Effects of Muscle Activation Pattern and Stability of the Lower Extremity's Joint on Falls in the Elderly Walking -Retrospective Approach- (노인 보행 시 하지 근 활동 양상과 관절의 안정성이 낙상에 미치는 영향 -후향성 연구-)
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- 한국체육학회지인문사회과학편
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- v.57 no.3
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- pp.345-356
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- 2018
Objective: The purpose of this study was to investigate the local stability of the lower extremity joints and muscle activation patterns of the lower extremity during walking between falling and non-falling group in the elderly women. Method: Forty women, heel strikers, were recruited for this study. Twenty subjects (age:72.55±5.42yrs; height:154.40±4.26cm; mass:57.40±6.21kg; preference walking speed:0.52±0.17m/s; fall frequency=1.70±1.26 times) had a history falls(fall group) within two years and Twenty subjects (71.90±2..90yrs; height:155.28±4.73cm; mass:56.70±5.241kg; preference walking speed: 0.56±0.13m/s) had no history falls(non-fall group). While they were walking on a instrumented treadmill at their preference speed for a long while, kinematic and EMG signals were obtained using 3-D motion capture and wireless EMG electrodes, respectively. Local stability of the ankle and knee joint were calculated using Lyapunov Exponent (LyE) and muscles activation and their co-contraction index were also quantified. Hypotheses were tested using one-way ANOVA and Mann-Whitey. Spearman rank was also used to determine the correlation coefficients between variables. Level of significance was set at p<.05. Results: Local stability in the knee joint adduction-abduction was significantly greater in fall group than non-fall group(p<.05). Activation of anterior tibials that acts on the foot segment dorsal flexion was greater in non-fall group than fall group(p<.05). CI between gastrocnemius and anterior tibials was found to be significantly different between two groups(p<.05). In addition, there was significant correlation between CI of the leg and LyE of the ankle joint flexion-extention in the fall group(p<.05). Conclusion: In conclusion, muscles that act on the knee joint abduction-adduction as well as gastrocnemius and anterior tibials that act on the ankle joint flexion-extention need to be strengthened to prevent from potential fall during walking.
The objective of this research is to do a cultural comparison on the daily lives of the children of Korea, Japan and China. To achieve this objective, the questionnares were distributed to the 2940 mothers of children from the ages of 3 to 6 in the countries of Korea, Japan and China. The target audience consisted of 941 mothers living in Seoul and Kyunggi area for Korea, 1007 mothers living in Tokyo for Japan, and 992 mothers living in Beijing for China. As a result of the research, we found out that firstly, although children in general got up anytime between 7:00am to 9:00am and went to bed between 8:00pm and 11:00pm, 61.5% of the Korean children went to bed after 10pm and 16.8% after 11pm. Besides that, we found that compared to 3.51% of Korean children who got up before 6am, 13.41% of Japanese children and 17.24% of Chinese children got up before 6:00am. So we could see that the Korean children got up later and went to bed later than their Japanese and Chinese counterpart. This pattern could also be seen in the average rising time and bed time. Korean children went to bed at 10:00pm and woke up at 7:75am whereas the Japanese children went to bed at 9:28pm and woke up at 7:39am, and the Chinese children went to bed at 9:05pm and woke up at 7:05am. The average sleeping hours for Japanese children was 10.12 hours, 9.50 hours for the Chinese and 9.75 hours for the Korean. As a result, we could see that the Korean children went to bed later, got up later and slept fewer hours than their Japanese and Chinese counterparts. Also, since the rising time and bedtime of the Korean children was later than those of the Chinese and Japanese counterparts, the former s' breakfast and dinner time was also much later. Secondly, we looked at the time children went off to and came back from institutes such as kindergarten and child care centers. The Chinese were earliest at going with average attendance at 7:83am, the Japanese came next at 8:59am and the Korean children were last at 8:90am, whereas the Japanese came first in coming back home at 3:36pm, Korean next at 3:91pm and the Chinese last at 5:46pm. Next when we looked at the hours spent at the kindergartens and child care centers, Japan spent 6.76 hours, Korea 7.01 hours and China spent the longest hours with 9.63 hours. Excluding China where all preschool institutes are centralized into kindergartens, we nest looked at time children went to and came back from the institutes as well as the time spent there. In the case of kindergarten, there was not much difference but in the case of child care centers, the Japanese children went to the child care centers mach earlier and came home later than the Korean children. Also, the time spent at the child care center was much longer for the Japanese than the Korean children. This