• Journal of The Korean Society of Integrative Medicine
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• v.9 no.2
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• pp.23-33
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• 2021

Purpose : This study aimed to investigate the effects of dual-task training according to the variability of the walking environment on balance, gait, and function in patients with stroke. Methods : Twenty-five patients with stroke were randomly assigned to experimental group I (n=12) and experimental group II (n=13). Experimental group I and II performed obstacle and non-obstacle walking training, respectively, along with cognitive tasks for 21 minutes per session, 3 times a week for 6 weeks. Both groups received additional general physical therapy for 30 minutes per session. The functional reach test (FRT), gait analyzer (G-Walk), and functional independence measure (FIM) were used to evaluate balance, gait and function of pre- and post-interventions, respectively, while gait cadence, gait velocity, and stride length were evaluated using a gait analyzer. Results : In the within-group comparison of FRT, all the two groups showed significant post-intervention improvements (p<.05). In within-group comparison of gait cadence, all the two groups showed significant post-intervention improvements (p<.05). In within-group comparison of gait velocity, all the two groups showed significant post-intervention improvements (p<.05). In within-group comparison of stride length, experimental group I showed significant post-intervention improvements (p<.05), while experimental group II did not show significant post-intervention improvements (p>.05). In within-group comparison of FIM scores, experimental group I showed significant post-intervention improvements (p<.05), while experimental group II did not show significant post-intervention improvements (p>.05). There was a significant difference in the change of FIM scores pre- and post-intervention (p<.05) in the between-group comparison. Conclusion : The results of this study show that dual-task training with cognitive tasks and walking training can improve the balance, gait and function of patients with stroke, and obstacle walking training is effective for improving functions including activities of daily living compared to non-obstacle walking training.

• PNF and Movement
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• v.15 no.3
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• pp.361-371
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• 2017

Purpose: The purpose of this study was to examine the effects of performing a dual task on gait velocity, temporospatial variables, and symmetry in subjects with subacute stroke. Methods: The study included 14 independent community ambulators with gait velocity of 0.8m/s. The Korean mini-mental state examination, the Berg balance scale, the Trunk impairment scale, and the Fugl-Meyer assessment scale were used to recruit homogeneous subjects. Subjects performed a single task (10m ambulation at a comfortable speed) and a dual task (10m ambulation at a comfortable speed while carrying a water-filled glass). Gait variables were examined with the OptoGait system. Results: The findings of this study were as follows: 1) Gait velocity decreased significantly in the dual-task condition as compared to the single task condition. 2) There were no significant differences between the paretic and non-paretic stances. 3) Paretic swing decreased significantly in the dual-task condition as compared to the single task condition. 4) The non-paretic, double-limb support phase increased significantly in the dual-task condition as compared to the single- task condition. 5) There was no significant difference in temporal symmetry. 6) Non-paretic step length decreased significantly in the dual-task condition as compared to the single-task condition. 7) There was no significant difference in spatial symmetry. Conclusion: Performing dual tasks decreases gait velocity, paretic swing phase, and non-paretic step length, while it increases non-paretic double limb support. In addition, although there is no difference in temporospatial symmetry, there is high inter-subject variability in temporospatial symmetry. Thus, dual tasks should be selected in accordance with the functional level of the hemiplegic patient, and inter-subject variability of the individual should be considered when dual tasks are considered for gait-training of hemiplegic patients.

• Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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• 2022.10a
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• pp.285-288
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• 2022

Objectives : This study aimed to determine whether Variability of Walking Environment Training can improve gait and balance in stroke patients. Methods : Twenty-four stroke patients are randomly assigned to experimental group 1 (n=8), experimental group 2 (n=8) and control group (n=8). Experimental group 1 performed unexpected obstacle walking training, experimental group 2 performed fixed obstacle walking training and control group performed non obstacle walking training for 12 minutes per session, 5 times a week for 4 weeks. The gait analyzer G-walk were evaluated using gait cadence, gait velocity, and stride length, balance was evaluated using FES-K and BBS. Results : In within-group comparison of gait cadence, gait velocity and stride length of change, the experimental 1,2 groups showed significant improvements post intervention (p<.05) but control group showed no significant improvement. In between-groups comparison there was significant difference in the change of gait cadence, gait velocity and stride length pre and post intervention. In within-group comparison of FES-K and BBS scores, the experimental 1,2 groups showed significant improvements post intervention (p<.05) but control group showed no significant improvement. In between-groups comparison there was significant difference in the change of FES-K and BBS scores pre and post intervention (p<.05).

