Soo-Kyung Bok

The Effects of Changes of Ankle Strength and Range of Motion According to Aging on Balance

Objective To investigate the changes of ankle strength and range of motion with aging and which of the ankle strength and range of motion are contributed to balance. Methods Sixty healthy people (24 men and 36 women) have undergone tests for ankle strength and range of motion, using Biodex System 4 Pro; a one-leg balance, including postural sway and stability index using a Balance System; in which data were collected in a self-reported Desmond fall risk questionnaire. Results Participants are classified into 3 groups by age (group 1, 20-40 years; group 2, 40-65 years; group 3, over 65 years). Stability index and postural sway is significantly increased with aging. Ankle plantarflexor strength and ankle eversion range of motion is significantly decreased with aging. Pearsons correlation revealed that ankle plantarflexor strength is significantly correlated with anterior/posterior sway, and ankle eversion range of motion is significantly correlated with medial/lateral sway in the aged group (over 65 years). Conclusion Stability, ankle plantarflexor strength, and eversion range of motion is declined with aging. In addition, strength of ankle plantarflexor and eversion range of motion is significantly correlated with balance stability. Further studies are needed for programs to improve the strength of plantarflexor, and range of motion of eversion of the ankle are beneficial in improving balance, stability, and prevention of falling in the elderly.

Effects of Custom-Made Rigid Foot Orthosis on Pes Planus in Children Over 6 Years Old

Objective To identify the effects of a custom-made rigid foot orthosis (RFO) in children over six years old with pes planus. Methods The medical records of 39 children (mean age, 10.3±4.09 years) diagnosed with pes planus, fitted with RFOs, and had who more than two consecutive radiological studies were reviewed. The resting calcaneal stance position (RCSP), anteroposterior talocalcaneal angle (APTCA), lateral talocalcaneal angle (LTTCA), the lateral talometatarsal angle (LTTMA), and calcaneal pitch (CP) of both feet were measured to evaluate foot alignment. After diagnosis, children were fitted with a pair of RFOs and recommended to walk with heel strike and reciprocal arm swing to normalize the gait pattern. A follow-up clinical evaluation with radiological measurements was performed after 12-18 months and after 24 months of RFO application. Post-hoc analysis was used to test for significant differences between the radiological indicators and RCSP. Results With RFOs, all radiological indicators changed in the corrective direction except LTTCA. RCSP and CP in the third measurement showed significant improvement in comparison with the second and baseline measurements. Additionally, APTCA and LTTMA revealed improvements at the third measurement versus the baseline measurements. Conclusion This study revealed that radiological indicators improved significantly after 24 months of RFO application. A prospective long-term controlled study with radiographical evaluation is necessary to confirm the therapeutic effects of RFOs and to determine the optimal duration of wear in children with pes planus.

The Effect of Different Foot Orthosis Inverted Angles on Plantar Pressure in Children with Flexible Flatfeet.

Although orthotic modification using the inverted technique is available for the treatment of flatfoot, empirical evidence for the biomechanical effects of inverted-angle foot orthoses (FOs) is lacking. The aim of this study was to evaluate the effects of different FO inversion angles on plantar pressure during gait in children with flatfoot. Twenty-one children with flexible flatfeet (mean age 9.9 years) were enrolled in this study. The plantar pressures were measured for the rearfoot; medial and lateral midfoot; and medial, central, and lateral forefoot as participants walked on a treadmill while wearing shoes only and shoes with the following 3 orthotic conditions: (i) orthosis with no inverted angle, (ii) orthosis with a 15° inverted angle, and (iii) orthosis with a 30° inverted angle. A one-way repeated measures analysis of variance (ANOVA) with the Bonferroni-adjusted post-hoc test was used to compare the mean values of each orthotic condition. Compared with the shoe only condition, the peak pressure decreased significantly under the medial forefoot and rearfoot with all FOs (p <0.05). However, no significant differences in the peak pressure under the medial forefoot and rearfoot were observed between the FOs. The peak pressure under the medial midfoot increased significantly with all FOs, and a maximal increase in the peak pressure was obtained with a 30° inverted angle orthosis. Furthermore, the contact area under the medial midfoot and rearfoot increased significantly with all FOs, compared with the shoe only condition (p <0.05). Again, no significant differences were observed between the FOs. For plantar pressure redistribution, a FO with a low inverted angle could be effective, accommodative, and convenient for children with flatfoot.

Recurrent cerebral infarction caused by mobile aortic arch thrombus refractory to warfarin therapy.