fact coincides with the Korean mothers' number one wish to the kindergartens and child care centers i.e. for the institutes to prolong their school hours. Thus, the time spent at child care centers for Korea was 7.75 hours, 9.39 hours for Japan and 9.63 hours for China. The time for Korea was comparatively much shorter than that of Japan and China but if we consider the fact that 50% of the target audience was working mothers, we could easily presume that the working parents who usually use the child care centers would want the child care centers to prolong the hours looked after their children. Besides this, the next most wanted wish mothers have towards the child care centers and kindergartens was for those institutes to "look after their children when sick". This item showed high marks in all three countries, and the marks in Korea was especially higher when compared to Japan and China. Thirdly, we looked at the private extracurricular activities of the children. We found that 72.6% of the Korean children, 61.7% of the Japanese children, and 64.6% of the Chinese children were doing private extracurricular activities after attending kindergarten or day care centers. Amongst the private extracurricular activities done by Korean children, the most popular one was worksheet with 51.9% of the children doing it. Drawing (15.20%) and English (11.6%) came next. Swimming (21.95%) was the most popular activity for Japan, with English (17.48%), music (15,79%) and sports (14.70%) coming next. For China, art (30.95%) was first with English (22.08%) and music (19.96%) following next. All three countries had English as the most popular activity related to art and physical activities after school hours, but the rate for worksheet studies was much higher for Korea compared to Japan China. The reason Koreans universally use worksheet in because the parents who buy the worksheet are mothers who have easy access to advertisement or salespeople selling those products. The price is also relatively cheap, the worksheet helps the children to grow the basic learning ability in preparation for elementary school, and it is thought to help the children to build the habit of studying everyday. Not only that but it is estimated that the worksheet education is being conducted because parents can share the responsibility of the children's learning with the worksheet-teacher who make home visits. Looking at the expenses spent on private extracurricular activities as compared to income, we found that China spent 5% of income for activities outside of regular education, Korea 3% and Japan 2%. Fourthly, we looked at the amount of time children spent on using multimedia. The majority of the children in Korea, Japan and China watch television almost every day. In terms of video games, the Japanese children played the games the most, with Korea and China following next. The Korean children used the computer the most, with Japan and China next. The Korean children used about 21.17% of their daily time on computers which is much more than the Japanese who used 20.62% of their time 3 or 4 times a week, or the Chinese. The Chinese children were found to use considerably less time on multimedia compared to the Korean of Japanese.
Nursing of today has as one of its objectives the solving of problems related to human needs arising from the demands of a rapidly changing society. This nursing objective, I believe, can he attained by the appropriate application of scientific principles in the giving of comprehensive nursing care. Comprehensive nursing care may be defined as nursing care which meets all of the patient's needs. the needs of patients are said to fall into five broad categories: physical needs, psychological needs, environmental needs, socio-economic needs, and teaching needs. Most people who become ill have adjustment problems related to their new situation. Because patient teaching is one of the most important functions of professional nursing, the success of this teaching may be used as a gauge for evaluating comprehensive nursing care. This represents a challenge foe the future. A questionnaire consisting of 67 items was distributed to 200 professional nurses working ill direct patient care at Yonsei University Medical Center in Seoul, Korea. 160 (80,0%) nurses of the total sample returned completed questionnaires 81 (50.6%) nurses were graduates of 3 fear diploma courser 79 (49.4%) nurses were graduates of 4 year collegiate nursing schools in Korea 141 (88,1%) nurses had under 5 years of clinical experience in a medical center, while 19 (11.9%) nurses had more than 5years of clinical experience. Three hypotheses were tested: 1. “Nurses had high levels of concept and knowledge toward patient teaching”-This was demonstrated by the use of a statistical method, the mean average. 2. “Nurses graduating from collegiate programs and diploma school programs of nursing show differences in concepts and knowledge toward patient teaching”-This was demonstrated by a statistical method, the mean average, although the results showed little difference between the two groups. 3. “Nurses having different amounts of clinical experience showed differences in concepts and knowledge toward patient teaching”-This was demonstrated by the use of a statistical method, the mean average. 