• Journal of Institute of Control, Robotics and Systems
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• v.16 no.10
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• pp.948-956
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• 2010

The purpose of this study was to test the effectiveness of a prototype KAFO (Knee-Ankle-Foot Orthosis) powered by two artificial pneumatic muscles during walking. We had previously built powered AFO (Ankle-Foot Orthosis) and KO (Knee Orthosis) and used it effectively in studies on assistance of plantaflexion and knee extension motion. Extending the previous study to a KAFO presented additional challenges related to the assistance of gait motion for rehabilitation training. Five healthy males were performed gait motion on treadmill wearing KAFO equipped with artificial pneumatic muscles to power ankle plantaflexion and knee extension. Subjects walked on treadmill at 1.5 km/h under four conditions without extensive practice: 1) without wearing KAFO, 2) wearing KAFO with artificial muscles turned off, 3) wearing KAFO powered only in plantaflexion under feedforward control, and 4) wearing KAFO powered both in plantaflexion and knee extension under feedforward control. We collected surface electromyography, foot pressure and kinematics of ankle and knee joint. The experimental result showed that a muscular strength of wearing KAFO powered plnatarfexion and knee extension under feedforward control was measured to be lower due to pneumatic assistance and foot pressure of wearing KAFO powered plnatarfexion and knee extension under feedforward control was measured to be greater due to power assistance. In the result of motion analysis, the ankle angle of powered KAFO in terminal stance phase was found a peak value toward plantaflexion and there were difference of maximum knee flexion range among condition 2, 3 and 4 in mid-swing phase. The current orthosis design provided plantaflexion torque of ankle jonit in terminal stance phase and knee extension torque of knee joint in mid-swing phase.

• Journal of Biomedical Engineering Research
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• v.22 no.4
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• pp.359-368
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• 2001

A new knee-ankle-foot-orthosis(KAFO) which uses an automatically-controlled electromechanical wrap spring clutch for the knee joint was developed in the present study. It was found that the output voltage from the foot switches of the developed KAFO was proportionally increased with respect to the applied load. The output voltage from the infrared sensor also decreased as the knee flexion angle increased. The knee joint system for the new KAFO weighs only 780g lighter than any other commercially available developed system. In addition, the solenoid reduces the reaction time for the automatic control of the knee joint. The static torque of the clutch was measured for three persons, and it satisfied the normal knee extension moment during the pre-swing. Three-dimensional gait analyses for three different gait patterns (normal gait, locked-knee gait, controlled-knee gait) from five normal subjects were conducted. Controlled-knee gait showed the maximum knee flexion angle of 40.56$\pm9.55^{\circ}$ and the maximum knee flexion moment of 0.20$\pm$0.07Nm/kg at similar periods in the normal gait. Our KAFO system satisfies both stability during stance phase and free knee flexion during the swing phase at the proper period during the gait cycle. Therefore, our KAFO system would be very useful in various low extremity orthotic applications.

• Journal of Korean Foot and Ankle Society
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• v.22 no.3
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• pp.100-104
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• 2018

Purpose: An axillary crutch is the most commonly used assistive device in foot and ankle patients who require nonweightbearing. On the other hand, its use frequently induces axillary or wrist pain and critical neurovascular injuries have been reported in several studies. This study compared the clinical outcomes of patients using the knee walker and axillary crutch. Materials and Methods: A retrospective analysis was performed comparing the utility of a knee walker and axillary crutch as a nonweightbearing ambulatory aid for 62 foot and ankle patients treated between November 2016 and March 2018. A comparative study of the two orthosis could be performed because all the patients temporarily used an axillary crutch before or after the use of a knee walker. A demographic study and comparative analysis based on the visual analogue scale (VAS) satisfaction score (0~100), complications, and fall down history were evaluated. Furthermore, under the assumption of having retreatment, their preference of orthosis between the knee walker and axillary crutch was investigated. Results: The mean age of the patients was 36.5 and the mean duration of ambulation with a knee walker and axillary crutch were 5.2 and 2.4 weeks. The VAS satisfaction score of the knee walker and crutch was 88.8 and 27.5, respectively (p<0.05). The most frequent complications of the knee walker and crutch were ipsilateral knee pain (6 cases) and axillary or wrist pain (56 cases), respectively. No case of falling down occurred during knee walker ambulation, but there were two cases of crutch ambulation. Fifty-eight patients (93.5%) preferred the knee walker and four patients (6.5%) preferred a crutch. Conclusion: Compared to the axillary crutch, the knee walker afforded lower complication and higher satisfaction. Most patients preferred the knee walker to a crutch. Therefore, the knee walker is an efficient and safe orthosis for foot and ankle patients who require nonweightbearing.

