• The Korean Journal of Pain
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• v.33 no.3
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• pp.258-266
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• 2020

Background: The genicular nerve block (GNB) is demonstrated from several reports to alleviate pain and improve knee functionality in patients with chronic knee osteoarthritis (OA). Ultrasound (US)-guided GNB has been the most used imaging method. This study aimed to compare the effectiveness of US-guided versus blind GNB in the treatment of knee OA. Methods: This prospective, randomized clinical trial included patients with knee OA based on American College of Rheumatology diagnostic criteria. The patients were evaluated for clinical and dynamometer parameters at the baseline, 4 weeks after treatment, and 12 weeks after treatment. The patients underwent blind injection or US-guided injection. Results: When compared with the baseline, both groups showed significant improvement in pain, physical function, and quality of life parameters. Significant differences were observed between the groups for clinical parameters (30-second chair stand test, 6-minute walk test) in favor of the US-guided group. On the other hand, blind injection was more significantly effective on some parameters of the Nottingham Health Profile. There wasn't any significant improvement in isokinetic muscle strength for either group. Conclusions: This study demonstrated that both US-guided and blind GNB, in the treatment of knee OA, were effective in reducing symptoms and improving physical function. GNB wasn't an effective treatment for isokinetic muscle function. US-guided injections may yield more effective clinical results than blind injections.

• Physical Therapy Korea
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• v.29 no.4
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• pp.262-268
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• 2022

Background: Virtual reality (VR) programs based on motion capture camera are the most convenient and cost-effective approaches for remote rehabilitation. Assessment of physical function is critical for providing optimal VR rehabilitation training; however, direct muscle strength measurement using camera-based kinematic data is impracticable. Therefore, it is necessary to develop a method to indirectly estimate the muscle strength of users from the value obtained using a motion capture camera. Objects: The purpose of this study was to determine whether the pedaling speed converted using the VR engine from the captured foot position data in the VR environment can be used as an indirect way to evaluate knee muscle strength, and to investigate the validity and reliability of a camera-based VR program. Methods: Thirty healthy adults were included in this study. Each subject performed a 15-second maximum pedaling test in the VR and built-in speedometer modes. In the VR speedometer mode, a motion capture camera was used to detect the position of the ankle joints and automatically calculate the pedaling speed. An isokinetic dynamometer was used to assess the isometric and isokinetic peak torques of knee flexion and extension. Results: The pedaling speeds in VR and built-in speedometer modes revealed a significantly high positive correlation (r = 0.922). In addition, the intra-rater reliability of the pedaling speed in the VR speedometer mode was good (ICC [intraclass correlation coefficient] = 0.685). The results of the Pearson correlation analysis revealed a significant moderate positive correlation between the pedaling speed of the VR speedometer and the peak torque of knee isokinetic flexion (r = 0.639) and extension (r = 0.598). Conclusion: This study suggests the potential benefits of measuring the maximum pedaling speed using 3D depth camera in a VR environment as an indirect assessment of muscle strength. However, technological improvements must be followed to obtain more accurate estimation of muscle strength from the VR cycling test.

• Physical Therapy Rehabilitation Science
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• v.11 no.4
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• pp.414-420
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• 2022

Objective: In this study, the test-retest reliability and validity were presented to evaluate the usability of isokinetic rehabilitation equipment for the knee joint. Design: Cross-sectional design, reliability & validity study. Methods: Thirty healthy adults participated in the study. A CSMI dynamometer was used as a standardized measuring device to present the validity of the equipment. It was measured based on the dominant leg. The average peak torque value was selected as the measurement variable. After the measurement, a questionnaire was conducted on safety, satisfaction, and performance through the usability evaluation questionnaire. Results: The knee joint isokinetic rehabilitation equipment showed high reliability with Intraclass Correlations Coefficients (ICC) =0.883~0.956. In order to check the validity of the equipment, the 95% confidence interval of the mean difference limit was confirmed by the Bland & Altman plot. As a result, all three angular velocities showed a smaller confidence interval in the flexion than in extension. There were less than 10 plots that were not included in 2 Standard Deviation (SD) between all measurements. As a result of the usability evaluation questionnaire, the average of the safety domain(4.9±0.4), satisfaction domain(4.1±0.8), performance domain(4.3±0.8). Conclusions: If the product is improved by supplementing the items identified in the usability evaluation process, it is judged that it can be used as a useful device in various knee joint rehabilitation fields.

