• Journal of Korean Physical Therapy Science
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• v.15 no.1
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• pp.67-74
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• 2008

A decrease in the ability to maintain static and dynamic balance after stroke could be related to the inability to select reliable sensory information in producing relative motor action needed to maintain postural stability. The purpose of this study was to compare the effects of two different types of surface conditions on the balancing ability of subjects with stroke. Eighteen hemiparetic subjects were assigned to an experimental and control group participating in a six－week rehabilitative therapeutic exercise program focusing on balance and mobility. Exercises were performed 3 to 5 times per week in a stable surface condition by the control group, and in an unstable surface condition by the experimental group. Pre－ and post test assessments involved the measurement of the static balance and dynamic balance, respectively by 7－item Berg Balance Scale－3P and by Pro－3 Balance System. Results showed that under the unstable surface condition, static balance in the experimental group showed more improvement than that of the control group.(Statistically, not very significant.) All the aspects of dynamic balance and mediolateral sway(balance) improved significantly than those of the control group. However, there were no significant differences between two groups. Overall, it can be concluded that under the unstable surface condition, the rehabilitative therapeutic exercise programs are effective in improving the dynamic balance of stroke subjects. The results suggest that the adaptation of the unstable surface in the rehabilitative therapeutic exercises could be effective for the patients with hemiplegia in balance. Further studies are needed to confirm the effectiveness of the unstable surface on improving balance and postural stability of hemiplegics.

• Journal of Korean Neurosurgical Society
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• v.30 no.11
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• pp.1271-1277
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• 2001

Objectives : Since vertebroplasty has been introduced, we performed short segment pedicle screw fixation with augmented intra-operative vertebroplasty in patients with unstable thoraco-lumbar fracture. Our intentions are to demonstrate the efficacy and indication of this new technique compare to conventional methods. Material and Methods : The surgery comprised of pedicle screw fixations on one level above and below the fracture site, and the fractured level itself, if pedicle is intact, and intra-operative vertebroplasty under the fluoroscopic guide with in-situ postero-lateral bone graft. Also, in cases of bone apposition, we removed those with small impactor through a transfascetal route. During the last 2 years, we performed in seven(7) unstable thoraco-lumbar fracture patients who consisted of two different characteristics, those four(4) with primary or secondary osteoporosis and three(3) of young and very healthy. All patients were followed clinically by A.S.I.A. score and radiography. Results : Mean follow up period was 14 months. We observed well decompressed state via transfascetal route in cases of bone fragments apposition and no hardware pullout in osteoporotic cases, no poly-methyl-methacrylate (PMMA) leakage through the fracture sites into the spinal canal, and no kyphotic deformities in both cases during follow-up periods. All patients demonstrated solid bony fusion except one following osteoporotic compression fracture on other sites. Conclusions : In the management of unstable thoraco-lumbar fracture, we believe that this short segment pedicle screw fixation with augmented intra-operative vertebroplasty reduce the total length or levels of pedicle screw fixation without post-operative kyphotic deformity.

• Journal of Korean Neurosurgical Society
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• v.53 no.2
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• pp.83-88
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• 2013

Objective : The authors reviewed their experiences of combined surgery (open door laminoplasty with unilateral screw fixation) for unstable multi-level cervical stenosis, to clarify the situation regarding the surgical approach most appropriate for the treatment of diffuse unstable multi-level cervical stenosis. Methods : From January 2011 to January 2012, combined surgery was performed for unstable multi-level cervical stenosis by one surgeon at our institution. The subjects of this study were 6 men of mean age 53.7 years (range, 48-71) with a mean follow-up of 9.3 (range, 3-14) months. All imaging studies showed severe multi-level cervical stenosis with spinal cord signal change, and instability or kyphotic deformity. A retrospective review of clinical, radiological, and surgical data was conducted. Results : Average laminoplasty level was 4.8 and the average screw fixation level was 5.0. Japanese Orthopedic Association score improved from an average of 5.2 to 11.2 points. According to Nurick's grades and Odom's criteria, symptom improvement was statistically significant. On the other hand, Cobb's angle changes were not significant. Average operation time was 5.86 hours with an average blood loss of 460 mL. No significant surgical complication was encountered. Conclusion : Despite the small cohort and the short follow-up duration, the present study demonstrates that laminoplasty with unilateral screw fixation is a safe and effective treatment for unstable multi-level cervical stenosis.

