month follow-ups, clinical and functional outcomes achieved using these strategies were equivalent.

• 대한정형외과학회지
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• 제56권6호
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• pp.484-490
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• 2021

목적: 류마티스 전족부 변형은 심한 무지 외반증과 소족지의 갈퀴 족지 변형으로 이루어진다. 저자들은 류마티스 전족부 변형에 대한 변형 Hoffman 술식의 중기 결과를 분석하고자 하였다. 대상 및 방법: 18명, 22예의 환자가 변형 Hoffman 술식 후 최소 2년 이상 추시되었다. 평균 연령은 54.7세였고 평균 추시 기간은 3년 4개월이었다. 임상적으로 시각통증척도와 미국 정형외과 족부족관절학회 점수를 술 전 및 술 후에 비교하였다. 또한 술 후 합병증과 환자의 만족도 및 족저부 굳은살의 소실 여부를 조사하였다. 방사선학적으로 무지 외반각, 제1-2 중족골간각, 제1 족지 지간각, 제1 족지 지간 관절의 관절염 발생 여부, 제1 중족지 관절 족배 굴곡각, 제1 중족지 관절의 유합 기간 등을 측정하였다. 결과: 임상적으로 시각통증척도와 미국 정형외과 족부족관절학회 점수는 술 전 평균 7.1점과 평균 30.3점에서 최종 추시 시 평균 1.5점과 평균 83.1점으로 호전되었다(p<0.001). 술 후 만족도는 전 환자가 만족하였으며, 술 후 족저부 굳은살은 모든 예에서 소실되었다. 방사선학적으로 무지 외반각, 제1-2 중족골간각, 제1 족지 지간각은 술 전 각각 평균 52.8도, 13.3도, 7.5도에서 최종 추시시 16.2도, 8.7도, 14.6도로 변화하였다(p<0.001). 제1 중족지 관절의 족배 굴곡각은 평균 17.2도였으며, 제1 중족지 관절은 평균 11.1주에 유합되었다. 합병증으로 소족지의 거상지 변형이 2예, 창상 문제가 1예, 제1 족지 지간 관절의 관절염이 2예에서 발생하였다. 제1 중족지 관절의 불유합은 관찰되지 않았다. 결론: 류마티스 전족부 변형에 대해 변형 Hoffman 술식은 안전하고 만족스러운 술식으로 사료된다.

• Journal of Acupuncture Research
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• 제18권4호
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• pp.68-81
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• 2001

Herniated lumbar intervertebral disc(H.I.V.D) is the most common reason causing low back pain and leg radiating pain. Objective : The purpose of this report is to observe the effects of oriental medical conservative treatment in the different herniated type. Methods : We investigated 30 patients suffering from low back pain with sciatica which were admitted to Taejon Cheonan O. M. hospital from Nov 1, 2000 to Apr 30, 2001. 30 patients had a diagnosis of herniated lumbar interver tebral disc by Lumbar-C.T and Lumbar-M.R.I. we treated 30 patients by oriental medical conservative treatment (Ex: acupuncture, herb-med, physical theraphy, bed-rest, etc.) Results : 1. The mean hospitalization of patients was 21.1 days. that in the bulging type was l4days, protruded type 21days, mixed type 27days, extruded type 30days. that shows the less herniation of lumbar intervertebral disc, the mean hospitalization was more short. 2. In the distribution of the clinical symptoms admitted at that time, low back pain, leg radiating pain were showed in the all types(29patients, 96.6%). and sensory disorder, muscle powerlessness were showed least in the bulg ing type(0%, 37.5%), but that were showed most in the extruded type(50%,75%). 3. In the result of treatment due to clinical syptoms, bulging type was more execellent than any other other types. 4. The less herniation of lumbar intervertebral disc, angle of straight leg raising test was higher. In the result of treatment due to angle of straight leg raising test, bulging type was more execellent than any other other types. 5. In the distribution of physical. test, positive case in the Peyton sign, Ankle Dorsiflexion were showed least in the bulging type(25%, 12.5%), but that were showed most in the extruded type(100%, 75%). 6. In the result of treatment due to physical.test, bulging type was more exec ellent than any other other types. 7. The efficacy of total treatment was 90%(when we set a standard things more than fair), that in the bulging type was 100%, protruded 92%, mixedtype 80%, extruded type 75%. Bulging type had a more remakable effectsthan any other types. Conclusions : The less herniation of lumbar intervertebral disc, clinical syptoms were slighter, physical. test were better, and efficacy of oriental medical conservative treatme nt was remakable high.

