• Archives of Plastic Surgery
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• v.49 no.1
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• pp.91-98
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• 2022

Background Predicting the need for post-traumatic reconstruction of lower extremity injuries remains a challenge. Due to the larger volume of cases in adults than in children, the majority of the medical literature has focused on adult lower extremity reconstruction. This study evaluates predictive risk factors associated with the need for free flap reconstruction in pediatric patients following lower extremity trauma. Methods An IRB-approved retrospective chart analysis over a 5-year period (January 1, 2012 to December 31, 2017) was performed, including all pediatric patients (<18 years old) diagnosed with one or more lower extremity wounds. Patient demographics, trauma information, and operative information were reviewed. The statistical analysis consisted of univariate and multivariate regression models to identify predictor variables associated with free flap reconstruction. Results In total, 1,821 patients were identified who fit our search criteria, of whom 41 patients (2.25%) required free flap reconstruction, 65 patients (3.57%) required local flap reconstruction, and 19 patients (1.04%) required skin graft reconstruction. We determined that older age (odds ratio [OR], 1.134; P =0.002), all-terrain vehicle accidents (OR, 6.698; P<0.001), and trauma team activation (OR, 2.443; P=0.034) were associated with the need for free flap reconstruction following lower extremity trauma in our pediatric population. Conclusions Our study demonstrates a higher likelihood of free flap reconstruction in older pediatric patients, those involved in all-terrain vehicle accidents, and cases involving activation of the trauma team. This information can be implemented to help develop an early risk calculator that defines the need for complex lower extremity reconstruction in the pediatric population.

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.69-71
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• 2016

Reconstruction of the lower extremities is difficult due to a lack of skin laxity and muscular tissues. Here, we present a case of lower extremity reconstruction via the anterior tibial artery perforator based segmental muscle island flap. Our patient was a 75-year-old male with a chronic ulcerative wound on the right lower leg from an old car accident. A $5.0{\times}0.5cm$ size ulcerative wound with tibial bone exposure was noted. We planned to reconstruct the lower extremity defect with a free flap, but the vessel status was severely compromised intraoperatively. Thus, we found the anterior tibial artery perforator using Doppler ultrasound, elevated the tibialis anterior muscle segment flap, and transposed it to cover the defect successfully. The flap presented with a nice contour and the skin graft covering the flap survived completely. There were no complications of the surgical site at three months follow-up and no gait morbidity. This is a meaningful case applying the concept of segmental muscle flap based on a perforator that had advantages including proper bulkiness, vascularization, and preservation of function, which were well applied, leading to great success.

• PNF and Movement
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• v.21 no.2
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• pp.265-272
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• 2023

Purpose: The purpose of this study was to investigate tactile sense perception of the lower extremities according to physical function in children with spastic cerebral palsy. Methods: This study was conducted on 15 children diagnosed with spastic cerebral palsy. Physical function measurement items included dynamic balance ability, gross motor function level, and lower extremity ankle spasticity. The lower extremity tactile sensation uses a monofilament to measure the sole of the first metatarsal head, the sole of the fifth metatarsal head, the heel, the anterior part of the shin midway between the patella and the ankle joint, the kneecap, the upper anterior iliac spine, and the knee. A total of six measurements were taken in the mid-femoral region of the bone. Spearman correlation analysis was performed to determine the degree of body function and lower extremity tactile perception. Results: As the physical function of children with spastic cerebral palsy deteriorated, there was a decrease in tactile sensation in the thigh area corresponding to the proximal lower extremity. (p <.05). Conclusion: Children with spastic cerebral palsy and poor physical function have sensory loss not only in the distal part but also in the proximal part, so a treatment approach that recognizes and improves it is necessary.

• The Journal of Korean Physical Therapy
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• v.8 no.1
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• pp.65-78
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• 1996

This study wan described the movement patterns when rising from supine to erect stance in the third through eighth decades. Two hundred fifty six subjects, ranging in age from 30 year to 89 were filmed while rising from a supine position. Movement patterns were classified using categorical descriptions of the action of the upper and lower extremity, head-trunk region. This study was designed to determine whether within the rising task the movement patterns of different regions of the body vary with age level and sex, to describe time by subjects to perform this task. The incidence of each movement pattern was calculated and graphed wi th respect to age level and sex. Erect standing time was increased by age increasing in beth sex group. The most common form of rising for subject in the third through fifth decades both sex usually involved symmeytrical push with upper extremity, symmetrical squat pattern with lower extremity, partial rotation pattern wi th head-trunk and symmetrical push to push and reach pattern with upper extremity, symmetri cal squat pattern with lower extremity. partial rotation with head-trunk. In the sixth through eighth decades usually involved symmetrical push to push and reach pattern with upper extremity, symmetrical squat pattern with lower extremity, partial rotation pattern with head-trunk in both sex group.