The mobile thrombus in the aortic arch is a rare condition, which becomes rarer when associated with cerebral infarction, resulting in disabling complications. Transesophageal echocardiography is useful for detecting the source of thrombi in the heart and aortic arch. Here, we report a case of a patient who suffered from recurrent cerebral infarction four times during the previous 18 months due to mobile thrombus in the aortic arch despite anticoagulant therapy. The thrombus with rocking motion (9.6 and 8 mm) was laid in the top of the aortic arch, and surgical resection was not allowed due to the location. We began anticoagulation therapy initially with heparin followed by a combination of warfarin, aspirin, and atorvastatin with an international normalized ratio between 2 and 3. The size of the aortic thrombi was significantly decreased by 3 mm and stabilized after 18 months.

Real-time Sitting Posture Monitoring System for Functional Scoliosis Patients

In recent years, with the increase in sitting time, real-time posture monitoring system is needed. We developed sitting posture monitoring system with accelerometer to evaluate postural balance. Unstable structure of the system was designed to assess asymmetrical balance caused by habitual sitting position. Postural patterns of normal group and patients with functional scoliosis group were analyzed. Consequently, inclination angle of scoliosis group were tilted to the posterior and left side. From these results, we concluded that real-time sitting posture monitoring system can be utilized to measure asymmetrical balance of patients and provide accurate diagnosis as well as treatment for individuals.

Correlation Analysis between Idiopathic Scoliosis and Pelvic Asymmetry Using Sitting Posture Measurement System

The effects of pelvic asymmetry and idiopathic scoliosis on postural balance sitting were studied by measuring inclination angle and electromyography. Subjects were classified into a control group, pelvic asymmetry group, scoliosis group, and scoliosis with pelvic asymmetry and then performed anterior, posterior, and left-right pelvic tilting while sitting on the sitting posture measurement system for 5 seconds to assess their postural balance. Inclination and obliquity angles between the groups were measured by an accelerometer located on the system. Surface electrodes were attached to the erector spinae muscles of each participant. Inclination and obliquity angles increased more symmetrically in participants with both pelvic asymmetry and scoliosis than with pelvic asymmetry or scoliosis alone. Muscle contraction patterns of erector spinae muscles may be influenced by spine curve type and region of idiopathic scoliosis. Asymmetrical muscle activities were observed on the convex side of scoliotic patients and these muscle activity patterns were changed by the pelvic asymmetry. From these results, sitting posture measurement system may be utilized to assess the effects of asymmetrical postural balance and muscle activity caused by pelvic asymmetry and scoliosis on the physical activity of adolescent patients in their daily lives.

Evaluation of Sitting Balance in Adolescent Idiopathic Scoliosis Patients with Pelvic Rotation Using Balance Board System with Accelerometer

Correlation analysis between scoliosis and pelvic axial rotation of adolescent idiopathic scoliosis patients was conducted using balance board system with accelerometer. 9 subjects were classified into scoliosis group and scoliosis with PAR group, and then their cobb angles, directions of pelvic axial rotation, and inclination angles were also measured. Inclination angles were assessed by using an accelerometer located on the balance board system. All subjects performed anterior, posterior, left, and right pelvic tilting on the system for 5 seconds during sitting. Inclination angles of scoliosis patients were changed significantly in the frontal and sagittal planes by the direction of the pelvic axial rotation. From the results, it was confirmed that postural balance of idiopathic scoliosis in adolescents may be influenced by cobb angle and pelvic axial rotation. In addition, balance board system with accelerometer can be utilized to provide useful information about the patients with idiopathic scoliosis and pelvic deformities in rehabilitation medicine.

The effects of talus control foot orthosis in children with flexible pes planus

Fourty children were participated in this study who had been diagnosed as flexible pes planus, and had more than two consecutive radiologic studies. The anteroposterior talocalcaneal angles (APTCA) and lateral talocalcaneal angles (LTTCA), the lateral talometatarsal angles (LTTMA) and the calcaneal pitch (CP) of both feet were measured to evaluate foot alignment. Severe flexible pes planus was diagnosed when Beighton hypermobility score was greater than 4 points and when either of the feet had greater than 10 degrees valgus of resting calcaneal stance position angle and indicators showed greater than 55 degrees in APTCA and LTTCA, greater than 10 degrees in LTTMA, lesser than 10 degrees of CP. Twenty children with flexible flat foot were fitted with a pair of RFO and another 20 children were fitted with TCFO. They were recommended to put on orthosis more than 8 hrs a day, to walk with heel strike at initial contact and reciprocal arm swing to normalize gait pattern. The follow up clinical evaluation with radiologic study was done after 12 months. Result With TCFO, all radiologic indicators changed toward corrective direction than with RFO. There were statistically significant improvements in CP and RCSP in both groups. (p < 0.05) In TCFO group, APTCA, RCSP improved significantly compared with RFO group. Conclusion This study showed that TCFO is effective in the treatment of children with severe flexible pes planus than RFO. The evaluation with long term follow up of radiographic study would be necessary to confirm the therapeutic effect of TCFO in children with pes planus.