Dynamic Changes of Pelvis and Lower Extremities after Operation in Lumbar Degenerative Kyphosis

OBJECTIVE: Gait pattern in patients with lumbar degenerative kyphosis (LDK) is disturbed because trunk bends forward due to decreased lumbar lordosis. Surgical therapy in LDK is required when conservative management fails. We investigated kinematic and kinetic changes of the pelvis, hip, and knee joints on the sagittal plane in patients with LDK before and after operation. METHOD: Fifteen patients underwent operations between March 1999 and September 2003. Gait analysis was performed for all patients. RESULTS: Total lumbar lordotic angle increased from 10.50 degrees +/-11.22 degrees to 26.71 degrees +/-8.80 degrees postoperation. In gait analysis, anterior pelvic tilting angle increased from maximum 7.86 degrees +/-9.69 degrees, minimum 4.40 degrees +/-9.82 degrees to maximum 12.61 degrees +/-5.36 degrees, minimum 9.68 degrees +/-5.63 degrees (p<0.05). Maximum hip flexion angle changed from 31.39 degrees +/-11.71 degrees to 35.83 degrees +/-5.84 degrees (p<0.05). Maximum knee flexion angle in terminal stance phase decreased from 13.32 degrees +/-7.34 degrees to 8.30 degrees +/-6.38 degrees (p<0.05). CONCLUSION: After corrective operation, an increase of lumbar spine lordosis and anterior pelvic tilt with decrease of knee flexion were observed. However, an increase of maximum hip flexion secondary to increased anterior pelvic tilting influenced ambulation negatively. Therefore, stretching of the hip flexor and strengthening of the hip extensor are required before and after operation.

The Development of Ankle Control Elastic Band for Improvement in Walking of Hemiplegic Patients

OBJECTIVE: The aims of this study were to verify that the newly developed ankle control elastic band (ACE band) can improve the gait pattern of hemiplegic patients by assessment of objective and subjective data. METHOD: ACE band consisted of medial ring, lateral ring, and elastic band was devised and 11 ambulatory stroke patients were evaluated with gait measurements, functional ambulation categories (FAC), functional reach test (FRT), and questionnaires for the effect of ACE band. Gait measurements were of 10 m walking time, cadence, stride length, stride period, stance phase, single support time, and single support time asymmetry ratio. RESULTS: Gait measurements with the ACE band showed significant improvement (p<0.05 or p<0.01). FAC and FRT with the ACE band were significantly increased (p<0.01), and the questionnaires suggested that wearing the ACE band helped improve toe dragging, swinging leg forward, taking weight through foot, confidence of gait, safety of gait, gait distance and gait velocity. CONCLUSION: ACE band was invented for improvement of hemiplegic gait, and its evaluation of gait measurements, FAC, FRT, and questionnaire showed that the ACE band was effective for hemiplegic gait after stroke.