• Journal of the Korean Society of Physical Medicine
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• v.14 no.1
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• pp.53-61
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• 2019

PURPOSE: This study examined the dynamic range of motion (ROM) of the hip, knee, and ankle joint when wearing different shoe sole lifts, as well as the limb asymmetry of the range according to the leg length discrepancy (LLD) during normal speed walking. METHODS: The participants were 40 healthy adults. A motion analysis system was used to collect kinematic ROM data. The participants had 40 markers attached to their lower extremities and were asked to walk on a 6 m walkway, under three different shoe lift conditions (without an insole, 1 cm insole, and 2 cm insole). Visual3D professional software was used to coordinate kinematic ROM data. RESULTS: Most of the ROM variables of the short limbs were similar under each insole lift condition (p>.05). In contrast, when wearing a shoe with a 2 cm insole lift, the long limbs showed significant increases in flexion and extension of the knee joint as well as; plantarflexion, dorsiflexion, pronation, eversion, and inversion of the ankle joint (p<.05). Of the shoes with the insole lifts, significant differences in all ROM variables were observed between the left and right knees, except for the knee internal rotation (p<.05). CONCLUSION: As the insole lift was increased, more ROM differences were observed between the left and right limbs, and the asymmetry of the bilateral lower limbs increased. Therefore, appropriate interventions for LLD are needed because an artificial mild LLD of less than 2.0 cm could lead to a range of musculoskeletal problems of the lower extremities, such as knee and ankle osteoarthritis.

• Korean Journal of Applied Biomechanics
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• v.30 no.4
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• pp.321-335
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• 2020

Objective: The purpose of this study was to investigate the effect of neck traction and foot type on plantar pressure distribution during walking. Method: Total of 24 data were collected from women working with a computer for more than 6 hours every day. Three groups by foot type were divided: Pes Planus, normal foot, and Pes Cavus. Depending on the foot type and cervical traction, plantar pressure variables were measured; CA, MF, PP, and CT. Each variable was divided into 12 masks. MANOVA was performed for the difference of plantar pressure variables by foot type, and a paired t-test was performed for the cervical traction within groups. Results: The total CA decreased in the Pes Planus (p<.001) and Pes Cavus (p<.05) groups. MF increased in the big toe (p<.01) and 2nd toe (p<.05) of the normal foot, and MF-3rd metatarsal decreased (p<.01). The MF-2nd toe (p<.01) and 3rd toe (p<.05) of Pes Cavus decreased. The PP decreased in 2nd toe (p<.05), 3rd toe (p<.01), and 4th toe (p<.05) of the Pes Cavus. In normal foot, the PP-3rd metatarsal (p<.05) and PP-4th metatarsal (p<.01) reduced. In Pes Planus, PP decreased in the hindfoot (p<.05). In Pes Cavus group wearing a neck-tractor, the CT-hindfoot increased (p<.05). Conclusion: There was a significant change in the plantar pressure change by foot type after neck traction. When walking with a neck-tractor, the heel impact was alleviated in the Pes Planus, and the Pes Cavus showed the smooth and effective propulsion in the push-off. Overall, weight acceptance was effectively performed when walking with neck-traction. It was also found that the neck-tractor corrects the alignment of the neck, thereby creating a more stable gait pattern.

• Journal of Korean Physical Therapy Science
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• v.18 no.2
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• pp.17-28
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• 2011

Purpose: The aim of this study was to ascertain the effects of the lower extremity muscle strengthening exercise on balance and ambulation of children with cerebral palsy. Methods: 10 subjects who participated in this research undertook the 12-week the lower extremity muscle strengthening exercise program, which consisted of a series of mat exercises and sling exercises. The statistical significances were examined by using Wilcoxon signed-rank test, a non-parametric test, for evaluating the improvement of balance and ambulation of the subjects. In order to evaluate the correlation among the variables, Pearson's correlation coefficients were also calculated. In all statistical analyses the significance level was selected as ${\alpha}$=0.05. Results: Berg balance scale(BBS) was significantly increased after the intervention(p<.05). Percentage weight bearing(PWB) was decreased after the intervention, but there was no significant difference. Time up and go test(TUG) value was significantly decreased(p<.05). Gait velocities was increased after the intervention, but there was no significance. Stride length, step lengths of the affected side and the sound side were significantly increased after the intervention(p<.05). In the correlation analyses of the measures before the intervention, TUG had significant negative correlation to BBS and gait velocity(p<.05). Stride length, step lengths of the sound side and the affected side had significant positive correlation between themselves(p<.01). In the correlation analyses of the measures after the intervention, TUG had significant negative correlation to BBS and gait velocity(p<.05). BBS revealed significant positive correlations to stride length, step lengths of the sound side and the affected side(p<.05). Stride length, step lengths of the sound side and the affected side had significant positive correlation between themselves(p<.01). Conclusion: Based upon the outcomes as above, it is likely that the muscle strength exercises have substantial effects on balance and ambulation of children with cerebral palsy. Thus various lower extremity muscle strengthening exercise programs are required to be studied and developed in order to contribute to functional improvements of children with cerebral palsy.

