• The Journal of Korean Physical Therapy
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• v.25 no.6
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• pp.399-404
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• 2013

Purpose: To investigate the effects of initiation side on gait symmetry in the chronic stroke patients. Methods: Twenty one patients with independent gait after stroke were divided into the paretic-leg gait initiation group (PLI) and the nonparetic-leg gait initiation group (NPLI). The symmetry ratio (SR) was calculated from of the spatiotemoral and kinematic parameter which measured by 3D motion analysis. Results: In the spatiotemporal variables, SR-step length and SR-velocity was significantly different between groups (p<0.05). In the kinematic variables, SR-TOAA and SR-SwPAA of the hip joint was significantly different between groups (p<0.05). Conclusion: We suggest that the initiating leg may influence on the gait symmetry of stroke patient These results will be a helpful reference in hemiplegic gait training or intervention.

• Physical Therapy Korea
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• v.21 no.1
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• pp.13-19
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• 2014

The purpose of this study was to determine the effect of gait initiation training on gait and center of pressure (CoP) during gait initiation in stroke patients. Twenty-three subjects were randomly assigned to either an experimental group (EG) or a control group (CG). The EG received gait initiation training with increased CoP posterior distances the maximum the rear on gait training. The CG received general gait training. Both groups received training three times a week over a period of four consecutive weeks. The figures for CoP distances the maximum the rear, CoP distances time the mover the maximum the rear, the Tinetti Performance-Oriented Mobility Assessment (POMA), and gait velocity were recorded both before and after the training sessions for both groups. The EG's results for CoP distances the maximum the rear, CoP distances time the mover the maximum the rear, and POMA improved after training (p<.05). In terms of the rate of change of CoP distances the maximum the rear, the EG demonstrated a significantly higher increase (p<.05) than did the CG. The results of this study suggest that increased CoP distances the maximum the rear affect the gait initiation and gait performance of stroke patients. Further studies with a larger sample size are necessary to verify the accuracy of the results of this study.

• Journal of Biomedical Engineering Research
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• v.31 no.1
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• pp.50-55
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• 2010

Gait initiation is a transitional process from the balanced upright standing to the beginning of steady-state walking. Dysbalanced gait initiation often causes stroke patients to fall. The net center of pressure, measured by two triaxial force plates from twenty healthy subjects and two stroke patients, was investigated to assess asymmetry of gait initiation in hemiparetic subjects. The time interval and distance of the net center of pressure(CoP) moved from the initiation point to the toe off(S1) and from the toe off to the initial contact(S2) were calculated during gait initiation of normal and stroke patients. When the patient with right hemiplegia(A) initiated his gait with right foot, the time interval and the distance of the net CoP in S1 and S2 were smaller than that of normal subjects' values. However, he initiated the gait with left foot(unaffected side) the time interval and the distance of net CoP in S1 were larger than normative values. Differently, the patient with left hemiplegia(B) has shown that larger time interval and distance in S1 and smaller time interval and distance in S2 in both sides. His asymmetry(with which side the gait initiated) was not significant. It is too early to conclude that these results could be general characteristics of the stroke patients because the variations were large and moreover, the level of motor recovery of the patients was different. However, it is expected that these trials could help to set up the strategy of the therapy for the rehabilitation or prevention of fall in stroke patients.

• Proceedings of the ESK Conference
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• 1995.10a
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• pp.141-155
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• 1995

To understand kinetic characteristics during the process of initation of gait from standing, from the visual cue to toe off of the stance limb, vertical ground reaction forces(GRF) and center of pressure(COP) during gait initation period were evaluate with two force platforms placed side by side in thirty two adults(young 16, elderly 16, each mean age 27.79 and 51.70 years) with no history of 7 neuromusculo-skeletal abnormality. Gaint initation period of swing and stance limbs, percentage of gait initiation period and ratio of the vertical forces to body weight at each peak of the vertical forces of both limbs, and also movement of net COP were measured and described. 2 groups, one of 16 young adults and another of 16 elderly adults, were compared statistically. These data showed the increase of initiation of gait period and the decrease of movement of net COP, nd also can now be used as a part of database when initation of gait in subjects with neuromusculoskeletal abnormalities need to be evaluated.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2004.05a
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• pp.289-289
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• 2004

