• The Journal of Korean Physical Therapy
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• v.16 no.4
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• pp.38-58
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• 2004

The regain of independent ambulatory ability is a important goal in the rehabilitation program of hemiplegic patient. Not only the function of lower extremity muscles, but also trunk muscles which stabilize extremities and pelvis, are important factors in normal gait. Therefor, it is necessary to develop an effective program which can improve muscle strength and symmetric activity of trunk muscles. The purpose of this study was to evaluate the influence of trunk muscle strengthening by forceful respiratory exercise on the gait asymmetry ratio in hemiplegic patient. 45 Hemiplegic patients due to stroke was randomized in 3 groups, forceful expiratory training(FET), forceful inspiratory training(FIT) and control group. In the experimental groups, ordinary physical therapy with forceful expiratory training and forceful inspiratory training for 20 minutes duration 3 times per week for 6 weeks were respectively performed. In the control group, only ordinary physical therapy was done. Before and after experiments, temporal-spatial gait parameters was measured in all patients. The data of 28 patients who carried out the whole experimental course were statistically analysed. The results of these experiment are as follows : 1. In comparison of difference of single support time asymmetry ratio among 3 groups, the FET group was significantly decreased than the control group (p<.05). 2. In comparison of difference of step length asymmetry ratio among 3 groups, the FIT group was significantly decreased than the control group (p<.05). Based on these results, it is concluded that the forced respiratory exercise program for 6 weeks can be improve the gait asymmetry ratio in hemiplegic patients. Therefore, the forced respiratory exercise is useful to improve the walking ability in hemiplegic patients. Since this study dealt only with the patients who could walk more than 3 meters in distance on floor independently, the further study for evaluating the influence of the forceful respiratory exercise on patients with acute stage stroke and also the development in various methods of use are expected.

• Korean Journal of Applied Biomechanics
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• v.17 no.1
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• pp.111-119
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• 2007

The purpose of this study was to investigate muscle activity and gait pattern in lower limb depending on the outsole of heel rockers. Fifteen healthy men volunteered for this experiment. Each subject performed totally three trails with two pairs of different heel rocker shoes and a pair of normal running shoes at speed of 1.33m/s for 1 minute during walking on a treadmill. Kinematic data gathered in 100Hz was recorded and analyzed by using the 3D motion capture system to measure the trunk tilt and joint angle of the right lower limb. And the lower extremity muscle activities were simultaneously recorded in 1000Hz and assessed by using EMG. The statistical analysis was the one-way ANOVA with the repeated measures to compare among the three kinds of shoes. The level of statistical significance for all tests was 0.05. Joint angle of lower limb was showed statistically significant different in MST(hip joint), LHS(ankle joint), and RTO(knee and ankle joint). Muscle activity of rectus femoris and biceps femoris was statistically increased in both heel rocker shoes during gait cycle on treadmill. The maximum peak time of tibialis anterior in the negative heel rocker showed the delay of approximately 23.8%time than normal shoes. Gait pattern variability of the negative heel rocker was increased in the first half of the stance phase and the variability of the positive heel rocker was increased in the terminal stance phase. In Conclusion, stability was decreased in between joints of lower limb on positive heel rocker than negative heel rocker. This study found that there were different joint angle, muscle activity, gait pattern and coordinate system of the lower limb in each kind of shoes. These unstability affected the lower extremity and the whole body. A further study has to be continued with study of rehabilitation and exercise for a long-term.

• Journal of Institute of Control, Robotics and Systems
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• v.17 no.10
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• pp.1021-1028
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• 2011

The objective of this paper is to optimize the design parameters of a novel mechanism for a robotic knee orthosis. The feature of the proposed knee othosis is to drive a knee joint with independent actuation during swing and stance phases, which can allow an actuator with fast rotation to control swing motions and an actuator with high torque to control stance motions, respectively. The quadriceps device operates in five-bar links with 2-DOF motions during swing phase and is changed to six-bar links during stance phase by the contact motion to the patella device. The hamstring device operates in a slider-crank mechanism for entire gait cycle. The suggested kinematic model will allow a robotic knee orthosis to use compact and light actuators with full support during walking. However, the proposed orthosis must use additional linkages than a simple four-bar mechanism. To maximize the benefit of reducing the actuators power by using the developed kinematic design, it is necessary to minimize total weight of the device, while keeping necessary actuator performances of torques and angular velocities for support. In this paper, we use a SGA (Simple Genetic Algorithm) to minimize sum of total link lengths and motor power by reducing the weight of the novel knee orthosis. To find feasible parameters, kinematic constraints of the hamstring and quadriceps mechanisms have been applied to the algorithm. The proposed optimization scheme could reduce sum of total link lengths to half of the initial value. The proposed optimization scheme can be applied to reduce total weight of general multi-linkages while keeping necessary actuator specifications.

