• 한국전문물리치료학회지
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• 제22권2호
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• pp.1-10
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• 2015

The common features of walking in patients with stroke include decreased gait velocity and increased asymmetrical gait pattern. The purpose of this study was to identify important factors related to impairments in gait velocity and asymmetry in chronic stroke patients. The subjects were 30 independently ambulating subjects with chronic stroke. The subjects' impairments were examined, including the isokinetic peak torque of knee extensors, knee flexors, ankle plantarflexors, and ankle dorsiflexors. Passive and active ranges of motion (ROM) of the ankle joint, ankle plantarflexor spasticity, joint position senses of the knee and ankle joint, and balance were examined together. In addition, gait velocity and temporal and spatial asymmetry were evaluated with subjects walking at their comfortable speed. Pearson correlations and multiple regressions were used to measure the relationships between impairments and gait speed and impairments and asymmetry. Regression analyses revealed that ankle passive ROM and peak torque of knee flexors were important factors for gait velocity ($R^2=.41$), while ankle passive ROM was the most important determinant for temporal asymmetry ($R^2=.35$). In addition, knee extensor peak torque was the most significant factor for gait spatial asymmetry ($R^2=.17$). Limitation in ankle passive ROM and weakness of the knee flexor were major contributors to slow gait velocity. Moreover, limited passive ROM in the ankle influenced the level of temporal gait asymmetry in chronic stroke patients. Our findings suggest that stroke rehabilitation programs aiming to improve gait velocity and temporal asymmetry should include stretching exercise for the ankle joint.

• The Journal of Korean Physical Therapy
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• 제21권3호
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• pp.53-59
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• 2009

Purpose: The purpose of this study was to investigate the effects of proprioceptive exercise on the body alignment of elderly women. Method: The experimental group consisted of twenty elderly women who participated in proprioceptive exercise for 8 weeks. The subjects were measured using Global Posture System equipment for assessing their body alignment. Body alignment was measured at the ear, shoulder joint, knee joint and calcaneocuboid joint on the sagittal plane, and the left and right acromion process positions, the ASIS and the medial malleoulus on the coronal plane. The body alignment data was used to assess the changes before and after proprioceptive exercise. The data of the experimental group was compared and analyzed using the Wilcoxon singed-rank test between before and after proprioceptive exercise. The Mann-Whithney test was used to compare the experimental group and the control group. Result: The result of this study was that the body alignment of the experimental group at the ear and knee joint on the sagittal plane was significantly in alignment with the line of gravity (p<0.05) before and after proprioceptive exercise. The body alignment was statistically different (p<0.05) between the experimental group and the control group on the frontal plane and sagittal plane. Conclusion: This study showed that proprioceptive exercise does affect the body alignment in elderly women. This indicates that there is interaction that plays a crucial role for proprioceptive stimuli and the body alignment.

• 대한물리의학회지
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• 제11권4호
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• pp.93-103
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• 2016

PURPOSE: The purpose of this study is to determine the effect of therapeutic exercise on pain, range of motion and strength, and balance ability in a patient with an anterior ankle impingement (AAI). METHODS: A-32-year-old male presented limited ankle motion and pain with forced dorsiflexion at both ankle joints. In response, a therapeutic exercise program consisted of ankle joint mobilization, strength exercises using an elastic band, and proprioceptive exercises including semi-squats and a one-legged standing exercise with open and closed eyes. The program was performed for 40 min/day, twice per week, for 8 weeks. Pain, range of motion (ROM), and muscle strength (ankle dorsiflexion, plantarflexion, inversion, and eversion), as well as a one-legged standing test of both ankles, were measured before and after 4 and 8 weeks of therapeutic exercise. RESULTS: VAS decreased in both ankles after 8 weeks of exercise, respectively, compared to baseline levels. Range of motion and strength increased in both ankles for dorsiflexion, plantarflexion, inversion, and eversion after 8 weeks of exercise compared to baseline levels. In addition, the ability to perform a one-legged standing test with eyes opened and closed improved in both legs after 8 week of exercise compared to baseline levels. CONCLUSION: These results suggest that therapeutic exercise improves pain, ROM, muscle strength, and balancing ability in patients with AAI.