• Journal of Korean Foot and Ankle Society
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• v.19 no.4
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• pp.142-150
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• 2015

Purpose: Restoration of ankle stability through the strengthening exercise of peroneus muscles is considered an important factor for achievement of successful outcomes, in the rehabilitation program following ankle ligament injuries. However, there were few definitive data on normal muscle strength, including eversion power by peroneus muscles. This study was conducted to evaluate the muscle strength of ankle joint measured using an isokinetic dynamometer in normal Koreans. Materials and Methods: Sixty adults (120 ankles) were recruited and divided into three groups (20 in their twenties, 20 in thirties, and 20 in forties). Each group consisted of 10 males and 10 females. The selection criteria were no history of ankle injury and no evidence of instability. The peak torque, total work, and deficit ratio were measured using the Biodex$^{TM}$ (Biodex Medical Systems). Differences in muscle strength by age, gender and dominant versus non-dominant side were analyzed. Results: The peak torque of dorsiflexion was average 31.5 Nm at $30^{\circ}/s$ of angular velocity and 18.8 Nm at $90^{\circ}/s$; average 69.3 Nm ($30^{\circ}/s$) and 42.4 Nm ($90^{\circ}/s$) on plantarflexion; average 19.6 Nm ($30^{\circ}/s$) and 10.8 Nm ($90^{\circ}/s$) on inversion; average 12.9 Nm ($30^{\circ}/s$) and 8.0 Nm ($90^{\circ}/s$) on eversion. The deficit ratio of strength in women was average 61.1% of men on dorsiflexion; average 66.2% on plantarflexion; average 48.5% on inversion; average 55.4% on eversion. The deficit ratio in non-dominant foot was average 88.6% of dominant foot on dorsiflexion; average 90.1% on plantarflexion; average 85.1% on inversion; average 85.6% on eversion. Conclusion: The muscle strength of the ankle joint showed a tendency to weaken with age. There were significant differences in muscle strength by gender and dominancy. Further studies for comparison of patients with ankle instability, a comparison between before and after surgery for instability, the correlation between clinical outcomes and the recovery in muscle strength will be needed.

• Journal of International Academy of Physical Therapy Research
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• v.4 no.2
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• pp.600-604
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• 2013

The purpose of this study was to implement a program of combined muscle stregth and proprioceptive exercises and to examine the impacts of these exercises on functional ankle instability(FAI). Experiments were conducted with 30 adult males and females in their 20s, and the exercise programs were implemented three days per week for four weeks. FAI was defined as a feeling of giving way after an ankle sprain and having a Cumberland ankle instability tool score of 24 points or less. The study subjects were randomly assigned to either a control group, a muscle-strengthening exercise group, or a combined muscle-strengthening and proprioceptive exercise group consisting of 10 subjects each. A Biodex isokinetic dynamometer was used to assess the subjects'ankle strength at selected speeds of $60^{\circ}/sec$ and $120^{\circ}/sec$. The peak torque % body weight showed significant differences in plantar flexion, dorsiflexion, inversion, and eversion. There were also significant differences in proprioception. The results suggest that applying combined muscle-strength and proprioceptive exercises to subjects with FAI is a more effective intervention than applying only muscle-strengthening exercises.

• Physical Therapy Korea
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• v.13 no.3
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• pp.10-17
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• 2006

The purpose of this study was to determine the consequence of resistance strengthening exercise on the hip flexor and extensor performed to improve functional mobility in stroke patients more than six months post stroke. Seventeen patients were randomized into two groups. Both groups received conventional physical therapy for six weeks. In addition, the experimental group performed eccentric resistance strengthening exercise in the hip flexor and extensor using an isokinetic dynamometer. The hip flexor and extensor strength, stair up and down mobility, timed get up and go (TUG), 10 m gait velocity, and functional reach were repeatedly measured at baseline, three weeks, and six weeks after treatment. The results were as follows: 1. The experimental group improved more remarkably in the hip flexor and extensor strength, stair up and down mobility, and the 10 m gait velocity after three weeks and six weeks of treatment (p<.05), 2. The control group improved significantly in the hip flexor and extensor strength, and 10 m gait velocity after three weeks of treatment (p<.05), 3. At each three and six week point, the experimental group made greater gains in hip flexor and extensor strength, stair up and down mobility, and 10 m gait velocity than the control group (p<.05). In conclusion, it is desirable to perform resistance strengthening exercises combined with conventional physical therapy to improve functional mobility in chronic stroke patients.