• Journal of Biomedical Engineering Research
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• v.28 no.5
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• pp.636-646
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• 2007

Adequate postural control depends on the spatial and temporal integration of vestibular, visual, and somatosensory information. Especially, the musculoskeletal function is essential to maintain the postural control. The experimental studies was performed on the muscular activities in the lower extremities during maintaining and moving exercises on an unstable platform with Magneto Rheological(MR) dampers. The unstable platform of the developed system was controlled by electric currents to the MR dampers. A subject executed the maintaining and moving exercises which are presented through the display monitor. The electromyographies of the eight muscles in lower extremities were recorded and analyzed in the time and the frequency domain: the muscles of interest were rectus femoris(RF), biceps femoris(BF), tensor fasciae latae(TFL), vastus lateralis(VL), vastus medialis(VM), gastrocnemius(Ga), tibialis anterior(TA), Soleus(So). The experimental results showed that the muscular activities differed in the four moving exercises and the nine maintaining exercises. For the anterior-posterior pattern, the TA showed highest activities; for the left-right pattern, the TFL; for the 45, $-45^{\circ}$ pattern, the TFL and TA. Also, the rate of the increase in the muscular activities were affected by the condition of the unstable platform with MR dampers for the maintaining and moving exercises. The experimental results suggest that the choice of different maintaining and moving exercises could selectively train different muscles in various intensity. Futhermore, the findings suggested that the training using this system can improve the ability of postural control.

• Journal of Biomedical Engineering Research
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• v.28 no.5
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• pp.647-656
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• 2007

The purpose of this study was to analyze the effects of vibratory stimulus as somatosensory inputs on the postural control in human standing. To study these effects, the center of pressure(COP) was observed while subjects were standing on a stable and an unstable support with co-stimulated mechanical vibrations to flexor ankle muscles(tibialis anterior tendon, achilles tendon) and two plantar zones on both foot. The COP sway measurement was repeated twice in four conditions: (1) with visual cue and vibration, (2) without visual cue and vibration, (3) with visual cue and without vibration, (4) without visual cue and with vibration. The calculated parameters were the COP sway area and the distance, the median frequency and the spectral energy of COP sway in three intervals $0.1{\sim}0.3,\;0.3{\sim}1,\;1{\sim}3Hz$. The results showed that vibratory stimulus affect postural stability. The reduction rate of the COP sway with vibratory stimulus were higher on the unstable support because the effect of postural stability increases when afferent nervous flow is more activated by vibration on unstable support. If unclear visual or vibratory information is received, one type of information is compared with the other type of sensory information. Then the input balance between visual and vibratory information is corrected to maintain postural stability. These findings are important for the rehabilitation system of postural balance control and the use of vibratory information.

• Korean Journal of Applied Biomechanics
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• v.16 no.3
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• pp.165-172
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• 2006

The purpose of this study was to determine effects of 12-week wearing of unstable shoe on the standing posture and gait mechanics. Nine healthy men were asked to wear the unstable shoes for 12-week and walk for 30 minute everyday. Their standing posture and gait mechanics were measured before and after treatment. Standing posture was measured for each side(anterior, posterior, lateral) for standing position. And gait analysis was measured joint angle of a right lower limb between first right heel contact and second right heel contact. Kinematic data were collected using video camera at 30 frame per seconds. Statistical analysis was paired t-test(p<.05) to compare before training with after that. A head tilt angle was significantly decreased for posterior side(p<.05). The angle of between center of line and surface was significantly decreased at midstance and take off during walking(p<.05). Ankle dorsiflexion significantly increased at heel contact2(p<.05) and ankle plantarflexion significantly increased at midstance and midswing(p<.05). The increase of ankle dorsiflexion showed that our results consisted with previous study. In conclusion, there was not large significant difference in static standing posture but joint angle of lower limb represented many changes with increasing of ankle motion during walking. These were of benefit to body by increasing leg muscle activity but it was necessary for man having a ankle problem to consider. Further studies concerning optimum outsole angle of unstable shoes are necessary.

• Physical Therapy Korea
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• v.20 no.3
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• pp.1-8
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• 2013

The purpose of this study was to determine the effectiveness of sit-to-stand training on unstable surfaces in individuals with stroke. Nineteen subjects with chronic stroke were divided into two groups: an experimental group (10 subjects) and a control group (9 subjects). They received 30 minutes of Neuro-developmental therapy (NDT) treatment, and sit-to-stand exercise for 15 minutes three times a week for four weeks. During the sit-to-stand training, the experimental group performed on an unstable AIREX balance pad, but the control group performed on a stable surface. Balance ability and weight-bearing distribution during quiet standing were measured before and after training period using the 7-item Berg balance scale-3P (BBS-3P) and the Five-times-sit-to-stand test (FTSST). In addition, the muscle strength of the knee extensor was evaluated before and after the training period. The results were as follows: 1) The weight-bearing distribution forward of the affected leg, increased significantly in the experimental group after the four-week intervention (p<.05), 2) The 7-item BBS-3P and FTSST increased significantly in the experimental group after the four-week intervention (p<.05), 3) The knee extensor muscle strength in both groups increased significantly after the four-week intervention (p<.05). In conclusion, the results of this study did not show that the sit-to-stand training on an unstable surface was more effective than on a stable surface. However, the results suggested that sit-to-stand training is effective in the balance training of stroke patients.

