Lower Extremities Committee of Korean Academy of Medical Sciences Guideline for Impairment Rating develops new guidelines which are based on McBride method, American Medical Association Guides, Disability evaluation by The Korean Orthopaedic Association, The Korean Neurosurgery Society, and Korean Academy of Rehabilitation Medicine. The committee analyzed and discussed to create an ideal method practical in Korea. Our committee endeavors to develop new methods which are easy to use, but are suitable for professional use and also independent from the examinee's intentions. The lower extremities are evaluated on the basis of anatomic change, functional change, and diagnosis based evaluation. Nine methods are used to assess the lower extremities. Anatomic assessment includes leg length discrepancy, ankylosis, amputation, skin loss, peripheral nerve injury, and vascular disease. In functional assessment, range of motion and muscle strength are included. Diagnosis-based assessments are used to evaluate impairment caused by specific fractures, deformities, ligament instability, meniscectomies, post-traumatic arthritis, fusion of the foot, and lower extremity joint replacements.
Ankylosis/classification/physiopathology ; *Disability Evaluation ; Humans ; Korea ; Lower Extremity/pathology/*physiopathology ; Muscle Weakness/classification/physiopathology ; Program Development ; Severity of Illness Index

OBJECTIVETo observe differences of immediate effect of twirling reinforcing-reducing manipulation at head acupoints on muscle force in patients with acute ischemic stroke.

METHODSA total of 126 patients who met the inclusive criteria were randomly divided into a twirling reinforcing group, a mild reinforcing-reducing group and a twirling reducing group, 42 cases in each one. The lines between Baihui (GV 20) and bilateral Taiyang (EX-HN 5) were selected and treated with successive insertion of three needles. The twirling reinforcing method was used in the twirling reinforcing group, and mild reinforcing-reducing method was used in the mild reinforcing- reducing group, and twirling reducing method was used in the twirling reducing group. Each needle was manipulated for 1 min, which was repeated once every 10 min. The needles were retained for 30 min. Muscle force was evaluated immediately after treatment.

RESULTS(1) Muscle force of upper limb: after acupuncture, the muscle force of proximal and remote ends were all improved significantly in three groups (all P < 0.05), which was more obvious in proximal end (all P < 0.05). The improvement of the muscle force of proximal end in the twirling reinforcing group was superior to those in the mild reinforcing-reducing group and twirling reducing group (both P < 0.05); the differences of the muscle force of remote end were not significant among three groups (all P > 0.05). (2) Muscle force of lower limb: after acupuncture, the muscle force of proximal and remote ends was all improved significantly in the three groups (all P < 0.05). The improvement of the muscle force of proximal end was superior to that of remote end in the twirling reinforcing group and mild reinforcing-reducing group (both P < 0.05).

CONCLUSIONThe twirling reinforcing manipulation at head acupoints is superior to mild reinforcing-reducing and twirling reducing manipulation for muscle force in patients with acute ischemic stroke, which is more significant in proximal end of limbs.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Ischemia ; therapy ; Lower Extremity ; physiopathology ; Male ; Middle Aged ; Stroke ; physiopathology ; therapy ; Treatment Outcome ; Upper Extremity ; physiopathology

Amyoplasia congenita is a diagnostic subgroup of children with arthrogryposis multiplex congenita (AMC). AMC is a relatively rare syndrome characterized by multiple joint contractures at birth. Amyoplasia congenita is the most common type of this syndrome with an occurrence rate of 1 in 10, 000 live births, and mainly refers to the disorders with limb involvement. In this report, the author presents a premature baby with amyoplasia congenita, whose hips showed flexion, abduction, and external rotation contractures. The knees showed fixed extension contractures, so that his lower extremities were cylindrical with absent skin creases at birth.
Adult ; Arthrogryposis/*physiopathology/therapy ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Lower Extremity ; Male

Adult ; Aneurysm, Dissecting ; complications ; Aortic Aneurysm ; complications ; Humans ; Lower Extremity ; physiopathology ; Male

OBJECTIVE: To analyze the balance function of injured lower limb by dynamic posturography. METHODS: Using the dynamic posturography instrument, the postural evoked responses of sixty-two normal people and two hundred and fifty-eight people with injured lower limb bones and joints were detected. The test was included sensory organization test (SOT) and adaption test (ADT). The results of two groups were compared by t test. RESULTS: Compared with the normal people, the impaired people had significant statistical differences in balance scores of SOT3-SOT6 and proportion score of dynamic proprioception (P < 0.05). There was no obvious decrease in ADT. CONCLUSION The balance function of injured lower limb significantly decreases.
Case-Control Studies ; Humans ; Lower Extremity/physiopathology* ; Postural Balance/physiology* ; Posture/physiology* ; Proprioception/physiology*

OBJECTIVETo compare the differences in the efficacy on lower limb motor function in children with spastic cerebral palsy between the combined therapeutic program of Jin three-needle therapy and MOTOmed intelligent motor training and the simple MOTOmed.

