When applying FES to patients, proper evaluation must be performed prior to treating patient. Patients with thoracic lesions between $T_4{\sim}T_{12}$ are suitable for FES. However, these patients must have excitability of the leg muscles. Thus, excitability testing is an essential part of the screening program(stimulation at 80V gives a response). Before standing or walking is attempted the patients must perform restrengthening exercise, so that the Quadriceps muscle group minimum strength is 40 Nm (corresponding to a manual grade of F+ to G). After that walking and standing can be attempted. The effects of FES are as follows: prevents pressure sores; development and maintenance of muscle properties; prevents disuse atrophy and contractures.
Journal of the Korean Society of Physical Medicine
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v.15
no.4
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pp.163-174
/
2020
PURPOSE: This study examined the effects of Robot Tilt-table Training (RTT) on the lower extremity strength, balance, gait, and satisfaction with rehabilitation, in patients with subacute stroke (less than six months after stroke onset), and requiring intensive rehabilitation. METHODS: A total of 29 subacute stroke patients were divided into an RTT group (n = 14) and a Body Weight Support Treadmill Training (BWSTT) group (n = 15). The mean age of patients was 62 years. RTT and BWSTT were performed for four weeks, three times a week, for 30 minutes. Isometric strength of the lower extremities before and after intervention was compared by measuring the maximal voluntary isometric contraction of the lower extremity muscles. To compare the balance function, the center of pressure (COP) path-length and COP velocity were measured. Timed Up & Go test (TUG) and 10 Meter Walking Test (10 MWT) were evaluated to compare the gait function. A satisfaction with rehabilitation survey was conducted for subjective evaluation of the subject's satisfaction with the rehabilitation training imparted. RESULTS: In the intra-group comparison, both groups showed significant improvement in lower extremity strength, balance, gait, and satisfaction with rehabilitation, by comparing the parameters before and after the intervention (p < .05). Comparison of the amount of change between groups revealed significant improvement for all parameters in the RTT group, except for the 10 MWT (p < .05). CONCLUSION: Both groups are effective for all variables, but the RTT group showed enhanced efficacy for variables such as lower extremity strength, balance, gait, and satisfaction with rehabilitation, as compared to the BWSTT group.
This research was designed to investigate how the exercise program affects paraplegic standing and walking employing functional electrical stimulation(FES). Emphasis was also given to fatigue of major lower extremity muscles induced by different types of electrical stimulation. We applied continuous and intermittent rectangular pulse trains to quadriceps of 10 normal subjects and 4 complete paraplegic patients. The frequencies were 20Hz and 80Hz, and the knee angle was fixed at 90$^{\circ}$and 150$^{\circ}$to investigate how muscle fatigue is related to muscle length. The knee extensor torque was measured and monitored. We have been training quadriceps and gastrocnemius of a male paraplegic patient by means of electrical stimulation for the past two year. FES standing was initiated when the knee extensors became strong enough to support the body weight, and then the patient started FES walking utilizing parallel bars and a walker. We used an 8-channel constant-voltage stimulator and surface electrodes. The experimental results indicated that paralyzed muscles fatigued rapidly around the optimal length contrary to normal muscles and confirmed that low frequency and intermittent stimulation delayed fatigue. Our exercise program increased muscle force by approximately 10 folds and decreased the fatigue index to half of the initial value. In addition, the exercise enabled the patient to voluntarily lift each leg up to 10cm, which was of great help to the swing phase of FES walking. Both muscle force and resistance to fatigue were significantly enhanced right after the exercise was applied every day instead of 6 days a week. Up to date, the patient can walk for more than two and half minutes at 10m/min while controlling the on/off time of the stimulator by pushing the toggle switch attached to the walker handle.
The purpose of this study was to analyse the gait characteristics of stroke patients walking on a Zebris system, through quantitative three-dimensional biomechanical analysis. They underwent a continuous rehabilitation training program (RTP). A comparison was made between 3 month and 6 month RTP participants. Their ages were between 60 and 65. The data were analyzed by t-test. The result of comparative analysis of the two groups can be summarized as below. Temporal-spatial data, sagittal plane angular kinematics data, and peak ground reaction force and max pressure data showed that there were no significant differences between the 3 month RTP group and the 6month RTP group (Table 2, Table3, Table 4). It can be suggested that patients with hemiplegia after stroke can improve their walking function through continuous RTP participation.
