• Journal of Biomedical Engineering Research
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• v.15 no.4
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• pp.429-438
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• 1994

An electrical stimulator was designed to induce locomotion for paraplegic patients caused by central nervous system injury. Optimal stimulus parameters, which can minimize muscle fatigue and can achieve effective muscle contraction were determined in slow and fast muscles in Sprague-Dawley rats. Stimulus patterns of our stimulator were designed to simulate eleclromyographic activity monitored during locomotion of normal subjects. Muscle types of the lower extremity were classified according to their mechanical property of contraction, which are slow muscle (msoleus m.) and fast muscle (medial gastrocnemius m., rectus femoris m., vastus lateralis m.). Optimal parameters of electrical stimulation for slow muscles were 20 Hz, 0.2 ms square pulse. For fast muscle, 40 Hz, 0.3 ms square pulse was optimal to produce repeated contraction. Higher'stimulus intensity was required when synergistic muscles were stimulated simultaneously than when they were stimulated individually. Electrical stimulation for each muscle was designed to generate bipedal locomotion, so that individual muscles alternate contraction and relaxation to simulate stance and swing phases. Portable electrical stimulator with 16 channels built in microprocessor was constructed and applied to paraplegic patients due to lumbar cord injury. The electrical slimulator restored partially gait function in paraplegic patients.

• The Journal of Korean Physical Therapy
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• v.14 no.4
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• pp.131-146
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• 2002

In the last years, it has become possible to regain some locomotor activity in patients with incomplete spinal cord injury (SCI) through intense training on a treadmill. The ideas behind this approach owe much to insights derived from animal studies. Many studies showed that cats with complete spinal cord transection(spinalized animals) can recover locomotor function. These observations were at the basis of the concept of the central pattern generator located at spinal level. The neural system responsible for the locomotor restoration in both cats and humans is thought to be located at spinal level and is referred to as the central pattern generator(CPG). The evidence for such a spinal CPG in human is emphasis on some recent developments which support the view that there is a human spinal CPG for locomotion. An important element in afferent inputs for both spinal injured cats and humans is the provision of adequate sensory input related locomotor, which can possibly activate and/or regulate the spinal locomotor circuitry This review article deals with the afferent control of the central pattern generator. Furthermore, the application of adequate afferent inputs related locomotor for stroke patients will be able to facilitate locomotion ability, which is automatic, cyclic, rhythmic. These insights can possibly contribute to a better therapeutic approach for the rehabilitation of gait in patients with stroke.

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.69-71
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• 2016

Reconstruction of the lower extremities is difficult due to a lack of skin laxity and muscular tissues. Here, we present a case of lower extremity reconstruction via the anterior tibial artery perforator based segmental muscle island flap. Our patient was a 75-year-old male with a chronic ulcerative wound on the right lower leg from an old car accident. A $5.0{\times}0.5cm$ size ulcerative wound with tibial bone exposure was noted. We planned to reconstruct the lower extremity defect with a free flap, but the vessel status was severely compromised intraoperatively. Thus, we found the anterior tibial artery perforator using Doppler ultrasound, elevated the tibialis anterior muscle segment flap, and transposed it to cover the defect successfully. The flap presented with a nice contour and the skin graft covering the flap survived completely. There were no complications of the surgical site at three months follow-up and no gait morbidity. This is a meaningful case applying the concept of segmental muscle flap based on a perforator that had advantages including proper bulkiness, vascularization, and preservation of function, which were well applied, leading to great success.

• Journal of Yeungnam Medical Science
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• v.36 no.2
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• pp.92-98
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• 2019

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

• Journal of Korean Dental Hygiene Science
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• v.4 no.1
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• pp.53-64
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• 2021

Background: The elderly in long-term care facilities tend to have a diminished oral health status, with a high prevalence of dental caries and periodontal disease, as reduced cognitive function, joint mobility, and gait ability hinder the performance of oral hygiene. To improve the oral health of the elderly at long-term care facilities, it is necessary to have precise guidelines for oral health care and assessment; however, such guidelines are not readily available. Therefore, the present study aimed to develop an oral care assessment tool with verified reliability and validity. Methods: The participants in this study were 100 elderly patients at a care facilities and 10 clinical dental hygienists. Collected data were analyzed using the descriptive statistics, content validity index, and inter-rater reliability, as well as the analyses of intra-class correlation coefficient. Results: After a review of relevant literature, a preliminary questionnaire comprised of seven questions related to the evaluation of oral health was formed. After revising and supplementing the questions through a content validity test, a total of nine questions were selected. Conclusion: The novel assessment tool developed for the present study is anticipated to allow analyses of the level of problems related to oral health care before routine and professional care. Moreover, regular oral health status check-ups will enable the early diagnosis and treatment of diseases.

• Journal of Sasang Constitutional Medicine
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• v.35 no.3
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• pp.1-11
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• 2023

Objective This case report is to show the effectiveness of Sasang Constitutional Medicine treatment on the patient with delayed encephalopathy after acute carbon monoxide intoxication. Methods A 40-year-old female patient diagnosed with delayed encephalopathy after carbon monoxide poisoning 2 weeks ago before visiting our hospital. The patient suffered gait disturbance and cognitive disorder. She was identified as Soyangin and treated with Sasang constitutional Herbal Medicine(Yangkyuksanwha-tang and Hyungbangjihwang-tang). Improvement of symptoms was evaluated through Korean Version of Mini Mental Status Examination score(MMSE-K), Modified Barthel Index(MBI), Manual Muscle Testing(MMT), Range of Motion(ROM) and Hand Function Test. Results After 7 weeks of treatment, total score of MMSE-K increased from 0 to 26, the patient could walk by herself and had no trouble carrying out her daily life. Conclusions This case showed the effectiveness of Sasang constitutional medicine treatment for delayed encephalopathy after acute carbon monoxide intoxication.