METHODSEighty children with spastic cerebral palsy were randomized into an observation group and a control group, 40 cases in each group. In the observation group, Jin three-needle therapy was used at four mind points, three brain points, three intelligent points, three temporal points, three knee points and three foot points, as well as Chengjin (BL 56), Chengshen (BL 57) and the other. Additionally, MOTOmed was given in assistance with conventional rehabilitation training. In the control group, MOTOmed and the conventional rehabilitation training were adopted. In the two groups, the treatment was given once a day, 20 treatments made one session and there were 3 to 5 days at interval between the two sessions. The efficacy evaluation was performed after continuous 3 sessions of treatment. The gross motor function measure (GMFM) and modified Ashworth scale (MAS) were applied for the evaluation before and after treatment in the two groups.

RESULTSAfter 3 sessions of treatment, GMFM score was increased apparently as compared with that before treatment in the two groups (P < 0.01, P < 0.05). After treatment, GMFM score in the observation group was increased more remarkably than that in the control group (55.32 +/- 17.10 vs 47.48 +/- 17.18, P < 0.05). After treatment, the total effective rate of gastrocnemius Ashworth spasm grade [90.0% (36/40)] in the observation group was better apparently than [72.5% (29/40)] in the control group (P < 0.05).

CONCLUSIONThe combined therapeutic program of Jin three-needle therapy and MOTOmet intelligent motor training improves the lower limb motor function of the children with spastic cerebral palsy and its efficacy is better than simple MOTOmed.

Acupuncture Therapy ; Cerebral Palsy ; physiopathology ; psychology ; therapy ; Child ; Child, Preschool ; Female ; Humans ; Intelligence ; Lower Extremity ; physiopathology ; Male ; Motor Activity

To develop an objective and scientific method to evaluate the brain injured and brain diseased persons with motor dysfunction, American Medical Association's Guides to the Evaluation of Permanent Impairment was used as an exemplar. After the motor dysfunction due to brain injury or brain disease was confirmed, active range of motion and muscle strength of affected extremities were measured. Also, the total function of extremities was evaluated through the assessment of activities of daily living, fine coordination of hand, balance and gait. Then, the total score of manual muscle test and functional assessment of impaired upper and lower extremity were added, respectively. Spasticity of upper and lower extremity was used as minus factors. Patients with movement disorder such as Parkinson's disease were assessed based on the degree of dysfunction in response to medication. We develop a new rating system based on the concept of total score.
Brain Diseases/classification/*diagnosis/physiopathology ; Brain Injuries/classification/*diagnosis/physiopathology ; *Disability Evaluation ; Hand/physiopathology ; Humans ; Korea ; Lower Extremity/physiopathology ; Motor Skills ; Program Development ; Severity of Illness Index ; Upper Extremity/physiopathology

OBJECTIVETo assess the effect of electroacupuncture in different frequencies by electromyography and walking function measure in post-stroke patients with lower-extremity (OLE) spasticity and hemiparesis.

METHODSFifty cases of post-stroke whose motor deficit was classified into Brunnstrom stage II - IV were randomly divided into a 100 Hz group, a 50 Hz group and a 2 Hz group. They were accepted 100 Hz, 50 Hz or 2 Hz of electroacupuncture (EA) therapy combined with standard rehabilitation program. Main outcome measures included integrated electromyography (IEMG) score during maximum isometric voluntary contraction (MIVC) of the knee flexors and extensors, ankle dorsiflexors and planterflexors in the affected LE recorded by surface EMG, Co-contraction ratio calculated by IEMG score of the antagonist over that of the agonist plus antagonist, Composite Spasticity Scale (CSS), Fugl-Meyer Motor Scale (FMS) and Functional Ambulation Categories (FAC) on LE. All outcomes were assessed at the baseline and after treatment by the professional practitioners who blinded to the treatment.

RESULTSAfter EA treatment, IEMG of rectus femoris were decreased in 100 Hz and 50 Hz groups (P < 0.01, P < 0.05), and better than that in 2 Hz group (both P < 0.05); gastrocnemius IEMG were decreased in 100 Hz and 50 Hz groups (P < 0.05, P < 0.01); but IEMG of tibialis anterior muscle was increased only in 50 Hz group (P < 0.05). During knee flexion, EMG co-contraction ratio in MIVC declined in 100 Hz and 50 Hz groups were decreased significantly (P < 0.05, P < 0.01), and the co-contraction ratio between the non-affected and affected side were increased significantly in all the 3 groups after treatment (P < 0.01, P < 0.05). During ankle dorsiflexion, co-contraction ratio were decreased significantly in all the 3 groups (P < 0.05, P < 0.01), and cocontraction ratio between the non-affected and affected side was increased significantly only in 100 Hz after treatment (P < 0.01). FMS score, CSS and FAC were improved in all the 3 groups after treatment (all P < 0.01), but only FAC in 100 Hz group showed better effect than that in 50 Hz group or 2 Hz group (both P < 0.05).

