• 한국전문물리치료학회지
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• 제21권2호
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• pp.37-47
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• 2014

Falls are common after stroke and most frequently related to loss of balance while walking. Consequently, preventing falls is one of the goals of acute, rehabilitative, and chronic stroke care. The purpose of this study was to investigate the incidence and risk factors of falls and to determine how well the Falls Efficacy Scale (FES), Timed Up and Go test (TUG), and Berg Balance Scale (BBS) could distinguish between fallers and non-fallers among stroke patients during inpatient rehabilitation. One hundred and fifteen participants with at least 3 months post-stroke and able to walk at least 3 m with or without a mono cane participated in this study. Fifty-four (47%) participants reported falling, and 15 (27.8%) had a recurrent fall. Logistic regression analysis for predicting falls showed that left hemiplegia [odds ratio (OR)=4.68] and fear of falling (OR=5.99) were strong risk factors for falls. Fallers performed worse than non-fallers on the FES, TUG, and BBS (p<.05, p<.01, respectively). In the receiver operator characteristic curve analysis, the TUG demonstrated the best discriminating ability among the three assessment tools. The cut-off score was 22 seconds on the TUG for discriminating fallers from non-fallers (sensitivity=88.9%, specificity=45.9%) and 27 seconds for discriminating recurrent fallers from single fallers and non-fallers (sensitivity=71.4%, specificity=40.2%). Results suggest that there is a need for providing fall prevention and injury minimization programs for stroke patients who record over 22 seconds on the TUG.

• The Journal of Korean Physical Therapy
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• 제13권3호
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• pp.643-651
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• 2001

Osteoarthritis(OA) is a widespread, slowly developing disease with a high prevalence rate increasing with age. The most common big joints involved in OA is the knee, where the disease particulary strikes, causing difficulties in rising from a chair. climbing stairs, kneeling. standing, and walking. The primary complaints of these patients include pain, stiffness. instability, and loss of function. The purpose of this study was to assess the impact of self-reported symptoms and limited flexion, and limited extension on functional impairment in patients with knee osteoarthritis. In the data collection, a total of 206 who had visited the physiotherapy unit at six different departments of orthopedics were interviewed in K City from June to September, 2000. The results of the study summarized are as fellows: 1. There was a significant difference among different degree group of limited flexion(p<0.05). A group difference was demonstrated between <5 ${\sim}$ 15 and 16 > (F=16.21, p<0.05). In the relationship between the degree of limited flexion and the level of functional impairment, the h igher the range of limited flexion, the lower the level of functional impairment. 2. In the relationship between the degree of limited extension and the level of functional impairment, a group difference was revealed between the non-limitation group and the <10 and 11 < However, no significant difference was noted between 11 ${\sim}$ 20 and 21 >(F= 13.37, p<0.05). In conclusion, finding above suggest that functional impairment is closely correlated with limited tlexion and extenion

• 한국전문물리치료학회지
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• 제9권3호
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• pp.47-65
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• 2002

This study examined the correlations among the Berg Balance Scale, which is a clinical tool used to evaluate balance ability, spatiotemporal parameters of gait, and falling; determined the parameters most closely related to falling; and identified a discriminatory parameter and its predictability. Thirty-four subjects aged 72 to 92 years participated in this study. Following a questionnaire survey about falling, the Berg Balance Scale and spatiotemporal parameters of gait were measured. The results revealed that the incidence of falls increased with aging and an accompanying reduction in the flexion range of motion of the hip joint. The gait characteristics of elderly people who fell easily included a slower walking speed, shorter stride, and longer stance time than other elderly. When the cutoff score was set at 45, the Berg Balance Scale was able to identify correctly those individuals who truly have experience of falling than when the cutoff score was set at 39. But when the cutoff score was set at 39, the scale's specificity identifying correctly those individuals who truly have not experience of falling was higher than at the cutoff score of 45. Therefore, the Berg Balance Scale is an appropriate screening method in a clinical setting for the early detection of elderly people at risk of falling. In conclusion, elderly people with a Berg Balance Scale score. below 45 are the most likely to fall owing to their decreased balance ability.

