• The Journal of Korean Physical Therapy
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• v.30 no.5
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• pp.199-203
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• 2018

The number of reported cases with dual disability is increasing for the past few decades. Currently, dual disability of lower limb amputation and motor weakness after stroke became a strong issue in public concern. The functional levels of patients have shown in the wide range from independent community ambulation to non-ambulation. Thus, it indicates that favorable outcomes for dual disability may depend upon adopted rehabilitative strategies. We present the case of a man with left below-knee amputation and severe right-sided weakness following a huge putaminal hemorrhage. He had suffered from extreme pain and misfit of the prosthetic socket and the complicated residual limb for three years prior to the stroke. Forty days post-stroke, we performed a revision surgery to resolve the complications of bony overgrowth, verrucous hyperplasia, and neuroma and applied an ankle foot orthosis (AFO). Two years post-stroke, he was able to ambulate outside his home and negotiate stairs using a cane. This is the first case with the dual disability of lower limb amputation and contralateral hemiplegia to undergo revision surgery. The results suggest that an early revision surgery and use of an AFO are crucial for achieving a higher level of mobility in such cases.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.108-114
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• 1999

In general, amputation has been performed in the treatment of diabetic foot which doesn't respond to the conservative treatment. We have evaluated the existence of post-operative infection, the morbidity of donor site, the degree of recovery of sensation, weight bearing ambulation and recurrence in the 6 cases(5 patients) of diabetic foot patients among the 230 cases of free flap transfer done in our department. In all cases of free flap transfer to diabetic foot, 100% of survival rate was shown. The sensory recovery was more than average of 40% of the area of the transferred flap, and two points discrimination was shown average of 5cm as a result. In all cases, no evidence of post-operative infection was discovered and the weight bearing gradually became easier, and at the average of 5 months after operation, the full weight bearing ambulation became possible. If the infection of diabetic foot and the level of blood sugar could be controlled successfully, the free flap transfer could be considered one of the treatment option to avoid amputation.

• The Journal of Korean Physical Therapy
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• v.16 no.1
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• pp.183-207
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• 2004

The purpose of this study was to describe and compare the temporo-spatial gait characteristics of healthy elderly people with those osteoarthritis patients. 100 patients reported knee osteoarthritis, diagnosed at the hospital or clinic located in Daegu and Kyungbuk province and 100 normal elderly subjects were participated in this study. Temporal and spatial parameters of gait were analysed for using the computerized GAITRite system. The system integrates specific components of locomotions to provide a single, numerical representation of gait, the Functional Ambulation Performance score. Differences in gait characteristics between the two groups were examined using a correlated t-test and Pearson Correlation(p<.05). Significant differences were observed between the groups for temporal parameters(step time, double support time, stance phase, mean velocity) and spatial parameters(step length, step/extremity ratio)(p<.05). Also there was difference in the functional ambulation performance score between normal elderly subjects and knee osteoarthritis patients(p<.05). Consequently, it may help detect the abnormal gait pattern indicated the main problem in degenerative knee osteoarthritis patients as well as provide data analysing the pathokinesiologic components by comparing normal elderly.

• Archives of Reconstructive Microsurgery
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• v.26 no.1
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• pp.18-22
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• 2017

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.

• Journal of Korean Foot and Ankle Society
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• v.26 no.3
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• pp.118-122
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• 2022

Although total ankle arthroplasty (TAA) has increased considerably in the past ten years, reflecting improvements in implant design and survivorship, the clinical outcomes have been less satisfactory than total hip or total knee arthroplasties. Several issues under debate include postoperative management and rehabilitation in TAA. Especially, there is no consensus or evidence for the most appropriate postoperative management and rehabilitation for patients undergoing TAA. This study was therefore undertaken to suggest appropriate postoperative management and rehabilitation in TAA, after reviewing published articles and focusing on the following topics: prehabilitation, hospital stay, immobilization type and duration, weight-bearing management, pharmacological treatment, and adopted rehabilitation protocols. In previous studies, the postoperative management and rehabilitation proposed depended on the surgeon's preference, the patient's characteristics, and the associated surgical procedures performed after TAA. Nonetheless, our research indicates the best approach is to include a prehabilitation program, immobilization in the early postoperative stage (2~4 weeks), range of motion exercise with partial weight-bearing ambulation, followed by full weight-bearing ambulation after six weeks. Further studies are required to develop a standardized rehabilitation protocol and improve the overall quality of care after TAA.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.93-99
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• 2008