• Journal of Biomedical Engineering Research
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• v.31 no.4
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• pp.310-315
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• 2010

Estimation of muscle forces is important in biomechanics, therefore many researchers have tried to build a muscle model. Recently, optimization techniques for adjusting muscle parameters, i.e. EMG-driven model, have been used to estimate muscle forces and predict joint moments. In this study, an EMG-driven model based on the previous studies has been developed and isometric and isokinetic contraction movements were evaluated to validate the developed model. One healthy male participated in this study. The dynamometer tasks were performed for maximum voluntary isometric contractions (MVIC) for ankle dorsi/plantarflexors, isokinetic contraction at both $30^{\circ}/s$ and $60^{\circ}/s$. EMGs were recorded from the tibialis anterior, gastrocnemius medialis, gastrocnemius lateralis and soleus muscles at the sampling rate of 1000 Hz. The MVIC trial was used to customize the EMG-driven model to the specific subject. Once the subject's own model was developed, the model was used to predict the ankle joint moment for the other two dynamic movements. When no optimization was applied to characterize the muscle parameters, weak correlations were observed between the model prediction and the measured joint moment with large RMS error over 100% (r = 0.468 (123%) and r = 0.060 (159%) in $30^{\circ}/s$ and $60^{\circ}/s$ dynamic movements, respectively). However, once optimization was applied to adjust the muscle parameters, the predicted joint moment was highly similar to the measured joint moment with relatively small RMS error below 40% (r = 0.955 (21%) and r = 0.819 (36%) and in $30^{\circ}/s$ and $60^{\circ}/s$ dynamic movements, respectively). We expect that our EMG-driven model will be employed in our future efforts to estimate muscle forces of the elderly.

• The Korean Journal of Pain
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• v.35 no.3
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• pp.280-290
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• 2022

Background: This study aimed to determine the impact of complex decongestive therapy applications on upper extremity function in breast cancer patients who developed adhesive capsulitis after lymphedema. Methods: Thirty patients who developed adhesive capsulitis due to lymphedema were divided into two groups as study (n = 15) and control (n = 15) groups. Both groups received 20 minutes of exercise five days a week for three weeks using a Biodex isokinetic dynamometer, as well as a hot pack and TENS (Transcutaneous Electrical Nerve Stimulation) treatment to the shoulder joint. The study group received 45 minutes of intensive decongestive therapy along with the adhesive capsulitis treatment. The visual analogue scale was used to assess pain, circumference, and volumetric measurements were used to assess edema, and the Arm, Shoulder, and Hand Problems Questionnaire (DASH: Disabilities of the Arm, Shoulder, and Hand) was used to assess upper extremity functionality. The shoulder range of motion was evaluated. Results: Both groups had improvements in pain (P < 0.001), shoulder joint range of motion (P < 0.001), and upper extremity functionality (P < 0.001) after the treatment. There was a significant decrease in circumference and volumetric measurements in the study group (P < 0.001). However, no differences were seen in measurements in the control group. Conclusions: The results showed that complex decongestive therapy was beneficial in reducing lymphedema in breast cancer patients who acquired adhesive capsulitis due to lymphedema. Consequently, the authors believe that supplementing conventional physiotherapy with complex decongestive therapy will benefit patients.