• 한국운동역학회지
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• 제23권4호
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• pp.335-345
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• 2013

The purpose of this study was to investigate the effects of foot type and ankle joint fatigue levels on the trajectories of center of pressure and center of mass during a single-leg stance. The study subjects included 24 healthy women (normal foot group, n=10; pronated foot group, n=14). Ankle joint muscle fatigue was induced by using an isokinetic dynamometer, where the fatigue levels were measured on plantar flexion and dorsiflexion at angular velocities of $30^{\circ}/s$ at 50% and 30% of the peak torque of ankle plantar flexion. Following assessments in the anteroposterior direction according to the level of fatigue, the pronated foot group showed decreased single-leg stance ability at 50% and 30% of the fatigue level. Moreover, the normal foot group showed better single-leg stance ability than the pronated foot group at 30% of the fatigue level. Following assessments in the mediolateral direction, we noted that the single-leg stance ability did not differ significantly according to the levels of fatigue or foot type. In conclusion, ankle plantar flexion at 50% and 30% of the peak torque reduced the ability of the pronated foot group to achieve a single leg stance in the anteroposterior direction. Moreover, the normal foot group showed better single-leg stance ability than the pronated foot group.

• 한국학교ㆍ지역보건교육학회지
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• 제10권2호
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• pp.29-42
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• 2009

연구목적: 본 연구는 고교운동선수들의 스포츠상해(부상)현황 파악을 통한 사고 및 손상예방을 목적으로 개발된 손상감시프로그램을 설명하고, 1년간 수집된 자료를 보고하기 위하여 수행되었다. 연구방법: 본 연구는 미국 플로리다주 내의 10개 고등학교에 재학 중인 학생 운동선수들의 스포츠상해(부상)에 대한 세부내용(사고경위, 상해부위, 사고 당시 환경적 요소 등)을 수집하여 이루어졌다. 학생 운동선수들에게 발생한 스포츠상해 조사 및 보고는 2007년에서 2008년에 걸친 학기동안 각 학교에 배치된 운동트레이너(Certified Athletic Trainer)에 의해 이루어졌다. 연구결과: 조사기간 동안 10개 조사대상 고등학교에서 614건의 스포츠상해가 발생하였고, 연습 중 사고노출 비율(1,000회의 연습 중 1명의 선수가 상해를 입는 경우를 기준으로 함)에 있어서는 풋볼(Football)이 2.73을 기록해 가장 높은 상해율을 보였으며 여자축구(2.03)와 남자농구(1.67)가 그 뒤를 이었다. 실전경기 중 사고노출 비율(1,000회의 실전경기당 1명의 선수가 상해를 입는 경우를 기준으로 함)의 경우, 풋볼(Football)이 14.4, 여자농구가 9.96, 레슬링이 7.1을 기록하였다. 운동상해로 인한 증상은 염좌/삠(관절손상)이 가장 많았고, 가장 많이 다치는 신체부위는 발목, 무릎, 머리인 것으로 나타났다.

• 한국전문물리치료학회지
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• 제17권2호
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• pp.60-66
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• 2010

In chronic ambulatory hemiplegic patients, structural changes might be developed at both ankles possibly due to unequal and repetitive weight bearing on tendons and ligaments. We examined ankles by sonography to find out structural changes of tendons and ligaments of both ankles in ambulatory hemiplegic patients. Nineteen ambulatory hemiplegic patients over 1 year were included as study subjects. All subjects had no previous trauma or disease history in their ankle joints and they were able to walk independently or with supervision but had spastic ankles with equinovarus tendency. We examined both ankle joints by sonography to see joint effusion and measure width, thickness, and area of tendons of the tibialis anterior, tibialis posterior, and Achilles, and also ligaments of the anterior talofibular and calcaneofibular. We compared sonographic features of the hemi-side ankle with the sound-side ankle. There were no significant differences between hemi-side and sound-side ankles in almost all measured parameters of tendons and ligaments. However, the width of the hemi-side tibialis posterior tendon ($7.24{\pm}1.52$ mm) was narrower than the sound-side tendon ($8.61{\pm}1.37$ mm). With the amount of active joint motion and weight bearing possibly preventing ligament and tendon atrophy even though marked weakness, spasticity occurred during the chronic hemiplegic phase.

• 한국CDE학회논문집
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• 제17권3호
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• pp.149-155
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• 2012

The ankle over-pronation causes the mechanical overloading transferred to proximal areas (i.e. knees or hips) over time. Thus, the over-pronation is recognized as a contributory factor in a wide variety of musculo-skeletal pathologies in lower extremities. Commonly, over-pronated ankles are treated using specially designed insoles that support medial heels and correct the posture of lower limbs. However, the biomechanical effects of the insoles are not yet fully understood, so there still are controversies whether such insoles really have clinical significance. In this study, in order to verify the effects of insoles and determine the best shape of the insoles, we examined how the medio-lateral knee joint reaction force changes due to insole conditions through a case study about a subject. As a result, it is revealed that the medial heel post, which drastically reduced the peak medio-lateral knee joint reaction force, has significant effects on the gait of the over-pronated patients. However, in case that the arch support is combined together, the positive effect of the medial heel post may rather decrease.