Purpose: To evaluate the result of the early exercise and rehabilitation after limited posterior operative treatment of the calcaneal fractures. Materials and Methods: Between May 2005 and December 2007, 43 cases with intraarticular calcaneal fractures were treated by open reduction with K-wires and Steinmann pins. Mean age and mean follow-up period were 42.5 years old and 15 months. All patients were treated with the same postoperative protocol, the early exercise of subtalar joint without short leg splint and cast was began after postoperative 1 day, non-weight bearing crutch ambulation did after 2 weeks, partial-weight bearing crutch ambulation did after 6 weeks, without crutch ambulation did after 10 weeks. The fractures was classified by Essex-Lopresti and Sanders classification using radiographs and the functional outcomes were evaluated by circle draw exercise, AOFAS score. Results: By Essex-Lopresti classification, the tongue type was 6 cases (14%), the joint depression type was 15 cases (35%), the combined type was 22 cases (51%). By Sanders classification, type II were 10 cases (23%), type III were 15 cases (58%), and type IV were 8 cases (19%). By AOFAS functional evaluation, the mean preoperative scores were 70.3 and 70.5 respectively, mean postoperative scores were 83.7 and 86.9 respectively. There were satisfactory results in 40 cases but 3 cases were unsatisfactory including on case of lateral impingement and 2 cases of traumatic arthritis of subtalar joint. Conclusion: We obtained satisfactory result of the early exercise of subtalar joint without short leg splint and cast and rehabilitation after limited posterior operative treatment of the calcaneal fractures.

• Journal of Korean Academy of Nursing
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• v.14 no.2
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• pp.38-46
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• 1984

The purpose of this study was to test the effect of the structured preoperative teaching on post-operative recovery and to observe the effects of an structured preoperative teaching on the adult surgical patient's ventilatory function ability, the length of hospital stay, the number of analgesics within a 72 hour postoperative period, the length of early ambulation. The research question investigated in this study was: What would be the effects of a structured preoperative teaching upon the adult surgical patients postoperative recovery? This study was based on a sample of 40 patients who were scheduled for abdominal surgery. They were asssigned alternately to experimental and control group. Among 40 subjects, 20 were placed in the experimental group and 20 in the control group. Preoperative ventilation function testing of control and experimental subjects was done the evening before surgery and before the patient received the structured preoperative teaching. A structured preoperative teaching was given to the subjects in the exporimental group only by writer. Postoperative testing was done the 5th postoperative day. The data were collected over a period of two months, from Aug. 8 to Oct. 31, 1983. For the analysis of the data and test for the hypotheses, the t-test with mean difference was used. The results of this study regarding the four-hypotheses were as follows: 1. Experimental group which received structured preoperative eaching will have more increase to-cough and deep breathe as measured byhis forced vital capacity(FVC), forced expiratory volume 1 (FEV1), maximal voluntary volume 15 (MVV 15) than control group without structured preoperative teaching. The ventilation function ability was more increase in experimental group than in control group, the mean difference was statistically significant at 0.01 level. Hypotheses 1 was supported. 2. Experimental group with structured preoperative teaching will have more reduced the length of hospital stay than control group without structured preoperative teaching. The length of hospital stay of the experimental group and control group were 11.90 days and 16.05 days respectively. However, the difference was. not statistically significant at .05 level. Therefore the hypothese 2 was not supported. 3. Experimental group with structured preoperative teaching will have more reduce the number of analgesics within a 72 hour postoperative period than control group. The number of analgesics within a 72 hour' postoperative period of experimental group and control group were 1.65 times and 2.4 times. The difference was not statically significant at .05 level. Therefore, the hypotheses 3 was not supported. 4. Experimental group with structured preoperative. teaching will have more reduce the length of early ambulation than control group without structured preoperative teaching. The length of early ambulation of experimental group and control group were 2.2 days and 3.5 days respectively The difference was statistically signficant at 0.05 level. Thus the hypothess 4 was supported.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.10 no.1
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• pp.83-101
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• 2004

