• Journal of the Korean Burn Society
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• v.23 no.2
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• pp.31-36
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• 2020

Purpose: Scar contracture influence the outcome of burn patients significantly. This study aims to investigate the feasibility of robot-assisted training for the lower extremity rehabilitation of burn patients. Methods: This pilot study was conducted on 7 burn patients for 8 weeks between January 2019 and November 2019. Two of 7 patients withdrew from this study because one had skin abrasion on the legs which thigh fastening devices were applied on and the other was not participate in the assessment at 4 weeks after training. Final 5 patients received gait training with SUBAR^® and numeric rating scale (NRS), 6-minutes walking test, and range of motion in flexion and extension of knee and ankle joint were evaluated before training, 4 weeks and 12 weeks after training. Results: The subjects had a mean age of 51.8±98 years, mean total burn surface area of 30.8±13.7%, mean duration from injury to 1^st assessment of 102.8±39.3 days. Anyone of 5 patients did not have musculoskeletal or cardiovascular side effects such as increased or decreased blood pressure or dizziness. The significant improvement in NRS, gait speed, and range of motion in knee extension and ankle plantarflexion after robotic training (all P<0.05). Conclusion: Robot-assisted training could be feasible for the rehabilitation of burn patients and it could improve muscle strength and range of motion in lower extremities, and gait function.

• Journal of the Korean Orthopaedic Association
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• v.56 no.3
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• pp.253-260
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• 2021

Purpose: The least constrained prosthesis is generally recommended in primary total knee arthroplasty (TKA). Nevertheless, a varus/valgus constrained (VVC) prosthesis should be implanted when a semi-constrained prosthesis is not good for adequate stability, especially in the coronal plane. In domestic situations, however, the VVC prosthesis could not always be prepared for every primary TKA case. Therefore, it is sometimes impractical to use a VVC prosthesis for unsual unstable situations. This study provides information for preparing VVC prostheses in the preoperative planning of primary TKA through an analysis of primary VVC TKA cases. Materials and Methods: This study reviewed 1,797 primary TKAs, performed between May 2003 and February 2016. The reasons for requiring VVC prosthesis and the preoperative conditions in 29 TKAs that underwent primary TKA with a VVC prosthesis were analyzed retrospectively. Results: In primary TKA, 29 cases (1.6%) in 27 patients (6 male and 21 female) used VVC prosthesis. Two patients underwent a VVC prosthesis on both knees. The mean age of the patients was 63.4 years old (34-79 years). The mean flexion contracture was 16.2° (-20°-90°), and the mean angle of great flexion was 111.7° (35°-145°). The situations requiring a VVC prosthesis were severe valgus deformity in 10 knees, knee stiffness requiring extensive soft tissue release in 10 knees, previously injured collateral ligaments in five knees, and distal femoral bone defect due to avascular necrosis in four knees. The mean tibiofemoral angle was 25.7° (21°-43°) in 10 cases with a valgus deformity. The mean flexion contracture was 37.5° (20°-90°), and the mean range of motion was 48.5° (10°-70°) in 10 cases with knee stiffness. Conclusion: The preparation of VVC prosthesis is recommended, even for primary TKA in cases of severe valgus deformity (tibiofemoral angle>20°), stiff knee (the range of motion: less than 70° with more than 20° flexion contracture), and the cases with a previous collateral ligament injury. This information will help in the preparation of adequate TKA prostheses for unusual unstable situations.