보행 시작(Gait Initiation)은 정적 기립상태에서 출발하여 일정한 보행주기가 반복되기 전까지의 과정을 말한다. 이러한 보행의 시작은 아주 짧은 시간에 무의식적으로 이루어지는 움직이지만, 신경계의 조절 근육의 작용 및 생체역학적인 힘의 복합적인 통합에 의해 이루어진다. 노인의 낙상은 보행시작의 과정에 있어서 주로 신체노화와 질병으로 인한 균형 조절능력의 감소를 가장 큰 요인으로 보고 있다. 하지만 지금까지는 주로 운동역학과 동적 근전도에 대한 연구가 주류를 이루었다.(중략)

• Physical Therapy Korea
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• v.14 no.4
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• pp.44-49
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• 2007

The purpose of this study was to investigate the effects of auditory cues in the form of a metronome on gait initiation (GI) in Parkinson's disease (PD). 2 patients (mean age: 54 yrs) with idiopathic PD participated in the study. All patients (Hoehn and Yahr disability score of 2.0) were tested in the "on" state approximately 1.5 hours following the administration and fully responding to their PD medications. Subjects first initiated walking at self-initiated speeds to determine their cadences. Then, subjects were asked to initiate gait along the walkway while keeping pace with a metronome. The metronome rate (in beats/min) was set at a cadence 85% (slow condition), 100% (normal condition) and 115% (fast condition) of gait for each subject. Subjects were able to increase the speed of GI with faster cadence, but the speed of GI for the slow condition was similar to that of the normal condition. Swing toe-off was 578.3 ms for the fast condition, 709.4 ms for the normal condition and 736.2 ms for the slow condition. Respective times for swing heel-strike were 894.3 ms, 1110.2 ms and 1119.1 ms, and stance toe-off were 1105.4 ms, 1338.5 ms, and 1343.1 ms. Except for stance unloading ground reaction forces were greatest for the fast condition and smallest for the slow condition. It appears that PD patients were able to modulate GRFs and temporal events in response to auditory cues to achieve the peak acceleration force of the swing and stance limb. The findings from this study provided preliminary data, which could be used to investigate how PD patients modulate GRFs and temporal events during GI in response to tasks.

• Physical Therapy Korea
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• v.13 no.4
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• pp.79-86
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• 2006

The purpose of the current experiment was to describe interlimb coordination when swing limb conditions are being manipulated by constraining step length or by adding a 5 or 10 pound weight to the swing limb distally. Subjects were asked to begin walking with the right limb to land on the primary target (normal step length) that is 10 cm in diameter. However, if, during movement, the light was illuminated, then the subject had to step on one of the secondary targets (long and short step length). These three step length conditions were repeated while wearing a 5 pound ankle weight and then when wearing a 10 pound ankle weight. Ground reaction force (GRF) data indicated that there were changes in the forces and slopes of the swing and stance Fx GRFs. Long stepping subjects had to increase the propulsive force required to increase step length. Consequently, swing and stance toe-off greatly increased in the long step length condition. Short step length subjects had to adequately adjust step length, which decreased the speed of gait initiation. Loading the swing limb decreased the force and slope of the swing limb. Swing and stance toe-off was longest for the long step length condition, but there was a small difference of temporal events between no weight and weight condition. It appears that subjects modulated GRFs and temporal events differently to achieve the peak acceleration force of the swing and stance limb in response to different tasks. The findings from the current study provide preliminary data, which can be used to further investigate how we modulate forces during voluntary movement from a quiet stance. This information may be important if we are to use this or a similar task to evaluate gait patterns of the elderly and patient populations.