• Physical Therapy Korea
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• v.20 no.1
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• pp.64-73
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• 2013

The purposes of this study were to develop a new orthosis controlling ankle and knee joint motion during the gait cycle and to identify the effects of the newly designed orthosis on gait kinematics and tempospatial parameters, including coordination of the extremities in stroke patients. Fifteen individuals who had sustained a stroke, onset was 16 months, participated in this study. Before application of the measurement equipment the subjects were accustomed to walking on the ankle-foot orthosis (AFO) or stance control knee with knee flexion assisted-oil damper ankle-foot orthosis (SCKAFO) for 5 minutes. Fifteen patients were investigated for 45 days with a 3-day interval between sessions. Measurements were walking in fifteen stroke with hemiparesis on the 3D motion analysis system. Comparison of AFO and SCKAFO are gait pattern. The difference between the AFO and SCKAFO conditions was significant in the gait velocity, step length of the right affected side, stance time of both legs, step-length asymmetry ratio, single-support-time asymmetry ratio, ${\phi}$-thigh angle and ${\phi}$-shank angle in the mid swing (p<.001). Using a SCKAFO in stroke patients has shown similar to normal walking speeds can be attained for walking efficiency and is therefore desirable. In this study, the support time of the affected leg with the SCKAFO was longer than with the AFO and the asymmetry ratio of single support time decreased by more than with the AFO. This indicates that the SCKAFO was effective for improving gait symmetry, single-support-time symmetry. This may be due to the decrease of gait asymmetry. Thus, the newly designed SCKAFO may be useful for promoting gait performance by improving the coordination of the extremity and decreasing gait asymmetry in chronic stroke patients.

• Journal of rehabilitation welfare engineering & assistive technology
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• v.8 no.3
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• pp.177-185
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• 2014

In this study, the exoskeleton orthosis for the assistance of dorsiflexion torque in ankle joint to prevent foot-drop was developed. It was consist of three part; 1) the power part using artificial pneumatic actuator, 2) wearing part of ankle and knee joints to fix the orthosis, and 3) control part to detect the gait phase using physiological signal. The dorsiflexion torque was generated by the artificial pneumatic actuator connected with wearing part between ankle and knee joint. The accurate timing to assist dorsiflexion torque is made up of physiological signal in foot sole part that detect the gait phase, that is, stance and swing phase in each foot. We conduct the experiment to investigate the effect of exoskeleton orthosis to the 7 elderly people and 10 healthy people. The result showed that the muscular activities in tibialis anterior muscle were reduced because of the assistance of dorsiflexion torque in ankle joint using the exoskeleton orthosis.

• 제어로봇시스템학회:학술대회논문집
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• 2005.06a
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• pp.2444-2447
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• 2005

The purpose of this study was to analyze the gait motion of the aged with a lower limbs orthosis. The gait motion was analyzed with and without lower limbs orthosis using APAS 3D Motion Analysis System. The pattern of lower limbs motion was tracked based on four targets attached to the body of the subject. The targets were positioned at hip, knee, ankle, and foot. The parameters measured were the displacement, the velocity, and the acceleration of the four targets. The improvement in the measured values on the displacement and the velocity of the four targets were small with the orthosis due to inconvenience of wearing it, but the increase in the acceleration was large due to the elastic force of the rubber actuator. Especially, the increase of the acceleration of foot with lower limbs orthosis seems to help the gait motion of the elderly.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2002.05a
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• pp.132-135
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• 2002

In the present study, an electro-mechanical KAFO (knee-ankle-foot orthosis) which satisfies both the stability in stance and the knee flexion in swing was developed and evacuated in eight polio patients. A knee joint control algorithm suitable for polio patients who are lack of the stability in pre-swing was also developed and various control systems and circuits were also designed. In addition, knee flexion angles and knee moments were measured and analyzed for polio patients who used the developed KAFO with the three-dimensional motion analysis system. Energy consumption was also evaluated for the developed KAFO by measuring the movement of the COG (center of gravity) during gait. From the present study, the designed foot switch system successfully determined the gait cycle of polio patients and controlled knee joint of the KAFO, resulting in the passive knee flexion or foot clearance during swing phase. From the three-dimensional gait analysis for polio patients, it was found that the controlled-knee gait with the developed electro-mechanical KAFO showed the knee flexion of 40$^{\circ}$∼45$^{\circ}$ at an appropriate time during swing. Vertical movements of COG in controlled-knee gait (gait with the developed electro-mechanical KAFO) were significantly smaller than those in looked knee gait(gait with the locked knee Joint). and correspondingly controlled-knee gait reduced approximately 40% less energy consumption during horizontal walking gait. More efficient gait patterns could be obtained when various rehabilitation training and therapeutic programs as well as the developed electro-mechanical KAFO were applied for polio patients.