• Physical Therapy Korea
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• v.24 no.2
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• pp.58-65
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• 2017

Background: Children with cerebral palsy (CP) have impaired postural control, but critically require the control of stability. Consequently, therapeutic interventions for enhancing postural control in children with CP have undergone extensive research. One intervention is sensorimotor training (SMT) using a Flexi-bar, but this has not previously been studied with respect to targeting trunk control in children with CP. Objects: This study was conducted to determine the effect of SMT using a Flexi-bar on postural balance and gait performance in children with CP. Methods: Three children with ambulatory spastic diplegia (SD) participated in the SMT program by using a Flexi-bar for forty minutes per day, three times a week, for six weeks. Outcome variables included the pediatric balance scale (PBS), trunk control movement scale (TCMS), 10 meter walking test (10MWT), and 3-dimensional movement coordination measurement. Results: The SMT provided no statistically significant improvement in PBS, TCMS, 10MWT, or 3-dimensional movement coordination measurement. However, positive changes were observed in individual outcomes, as balance and trunk control movement were improved. Conclusion: SMT using a Flexi-bar may be considered by clinicians as a potential intervention for increasing postural balance and performance in children with SD. Future studies are necessary to confirm the efficacy of Flexi-bar exercise in improving the functional activity of subjects with SD.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.15 no.1
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• pp.22-31
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• 2009

Purpose The purpose of this study was to compare the effects of closed kinetic chain exercise and open kinetic chain exercise in improving the balance of patients with hemiplegia. Methods Ten patients with stroke were randomly allocated to either a closed kinetic chain exercise (CKC) group(n=5) or an open kinetic chain exercise(OKC) group(n=5). The subjects of each group followed the exercise regimen of their respective groups, and each exercise was performed for 50 mins per day, 3 days per week, for 4 weeks. Assessment was made using Berg Balance Scale (BBS), One Leg Standing(OLS) test, and Timed up and go(TUG) test. The 2 groups were assessed twice: before and after the intervention. Results The TUG test score was significantly different in the CKC group between before and after intervention (p<.05); however, there was no such deference in the OKC group (p>.05). Further, the scores of the BBS and OLS tests were not significantly different for the 2 groups between before and after intervention (p>.05). The hanges in these BBS and OLS score were not significantly different(p>.05); however, there was a significant difference in the change in the TUG scores (p<.05). Conclusion On the basis of the results of this study, we found that the closed kinetic chain exercise is more effective in improving the walking ability and dynamic balance in patients with stroke. Future studies are warranted in this regard.

• Journal of the Korea Convergence Society
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• v.11 no.3
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• pp.119-126
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• 2020

The purpose of this study is to identify trends in the type and method of Inertial Measurement Unit (IMU) by investigating studies on the type and method of convergence study of the IMU by systematic review. The study was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. 23 studies that meet the selection criteria were selected from 630 studies identified by three databases. As a result of this study, showed that various research using IMU was being conducted around the world, and the type of IMU was strap, full body suit, belt, wrist watch, shoes and glove. Among them, the number of strap-type IMUs was the largest at 11. The IMU's strengths were simplicity, real-time data collection and ease of application, which were used as measurement methods such as task, walking, and range of joint. The result of this study is expected to be used as basic data for experts in the medical and rehabilitation fields that conduct IMU research.

• The Journal of Korean Physical Therapy
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• v.16 no.1
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• pp.32-48
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• 2004

The purpose of this study was to evaluate the change of functional ambulation profile(FAP) and temporal-spatial gait parameters in hemiplegic patient by forceful respiratory exercise. 28 Hemiplegic patients due to stroke was randomized in 3 groups, forceful expiratory training(FET), forceful inspiratory training(FIT) and control group. In the experimental groups, ordinary physical therapy with forceful expiratory training and forceful inspiratory training for 20 minutes duration 3 times per week for 6 weeks were respectively performed. In the control group, only ordinary physical therapy was done. FAP and temporal-spatial gait parameters was measured at before and after experiments. The results of this experimental study were as follows : 1. In comparison of FAP before and after experiment, the FAP was significantly increased in the FET and FIT group (p<.01). In comparison of difference of FAP among 3 groups, there was the significant difference between the FIT group and the control group (p<.05). 2. The results of temporal-spatial gait parameters are as follows : 1) In comparison of gait velocity before and after experiment, the gait velocity was significantly increased in the FET and FIT group (p<.05). In comparison of difference of the gait velocity among 3 groups, there was the significantly difference between the FIT group and the control group (p<.05). 2) In comparison of gait cadence before and after experiment, the gait cadence was significantly increased in FIT group (p<.05). In comparison of the difference of the gait cadence among 3 groups, there was no significant difference between the FIT group and the control group (p>.05). Based on these results, it is concluded that the forced respiratory exercise program for 6 weeks can be improve the FAP and temporal-spatial gait parameters in hemiplegic patients. Therefore, the forced respiratory exercise is useful to improve the walking ability in hemiplegic patients.