• Korean Journal of Applied Biomechanics
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• v.17 no.1
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• pp.111-119
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• 2007

The purpose of this study was to investigate muscle activity and gait pattern in lower limb depending on the outsole of heel rockers. Fifteen healthy men volunteered for this experiment. Each subject performed totally three trails with two pairs of different heel rocker shoes and a pair of normal running shoes at speed of 1.33m/s for 1 minute during walking on a treadmill. Kinematic data gathered in 100Hz was recorded and analyzed by using the 3D motion capture system to measure the trunk tilt and joint angle of the right lower limb. And the lower extremity muscle activities were simultaneously recorded in 1000Hz and assessed by using EMG. The statistical analysis was the one-way ANOVA with the repeated measures to compare among the three kinds of shoes. The level of statistical significance for all tests was 0.05. Joint angle of lower limb was showed statistically significant different in MST(hip joint), LHS(ankle joint), and RTO(knee and ankle joint). Muscle activity of rectus femoris and biceps femoris was statistically increased in both heel rocker shoes during gait cycle on treadmill. The maximum peak time of tibialis anterior in the negative heel rocker showed the delay of approximately 23.8%time than normal shoes. Gait pattern variability of the negative heel rocker was increased in the first half of the stance phase and the variability of the positive heel rocker was increased in the terminal stance phase. In Conclusion, stability was decreased in between joints of lower limb on positive heel rocker than negative heel rocker. This study found that there were different joint angle, muscle activity, gait pattern and coordinate system of the lower limb in each kind of shoes. These unstability affected the lower extremity and the whole body. A further study has to be continued with study of rehabilitation and exercise for a long-term.

• Journal of the Korean Society of Physical Medicine
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• v.17 no.1
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• pp.93-108
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• 2022

PURPOSE: This review sought to confirm the correlation between dual-task gait and cognitive function in cognitively impaired and healthy older adults. METHOD: We used four databases (DBs), Pubmed, Cochrane library, Kmbase, and Koreamed. Searches were carried out according to the PICOS method, P (participants) were the elderly (above 65 years) with cognitive decline, I (intervention) was walking with dual tasks, C (control group) comprised the elderly without cognitive decline, O (outcome) was the correlation between gait and cognitive function and S (study) was the cross-sectional study. For the methodological quality assessment of each study, we used the Quality Assessment Tool for Observation Cohort and Cross-Sectional Studies provided by the National Institutes of Health (NIH). RESULTS: A total of 10 articles were included in this systematic review. For the components of gait, we used pace, rhythm, and variability and we observed that mild cognitive impairment mostly causes low gait performance while performing dual tasks. Among the 10 articles, 9 articles studied pace, of which 7 showed significant results. However, 2 were not significant. Also, 1 article that studied rhythm and 3 articles that studied variability showed significant results. The methodological quality of the 10 studies was fair. CONCLUSION: Gait pace was found to have a high correlation between memory, which is a cognitive ability, and overall cognitive function. It was observed that older adults with mild cognitive impairment have reduced gait pace in single-task walking, and further decrease in dual-task gait pace shows the correlation between memory and gait pace during walking.

• Korean Journal of Biological Psychiatry
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• v.28 no.1
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• pp.7-12
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• 2021

Considering that the aged population increases and the mobility problem is pointed out as a factor that indisposes the quality of life, cognition, and mood, it is important to understand and evaluate the elderly's mobility. Factors that deteriorate mobility in the elderly include physical senility, various health changes including chronic diseases, polypharmacy as well as anticholinergics. Common mobility problems in old age are reduced gait speed, increased gait variability in walking length, careless walking, and frequent falls. Several studies have reported that decreased mobility and deterioration of gait can predict cognitive decline and emotional problems. Aerobic exercise, resistance exercise, and balance exercise are suggested as therapeutic interventions for mobility problems. Active correction for factors that reduce mobility in the elderly and prescribing physical activity can conserve the elderly's quality of life and help improve cognition and mood. There is a need for related research in the future.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.1
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• pp.208-215
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• 2020

This study investigated the relationship among gait variables and physical fitness variables for Korean elderly people. Two hundred elderly people aged 65 to 85, (100 men and 100 women) participated in this study. They performed senior fitness test consisting of 6 tests, 3 additional physical tests (vertical jump, one leg stand, and grip force), body composition measures, and gait test. The gait test used shoes having an inertia measurement device in the outer-soles. The results indicated that the stride length, 6-min walking, lean body mass, and dumbbell curls were significantly affected by age (the above 75 group vs. the below 75 group). Among 33 measured parameters, the principal component analysis (PCA) revealed five PCs such as gait characteristics, physical features, gait variability, and fitness levels. In addition, the correlation analysis showed that the preferred walking speed was significantly, positively associated with stride length and single support time, whereas it was negatively associated with double support time and gait variability.(Ed note: please confirm my modification) In conclusion, sarcopenia should be avoided in elderly people, and resistance exercise is highly recommended to help elderly people maintain their gait ability.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.3
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• pp.99-108
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• 2020