• Physical Therapy Korea
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• v.22 no.3
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• pp.23-32
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• 2015

The purpose of this study was to identify the effects of mechanical traction applied to the knee joint on pain, knee range of motion (ROM), timed up and go (TUG) and Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) in patients with knee osteoarthritis (KOA) of Kellgren-Lawrence radiological rating scale II or III. Twenty three patients participated in the experiment for a period of four weeks. After baseline assessment, the patients with KOA were randomized into two groups: the traction group ($n_1=12$), which received traction with general physical therapy; and the control group ($n_2=11$), which received general physical therapy only on unilateral knee joints. Patients received interventions once a day, three times a week, for four weeks. Wilcoxon signed-rank test was used to analyze the change of dependent variances within the group during pre and post intervention. Mann-Whitney U test was used to analyze the change of dependent variances as TUG and passive ROM between the two groups. Analysis of covariance was used to analyze the change of dependent variances as numeric pain rating scale (NPRS) and WOMAC score between the two groups. In Wilcoxon signed-rank test, the traction group improved significantly with regard to NPRS (p<.01), passive knee flexion ROM (p<.01), passive knee extension (p<.05), TUG (p<.01) and WOMAC scores (p<.01) after intervention for four weeks, but not for the control group. In the Mann-Whitney U test and analysis of covariance, no significant difference was seen among all the dependent variances after intervention for four weeks between the two groups. These outcomes suggest that further studies should be carried out to determine the effects of mechanical traction prior to using it for the treatment of patients with knee osteoarthritis.

• Journal of the Korean Society of Physical Medicine
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• v.4 no.3
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• pp.149-156
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• 2009

Purpose：The hamstring muscle has an important role in standing, walking and other functions related to daily living. Most people with Cerebral Palsy(CP) have muscle tightness, especially in the hamstring, which may cause abnormal alignment in the lower extremities. To investigate an effective treatment for hamstring muscle tightness by observing the effects of heat pack or Soft tissue mobilization(STM) on hamstring muscles. Methods：Thirteen-two volunteers with CP aged between 9 and 13 years($M\pmSD$: $11\pm1.46$), were recruited and divided into four groups of four: (1) the STM for people with Spastic CP group, (2) the heat pack(HP) for people with Spastic CP group, (3) the STM for people with Mixd CP group, and (4) the heat pack for people with Mixed CP group. All received treatment three times per week for six weeks. A inclinometer was used to measure for hip flexion & knee extension joint range motion(ROM). Results：The ROM of hip flexion & knee extension were improved at the STM and HP for people with Spastic CP groups. The ROM and hip flexion were improved at the STM and HP for people with Mixed CP groups. The amount of increase ROM are differenced by the types of CP. Conculusion：STM and heat pack, both are effective for people with CP especially for Spastic CP.

• PNF and Movement
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• v.21 no.3
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• pp.345-356
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• 2023

Purpose: The aim of this study was to investigate the effects of physical therapy combined with a virtual reality (VR) game on pain, quality of life (QOL), engagement, and knee function in post-knee-surgery patients. Methods: Twenty-four patients who had undergone knee surgery four weeks or more before the study were recruited. Two withdrew from the study during the four-week experimental period, and a total of 22 patients were included in the final analysis. Routine physical therapy consisting of electrostimulation (10 min.) and therapeutic massage (10 min.) was the base intervention for all groups. The experimental group (n = 10) was additionally exposed to a VR game intervention, while the control group (n = 12) underwent an intervention involving similar motions as the experimental intervention but with no VR. The intervention for the experimental group used the game Rig Fit Adventure on Nintendo switch. Both groups underwent their respective interventions 3 times a week (35 min. per session) for 4 weeks. Pain was assessed using the numeric rating scale (NRS), and QOL was assessed using the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L). Engagement was assessed using the Korea flow state scale (K-FSS). Finally, knee movement and function were assessed based on knee flexion and extension, range of motion (ROM), and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Results: After the four-week physical therapy, both groups showed significant reductions in pain (on the NRS), increased knee ROM (flexion), better WOMAC scores, and increased EQ-5D-5L scores (p < 0.05), with the experimental group showing significantly better improvements in EQ-5D-5L and K-FSS scores (p < 0.05). Conclusion: The results of this study confirm that a VR-game-integrated intervention is effective for improving pain, QOL, engagement, and knee function in post-knee surgery patients and that VR-game-integrated interventions could be therapeutic alternatives for patients bedridden for prolonged periods with little motivation for rehabilitation.