• 국제물리치료학회지
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• 제5권2호
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• pp.738-742
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• 2014

This study was conducted to investigate the effect of FES and ankle mobilization on the ankle motion and the quality of gait of chronic hemiplegic patients with limited ankle joint motions. As research subjects, 24 chronic hemiplegic patients who could walk independently, regardless of assistive aids, were selected. Then, 8 subjects received mobilization randomly and 8 subjects received FES and 8 subjects received mobilization and FES, at the same time. The dorsiflexion PROM significantly increased in the group of mobilization therapy, mobilization and FES all together(p<.01). There were statistically significant differences among the three groups(p<.01). The 10m walking test significantly decreased in the group of mobilization therapy, mobilization and FES all together(p<.05). There were statistically significant differences among the three groups(p<.01). The gait velocity significantly increased in the group of mobilization therapy, FES therapy, mobilization and FES all together(p<.05). There were statistically significant differences among the three groups(p<.01). The stride length significantly increased in the group of mobilization therapy, mobilization and FES all together(p<.05). There were statistically significant differences among the three groups(p<.05). In conclusion, these findings demonstrate that rather than only using one treatment technique, applying mobilization and FES together brings a more satisfactory result to hemiplegic patients with limited ankle joint motions.

• 대한의용생체공학회:의공학회지
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• 제41권3호
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• pp.121-127
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• 2020

The purpose of this paper is to review the validation on the application of low frequency IMU(Inertial Measurement Unit) sensors by replacing high frequency motion analysis systems. Using an infrared-based 3D motion analysis system and IMU sensors (22 Hz) simultaneously, the gait cycle and knee flexion angle were measured. And the accuracy of each gait parameter was compared according to the statistical analysis method. The Bland-Altman plot analysis method was used to verify whether proper accuracy can be obtained when extracting gait parameters with low frequency sensors. As a result of the study, the use of the new gait assessment system was able to identify adequate accuracy in the measurement of cadence and stance phase. In addition, if the number of gait cycles is increased and the results of body anthropometric measurements are reflected in the gait analysis algorithm, is expected to improve accuracy in step length, walking speed, and range of motion measurements. The suggested gait assessment system is expected to make gait analysis more convenient. Furthermore, it will provide patients more accurate assessment and customized rehabilitation program through the quantitative data driven results.

• 대한물리의학회지
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• 제13권2호
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• pp.75-87
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• 2018

PURPOSE: The purpose of this study was to describe and analyze the components of physical therapy interventions to enhance postural control and mobility in children with spastic diplegia. METHODS: Thirsty-eight physical therapists working in rehabilitation settings volunteered to record the components of physical therapy interventions used during 894 treatment sessions for 179 children with spastic diplegia presenting with difficulties in postural control and mobility. Descriptive statistics were used to analyze the general characteristics of the therapists, the patients, and the frequency of the interventions. A one-way analysis of variance (ANOVA) and chi-square test were used to describe the components of the interventions and the goals of treatment. RESULTS: In clinical practice, physical therapists primarily used methods including "Hands-on: facilitation" (n=1990, 36.47%) and "Hands-off: practice" (n=1355, 24.83 %). Only 13.96% (n=762) of the interventions allowed patients to be independent or active outside of the treatment sessions. Interventions reflecting the therapeutic aims were performed for sitting (17.53%), standing (18.25%), and walking (27.39%). CONCLUSION: Physical therapists mostly used "therapistled" interventions to treat impaired postural control and mobility in children with spastic diplegia. Interventions to facilitate independent activity or practice outside the treatment sessions are infrequently used. These types of interventions were used regardless of the aims of treatment.

• The Journal of Korean Physical Therapy
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• 제23권6호
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• pp.15-22
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• 2011

Purpose: This research investigated falls due to obstacles that occur among elderly people by assessing changes in the values of plantar foot force, peak force, and plantar foot pressure in elderly subjects while they were stepping over obstacles of different heights. Methods: The subjects were 20 elderly people aged 70-80 years; Pressure was measured on flat ground(0 cm), and after installing obstacles of 8 cm and 12 cm using the F-scan system, which is a resistance-type pressure sensor. A one-way analysis of variance was performed to compare pressure on each part of the foot according to various heights after collecting data using the Tekscan program. The least significant difference test was used for the post-hoc analysis, A p-value <0.05 was considered significant. Results: The force value for the toe area (parts 1, and 2) and contact pressure increased significantly with the 12 cm obstacle (p<0.05). The peak force value and the peak contact pressure for part 1 increased significantly with the 12 cm obstacle (p<0.05). Conclusion: Larger changes appeared in the functions and structure of the foot while subjects walked over obstacles of different heights compared to flatland walking. This result suggests that people have safety strategies to prevent falls, and that there is a need for a more realistic approach through practice to overcome obstacles of various heights to prevent falls.