PURPOSE: This study examined the effects of the confusion level in performing dual tasks using smartphones while walking in subjects with chronic ankle instability (CAI). METHODS: Twenty subjects with CAI and 20 healthy subjects participated in the study. The spatial, temporal, spatial-temporal, and variability gait parameters were measured using GAITRite under four different conditions: general gait, web surfing during gait, texting during gait, and gaming during gait. Two-way repeated-measures analysis of variance was used to analyze the interaction according to the group (2) and confusion level in dual-tasks (4). One-way repeated-measures analysis of variance was used to compare the changes within the group according to the confusion level in dual-tasks. The changes between groups were compared using an independent t-test. The statistical significance level was set to p = .05. RESULTS: Significant interactions in the temporal and spatial-temporal gait parameters were found between the dual-task conditions and the other groups (p < .05). Significant within-group differences in the spatial, temporal, and spatial-temporal gait parameters were found according to the confusion level in dual tasks (p < .05). Significant between-group differences were observed in the temporal and spatial-temporal gait parameters according to the confusion level in dual tasks (p < .05). CONCLUSION: The effect of the confusion level in dual tasks was greater in subjects with CAI than in healthy individuals. This study suggests that to prevent reinjury to the ankle, subjects with CAI should avoid dual tasks such as using smartphones while walking.

• Korean Journal of Applied Biomechanics
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• v.16 no.2
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• pp.145-151
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• 2006

A large interindividual variability and some abnormally kinematic patterns at the lower extremity were the main features of the gait in children with Down syndrome. The purposes of this study were to investigate the gait asymmetry and biomechanical difference between dominant leg and non dominant leg in children with Down syndrome. Seven boys with Down Syndrome(age: $120{\pm}0.9yrs$, weight $34.4{\pm}8.4kg$, leg length: $68.7{\pm}5.0cm$) participated in this study. A 10.0 m ${\times}$ 1.3 m walkway with a firm dark surface was built and used for data collection. Three-dimensional motion analyses were performed to obtain the joint angles and range of motions. The vertical ground reaction forces(%BW) and impulses($%BW{\cdot}s$) were measured by two force plates embedded in the walkway. Asymmetry indices between the legs were computed for all variables. After decision the dominant leg and the non dominant leg with max hip abduction angle, paired samples t-test was employed for selected kinematic and ground reaction force variables to analyze the differences between the dominant leg and the non dominant leg. The max hip abduction angle during the swing phase showed most asymmetry, while the knee flexion angle at initial contact showed most symmetry in walking and running. The dominant leg showed more excessive abduction of hip in the swing phase and more flat-footed contact than the non dominant leg. Vertical peak force in running showed more larger than those of in walking, however, vertical impulse showed more small than walking due to decrease of support time. In conclusion, the foot of dominant leg contact more carefully than those of non dominant leg. And also, there are no significant difference between the dominant leg and the non dominant leg in kinematic variables and ground reaction force due to large interindividual variability.

• The Journal of Korean Physical Therapy
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• v.27 no.2
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• pp.112-117
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• 2015

Purpose: The purpose of this study was to examine the effects of a task-specific obstacle crossing rehabilitation program on functional gait ability in patients with cerebellar ataxia. Overall, we sought to provide ataxia-specific locomotor rehabilitation guidelines for use in clinical practice based on quantitative evidence using relevant analysis of gait kinematics including valid clinical tests. Methods: Patients with cerebellar disease (n=13) participated in obstacle crossing training focusing on maintenance of dynamic balance and posture, stable transferring of body weight, and production of coordinated limb movements for 8 weeks, 2 times per week, 90 minutes per session. Throughout the training of body weight transfer, the instructions emphasized conscious perception and control of the center of body stability, trunk and limb alignment, and stepping kinematics during the practice of each walking phase. Results: According to the results, compared with pre-training data, foot clearance, pre-&post-obstacle distance, delay time, and total obstacle crossing time were increased after intervention. In addition, body COM measures indicated that body sway and movement variability, therefore posture stability during obstacle crossing, showed improvement after training. Based on these results, body sway was reduced and stepping pattern became more consistent during obstacle crossing gait after participation in patients with cerebellar ataxia. Conclusion: Findings of this study suggest that task-relevant obstacle crossing training may have a beneficial effect on recovery of functional gait ability in patients with cerebellar disease.