• Physical Therapy Korea
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• v.30 no.2
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• pp.110-119
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• 2023

Background: Osteoarthritis is a common condition with an increasing prevalence and is a common cause of disability. Osteoarthritic pain decreases the quality of life, and simple gait training is used to alleviate it. Knee osteoarthritis limits joint motion in the sagittal and lateral directions. Although many recent studies have activated orthotic research to increase knee joint stabilization, no study has used patellar tendon straps to treat knee osteoarthritis. Objects: This study aimed to determine the effects of patellar tendon straps on kinematic, mechanical, and electromyographic activation in patients with knee osteoarthritis. Methods: Patients with knee osteoarthritis were selected. After creating the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), leg length difference, Q-angle, and thumb side flexion angle of the foot were measured. Kinematic, kinetic, and muscle activation data during walking before and after wearing the orthosis were viewed. Results: After wearing the patellar tendon straps, hip adduction from the terminal stance phase, knee flexion from the terminal swing phase, and ankle plantar flexion angle increased during the pre-swing and initial swing phases. The cadence of spatiotemporal parameters and velocity increased, and step time, stride time, and foot force duration decreased. Conclusion: Based on the results of this study, the increase in plantar flexion after strap wearing is inferred by an increase due to neurological mechanisms, and adduction at the hip joint is inferred by an increase in adduction due to increased velocity. The increase in cadence and velocity and the decrease in gait speed and foot pressure duration may be due to joint stabilization. It can be inferred that joint stabilization is increased by wearing knee straps. Thus, wearing a patellar tendon strap during gait in patients with knee osteoarthritis influences kinematic changes in the sagittal plane of the joint.

• Physical Therapy Korea
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• v.20 no.1
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• pp.18-27
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• 2013

The purpose of this study was to compare the ring lock type knee-ankle-foot orthosis (KAFO) with newly developed 4-bar linkage KAFO on the gait characteristics of persons with poliomyelitis clinically. This 4-bar linkage is the stance control type KAFO which provide the stability during stance phase and knee flexion during swing phase. Two subjects participated in this study voluntarily. We provided the customized 4-bar linkage KAFO then asked the subjects to walk in level surface and stairs under the two different KAFO conditions. The characteristics of gait in the persons with poliomyelitis were evaluated using a 3D motion analysis system and force plate. Additionally 6 minute walk test for physiological cost index were conducted using pulse oximeter to measure the energy consumption. In the results of this study, the differences of 4-bar linkage KAFO compared with ring lock type KAFO are as follows: (1) Walking speed, stride length, and step length on level increased in subjects, (2) The gait symmetry was improved by generated knee flexion and decreased pelvic external rotation on level and stairs walking, (3) Decreased vertical excursion of center of mass and pelvic elevation during swing phase was decreased on level, (4) Knee extension moment, hip flexion moment, hip and knee internal rotation moment of non-braced limb were decreased on level walking, (5) Walking speed in 6-minute walk test was increased and physiological cost index was decreased. These findings indicate that 4-bar linkage KAFO compared with ring lock type KAFO is effective in enhancing pattern, endurance, and energy consumption in level surface and stairs walking.

• Korean Journal of Applied Biomechanics
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• v.31 no.2
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• pp.95-103
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• 2021

Objective: The aim of this study was to investigate the differences in spatiotemporal gait performance, function, and pain of lower-extremity according to foot morphological characteristics. Method: This case-control study recruited 42 adults and they were classified into 3 groups according to foot morphology using navicular-drop test: pronated (≥ 10 mm), normal (5~9 mm), and supinated (≤ 4 mm) feet. Spatiotemporal gait analysis and questionnaires including Foot and Ankle Ability Measure activities of daily living / Sports, Western Ontario and McMasters Universities Osteoarthritis Index, Lower Extremity Functional Scale, International Physical Activity Questionnaire, and Tegner activity score were conducted. One-way analysis of variance was used for statistical analysis. Results: The pronated feet group showed longer loading response and double limb support in both feet and increased pre-swing phase in non-dominant feet. The supinated feet group demonstrated a longer swing phase in non-dominant feet and single limb support in dominant feet. However, there was no significant group difference in function and pain of knee joint and lower-extremity between groups. Conclusion: Our results indicated that abnormal spatiotemporal gait performance according to foot morphology. Although there was no difference in lower extremity dysfunction and pain according to the difference in foot morphology, they have the possibility of symptom occurs as a result of continuous participation in activities of daily living and sports. Therefore, individuals with pronated or supinated foot should be supplemented by utilizing an orthosis or training to restore normal gait performance.