분당 제생병원 재활의학과 스포츠재활 건강의학 클리닉 정 경 수 What is the Isokinetic ? 분당 제생병원 재활의학과 스포츠재활 건강의학 클리닉 정 경 수

Part I. “Isokinetic” Part II Part I. “Isokinetic” Part II. “Effect of Muscle Strengthning Exercise with Stroke Patient”

Part I. “Isokinetic”

Classification of Resistance Exercise 1. Isometric : Fixed speed (0º/sec),immovable Fixed resistance 2. Isotonic : Variable speed 3. Isokinetic : Fixed speed Accommadating resistance

Isometric Exercise - Performed at 0 °/sec speed without observable joint movement - Increased in the muscle belly - No functional movement is possible

Adavantage of Isometric - Used early rehabilitation - Increased static muscular strength - Helps retard atrophy - Can be performed anywhere

Disadavantage of isometric - Fairly specific to the joint angle where the exercises are performed ( = 20 °/sec) - Difficult to provide patient motivation - No contribution to muscular endurance - No improvement in functional force control accuracy

power ROM

What is the non-efficient ? Isotonic Exercise What is the non-efficient ?

Advantage of Isotonic exercise - Some can relatively inexpensive - Provides motivation by achievement - Can be progressively increased - Work take place through the R.O.M - Work occurs at speed greater than 0°/sec - Has concentric & eccentric component - Can improve muscular endurance

관절의 위치에 따른 근력의 변화 power ROM

Isoweight exercise POWER Isoweight ex. ROM

Disadvantage of isotonic - Load a muscle at its the weakest point in the R.O.M - Is not safe - Cause a reactive traumatic synovitis - Unable to spread workload evenly over entire R.O.M - Isotonic do not accommodate to pain

Definition of Isokinetic History James Perrine(late 1960’s) - Developed the concept of Isokinetic - Pre-set Fixed Dynamometer Speed - Resistance is totally accommodating throughout the R.O.M

Concept of Isokinetic Pre-set fixed Dynamometer Speed 2km/h 5km/h computer

Comparison of isotonic & isokinetic muscular contraction POWER Isokinetic isotonic slow fast ROM

Comparison of percent of muscular capacity loading through the ROM with isotonic and Isokinetic muscle loading Isotonic -------- Isokinetic Muscular Capacity ROM

Dynamometer speed 단위는 ? ˚/sec

Dyanamomater speed 1. Low speed 2. High speed

Advantage of Isokinetic - Accommodating resistance -maximal dynamic loading of a muscle throughout the ROM - Provide maximal resistance - Validity of equipment - Reliability of equipment

Advantage of Isokinetic Efficiency of muscular contraction Decreased joint compressive forces at high speeds Provides feedback to patient

Disadvantage of isokinetics - Cost of some equipment - Lack of personnel trained in use or interpretation of isokinetic testing and rehabilitation - Time consuming if more than one joint is exercised

Absolute contraindication Soft tissue healing constraint Severe Pain Extremely limited range of motion Severe joint effusion Unstable joint Acute strain(musculo-tendinous unit)

Relative Contraindication Pain Limited range of motion Effusion or synovitis Chronic third degree sprain Subacute sprain

What is the “Physioligical Overflow” ? Physilogical Overflow

Isokinetic concentric & eccentric Normal Good Fair Poor Trace Zero

Concentric & Eccentric Concentric contraction Joint movement speed acceration Eccentric contraction Joint movement speed deceration

Spastic Muscle Group Concentric exercise Eccentric exercise

Isokinetic Concentric Dynamometer speed Peak Torque

Isokinetic Eccentric Dynamometer speed 100˚/sec Peak Torque

Advantage of Eccentric Ex Energy efficiency Cardiovascular stress ***Repeated bout effect***

Muscle strength Neural factor Muscular Hypertrophy factor American journal of Physical Medicine,58 1979

DOMS Delayed onset Muscle Soreness Wilhite MR: Reliability of concentric & eccentric measurment of the quadriceps performance using the Isokinetic Dynamometer. J Orthop Sports Phys Ther.

Isokinetic data report interpretation 1. Torque = Force X Distance 2. Gravity Effect Torque 3. Peak torque in ft-lbs for flex/ext. 4. Torque to bodyweight Ratio. 5. Angle of Peak torque 6. Torque acceleration energy(TAE)

Isokinetic Data Report Interpretation 5. Average of power 6. Average Point Variance 7. Endurance, recovery ratio 8. Agonist/antagonist torque ratio

0˚ 135 ˚

Part II. “Effect of Muscle Strengthning Exercise with Stroke Patient”

Bobath 는 뇌손상환자에게 있서 muscle strength exercise 와 resistance exercise 를 적용하지 못하게함 Because of 1. Spsaticity 의 증가 2. 동시수축(Co-contraction) 의 증가 3. Selective movement 에 방해가 됨

Stroke환자에 있어 Bobath 가 주장하는 weakness는 무엇인가? 1. 실제적인것이 아니다. 2. Spasticity 가 있는 muscle 의 길항근육 집단의 과도한 Co-contraction 결과로 주장

Effect of Isokinetic Eccentric knee extensor and flexor in chronic hemiplegia patient. - 분당제생병원 재활의학과 - 2003 ISPRM .. - Isokinetic eccentric mode 사용 1) Brunstrom’s(1970) 2) Davis GJ(1981) 3) Dean E(1986) 4) Duncan PW (1989) 5) Lacerte M(1992) 5) Engart (1994)

연구목적 1. Isokinetic eccentric training 이 chronic hemiplegia 환자의 involve side knee flexior 와 extensor 의 근력변화 양상에 미치는 영향 2. Chronic hemiplegia 환자의 involve side knee flexor 와 extensor 를 isokinetic eccentric training 을 통해 기능적 회복 정도를 평가함으로 치료의 효과를 알아보고자함

6주간 isokinetic eccentric training 후 Conclusion 6주간 isokinetic eccentric training 후 1. Knee extensor 와 flexor 의 isokinetic eccentric 에서 peak Torque 와 Total work 가 control group 에 비해 유의하게 증가하였다 2. Knee extensor 와 flexor 의 isokinetic concentric 에서 peak torque와 Total work 가 control group 에 비해 유의하게 증가하였다. 3. Gait speed,stair up, sit to stand time에서control

Discussion Chronic hemiplegia 환자의 Isokinetic eccentric training 은involve side knee extensor 와 flexor 의 근력강화와 기능회복에 유용한 치료법으로 사료된다.

미국 뇌졸중 협회 (National Stroke Association) “Spasticity after stroke” Spasticity 와 muscle weakness 가 함께 stroke 환자에서 공존하지만 개별적으로 치료가 이루어져야 한다고 하였다. 그러므로 muscle weakness 가 있어서 기능에 장애가 되는 경우에는 저항을 이용한 근력강화운동이 필요하며, spasticity 로 인해 비정상적인 자세나 근육의 뻣뻣함을 증가시키는 경우에는 효과적인 spasticity 감소 전략이 필요하게 된다.