• 한국운동역학회지
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• 제26권2호
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• pp.237-242
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• 2016

Objective: The purpose of this study was to compare the joint movements and muscle activities of novices according to pedal type (flat, clip, and cleat pedal). Method: Nine novice male subjects (age: $24.4{\pm}1.9years$, height: $1.77{\pm}0.05m$, weight: $72.4{\pm}7.6kg$, shoe size: $267.20{\pm}7.50mm$) participated in 3-minute, 60-rpm cycle pedaling tests with the same load and cadence. Each of the subject's saddle height was determined by the $155^{\circ}$ knee flexion angle when the pedal crank was at the 6 o'clock position ($25^{\circ}$ knee angle method). The muscle activities of the vastus lateralis, tibialis anterior, biceps femoris, and gastrocnemius medialis were compared by using electromyography during 4 pedaling phases (phase 1: $330{\sim}30^{\circ}$, phase 2: $30{\sim}150^{\circ}$, phase 3: $150{\sim}210^{\circ}$, and phase 4: $210{\sim}330^{\circ}$). Results: The knee joint movement (range of motion) and maximum dorsiflexion angle of the ankle joint with the flat pedal were larger than those of the clip and cleat pedals. The maximum plantarflexion timing with the flat and clip pedals was faster than that of the flat pedal. Electromyography revealed that the vastus lateralis muscle activity with the flat pedal was greater than that with the clip and cleat pedals. Conclusion: With the clip and cleat pedals, the joint movements were limited but the muscle activities were more effective than that with the flat pedal. The novice cannot benefit from the clip and cleat pedals regardless of their pull-up pedaling advantage. Therefore, the novice should perform the skilled pulling-up pedaling exercise in order to benefit from the clip and cleat pedals in terms of pedaling performance.

• 대한족부족관절학회지
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• 제8권1호
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• pp.39-45
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• 2004

Purpose: The author modified the technique of Grice-Green, for managing flexible flat foot, with severe hindfoot valgus and possible dorsiflexion more than $15^{\circ}$. The purpose of this study was to evaluate the efficacy and results of this modified technique. Material and Methods: Total of 6 patients, 11 cases of pes planovalgus were operatively managed with Modified Grice-Green procedure from Nov. 1996 to April 2002. Total 11 cases in 6 patients were managed; 9 cases in 5 males, 2 cases in one female. The average age of the patients were 7.3 years (5.1-13.3 years). Average follow up period was 3.9 years (1.2-6.7 years). Patients were evaluated preoperatively and at last follow up radiologically and clinically. Radiologic evaluation were done by measuring the talocalcaneal and talo-$1^{st}$ metatarsal angles with the anteroposterior view; and by measuring the talo-$1^{st}$ metatarsal angles with the lateral view. The clinical outcome were rated by subjective and objective improvement level. Results: On follow up, 9 cases were complete satisfied, 2 cases were satisfied with minor reservation and no case had major reservations or dissatisfaction. Objective results were rated as excellent in 9 cases, good in 2 cases. Average preoperative talo-calcaneal and talo-$1^{st}$ metatarsal angles on anteroposterior radiograms were $34.4^{\circ}$ ($16-40^{\circ}$) and $32^{\circ}$ ($8-48^{\circ}$) respectively; which postoperatively on last follow up were $20^{\circ}$ ($3-37^{\circ}$) and $15.6^{\circ}$ ($3-34^{\circ}$) respectively. Average Preoperative talo-$1^{st}$ metatarsal angle on lateral radiogram was $18.4^{\circ}$ ($6-30^{\circ}$); which postoperatively on last follow up was $6.7^{\circ}$ ($-6-17^{\circ}$). Conclusion: Modified Grice-Green operative procedure is effective and satisfactory procedure for planovalgus deformity in children. but for more accurate results, more patients and further follow up period are needed.