• Physical Therapy Rehabilitation Science
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• v.11 no.4
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• pp.391-399
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• 2022

Objective: This study aimed to investigate the effects of fall-prevention exercise programs on fall efficacy, depression and health-related quality of life in elderly. Design: a randomized controlled trial Methods: A total of 57 participants over 65-years-old have been allocated to control and experimental groups. The experimental group received 8 weeks of fall-prevention exercises that included strengthening of lower extremities, balance and gait training. They received the exercises twice a week for 50 minutes as a group.Both groups were assessed using Modified Falls Efficacy Scale (MFES), Geriatric Depression Scale (GDS), and 36-Item Short-Form Health Survey (SF-36) prior and post to the intervention. The control group also received the same exercise program after the post evaluation. Results: The experimental group showed overall improvement in MFES, GDS, and physical components of SF-36 (p<0.05). The MFES was significantly increased in the experimental group after the intervention (p<0.05). The GDS was significantly decreased in the experimental group after the intervention (p<0.05). The SF-36, only physical Function, Role limitations due to physical health, general health, and energy and fatigue categories were improved in the experimental group after the intervention (p<0.05). Conclusions: The results showed 8 weeks of fall-prevention exercise programs can increase fall efficacy and physical related quality of life while reducing depression of elderly over 65.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.216-223
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• 2011

Objective : The purposes of this study are to estimate postoperative survival and ambulatory outcome and to identify prognostic factors thereafter of metastatic spinal tumors in a single institute. Methods : We reviewed the medical records of 182 patients who underwent surgery for a metastatic spinal tumor from January 1987 to January 2009 retrospectively. Twelve potential prognostic factors (age, gender, primary tumor, extent and location of spinal metastases, interval between primary tumor diagnosis and metastatic spinal cord compression, preoperative treatment, surgical approach and extent, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, Nurick score, Tokuhashi and Tomita score) were investigated. Results : The median survival of the entire patients was 8 months. Of the 182 patients, 80 (44%) died within 6 months after surgery, 113 (62%) died within 1 year after surgery, 138 (76%) died within 2 years after surgery. Postoperatively 47 (26%) patients had improvement in ambulatory function, 126 (69%) had no change, and 9 (5%) had deterioration. On multivariate analysis, better ambulatory outcome was associated with being ambulatory before surgery (p=0.026) and lower preoperative ECOG score (p=0.016). Survival rate was affected by preoperative ECOG performance status (p<0.001) and Tomita score (p<0.001). Conclusion : Survival after metastatic spinal tumor surgery was dependent on preoperative ECOG performance status and Tomita score. The ambulatory functional outcomes after surgery were dependent on preoperative ambulatory status and preoperative ECOG performance status. Thus, prompt decompressive surgery may be warranted to improve patient's survival and gait, before general condition and ambulatory function of patient become worse.

• Journal of the Korean Society of Physical Medicine
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• v.10 no.3
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• pp.19-27
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• 2015

PURPOSE: This study aimed to investigate the effects of pressure sense perception training (PSPT) on various surfaces on the somatosensory system, balance, and walking ability in chronic stroke patients. METHODS: Thirty patients with stroke participated in this study and were randomly assigned to one of three groups; group 1 received the general physical therapy and the PSPT on a stable surface, group 2 received the general physical therapy and the PSPT on an unstable surface, and group 3 received the general physical therapy alone. Participants in group 1 and group 2 underwent 30 min/session, 3 days per week, for 4 weeks. Pressure error (PE) was used to evaluate changes of proprioception. The Balancia, Functional reach test (FRT), and Timed Up and Go (TUG) were used to assess the balance ability, and the 10m Walking Test (10-MWT) was used to assess walking ability. RESULTS: Experimental groups (group 1 and group 2) showed significant differences in PE, FRT, TUG, and 10-MWT compared to the control group (p <0.05). Group 2 (PSPT on an unstable surface) was significantly different in PE, FRT, and 10-MWT from group 1 (p <0.05). No significant differences were observed for other measures. CONCLUSION: Pressure sense perception training on an unstable surface might be a significantly more effective method for improving somatosensory function, balance, and walking ability, than PSPT on a stable surface.

• PNF and Movement
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• v.16 no.3
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• pp.307-315
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• 2018

Purpose: The purpose of this study was to demonstrate the effects of a stepwise proprioceptive neuromuscular facilitation (PNF) pattern therapy in weightbearing positions on the balance and walking functions of a patient with subacute stroke. Methods: The patient was a 78-year-old man with right post-stroke hemiparesis who had decreased balance and gait function. During the baseline and withdrawal phases, no intervention was applied; however, in the intervention phase, the patient received a stepwise PNF pattern therapy in weight-bearing positions. Results: During the intervention phase, the LOS improved by 296.51% (from $2482.13mm^2$ to $626mm^2$), and walking speed improved by 18.70% (from 0.75 m/s to 0.64 m/s). The LOS and 10MWT values appeared to be clinically significantly improved after the intervention. In addition, the scores of the BBS and ABC scales improved by 100% (from 36 points to 18 points) and 56.52% (from 720 points to 460 points), respectively. Conclusion: These findings suggest that a stepwise PNF pattern therapy may be helpful in enhancing the balance and walking function of a patient with subacute stroke. Further studies are required to validate the results of this study.