• Journal of the Korean Society of Physical Medicine
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• v.7 no.3
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• pp.357-365
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• 2012

Purpose : The present study has been performed to find the effects on gross motor function and balance ability of applying a balance exercise program consisting of motions able to stimulate balance-related sensory systems on various support surfaces along with goal-oriented upper extremity tasks to enhance the balance ability. Methods : 10children diagnosed as having spastic diplegia were selected as the subject for this study, of whom 5children were randomly assigned to a control group (CG) and the remainder to a balance exercise group (BEG) to perform the upper extremity task on various support surfaces. Each intervention was executed 30minutes per session with 2sessions a week for 12weeks. To make comparisons before and after intervention, gross motor function measure; standing; demention D(GMFM;D), walking/running/jumping ;demention E (GMFM;E) and pediatric balance scale (PBS) were evaluated. Results : The CG showed a significant difference (p<.05) in GMFM;E. BEG showed a significant difference (p<.05) in GMFM;D as well as GMFM;E and in PBS before and after intervention. BEG showed a significant improvement (p<.05) in GMFM;D and the PBS compared with the CG whereas it did not indicate any statistically significant difference in GMFM;E. Conclusion : According to the results of this study, it has been shown that a balance exercise accompanied by upper extremity task on various support surfaces had an effect on improvement in the gross motor function and the balance ability of children with spastic diplegic cerebral palsy.

• Journal of the Korean Society of Physical Medicine
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• v.9 no.2
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• pp.201-211
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• 2014

PURPOSE: The purpose of this study was to investigate the inter-rater absolute reliability and the concurrent validity of the Tinetti-gait scale that was translated into Korean for chronic stroke patients. METHODS: Fifty-two patients with post-stroke participated in this study. Inter-rater reliability was analyzed by Intraclass Correlation Coefficient ($ICC_{3,1}$) and Kappa coefficient, and absolute reliability was analyzed by the Standard Error of Measurement (SEM), and the Minimal Detectable Change (MDC). Concurrent validity was analyzed by correlating between the Tinetti-gait scale and physical functions. The physical functions were measured by using the Dynamic Gait Index(DGI), 10m walking test(10WT), One Leg Standing Test of affected/non-affected side(OLST), Sit to Stand test(STS), (Fugl Meyer assessment of Lower Extremity(FM-LE). RESULTS: The inter-rater reliability of the Tinetti-gait scale was high; $ICC_{(3,1)}=.91$ (95% CI=.85~.95) (very reliable), the range of Kappa coefficient were .73~.92 (substantial~good). The inter-rater agreement of the each item in Tinetti-gait scale ranged from .74 to .92 (95 % CI=.59~.95) (reliable~very reliable). The SEM and MDC were .56 and 1.55, respectively. In the results of concurrent validity, there were moderate positive correlation between Tinetti-gait scale and DGI (r=.78), 10WT (r=.74), OLST (r=.65~.73), FM-LE (r=67). And there was moderate negative correlation between Tinetti-gait scale and STS (r=-79) (p<.01). CONCLUSION: The Tinetti-gait scale(Korean version) was a reliable and valid tool to measure gait ability in patients with chronic stroke. Thus, it could be a useful tool for examining a gait ability of post-stroke patients. Further study should be conducted to investigate the usability to predict fall risk of post-stroke patients of the Tinetti-gait scale.

• Physical Therapy Korea
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• v.26 no.4
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• pp.10-19
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• 2019

Background: In patients with lumbar spinal stenosis (LSS), lumbar flexion exercise (LFE) is considered a standard therapeutic exercise that widens the space between the spinal canal and intervertebral foramen. However, some researchers have reported that lumbar extension exercise (LEE) may improve lumbar pain and functional ability in patients with LSS. Although exercise intervention methods for patients with LSS have been widely applied in clinical settings, few studies have conducted comparative analysis of these exercise methods. Objects: This study aimed to compare the effects of LFE, LEE, and lumbar flexion combined with lumbar flexion-extension exercise (LFEE) on pain, range of motion (ROM), pelvic tilt angle, and functional gait ability in patients with LSS. Methods: A total of 30 patients with LSS, LFE (n1=10), LEE (n2=10), and LFEE (n3=10) were assigned to each of the three exercise groups. The numerical pain rating scale (NPRS), modified-modified schober test (MMST)-flexion, MMST-extension, pelvic tilt inclinometer, and 6-minute walking test (6MWT) were measured. Results: After the intervention, statistically significant differences were observed in the NPRS (p=.043), MMST-flexion (p<.001), MMST-extension (p<.001), and 6MWT (p=.005) between groups. According to the post hoc test, the NPRS was statistically significant difference between the LFEE and LEE groups (p=.034). The MMST-flexion was statistically significantly different between the LFE and LEE (p=.000), LFE and LFEE (p=.001), and LEE and LFEE (p=.001) groups. The MMST-extension was statistically significantly different between the LFE and LEE (p<.001), LFE and LFEE (p=.002), and LEE and LFEE (p=.008) groups. The 6MWT was statistically significantly different between the LFE and LFEE (p=.042) and the LEE and LFEE (p=.004) groups. Conclusion: This study suggested that LFEE was the most effective exercise for pain and functional gait ability in patients with LSS, LFE was the most effective exercise for lumbar flexion ROM, and LEE was the most effective exercise for lumbar extension ROM.