The propose of the study was to evaluate the efficacy of the partial body weight support during treadmill training on the ambulation in elderly with chronic stroke. Fourteen hemiplegic volunteers participated and were divided into an experimental and control groups. In the experimental group, the body weight support during treadmill training was performed 3 times per week for 6 weeks. In the control group, usual treadmill training was applied. Before and after experiments, temporal-spatial gait parameters were measured. The date of 14 patients who carried out the whole experimental course were statistically analyzed. The results of the study were : 1. In the comparison of gait velocity before and after experiment, the gait velocity was significantly increased in the experimental group and the control group(p<.05). In the comparison of difference of the gait velocity between groups, there was not, significant difference between the experimental group and the control group(p>.05). 2. In comparison of gait cadence before and after experiment, the gait cadence was significantly increased in both groups(p<.05). In the comparison of difference of the gait cadence between groups, there was not significant difference between the experimental group and the control group(p>.05). 3. In the comparison of step length before and after experiment, the step length was significantly increased in the experimental group and the control group(p<.05). In the comparison of difference of the step length between groups, there was not significant difference between the experimental group and the control group(p>.05). 4. In the comparison of single support time asymmetry before and after experiment, the single support time asymmetry was no significant difference between groups(p>.05). In the comparison of difference of the single support time asymmetry between groups, there was not significant difference between the experimental group and the control group(p>.05). 5. In the comparison of step length asymmetry before and. after experiment, the step length asymmetry was not significant difference between the experimental group and the control group(p>.05). In the comparison of difference of the single step length asymmetry between groups, there was not significant difference between the experimental group and the control group(p>.05).

• The Journal of the Korean bone and joint tumor society
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• v.16 no.2
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• pp.80-86
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• 2010

Purpose: The skeleton is commonly affected by metastatic cancer. The purpose of this study was to evaluate the results of treating metastatic pathologic fractures in lower extremities using locking plates. Materials and Methods: Between 2004 and 2010, we evaluated 12 patients (13 cases) of metastatic pathologic fractures in lower extremities, treated with the locking plate. Mean patient age was 62.2 years (range, 50-81 years), the locations of the fractures were; proximal femur in 2 cases, femoral mid-shaft in 3, distal femur in 3, proximal tibia in 4, and distal tibia in 1 case. The interval to wheelchair ambulation, pain relief and complications were evaluated. Additionally, we assessed operation time and postoperative blood loss. Results: Mean time from operation to wheelchair ambulation was 3.2 days (range, 1-6 days). Mean VAS scores improved from a preoperative score of 8.1 points (range, 7-9 points) to a score of 2.7 points (range, 2-4 points) at 1 week postoperatively. No early complications associated with surgery were encountered. Mean operation time was 88.4 minutes (range, 70-105 minutes), and mean postoperative blood loss was 246.5 ml (range, 130-320 ml). Conclusion: Internal fixation of metastatic pathologic fractures using a locking plate in the lower extremity can be an effective treatment option in the meta- or diaphyseal area of long bones with massive bony destruction or poor bone stock by offering early ambulation, pain relief and low postoperative complications.

• Journal of Korean Foot and Ankle Society
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• v.22 no.3
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• pp.100-104
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• 2018

Purpose: An axillary crutch is the most commonly used assistive device in foot and ankle patients who require nonweightbearing. On the other hand, its use frequently induces axillary or wrist pain and critical neurovascular injuries have been reported in several studies. This study compared the clinical outcomes of patients using the knee walker and axillary crutch. Materials and Methods: A retrospective analysis was performed comparing the utility of a knee walker and axillary crutch as a nonweightbearing ambulatory aid for 62 foot and ankle patients treated between November 2016 and March 2018. A comparative study of the two orthosis could be performed because all the patients temporarily used an axillary crutch before or after the use of a knee walker. A demographic study and comparative analysis based on the visual analogue scale (VAS) satisfaction score (0~100), complications, and fall down history were evaluated. Furthermore, under the assumption of having retreatment, their preference of orthosis between the knee walker and axillary crutch was investigated. Results: The mean age of the patients was 36.5 and the mean duration of ambulation with a knee walker and axillary crutch were 5.2 and 2.4 weeks. The VAS satisfaction score of the knee walker and crutch was 88.8 and 27.5, respectively (p<0.05). The most frequent complications of the knee walker and crutch were ipsilateral knee pain (6 cases) and axillary or wrist pain (56 cases), respectively. No case of falling down occurred during knee walker ambulation, but there were two cases of crutch ambulation. Fifty-eight patients (93.5%) preferred the knee walker and four patients (6.5%) preferred a crutch. Conclusion: Compared to the axillary crutch, the knee walker afforded lower complication and higher satisfaction. Most patients preferred the knee walker to a crutch. Therefore, the knee walker is an efficient and safe orthosis for foot and ankle patients who require nonweightbearing.