• Physical Therapy Korea
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• v.19 no.3
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• pp.98-104
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• 2012

The aim of this study was to examine the effects of repeated passive movement (RPM) of different velocities on the improvement of knee joint position sense (JPS) in post-stroke patients with hemiplegia, thereby investigate the possibility of clinical application in the initial stage of rehabilitation for patients with post-stroke hemiplegia. Thirteen hemiplegic patients participated in this study. For the subjects' knee JPS tests, a passive angle reproduction test and an active angle reproduction test were performed prior to and after the intervention, which involved 30 repetitions of passive full-range-of-motion flexion and extension exercise of the knee joints at randomized degrees of $0^{\circ}/s$, $45^{\circ}/s$, and $90^{\circ}/s$. Paired t-test analysis was done in order to compare changes in the pre- and post-intervention knee JPS. One-way repeated analysis of variance was used in order to compare changes in JPS after intervention at three different movement velocities. The level of significance was set at .05. The result was that the subjects' post-intervention knee JPS significantly improved after the RPM exercise at a $45^{\circ}/s$ and a $90^{\circ}/s$ relative to the RPM exercise $0^{\circ}/s$ (p<.05). JPS changes with RPM intervention at the rapid velocity of $90^{\circ}/s$ were most increased, suggesting the most effective enhancement in knee JPS is with intervention at the velocity (p<.05). Therefore, RPM intervention at a half or higher velocity improved stroke patients' knee JPS. During the initial stage of rehabilitation for patients with post-stroke hemiplegia, the efficient application of the RPM exercise at a half or higher velocity will be possible.

• Korean Journal of Applied Biomechanics
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• v.22 no.3
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• pp.357-363
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• 2012

The purpose of this study was to investigate the effects of different saddle heights on lower-limb joint angle and muscle activity. Six elite cyclists(age: $32.2{\pm}5.2years$, height: $171.0{\pm}3.5cm$, weight: $79.7{\pm}5.6kg$, cycle career: $13{\pm}6.2years$) participated in three min. submaximal(90 rpm) pedaling tests with the same load and cadence based on saddle heights where subject's saddle height was determined by his knee flexion angle when the pedal crank was at the 6 o'clock position. Joint angles(hip, knee, ankle joints) and the activity of lower limb muscles(biceps femoris(BF), vastus lateralis(VL), tibialis anterior(TA) and gastrocnemius medial(GM)) were compared by measuring 3D motion and electromyography(EMG) data. Results showed that there were significant differences in minimum hip & knee joint angle and range of motion of hip and knee joint between saddle heights. Onset timing and integrated EMG of only BF among 4 muscles were significantly different between saddle heights. Especially there was a negative relationship between minimum hip joint angle and onset timing of BF in most subject, which means that onset timing of BF became fast as the degree of bending of the hip joint became larger by saddle height. Optimal pedaling will be possible through increased amount of muscle activation due to the appropriate burst onset timing by proper pedaling posture with adjusted saddle height.

• Journal of the Korean Arthroscopy Society
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• v.4 no.1
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• pp.42-48
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• 2000