• PNF and Movement
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• v.16 no.2
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• pp.249-257
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• 2018

Purpose: This study aimed to explore the effects of additional trunk exercises on an unstable surface on the balance and walking ability of individuals with chronic stroke. Methods: Sixteen patients with chronic stroke participated in this study. The participants were randomly assigned to two groups: experimental group (n=8) and control group (n=8). All the participants underwent a typical physical therapy program for 30 min a day. Moreover, the experimental group participated in a 30 min trunk exercise program on an unstable surface, whereas the control group participated in a 30 min trunk exercise program on a stable surface. Both groups performed the exercises five times a week for three weeks. The Berg Balance Scale (BBS) was used to measure changes in balance. The gait variables were measured using the GAITRite system (CIR System Inc., Clifton, NJ, USA) to examine changes in walking ability. Results: Both groups showed a significant intragroup improvement in balance, gait speed, cadence, stride length, and double support period (p<0.05). In the intergroup comparisons after the intervention, the experimental group showed significant improvements over the control group in balance, gait speed, cadence, stride length, and double support period (p<0.05). Conclusion: This study applied additional trunk exercises on an unstable surface to chronic stroke patients, and the results showed a significant improvement in the patients' balance and walking abilities. Therefore, trunk exercise on an unstable surface may be applicable as an intervention method to improve the balance and walking ability of chronic stroke patients.

• Physical Therapy Korea
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• v.11 no.3
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• pp.59-70
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• 2004

The purpose of this study was to propose a task-related circuits program for stroke patients and to test the difference in functional improvements between patients undergoing conventional physical therapy and those participating in a task-related circuits exercise program. The subjects were 10 stroke in-patients of the Korea National Rehabilitation Center in Seoul. We measured the following variables: Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Tone Assessment Scale (TAS), speed of gait, rate of step, physiological costs index, age, weight, height, site of lesion, onset day and whether the subject participated in an exercise program. Collected data were statistically analyzed by SPSS 10.0/PC using descriptive statistics, Mann-Whitney U test, Wilcoxon rank sum test and Spearman's correlation. The results of the experiment were as follows: (1) In the pre-test and post-test for function, there was not a statistical significance between the group partaking in a task-related circuits program and the group of conventional physical therapy (p>.05). (2) In the MAS, BBS and speed of gait test, the group undergoing conventional physical therapy showed a statistical significance (p<.05). (3) In the MAS, BBS, speed of gait, PCI, TAS (passive, associated reaction, TAS total score), the group of task-related circuits program showed a statistical significance (p<.05). As a result, the group participating in a task-related circuits program had a more functional improvement than the group participating in conventional physical therapy. Therefore, an intervention recommended for a stroke patient would be a task-related circuits program consisting of a longer session of each task for a more improved functional recovery.

• Journal of Korean Clinical Health Science
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• v.5 no.1
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• pp.816-824
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• 2017

Purpose. This study was classified into normal and demented elderly through K-MMSE. The purpose of this study was to analyze gait characteristics of normal elderly and demented peoples using GAITRite walking system. Methods. The subjects of this study were selected as elderly people receiving home visit physical therapy. An independent t-test was conducted to verify the statistical significance of the time-space variables of the elderly with dementia. Results. Step time(p=0.041), cycle time(p=0.037), distance(p=0.024), and cadence(p=0.048) were significantly shorter in the normal elderly than in the demented elderly on flat place. The mean age was significantly longer in normal elderly than in elderly persons with dementia. Step time(p=0.022), cycle time(p=0.023), distance(p=0.019), and cadence(p=0.015) were significantly shorter in the mat walking. The mean age was significantly longer in normal elderly than in elderly patients with dementia. Stretch time, cycle time, distance, and hair support time were significantly shorter in the mat walking. The mean age of the elderly was significantly longer than that of the elderly with dementia. The spinal support time, which is a spatial variable, was significantly shorter in the normal elderly than in the demented elderly. Conclusions. It compares the various gait characteristics of the normal and demented elderly people, thereby increasing the walking ability of the elderly person more effectively. This study should be utilized as basic data for preventing fall-down.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.2
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• pp.63-70
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• 2016

PURPOSE: The aim of this study was to conduct an Otago exercise program with stroke patients in a clinical setting and ascertain its effects on balance and walking ability. METHODS: The participating subjects were 45 people who had been diagnosed with stroke. They were assigned to two groups (Otago exercise; OE, n=22; balance exercise; BE, n=23), and the exercises were conducted for three sessions per week for eight weeks. The main balance outcomes were evaluated using the timed up and go test (TUG) and the four step square test (FSST), while walking ability was evaluated using the 10 m walk test (10MWT), direction change ability was measured using the figure 8 of walk test (F8WT), and the decrease of fear was evaluated using the modified falls efficacy scale (MFES). RESULTS: In the analysis results, the Otago exercise group showed significant increases in TUG, FSST, 10MWT, and F8WT within the both groups. There were significant differences in all variables between the OE group and the BE group at the post-intervention evaluation, but there was no significant difference between the groups with respect to the 10MWT. This study showed that conducting Otago exercise in stroke patients increased the main outcomes for TUG, FSST, F8WT scores, but not for 10MWT. CONCLUSION: The results of this study demonstrated that Otago exercise would be useful to improve balance and gait for stroke patients who want to improve their abilities and activities of daily living.