• 대한물리치료과학회지
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• 제23권1호
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• pp.18-23
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• 2016

Purpose : The purpose of the present study is to report the effect of proprioception of ankle after kinesiotaping application on ankle. Method : This study has conducted to target 30 average adult subjects with no damage to the ankle joint (16 males and 14 females). The group is divided into experimental group and sham groups in random way. The subjects in the experimental group are applied taping kinesiology on ankle joint. The subjects in the sham group are applied a sham taping on the ankle joint which is not actually affected for real ankle joint problem. Each subjects in both groups has tree trials in plantarflexion, dorsiflexion, inversion, and eversion before and after application of the kinesiotaping or sham taping of the bare footed ankle. The outcome were determined from the difference between the target angle and the trial angle produced by the subject. Results : These results from the experiment shows that the experimental group compared to the difference in kinesiotaping angle values were significantly different from each dorsiflexion (DF), eversion (EV) (p<.05). Otherwise, in the sham group did not produce significant differences in any joint movement. In addition, when we compared between two groups (the experimental and sham groups), it did not show that there was significant differences. Conclusion : First, there is no significant difference between the sham group and kinesiotaping group after proprioceptive tests. Second, even though there is no significant outcome in statistical analysis, there is actual differences in the experiment. This result might be ceiling effect, and if the kinesiotaping were applied to actual ankle injury patients, this taping treatment could be very effective for curing this patient.

• 대한의용생체공학회:의공학회지
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• 제31권4호
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• pp.310-315
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• 2010

Estimation of muscle forces is important in biomechanics, therefore many researchers have tried to build a muscle model. Recently, optimization techniques for adjusting muscle parameters, i.e. EMG-driven model, have been used to estimate muscle forces and predict joint moments. In this study, an EMG-driven model based on the previous studies has been developed and isometric and isokinetic contraction movements were evaluated to validate the developed model. One healthy male participated in this study. The dynamometer tasks were performed for maximum voluntary isometric contractions (MVIC) for ankle dorsi/plantarflexors, isokinetic contraction at both $30^{\circ}/s$ and $60^{\circ}/s$. EMGs were recorded from the tibialis anterior, gastrocnemius medialis, gastrocnemius lateralis and soleus muscles at the sampling rate of 1000 Hz. The MVIC trial was used to customize the EMG-driven model to the specific subject. Once the subject's own model was developed, the model was used to predict the ankle joint moment for the other two dynamic movements. When no optimization was applied to characterize the muscle parameters, weak correlations were observed between the model prediction and the measured joint moment with large RMS error over 100% (r = 0.468 (123%) and r = 0.060 (159%) in $30^{\circ}/s$ and $60^{\circ}/s$ dynamic movements, respectively). However, once optimization was applied to adjust the muscle parameters, the predicted joint moment was highly similar to the measured joint moment with relatively small RMS error below 40% (r = 0.955 (21%) and r = 0.819 (36%) and in $30^{\circ}/s$ and $60^{\circ}/s$ dynamic movements, respectively). We expect that our EMG-driven model will be employed in our future efforts to estimate muscle forces of the elderly.

• The Journal of Korean Physical Therapy
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• 제23권4호
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• pp.45-51
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• 2011

Purpose: To determine the correct measurement methods of the ankle joint complex range of motion for measuring the neutral position and evaluate the rater reliability. In addition, the impact of training on the rater reliability was also assessed. Methods: The subjects were eleven healthy women, who were evaluated by two physical therapists and one physical therapist recorded the results of the study. Standard goniometer was used as the measurement tool. The ankle and subtalar joint neutral position and the active range of motion of the ankle and subtalar joint were measured. Intra-rater reliability and inter-rater reliability measures were analyzed with intraclass correlation coefficients. Results: Intra-rater reliability and inter-rater reliability ranged from high to medium for the neutral position of the ankle joint complex. Intra-rater reliability for dorsiflexion and plantarflexion measurements was medium, while the inter-rater reliability was high. The range of motion of the subtalar joint was measured, and the intra-rater reliability and inter-rater reliability were low and medium, respectively Also, the intra-rater reliability was increased with formal training of the measurement techniques. Intra-rater reliability was reduced in case the raters had not undertaken the training. Conclusion: In summary, the results obtained with the measurement tools and joint measurement of position, indicate the consistency of repeated measurements made by the same observers. Under the same circumstances along with repetition of the same measurement technique during training caused an increase in the rater reliability of formally trained raters.