1-1 ( stroke ) ( CVA cerebral vascular accident ) 1 2 3 1. (a) (b) 1
2. (a) (b) 1-2 2
1. Flaccid 2. Associated Movement 3. Start of Voluntary Movement with Synergy 4. Voluntary Movement with Break of Synergy 5. Voluntary Movement with Less Synergy than stage 4 6. Near Normal 3
1 2 1-3 gait cycle loading response,lr mid-stance, MST terminal stance, TST pre-swing, PSW initial swing, ISW mid-swing, MSW terminal swing, TSW 5 6 gait cycle initial contact,ic toe off,tof shear force reverse,sfr 4
double stance,ds 1-1 1-4 5
(AFO) 6
2-1 5 1. stance phase 2. swing phase 3. 4. 5. 1 low heel strike 2 foot-flat 3 forefoot contact dorsiflexion 7 1 15 7
15 25 hyper-extension extension moment plantar?flexion moment 1. 2. 5 ; 8
35 4 3 7 8 concentric contraction 2-2 9 AFO 9
2-1 KAFO 2-2 2-1 AFO ) 9 2-2 (KAFO ) 9 1
1 11 9 12 13 RADCLIFFE 14,15 16 17 18 19 5 5 2-3 6 1 2 = 5 3 MacGregor 1979 Physiological Cost Index 11
PCI 2 21 4 Winter 22 5 23 24 12
3-1 3-1-1 3-1 3-1 1 (Base rib cage) 2 (Greater trochanter) 3 (Lateral Epicondyle of thigh) 4 (Head of fibula) 13
5 (Lateral Malleolns) 6 (Heel) 7 (5-th Metatarsal) 3-1-2 sagittal plane Newton-Euler method 25 Lateral malleolus 5-th Metatarsal bone Head of fibula 1 Great trochanter Lateral Epicondyle of thigh 2 3 14
3-1 3-2 3-1 3-2 F x F y T 1 T 2 T 3 M t M g (N) (N) (N-m) (N-m) (N-m) (N-m) kg m/sec 2 15
m i l i r i I i q i &q i &&q i R x R y i kg i m i m i kg-m 2 i rad i rad/sec i rad/sec 2 N N (X c,y c ) m (X iu,y iu ) i m (X il,y il ) i m (F ix,f iy ) N 3-1-3 ( ) 1. ( ) 3-2 F = m && x R 3.1 x c x F = m && y R + m g 3.2 y c y 16
T 1 = I q&& m x&& ( y y ) + m y& c c U c ( x c x U ) + m g ( x c x U ) + R x ( y c y U ) R y ( x c x U ) 3.3 F 1y T 2 F 1x Knee F y T 1 F x I q&& m x&& c m && y c R x m g R y m 1 x&& 1c m 1 && y 1c m g 1 I 1 q&& 1 Ankle T 1 F x F y (a) (b) F 2y T 3 m 2 && x 2c m 2 && y 2c m g 2 F 2x Hip F 1x I 2 q&& 2 Knee T 2 m 3 x&& 3c I 3 q&& 3 m 3 && y 3c m 3 g F 1y T 3 17
(c) (d) 3-2 T 1 3.3 (Center of pressure) T 1 T 2 T 3 M t 2. ( ) F = m x&& + F 3.4 1x 1 1c x F = m && y + F + m g 3.5 1 y 1 1c y 1 T = T + I q&& m x&& ( y y ) + m && y ( x x ) 2 1 1 1 1 1c 1c 1U 1 1c 1c 1U + m g( x x ) F ( y y ) + F ( x x ) 1 1c 1U x 1L 1U y 1L 1U 3.6 3. ( ) F = m x&& + F 3.7 2x 2 2c 1x 18
F = m && y + F + m g 3.8 2 y 2 2c 1 y 2 T = T + I q&& m x&& ( y y ) + m y&& ( x x ) 3 2 2 2 2 2c 2c 2U 2 2c 2c 2U + m g( x x ) F ( y y ) + F ( x x ) 2 2c 2U 1x 2 L 2U 1 y 2 L 2U 4. ( ) 3.9 = & 3.1 Fx m3 x3c + F2 x F = m && y + F + m g 3.11 y 3 3c 2 y 3 M t = T + I q&& m && x ( y y ) + m & y 2 3 + m g( x 3 3c 3 x 3L ) 3 3c 3c 3L 3 3c ( x 3c x 3L ) 3.12 3-2 1.41 42.55 19
1.83 32.79 3-3 7 ms 5% 15 mm 3-4 2
Stick Diagram ( Stance Phase ) 15 1 2 3 4 5 6 7 8 9 1 11 12 13 14 1 Distance (mm) 5-5 1 15 2 25 3 35 Distance (mm) 3-3 Stick Digram ( Swing Phase ) 12 1 Distance (mm) 8 6 4 2 15 2 25 Distance (mm) 21