• Journal of Society of Preventive Korean Medicine
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• v.3 no.1
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• pp.147-155
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• 1999

In order to investigate the effect of circulating blood and extinguishing blood stasis method on acute ischemic stroke treatment, we compared muscle weakness in two groups. Dansamhwanotang was administered to experimental group and the Sopungtang was administered to comparison group. In prospective and consecutive study, 24 patients(male 14, female 10) were admitted to hospital within 6hours(median $4.21{\pm}2.45)$ after stroke attack. All of them were diagnosed computed tomography as acute cerebral infarction. We divided that patients into two groups. The experimental group was 13, took median $4.17{\pm}1.72hrs$ to admission after stroke attack and the comparison group 11, median $4.31{\pm}2.72hrs$ to admission after stroke attack. There was no statistical difference in time consumed from stroke onset to admission(P>0.05). Muscle weakness was measured on admission and 7 days later on AMA(American Medical Association) method. In the experimental group, muscle weakness on admission was $2.23{\pm}0.51$ and $2.79{\pm}0.72$ in upper and lower extremity, respectively. In comparison group, muscle weakness on admission was $2.17{\pm}0.43$ and $2.67{\pm}0.82$ in upper and lower extremity, respectively. There was no difference in muscle weakness(P〈0.05). In 7 days after, muscle weakness was $2.31{\pm}0.35$ in upper extremity and $3.15{\pm}0.12$ in lower extremity in experimental group, and $2.27{\pm}0.74$ in upper extremity and $3.45{\pm}0.48$, lower extremity in comparison group. There was no meaningful improvement statistically in upper extremity(p<0.05) but significant evolution in lower extremity(p<0.05). The muscle weakness comparison between admission time and 7 days later was as follows. Experimental group had improvement at the degree of $0.24{\pm}0.92$, $0.42{\pm}0.82$ in upper and lower extremity, respectively and comparison group, $0.12{\pm}0.82$, $0.27{\pm}0.97$ in same part(p<0.05). So, Dansamhwanotang administered group had more good muscle weakness improvement than Sopungtang administered group(P>0.05). From the above result, I suppose that circulating blood and extinguishing blood stasis method helps recover hemiparesis caused by acute ischemic cerabral disease, in acute stage at least.

• The Journal of Korean Physical Therapy
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• v.32 no.3
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• pp.163-167
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• 2020

Purpose: Unilateral strength training effects on contralateral sides have been demonstrated in previous studies for lower extremity exercise, upper extremity exercise, and unilateral surface electrical stimulation. This study was performed to investigate the effects of unilateral ankle training on muscle strength and the balance of contralateral lower extremity in healthy adults. Methods: Thirty healthy subjects were randomized equally to a training or a control group. Those in the training group received unilateral ankle isokinetic strengthening training of the dominant leg (right side) for 4 weeks. Contralateral single-limb balance, including Anterio-Posterior Stability Index (APSI), Medio-Lateral Stability Index (MLSI) and Overall Stability Index (OSI), was assessed before and after intervention. Results: Comparison of pre- and post-test data revealed significant improvements in ipsi- and contralateral ankle strengths, and significant improvement in contralateral single limb balance. Conclusion: These results have practical implications because they demonstrate that unilateral ankle isokinetic exercise improves ankle muscle strength and balance ability of contralateral lower extremity.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.1
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• pp.11-21
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• 2016