• Journal of Korean Neurosurgical Society
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• v.44 no.1
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• pp.8-14
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• 2008

Objective : The purpose of this study was to determine the efficacy of short segment fixation following postural reduction for the re-expansion and stabilization of unstable burst fractures in patients with osteoporosis. Methods : Twenty patients underwent short segment fixation following postural reduction using a soft roll at the involved vertebra in cases of severely collapsed vertebrae of more than half their original height. All patients had unstable burst fracture with canal compromise, but their motor power was intact. The surgical procedure included postural reduction for 2 days and bone cement-augmented pedicle screw fixations at one level above, one level below and the fractured level itself. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. Results : The mean follow-up period was 15 months. The mean pain score (visual analogue scale) prior to surgery was 8.1, which decreased to 2.8 at 7 days after surgery. The kyphotic angle improved significantly from $21.6{\pm}5.8^{\circ}$ before surgery to $5.2{\pm}3.7^{\circ}$ after surgery. The fraction of the height of the vertebra increased from 35% and 40% to 70% in the anterior and middle portion. There were no signs of hardware pull-out, cement leakage into the spinal canal or aggravation of kyphotic deformities. Conclusion : In the management of unstable burst fracture in patients with severe osteoporosis, short segment pedicle screw fixation with bone cement augmentation following postural reduction can be used to reduce the total levels of pedicle screw fixation and to correct kyphotic deformities.

• BMB Reports
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• v.29 no.4
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• pp.286-293
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• 1996

Association of antigenic peptide with class I MHC is believed to be crucial for maintaining stable conformation of class I molecules. T2 cells that are defective in TAP gene function mainly express class I molecules with an unstable conformation due to little or no association with antigenic peptides, whereas T1 cells that are normal in TAP gene function mainly express the stable form of class I molecules. In this work, attempts were made to determine the molecular stability of stable and unstable class I molecules. Dissociation of HLA-A2 molecules on T1 and T2 cells was monitored by flow cytometry using anti-HLA-A2 antibody after the cells were treated with brefeldin A to shut down the transport of newly-assembled HLA-A2. Estimated dissociation rate constants for the stable and unstable forms of HLA-A2 were 0.076 $h^{-1}$ and 0.66 $h^{-1}$, respectively. It appeared that both T1 and T2 cells express stable and unstable class I complex, but with different ratios of the two forms. Furthermore, $interferon-{\gamma}$ treatment of T1 cells appeared to induce the expression of both the stable and unstable class I molecules. These results demonstrate that class I MHC molecules can be divided into two groups in terms of structural stability and that they exist on the cell surface in both forms in a certain ratio.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.198-204
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• 1998

Unstable fractures of the proximal humerus continue to be difficult problems for orthopaedic surgeons. The optimum treatment of these fractures has remained a matter of controversy. We analyzed the clinical results of open reduction and plate fixation underwent for patients of unstable fractures of proximal humerus after minimum 12 months follow up. The purpose of this study is to evaluate the efficacy of open reduction and rigid plate fixation. Twenty-two patients were managed with open reduction and plate fixation. Mean follow up duration was 20.6 months(range, 12 to 28 mon.). Because the age of patient as a maker of degree of osteoporosis was considered the key factor in the success of anatomic reconstruction, we divided into two groups according to age. Group A was comprised of 12 cases with younger than 50 yrs of age. Ten cases of older than 50 yrs of age were Group B. According to Neer's classification, five cases(22%) were two part fracture, 12 cases(64%) were three part fracture, and three cases(14%) were four part fracture. We used the Neer rating system for evaluating the results. In Group A, overall scores were 79.1. In Group B, overall scores were 76.8. Overall scores in two part fracture were 85, overall scores in three part fracture 78.4 and overall scores in three part fracture 68.3. We achieved excellent or good results in nine cases(75%) of Group A and seven cases(70%) of Group B. Also, we obtained excellent or good results in all cases of two part fracture, ten cases(71%) of three fracture and one case(33%) of four part fracture. The complications were three metal loosening, one avascular necrosis of humeral head, one severe stiff shoulder, one superficial wound infection and one ectopic ossification. The results were excellent or good in 16 cases(73%) out of 22 cases. In conclusion, rigid fixation and supervised early exercise would be a good option for unstable fracture of the proximal humerus.