• The Journal of Korean Physical Therapy
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• v.17 no.1
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• pp.108-122
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• 2005

The gait training strategy in very important things for central nervous system(CNS) injury patients. There are many method and strategy for regaining of the gait who had CNS injury. A human being has central pattern generator(CPG) is spinal CPG for locomotion. It is a neural network which make the cyclical patterns and rhythmical activities for walking. Sensory input from loading and hip position is essential for CPG stimulation that makes the central neural rhythm and pattern generating structure. From sensory input, the proprioceptive information facilitate proximal muscles that controlled in voluntarily from cortical level and visual and / or acoustical information facilitate distal muscles that controlled voluntarily from subcortical level. Gait training method can classify that is functional level and structural level. Functional level includ level surface gait, going up and down the stair. It is important to facilitate a guide tempo in order to activate the central pattern generators. During the functional test or functional activities, can point out the poor period in gait that have to be facilitate in structural level. There are many access methods with patient position and potentiality. The methods are using of rhythmic initiation, replication and combination of isotonic with standing position. Clinically using it on weight transfer onto the stance leg, loading response, loading response and pre-swing, terminal stance, up and downwards stairs.

• Physical Therapy Korea
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• v.8 no.4
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• pp.81-89
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• 2001

There are two independent mechanisms to control the segmental reflex gain in humans during gait. They are presynaptic inhibition and homosynaptic depression. Through the mechanism of the presynaptic inhibition, the muscle spindle afferent feedback can be properly gated during eccentric phase of gait. The modulation of the presynaptic inhibition is reflected in the level of H-reflex at a constant EMG level. During the eccentric muscle activation presynaptic inhibition should increase to account for the lower amplitude level of H-reflex at a constant level of EMG. Homosynaptic depression is another mechanism responsible for regulating the effectiveness of the muscle spindle afferent feedback. Both the presynaptic inhibition and the monosynaptic depression are responsible for modulating reflex gain during gait initiation. Reflex modulation is influenced not only as a passive consequence of the alpha motor neuron excitation level, but also through supraspinal mechanisms. Spastic paretic patients show the impaired soleus H-reflex modulation either during the initial stance phase, or during the swing phase. This abnormal modulatory mechanism can partially and artificially be restored by the application of peripheral stimulus to the sole of the foot, provided that the segmental circuitry remains functional.

• Journal of Korean Physical Therapy Science
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• v.30 no.4
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• pp.92-110
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• 2023

Background: Digital therapeutics are software medical devices that provide evidence-based treatments to prevent, manage, and treat disease. Digital therapies have recently been shown to be effective in motivating children with cerebral palsy as a tool in neuropsychological therapy. Digital therapies improve postural control, balance and gait in children with cerebral palsy. Therefore, this study aims to investigate the effects of digital therapies on balance and gait in children with cerebral palsy and to provide guidelines for prescribing digital therapies for children with cerebral palsy. Design: A Systematic Review Methods: This study searched for English-language articles published in medical journals from January 2000 to July 2023 using PubMed and MEDLINE based on the year of initiation of the digital therapy. The search terms used in the study were 'digital technology' OR 'digital therapeutic' OR 'mobile application' OR 'mobile health' OR 'virtual reality' OR 'game' AND 'cerebral palsy', 'balance' 'gait' as the main keywords. The final article was assigned an evidence level and a Physiotherapy Evidence Database (PEDro) score to assess the quality of clinical trials studies. Results: The digital therapies applied to improve balance and gait in children with cerebral palsy are game-based virtual reality training and the Nintendo Wii Fit program. Both digital therapy interventions had a significant effect on improving balance in children with cerebral palsy, and virtual reality training significantly improved balance and gait. However, there were no significant improvements in balance and gait within two weeks of treatment, regardless of the type of digital intervention. Conclusion: The study suggests that this data will be important in building the evidence base for the effectiveness of digital therapies on balance and gait in children with cerebral palsy and in advancing clinical protocols.