PURPOSE: This study was examined the effects of aerobic exercise using a step box and lower extremity strengthening exercise with an elastic band on the balance ability and lower extremity muscular strength in elderly subjects. METHODS: Forty-one healthy adults were randomly divided into experimental group 1 (Exp 1, n=14), experimental group 2 (Exp 2, n=14), and a control group (n=13). The Exp 1 conducted lower limb strengthening exercise using an elastic band and the Exp 2 performed aerobic exercise with a step box 50 minutes per day, twice per week, for eight weeks. RESULTS: There was significant increase in the Exp 1 and Exp 2 in comparison of the change of lower limb muscle strength according to measurement time (p<.05). But there was no significant difference according to intervention methods. In one-leg standing test change among the three groups after the intervention, the Exp 1 and Exp 2 saw significant improvement compared to the control group (p<.05) but there was no significant difference according to intervention methods. The change of the functional reaching test results, the Exp 1 and Exp 2 saw significant improvement according to the time of measurement. In the change of the Timed Up and Go test, there was significant improvement in the Exp 1 and Exp 2 compared to the control group (p<.01), but there was no significant difference according to intervention methods. CONCLUSION: Exercise to lower extremity strengthening program accompanied with aerobic exercise is considered more effective in dynamical balance and ability to walk.

• Korean Journal of Applied Biomechanics
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• v.27 no.1
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• pp.45-52
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• 2017

Objective: The aim of this study was to investigate the periodicity of the lower extremity joint flexion/extension angle to compare the local stability between young and elderly women during walking on a treadmill. Method: Eighteen young women (mean $age=21.2{\pm}1.6y$; mean $mass=57.1{\pm}6.1kg$; mean $height=1.61{\pm}0.04m$) and 18 elderly women (mean $age=66.4{\pm}1.2y$; mean $mass=55.4{\pm}8.3kg$; mean $height=1.56{\pm}0.04m$) participated in this study. Approximate entropy (ApEn) was used to determine the periodicity in the lower limb joint angles. Results: The ApEn values of the two groups were statistically greater in the surrogate data test than in the original time series data (p<.05). The periodicity of the hip and ankle flexion/extension angles decreased in the elderly women group compared with the young women group (p<.05). The periodicity of the lower extremity joint flexion/extension angle showed that the ankle joint increased dominatingly in both groups (p<.05); the hip joint decreased compared with the knee joint in the young women group; and the knee joint decreased compared with the hip joint in the elderly women group (p<.05). Conclusion: These results suggest that the lower extremity joint flexion/extension angles of the young and elderly women during walking contained random noises as well as biological signals. In addition, the differences in the periodicity in the lower extremity joint between the young and elderly women may provide some insight in predicting potential falls and be used as a characteristic indicator for determining local stability in elderly women during walking.

• PNF and Movement
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• v.16 no.1
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• pp.143-150
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• 2018

Purpose: The purpose of this study was to investigate the influence of opposite lower extremity lateral muscle activation by proprioceptive neuromuscular facilitation (PNF) exercise targeting the lower extremities. Methods: Nineteen patients with chronic hemiplegia volunteered to participate in this study. PNF flexion, abduction, and internal rotation patterns; initial, end range, and extension patterns; abduction and internal rotation patterns; and initial and end range patterns were applied to the dominant lower extremity. Activation of lateral muscles (multifidus, gluteus medius, tensor fascia lata, and peroneous longus) of the paralyzed leg was then measured by electromyography (EMG). Results: There were significant differences in lateral muscle activation, depending on the PNF pattern applied, with the differences more significant in flexion, abduction, internal rotation, and end range patterns. Conclusion: PNF flexion, abduction, and internal rotation patterns can improve lateral muscle activation of one leg in the standing position in the gait cycle.

• Proceedings of the ESK Conference
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• 1993.04a
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• pp.1-9
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• 1993

A human gait study is required for the biomechanical design of running shoes. A tow-dimensional dynamic model was developed in order to analyze lower extremity kinematics and loadings at the right ankle, knee, and hip joints. The dynamic model consists of three segments, the upper leg, the lower leg, and the foot. Each segment was assumed to be a rigid body with one or two frictionless hinge joints. The lower extremity motion was assumed to be planar in the sagittal plane. A young male subject was involved in the gait test and his anthropometric data were measured for the calculation of segement mass and moment of inertia. The experimental data were obtained from three trials of walking at 1.2m/s. The foot-floor reaction data were measured from a Kistler force plate. The kinematic data were acquired using a three-dimensional motion measurement system (Expert Vision) with six markers, five of which were placed on the right lower extremity segments and the rest one was attached to the force plate. Based on the model and experimental data for the stance phase of the right foot, the calculated vertical forces reached up to 492, 540, and 561 N at the hip, knee, ankle joints, respectively. The flexion-extension moments reached up to 155, 119, and 33 Nm in magnitude at the corresponding joints.