We retrospectively reviewed the results of arthroscopic adhesiolysis on postoperative knee stiffness in order to observe the clinical improvement and to evaluate the prognostic factors. Arthroscopic adhesiolysis without extraarticular procedure was performed in 31 knees displaying persistent flexion or extension loss. The causes of arthrofobrosis were previous ligament surgeries in 17 knees, surgery for a fracture involving the articular surface of the knee in 10 cases and other causes in four cases. The average range of motion was $60^{\circ}(range,\;14^{\circ}-74^{\circ})$ preoperatively, and improved by $120^{\circ}(range,\;7^{\circ}-127^{\circ})$ immediately following the procedure. The range of motion at the final follow-up (average 34 months) was $129^{\circ}(range,\;3^{\circ}-132^{\circ})$. In the 17 patients with arthrofibrosis fellowing ligament surgery, the range of motion was improved from $65^{\circ}$ preoperatively to $135^{\circ}$ at final follow-up. The improvement in function and motion was achieved during the first postoperative year. In the 10 patients with arthrofibosis following intraarticular fractures, the range of motion was improved from $60^{\circ}$ preoperatively to $125^{\circ}$ at the final follow-up, and most of the increase in motion was achieved within the first 6 months. Patients who suffered from a limitation of motion for less than 7 months gained an average $70^{\circ}$ improvement in total range of motion following arthroscopic surgery. However, the total range of motion in patients with a duration of symptoms greater than 7 months improved by an average $49^{\circ}$ postoperatively. In conclusion, arthroscopic adhesiolysis without incisional procedure is an effective therapeutic modality in arthrofibrosis of intraarticular origin. Improved outcomes can be expected in stiffness after ligament surgery and a symptom duration of arthrofibrosis less than 7 months.

• Physical Therapy Korea
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• v.28 no.1
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• pp.65-71
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• 2021

Background: The hamstring is a muscle that crosses two joints, that is the hip and knee, and its flexibility is an important indicator of physical health in its role in many activities of daily living such as sitting, walking, and running. Limited range of motion (ROM) due to hamstring tightness is strongly related to back pain and malfunction of the hip joint. High-frequency diathermy (HFD) therapy is known to be effective in relaxing the muscle and increasing ROM. Objects: To investigate the effects of HFD on active knee extension ROM and hamstring tone and stiffness in participants with hamstring tightness. Methods: Twenty-four participants with hamstring tightness were recruited, and the operational definition of hamstring tightness in this study was active knee extension ROM of below 160° at 90° hip flexion in the supine position. HFD was applied to the hamstring for 15 minutes using the WINBACK device. All participants were examined before and after the intervention, and the results were analyzed using a paired t-test. The outcome measures included knee extension ROM, the viscoelastic property of the hamstring, and peak torque for passive knee extension. Results: The active knee extension ROM significantly increased from 138.8° ± 9.9° (mean ± standard deviation) to 143.9° ± 10.4° after the intervention (p < 0.05), while viscoelastic property of the hamstring significantly decreased (p < 0.05). Also, the peak torque for knee extension significantly decreased (p < 0.05). Conclusion: Application of HFD for 15 minutes to tight hamstrings immediately improves the active ROM and reduces the tone, stiffness, and elasticity of the muscle. However, further experiments are required to examine the long-term effects of HFD on hamstring tightness including pain reduction, postural improvement around the pelvis and lower extremities, and enhanced functional movement.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.1
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• pp.21-30
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• 2021

Background: This study aimed to investigate the effects of muscle energy technique (MET) and instrument assisted soft tissue mobilization (IASTM) on knee extension ROM, knee extensor/flexor strength and muscle thickness immediately and after 24 hours. Methods: A total of 30 subjects participated in this study. The participants were assigned to either MET (n=15) or IASTM (n=15). 90-90 straight leg raise, knee extensor/flexor muscle strength, muscle thickness test were measured before, immediately after and 24 hours after the intervention. Results: Both groups significantly improved knee extension ROM on immediate (MET 10.7°, IASTM 10.21° increased) and after 24 hours assessment (MET 5.61°, IASTM 5.47° increased)(p<.05). In the MET group, knee extension and flexion muscle strength increased immediately after intervention (p<.05). In the IASTM group, knee extension muscle strength increased and knee flexor muscle strength decreased immediately after intervention (p<.05). Furthermore, both groups showed a pattern of returning to the initial strength after 24 hours. In both groups, no significant difference in muscle thickness immediately and after 24 hours was observed (p>.05). Conclusion: According to the results of the present study, MET and IASTM technique showed lasting effectiveness in flexibility of shortened hamstring immediately after and in 24 hours after the intervention. In both groups, MET increased muscle strength and increased ROM, while IASTM decreased muscle strength and increased ROM, with no change in muscle thickness.