• Journal of Korean Physical Therapy Science
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• v.8 no.2
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• pp.967-976
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• 2001

The purpose of the present study was to the investigate the effect of aging in men and women on muscle strength of knee extensor and flexors by using the cybex 6000 isokinetic dynamometer. A total of 100 volunteers participated in this study and were divided into five groups according to their chronological age as follows: 20s, 30s, 40s, 50s, 60s, 10 men and 10 women in each decade respectively. Isokinetic ($60^{\circ}{\cdot}s-l$) knee extensor and flexor peak torque, peak torque to body weight ratio, opposing muscles(flexor/extensor) peak torque ratio, deficit of peak torque between dominant and non-dominant were measured. The results obtained were as follows: 1) In men, While the aged increased. the peak torque of the knee flexor and extensor statistically sig nificant decreased in the dominant and non-dominant side. 2) In women, Statistically significant difference of knee extensor peak torque was found as the aged increased in the dominant and non-dominant side, but significant difference of knee flexor peak torque did not that. 3) In men, No significant difference in the peak torque of knee flexor to body weight ratio was found as the aged increased in the non-dominant side, but statistically significant difference in the peak torque of knee flexor to body weight weight ratio was found as the aged increased in the dominant side. 4) In women. No significant difference in the peak torque of knee flexor to body weight ratio was found as the aged increased in the dominant side, but statistically significant difference in the peak torque of knee flexor to body weight ratio was found as the aged increased in the non-dominant side. 5) In men and women, While the aged increased, statistically significant difference was found the dominant and non-dominant side in the peak torque of knee extensor to body weight ratio. 6) Peak torque of hamstring to quadriceps ratio of dominant and non-dominant side in men and women were not significantly different as the age increases. 7) Mean deficit of peak torque between dominant and non-dominant side in men and women were not significantly different as the age increases. From these results we conclude a proper exercise program is need before 50s decade to preserve in muscle strength of knee flexors and extensors.

• Journal of Korean Academy of Nursing
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• v.26 no.3
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• pp.556-575
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• 1996

In an attempt to investigate the effect of a muscle strengthening exercise program on muscle strength, pain, depression, self-efficacy and quality of life of patients with knee osteoarthritis, a pre-experiment, one group pre-test & post-test design, was planned. Muscle strengthening exercise was carried out from May 22 through August 14, 1995 at isokinetic exercise room in rehabilitation department of University Hospital in Taejon. The subjects were seven female clients conveniently sampled from University Hospital located in Taejon, between 39 and 61 years of age, who had a osteoarthritis in knee. Muscle strengthening exercise program was composed of three sessions per week, one isokinetic exercise at angular velocity of 60° and 180° with Cybex isokinetic dynamometer and two resistance home exercise sessions with elastic band. Data were analyzed with frequency, percentage of change, Friedman test, Duncan test using SAS program. Results were obtained as follows : 1) Flexion and extension muscle strength at angular velocity of 60° and 180° were increased after 12weeks' exercise than those of before experiment. But exept flexion muscle strength at angular velocity of 180°(F=3.34, P=0.0261), there was no statistically significant difference among muscle strengths, which is measured every 3 weeks. 2) Pain was decreased after 6weeks' exercise than that of before experiment, and after 12weeks' exercise than that of 6weeks' exercise. There was statistically significant difference (F=4.28, P=0.0396). 3) Depression was increased after 6weeks' exercise than that of before experiment, and after 12weeks' execise than that of 6weeks' exercise. There was no statistically significant difference between before experiment and after 6weeks' exercise. But, there was statistically significant difference between after 6weeks' exercise and 12weeks' exercise(F=9.38, P=0.0035). 4) Self-efficacy was decreased after 6weeks' exercise than that of before exercise. But, it was increased after 12weeks' exercise than that of be-fore exercise and after 6weeks' exercise. But there was no statistically significant difference (F=1.46, P=0.2706). 5) Quality of life was increased after 6weeks' exercise than that of before exercise, and after 6weeks' exercise than that of 12weeks' exercise. But there was no statistically significant differ once (F=1.06, P=0.3816). Thus, the significant of muscle strengthening exercise for the improvement of muscle strength, pain, depression, is verified. But, this study was a pre-experiment with small size subjects. So, con-trolled experimental study is necessary to determine the effect of this muscle strengthening exercise program on muscle strength, pain, depression, self-efficacy, and quality of life of patients with knee osteoarthritis.