Purpose: The purpose of this study was to investigate the effect of microcurrent on fatigue of muscles in people who were flat-footed during gait. Methods: 10 flat-footed university students volunteered to participate in this study. 10 flat-footed subjects were divided into 2 groups, one group was experimental group of 5subjects(This group put on microcurrent induction shoes but the subjects were not able to feel the current.) and the other group was the control group of 5subjects(This group put on the general shoes which were similar in shape but microcurrent was not induced.) to perform double blind test and random sampling. Their gait muscle fatigue of 6 regions (vastus medialis, gastrocnemius, tibialis anterior, biceps femoris, erector spinae, and rectus abdominis muscle.) was measured by EMG MP150, Delsys Inc Boston, USA during walking and then they carried out the Harvard step with a platform (It was a arbitrarily made wooden platform of 100cm long, 50cm wide, 60cm high. They carried out climbing it for one second and descending it for one second by using the Metronome program, total 5minutes) for 5minutes. Right after that, the subjects walked on a treadmill at a speed of 4km/h for 10minutes and then their gait muscle fatigue of 6regions was assessed while they were walking on the ground as equally as before exercise. Results: The experimental group has resulted in lower average differences in gait muscle fatigue before and after exercise than those of the control group average 12.24Hz(P=0.009) at vastus medialis, average 8.52Hz(P=0.016) at gastrocnemius, average 9.16Hz(P=0.009) at tibialis anterior, average 8.66Hz(P=0.047) at biceps femoris, average 7.53Hz(P=0.016) at erector spinae, and average 7.80Hz(P=0.047) at rectus abdominis. All of the assessments of muscles have shown significant difference statistically. Conclusions: This result has shown that the use of micro current could decrease gait muscle fatigue of flat-footed people. It is recommended to use a microcurrent to reduce their gait muscle fatigue.
Park, Rae-Joon;Choi, Sang-Joon;Cheng, Goh Ah;Cho, Jeong-Sun;Lee, Yoon-Mi;Cho, Yong-Ho;Park, So-Hyun;Cho, Mi-Suk
The Journal of Korean Physical Therapy
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v.18
no.1
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pp.1-10
/
2006
Purpose: This study was to investigate how induced microcurrent shoes affect relief of feet pain, which often occurs to persons who are more than fifty years old and how they prevent fatigue of feet generated during everyday life. The subjects of this study were comprised af five males and five females, who agreed with this research and ate more than fifty years old. And they all have plantar faciitis and pain in their feet. Methods: Subjects ware the induced microcurrent shoes far more than 4 hours everyday during the test. When they wore those shoes, they also wore the specially produced shacks made of silver-mixed thread and they were asked to avoid serious exercise. Prior to starting test and after the test, assessments were carried out two times. In the examination before the test, general shoes were used and in examination after the test, induced microcurrent shoes used. Muscle fatigue was measured by electromyography(MP150, Biopac, USA). When the walking rate of subjects on a treadmill was increased from 2.Km/h to 3Km/h for 10 minutes, muscle activities of a lower leg were measured during the whale walking process by MP150 remote monitoring system(TEL 100C). And pain was measured by VAS. Results: The results are as follows. 1. Comparisons of VAS before and after experimentation showed that degree of pain was significantly decreased(p < .05). 2. Degree of fatigue of Tibialis anterior was significantly decreased after 6 weeks of treatment(p < .05). 3. Degree of fatigue of Soleus was slightly decreased after 6 weeks of treatment, but did not show significant difference (p > .05). Conclusion: The above results suggest that induced microcurrent shoes is helpful decreasing fatigue of feet and relief of feet pain.