CONCLUSIONElectroacupuncture therapy combined with rehabilitation program is effective for the spasticity status of lower-extremity in post-stroke. The therapeutic effect of EA in the frequencies of 100 Hz or 50 Hz is superior to that of 2 Hz stimulation and parameter of 100 Hz may be optimal.

Aged ; Electroacupuncture ; Electromyography ; Female ; Humans ; Lower Extremity ; physiopathology ; Male ; Middle Aged ; Muscle Spasticity ; etiology ; physiopathology ; therapy ; Paresis ; etiology ; physiopathology ; therapy ; Stroke ; complications ; Treatment Outcome ; Walking

OBJECTIVETo observe the impact on lower limbs balance function in treatment of yin-yang meridians acupuncture with respiratory reinforcing and reducing manipulation involved in the patients of stroke by applying B-PHY balance function test training system so as to provide the objective evidence in treatment of stroke; with acupuncture.

METHODSOne hundred patients were randomized into an observation group and a control group, 50 cases in each one. In the control group, the basic treatment was applied, without other relevant rehabilitation therapies associated. In the observation group, with the basic treatment as the control group's, the therapy of the yin-yang meridians acupuncutre with respiratory reinforcing and reducing manipulation was adopted. On the yin meridians, Zuwuli (LR 10), Xuehai (SP 10), Yinlingquan (SP 9), Sanyinjiao (SP 6) and the others were selected and stimulated with reducing manipulation achieved by the coordination of patient's respiration. On the yang meridians, Biguan (ST 31), Liangqiu (ST 34), Yanglingquan (GB 34) and the others were selected and stimulated with reinforcing manipulation achieved by the coordination of patient's respiration. The treatment was given once a day and for 28 days totally. Before treatment and in 28 days of treatment, B-PHY balance function test training system was used to determine the weight shift track parameters (track length, peripheral square, track length of per unit square, left-right offset and rectangle square), the weight shift track distance parameters [mean of X axle weight shift distance (Mean-X), mean of Y axle weight shift distance (Mean-Y), maximum of X axle weight shift distance (Max-X), maximum of Y axle weight shift distance (Max-Y), weight shift distance (LSKG), weight shift square (SSKG), square ratio of weight shift (LFS)], stability coefficient (SI) and weight distribution coefficient (WDI).

RESULTSAfter treatment, the differences in the weight shift track parameters, SI and WDI were significant as compared with those before treatment in the patients of the two groups (all P<0.01); while the differences in the weight shift distance parameters in the observation group were improved obviously after treatment as compared with those before treatment (all P<0.01), the differences of Mean-X, Max-Y and LFS in the control group were improved after treatment as compared with those before treatment (all P<0.01). Except SSKG, the improvements after treatment in the rest indices in the observation group were better than those in the control group (all P<0.05).

CONCLUSIONThe yin-yang meridians acupuncture with respiratry reinforcing and re- ducing manipulation effectively improves the lower limbs balance function in the patients of stroke.

Acupuncture Therapy ; Adult ; Aged ; Female ; Humans ; Lower Extremity ; physiopathology ; Male ; Meridians ; Middle Aged ; Postural Balance ; Respiratory System ; physiopathology ; Stroke ; physiopathology ; therapy ; Treatment Outcome ; Yin-Yang

To compare the effect of cold or room temperature of tumescence anesthesia solution on pain perception during and after endovenous laser ablation (EVLA) for varicose veins of lower limb.
 Methods: A total of 51 patients with lower extremity varicose vein were treated by EVLA with tumescence anesthesia solution. All patients were used for local anesthesia and randomly divided into 2 groups according to the temperature of tumescence anesthesia solution: Group A (n=26) with room temperature (24 ℃) of tumescence anesthesia solution and Group B (n=25) with cold (4 ℃) tumescence anesthesia solution. Number rating scale (NRS) was recorded immediately after the procedure and postoperative 1, 2, 3 day. Patients were asked to register pain scores during the week.
 Results: The mean linear endovenous energy density (LEED) in the 2 groups was not significantly different (P>0.05). The ratio of patients without pain during the operation in the Group A was lower than that in the Group B (30.8% vs 64%, P<0.05). On the day of operation and postoperative day 1, 2, 3, the average number rating scale (NRS) scores in the Group A were greater than those in the Group B (P<0.05). Postoperative day 1, only 30.8% of the patients in the Group A resumed daily activities, which was lower than that (68% of the patients) in the Group B.
 Conclusion: In the process of EVLA for varicose veins of lower limb, there is less pain during operation and post-operation using cold tumescence anesthesia solution comparing room temperature tumescence anesthesia solution.
Anesthesia ; methods ; Cold Temperature ; Humans ; Intraoperative Complications ; physiopathology ; Laser Therapy ; Lower Extremity ; Pain Measurement ; Pain Perception ; physiology ; Pain, Postoperative ; physiopathology ; Treatment Outcome ; Varicose Veins ; physiopathology ; surgery