3-4 3-5 3-6 3-6 N-m/kg N-m dorsiflexion moment 22
Ankle angle(degree) Ankle angle(degree) 1-1 Dorsi-flexion fast cadence -2 2 4 6 8 1 1-1 Plantar Flexion slow cadence -2 2 4 6 8 1 % gait cycle 3-5 23
Knee Angle(degree) Knee Angle(degree) 8 6 4 2 Flexion fast cadence 2 4 6 8 1 8 6 4 2 Flexion slow cadence 2 4 6 8 1 % gait cycle 3-6 24
Knee Angle(degree) Knee Angle(degree) 8 6 4 2 Flexion fast cadence 2 4 6 8 1 8 6 4 2 Flexion slow cadence 2 4 6 8 1 % gait cycle 3-7 3-7 T 1 F x F y T 2 + [ R x ( y c y 1U ) + R y ( x c x 1U )] + [ m g ( x c x 1U ) m 1 g ( x 1c x 1U )] + [ I q&& I q&& 1 1 + m x&& c ( y c y 1U ) m y&& c ( x c x 1U ) + m x&& 1 1c ( y 1c y 1U ) m y&& 1 1c ( x 1c x 1U )] = 3.13 25
fast cadence Moment (N-m/kg).5 T2 -.5 5 1.5 [ A ] -.5 5 1.5 [ B ] Extension.5 -[ C ] Extension -.5 -.5 5 1 % Gait Cycle 5 1 % Gait Cycle 3-8 3.13 A B C T 2 + A + B + C = 3-8 3-9 T 2 A B - C A B - C T 2 T 2 26
slow cadence Moment (N-m/kg).5 T2 -.5 5 1.5 [ A ] -.5 5 1.5 [ B ] Extension.5 -[ C ] Extension -.5 -.5 5 1 % Gait Cycle 5 1 % Gait Cycle 3-9 load line of ground reaction force 3-7 27
28
4-1 3-3 1~4 ~16% 29
1 Y coordinate of mass center of upper body (mm) 1185 118 1175 117 1165 116 1155 115 1145 114 1135 2 4 6 8 1 % Gait Cycle 4-1 4-1 29 % 8 % 3
5 % 58 % 33.3 mm 4-1 3-3 4~8 16~33% 29 % 31
3-3 11~14 51~67% 12 17 4-1 15 7 7 1 4-2 1. 32
2. 3. 4. 4-2 1 A4 1 A7 A9 A5 2 33
A6 A4 A7 34
(a) (b) (c) 4-2 35
A4 A5 A7 A8 A6 A4 A5 A8 A6 A8 A1 2 A6 A8 A6 A7 A6 A7 A7 A7 A6 A8 A1 A6 A7 A4 36
A6 4-3(a) r 2 T 1 M 3 + F 2d = 4.1 r 2 T 1 A6 F 2 A7 d = cos( φ + θ) l F 2 l A6 A6 A7 A6 F 2 A6 A6 A6 A9 A4 A4 A6 A4 A6 M 3 A1 4-3(b) h( γ ) = = e e 2 2 + f + f 2 2 2ef + 2ef cos( π γ ) cos( γ ) 4.2 h(γ ) C D γ e f D E C E M 3 = K 3( h( γ ) h ) g 4.3 K 3 h 37
g E CDE h( γ ) g = f e sin( γ ) 4.4 4.3 4.4 3 ( h M 3 = K 1 ) ef sin( γ ) 4.5 h( γ ) C-E-D A7 4-3(c) p q F 1 = F 2 = K 1 ( θ + ψ α) 4.6 F 1 F 2 p sin( φ) q = l sin( θ) A6 θ A6 φ A4 α A4 4-3(d) M p ) T 4.7 b 1 F1 ( 2 1 = r M 1 b T 1 A4 A6 38
bd M 1 = K 1( θ + ψ α) + K 1( θ + ψ α) + bm q 3 4.8 ϕ f θ e γ (a) ( b) 39
q p (c) ( 4-3 d) 4
4-4 A 4.8 A7 B 4.8 A7 A6 A6 A7 C 4.8 A1 4.8 A4 b b b 25 2 15 A Moment (N-m) 1 5-5 -1 C D A E B -15-5 5 1 15 2 Ankle Angle (degree) 4-4 41
A6 A7 A6 A4 A6 b A6 4-4 D 4-4 E 4-3 16 14 15 42
43
5-1 1.A5 8mm, 2.A6 5mm, 3.A4 27mm, 4.A6 4mm A9 A7 A1 A1 2 A9 A6 A1 A6 A8 A8 44
5-1 5-1.5.25m A6 5-2 3-6 6-7 45
Wear new AFO Ankle angle(degree) 1-1 Dorsi-flexion -2 2 4 6 8 1 1 Moment( N-m/kg ).5 2 4 6 8 1 % gait cycle 5-2 5-2 46
1 2 5 4 15 3 Y (mm ) 1 Y (mm ) 2 5 1-8 -6-4 -2 2 4 X (mm ) -1-2 X (mm ) 5-3 45 4 35 Extension Moment(N-m) 3 25 2 15 1 5 1 2 3 4 5 6 7 Knee Angle(degree) 5-4 47
6-1 A6 A6 A7 A1 A6 6-1 48
5-2 3-6 49
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