The aim of this study was to evaluate the effects of walking on a treadmill while using dynamic functional electrical stimulation (Dynamic FES) on functional ability and gait in chronic stroke patients. This was a prospective, randomized controlled study. Twelve patients with chronic stroke (>24 months) who were under grade 3 in dorsiflexor strength with manual muscle test were included and randomized into intervention (Dynamic FES) ($n_1$=7) and control (FES) ($n_2$=5). Both the Dynamic FES group and FES group were given a neuromuscular development treatment. The Dynamic FES group has implemented a total of 60 minutes of exercise treatment and gait training with Dynamic FES application. The FES group, with the addition of applying FES while sitting, has also implemented a total of 90 minutes of gait training on treadmill after the exercise treatment. Both two groups accomplished the program, twice a week, for a total of 24 times in a 12-week period. Exercise treatment, gait training on treadmill, and both Dynamic FES and FES were implemented for 30 minutes each. Korean version activities-specific balance confidence scale (K-ABC) was measured to determine self-efficacy in balance function. Timed up and go (TUG) test was performed to evaluate the physical performance. K-ABC, TUG, Berg balance scale (BBS), modified physical performance test (mPPT) and G-walk were evaluated at baseline and at 12 weeks. After 12 weeks, statistically significant differences (p<.05) were apparent in the Dynamic FES group in the changes in K-ABC and BBS. mPPT, TUG, gait speed, stride length and stance phase duration (%) were compared with the FES group. K-ABC had higher correlation to BBS, along with mPPT to TUG. Our results suggest that walking with Dynamic FES in chronic stroke patients may be beneficial for improving their balance confidence, functional ability and gait.
The purpose of this study was to privide basic data for footwear development according to walking mechanics by comparing gait cycle difference between barefoot walking and walking shoes. The walking period was measured in 30 normal adult women with no foot deformity and abnormality. The first subject walked in sneakers and measured the cycle. And then, the subjects walked barefoot and the period was measured to obtain data. The data were taken form corresponding paired T-test. The results were as follows: In barefoot walking, the stance phase left side(p <.001), right side(p <.005), the loading response left side(p <.009), right side(p <.002) ), the pre-swing left side(p <.002), right side (p <.011), the double stance phase(p <.004) were increased and the mid-stance left side (p <.016), right side(p. 001), the swing phase left side(p<.001) was decreased. This suggests that barefoot walking increases the input of various senses of the foot, which makes stable walking possible. It is necessary to improve shoes based on the walking cycle in the future.
Journal of rehabilitation welfare engineering & assistive technology
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v.10
no.2
/
pp.107-112
/
2016
The purpose of this study was to determine the effect of aquatic ramp walking exercise on the activity of the quadriceps, gait and activity of daily living in child with Spinal Muscular Atrophy (SMA) type II. A 5 years-old girl with SMA type II participated in this study. This study used single-subject reverse(A-B-A) design study. There are 12 sessions(4weeks 3 times a week) each during the baseline phase(A), the intervention phase(B), the follow up phase(A). During the baseline phase and the follow up phase performed general aquatic therapy, the intervention phase additional performed walking activity on ramp in pool (60m). Surface electromyogram, Timed Up and Go (TUG) test, ACTIVLIM were used as outcome. During the intervention phase, there were decrease on the activity of the quadriceps. In modified TUG test, gait time reduced during the intervention phase. The ACTIVLIM logit score increased during intervention phase by comparison with the baseline phase. These findings suggest that an aquatic ramp walking exercise activities have the therapeutic possibility on the quadriceps activity and gait ability for child with SMA type II.
This study was performed to investigate the effect of therapeutic exercise on brain-derived neurotrophic factor manifestation after global brain ischemia in rats. Nine rats with global ischemia were divided at random into two group. In the control group, three rats remained in cage. But, in the end, two rats were alive. In the therapeutic exercise group, six rats remained. The five rats of this group was swam for 30 minutes everyday for a week. The brain-derived neurotrophic factor expression was identified from immunohistochemistry. The results of this study were as follows : 1. In the control group, a little expression of brain-derived neurotrophic factor was observed at cortex and hippocampus layer, but cell body and axon was observed obscurely. 2. In the experimental group, a much expression of brain-derived neurotrophic factor was observed at cortex and hippocampus layer, and cell body and axon was observed clearly. In the neurological examination(beam-walking test). experimental group was obtained higher 1.4 points than control group. BDNF expression was increased by swimming for 30 minutes everyday for a week. Therefore, therapeutic exercise contribute to brain plasticity after brain ischemia.
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