• Korean Journal of Applied Biomechanics
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• v.26 no.3
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• pp.293-301
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• 2016

Objective: The purpose of this study was to analyze the effects of freezing of gait and visual information on the static postural control ability in patients with Parkinson's Disease (PD) during the bipedal stance with feet together. Method: This study included a total of 36 patients with PD; the freezer group included 17 PD patients (age: $69.3{\pm}6.2yrs$, height: $159.6{\pm}9.0cm$, weight: $63.4{\pm}9.78kg$) and the nonfreezer group included 19 PD patients (age: $71.4{\pm}5.6yrs$, height: $155.8{\pm}7.1cm$, weight: $57.7{\pm}8.6kg$). Static postural control ability was analyzed using variables of center of pressure (COP) and dividing by mediolateral, anteroposterior, and integration factors during a bipedal stance with the eyes open and closed. Results: Freezers and nonfreezers showed increases in anteroposterior velocity, mediolateral velocity, averaged velocity, and mediolateral 95% edge frequency when visual information was blocked. Additionally, freezers had greater anteroposterior range, 95% confidence ellipse area, and COP anteroposterior mean position than nonfreezers. Conclusion: Freezers and nonfreezers showed a reduction in static postural control ability when visual information was blocked. Additionally, the results of this study found a significant difference in static postural control ability between freezers and nonfreezers with PD. In particular, anteroposterior range, 95% confidence ellipse area, and COP anteroposterior mean position might be used to distinguish between freezers and nonfreezers with PD.

• Korean Journal of Applied Biomechanics
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• v.20 no.2
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• pp.191-196
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• 2010

The purpose of this study was to investigate the effect of gait speed and walkway slope on the body acceleration, for the future validation of using an accelerometer in the estimation of energy consumption. Ten young healthy subjects with accelerometers on the upper thigh and ankle walked on a treadmill at 9 conditions(three speeds ${\times}$ three slopes) for 5 minutes. Acceleration signals of four directions, i.e. anterior-posterior(AP), medio-lateral(ML), superior-inferior(SI) and vector sum(VS) directions, of each sensor were measured, and root means squared(RMS) values of them were used as analysis variables. As statistical analysis, repeated measure two-way ANOVA was performed for RMS accelerations at each attachment sites, with slope and velocity as independent factors. At both the upper thigh and ankle, RMS acceleration of all directions were affected by gait velocities(p<.001) showing greater accelerations for higher velocities. Contrary to expectations, no slope effect existed in RMS accelerations at hip. Moreover, RMS acceleraion at ankle decreased with slope in SI and VS directions(p<.01). These results suggests that RMS acceleration cannot reflect the change in physical activity due to the change in walkway slope.

• Annals of Rehabilitation Medicine
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• v.39 no.6
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• pp.897-904
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• 2015

Objective To investigate differences in plantar pressure distribution between a normal gait and unpredictable slip events to predict the initiation of the slipping process. Methods Eleven male participants were enrolled. Subjects walked onto a wooden tile, and two layers of oily vinyl sheet were placed on the expected spot of the 4th step to induce a slip. An insole pressure-measuring system was used to monitor plantar pressure distribution. This system measured plantar pressure in four regions (the toes, metatarsal head, arch, and heel) for three events: the step during normal gait; the recovered step, when the subject recovered from a slip; and the uncorrected, harmful slipped step. Four variables were analyzed: peak pressure (PP), contact time (CT), the pressure-time integral (PTI), and the instant of peak pressure (IPP). Results The plantar pressure pattern in the heel was unique, as compared with other parts of the sole. In the heel, PP, CT, and PTI values were high in slipped and recovered steps compared with normal steps. The IPP differed markedly among the three steps. The IPPs in the heel for the three events were, in descending order (from latest to earliest), slipped, recovered, and normal steps, whereas in the other regions the order was normal, recovered, and slipped steps. Finally, the metatarsal head-to-heel IPP ratios for the normal, recovered, and slipped steps were $6.1{\pm}2.9$, $3.1{\pm}3.0$, and $2.2{\pm}2.5$, respectively. Conclusion A distinctive plantar pressure pattern in the heel might be useful for early detection of a slip event to prevent slip-related injuries.