2. “Nurses graduating from collegiate programs and diploma school programs of nursing show differences in concepts and knowledge toward patient teaching”-This was demonstrated by a statistical method, the mean average, although the results showed little difference between the two groups. 3. “Nurses having different amounts of clinical experience showed differences in concepts and knowledge toward patient teaching”-This was demonstrated by the use of the T-test. Conclusions of this study are as follow: Before attempting the explanation, of the results, the questionnaire will he explained. The questionnaire contained 67 questions divided into 9 sections. These sections were: concept, content, time, prior preparation, method, purpose, condition, evaluation, and recommendations for patient teaching. 1. The nurse's concept of patient teaching: Most of the nurses had high levels of concepts and knowledge toward patient teaching. Though nursing service was task-centered at the turn of the century, the emphasis today is put on patient-centered nursing. But we find some of the nurses (39.4%) still are task-centered. After, patient teaching, only a few of the nurses (14.4%) checked this as “normal teaching.”It seems therefore that patient teaching is often done unconsciously. Accordingly it would he desirable to have correct concepts and knowledge of teaching taught in schools of nursing. 2. Contents of patient teaching: Most nurses (97.5%) had good information about content of patient teaching. They teach their patients during admission about their diseases, tests, treatments, and before discharge give nurses instruction about simple nursing care, personal hygiene, special diets, rest and sleep, elimination etc. 3. Time of patient teaching: Teaching can be accomplished even if there is no time set aside specifically for it. -a large part of the nurse's teaching can be done while she is giving nursing care. If she believes she has to wait for time free from other activities, she may miss many teaching opportunities. But generally proper time for patient teaching is in the midmorning or midafternoon since one and a half or two hours required. Nurses meet their patients in all stages of health: often tile patient is in a condition in which learning is impossible-pain, mental confusion, debilitation, loss of sensory perception, fear and anxiety-any of these conditions may preclude the possibility of successful teaching. 4. Prior preparation for patient teaching: The teaching aids, nurses use are charts (53.1%), periodicals (23.8%), and books (7.0%) Some of the respondents (28.1%) reported that they had had good preparation for the teaching which they were doing, others (27.5%) reported adequate preparation, and others (43.8%) reported that their preparation for teaching was inadequate. If nurses have advance preparation for normal teaching and are aware of their objectives in teaching patients, they can do effective teaching. 5. Method of patient teaching: The methods of individual patient teaching, the nurses in this study used, were conversation (55.6%) and individual discussion (19.2%) . And the methods of group patient teaching they used were demonstration (42.3%) and lecture (26.2%) They should also he prepared to use pamphlet and simple audio-visual aids for their teaching. 6. Purposes of patient teaching: The purposes of patient teaching is to help the patient recover completely, but the majority of the respondents (40.6%) don't know this. So it is necessary for them to understand correctly the purpose of patient teaching and nursing care. 7. Condition of patient teaching: The majority of respondents (75.0%) reported there were some troubles in teaching uncooperative patients. It would seem that the nurse's leaching would be improved if, in her preparation, she was given a better understanding of the patient and communication skills. The majority of respondents in the total group, felt teaching is their responsibility and they should teach their patient's family as well as the patient. The place for teaching is most often at the patient's bedside (95.6%) but the conference room (3.1%) is also used. It is important that privacy be provided in learning situations with involve personal matters. 8. Evaluation of patient teaching: The majority of respondents (76.3%,) felt leaching is a highly systematic and organized function requiring special preparation in a college or university, they have the idea that teaching is a continuous and ever-present activity of all people throughout their lives. The suggestion mentioned the most frequently for improving preparation was a course in patient teaching included in the basic nursing program. 9. Recommendations: 1) It is recommended, that in clinical nursing, patient teaching be emphasized. 2) It is recommended, that insertive education the concepts and purposes of patient teaching he renewed for all nurses. In addition to this new knowledge, methods and materials which can be applied to patient teaching should be given also. 3) It is recommended, in group patient teaching, we try to embark on team teaching.