• The Journal of Korean Physical Therapy
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• 제16권4호
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• pp.38-58
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• 2004

The regain of independent ambulatory ability is a important goal in the rehabilitation program of hemiplegic patient. Not only the function of lower extremity muscles, but also trunk muscles which stabilize extremities and pelvis, are important factors in normal gait. Therefor, it is necessary to develop an effective program which can improve muscle strength and symmetric activity of trunk muscles. The purpose of this study was to evaluate the influence of trunk muscle strengthening by forceful respiratory exercise on the gait asymmetry ratio in hemiplegic patient. 45 Hemiplegic patients due to stroke was randomized in 3 groups, forceful expiratory training(FET), forceful inspiratory training(FIT) and control group. In the experimental groups, ordinary physical therapy with forceful expiratory training and forceful inspiratory training for 20 minutes duration 3 times per week for 6 weeks were respectively performed. In the control group, only ordinary physical therapy was done. Before and after experiments, temporal-spatial gait parameters was measured in all patients. The data of 28 patients who carried out the whole experimental course were statistically analysed. The results of these experiment are as follows : 1. In comparison of difference of single support time asymmetry ratio among 3 groups, the FET group was significantly decreased than the control group (p<.05). 2. In comparison of difference of step length asymmetry ratio among 3 groups, the FIT group was significantly decreased than the control group (p<.05). Based on these results, it is concluded that the forced respiratory exercise program for 6 weeks can be improve the gait asymmetry ratio in hemiplegic patients. Therefore, the forced respiratory exercise is useful to improve the walking ability in hemiplegic patients. Since this study dealt only with the patients who could walk more than 3 meters in distance on floor independently, the further study for evaluating the influence of the forceful respiratory exercise on patients with acute stage stroke and also the development in various methods of use are expected.

• 한국운동역학회지
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• 제17권1호
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• pp.111-119
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• 2007

The purpose of this study was to investigate muscle activity and gait pattern in lower limb depending on the outsole of heel rockers. Fifteen healthy men volunteered for this experiment. Each subject performed totally three trails with two pairs of different heel rocker shoes and a pair of normal running shoes at speed of 1.33m/s for 1 minute during walking on a treadmill. Kinematic data gathered in 100Hz was recorded and analyzed by using the 3D motion capture system to measure the trunk tilt and joint angle of the right lower limb. And the lower extremity muscle activities were simultaneously recorded in 1000Hz and assessed by using EMG. The statistical analysis was the one-way ANOVA with the repeated measures to compare among the three kinds of shoes. The level of statistical significance for all tests was 0.05. Joint angle of lower limb was showed statistically significant different in MST(hip joint), LHS(ankle joint), and RTO(knee and ankle joint). Muscle activity of rectus femoris and biceps femoris was statistically increased in both heel rocker shoes during gait cycle on treadmill. The maximum peak time of tibialis anterior in the negative heel rocker showed the delay of approximately 23.8%time than normal shoes. Gait pattern variability of the negative heel rocker was increased in the first half of the stance phase and the variability of the positive heel rocker was increased in the terminal stance phase. In Conclusion, stability was decreased in between joints of lower limb on positive heel rocker than negative heel rocker. This study found that there were different joint angle, muscle activity, gait pattern and coordinate system of the lower limb in each kind of shoes. These unstability affected the lower extremity and the whole body. A further study has to be continued with study of rehabilitation and exercise for a long-term.

• 제어로봇시스템학회논문지
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• 제17권10호
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• pp.1021-1028
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• 2011

The objective of this paper is to optimize the design parameters of a novel mechanism for a robotic knee orthosis. The feature of the proposed knee othosis is to drive a knee joint with independent actuation during swing and stance phases, which can allow an actuator with fast rotation to control swing motions and an actuator with high torque to control stance motions, respectively. The quadriceps device operates in five-bar links with 2-DOF motions during swing phase and is changed to six-bar links during stance phase by the contact motion to the patella device. The hamstring device operates in a slider-crank mechanism for entire gait cycle. The suggested kinematic model will allow a robotic knee orthosis to use compact and light actuators with full support during walking. However, the proposed orthosis must use additional linkages than a simple four-bar mechanism. To maximize the benefit of reducing the actuators power by using the developed kinematic design, it is necessary to minimize total weight of the device, while keeping necessary actuator performances of torques and angular velocities for support. In this paper, we use a SGA (Simple Genetic Algorithm) to minimize sum of total link lengths and motor power by reducing the weight of the novel knee orthosis. To find feasible parameters, kinematic constraints of the hamstring and quadriceps mechanisms have been applied to the algorithm. The proposed optimization scheme could reduce sum of total link lengths to half of the initial value. The proposed optimization scheme can be applied to reduce total weight of general multi-linkages while keeping necessary actuator specifications.