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분당 제생병원 재활의학과 스포츠재활 건강의학 클리닉 정 경 수
What is the Isokinetic ? 분당 제생병원 재활의학과 스포츠재활 건강의학 클리닉 정 경 수
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Part I. “Isokinetic” Part II
Part I. “Isokinetic” Part II. “Effect of Muscle Strengthning Exercise with Stroke Patient”
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Part I. “Isokinetic”
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Classification of Resistance Exercise
1. Isometric : Fixed speed (0º/sec),immovable Fixed resistance 2. Isotonic : Variable speed 3. Isokinetic : Fixed speed Accommadating resistance
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Isometric Exercise - Performed at 0 °/sec speed
without observable joint movement - Increased in the muscle belly - No functional movement is possible
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Adavantage of Isometric
- Used early rehabilitation - Increased static muscular strength - Helps retard atrophy - Can be performed anywhere
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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
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power ROM
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What is the non-efficient ?
Isotonic Exercise What is the non-efficient ?
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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
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관절의 위치에 따른 근력의 변화 power ROM
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Isoweight exercise POWER Isoweight ex. ROM
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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
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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
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Concept of Isokinetic Pre-set fixed Dynamometer Speed 2km/h 5km/h
computer
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Comparison of isotonic & isokinetic muscular contraction
POWER Isokinetic isotonic slow fast ROM
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Comparison of percent of muscular capacity loading through the ROM with isotonic and Isokinetic muscle loading Isotonic Isokinetic Muscular Capacity ROM
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Dynamometer speed 단위는 ? ˚/sec
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Dyanamomater speed 1. Low speed 2. High speed
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Advantage of Isokinetic
- Accommodating resistance -maximal dynamic loading of a muscle throughout the ROM - Provide maximal resistance - Validity of equipment - Reliability of equipment
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Advantage of Isokinetic
Efficiency of muscular contraction Decreased joint compressive forces at high speeds Provides feedback to patient
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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
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Absolute contraindication
Soft tissue healing constraint Severe Pain Extremely limited range of motion Severe joint effusion Unstable joint Acute strain(musculo-tendinous unit)
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Relative Contraindication
Pain Limited range of motion Effusion or synovitis Chronic third degree sprain Subacute sprain
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What is the “Physioligical Overflow” ?
Physilogical Overflow
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Isokinetic concentric & eccentric
Normal Good Fair Poor Trace Zero
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Concentric & Eccentric
Concentric contraction Joint movement speed acceration Eccentric contraction Joint movement speed deceration
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Spastic Muscle Group Concentric exercise Eccentric exercise
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Isokinetic Concentric
Dynamometer speed Peak Torque
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Isokinetic Eccentric Dynamometer speed 100˚/sec Peak Torque
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Advantage of Eccentric Ex
Energy efficiency Cardiovascular stress ***Repeated bout effect***
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Muscle strength Neural factor Muscular Hypertrophy factor
American journal of Physical Medicine,
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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.
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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)
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Isokinetic Data Report Interpretation
5. Average of power 6. Average Point Variance 7. Endurance, recovery ratio 8. Agonist/antagonist torque ratio
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0˚ 135 ˚
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Part II. “Effect of Muscle Strengthning
Exercise with Stroke Patient”
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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
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Stroke환자에 있어 Bobath 가 주장하는 weakness는 무엇인가?
1. 실제적인것이 아니다. 2. Spasticity 가 있는 muscle 의 길항근육 집단의 과도한 Co-contraction 결과로 주장
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Effect of Isokinetic Eccentric knee extensor and flexor in chronic hemiplegia patient.
- 분당제생병원 재활의학과 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)
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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
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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
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Discussion Chronic hemiplegia 환자의 Isokinetic eccentric training 은involve side knee extensor 와 flexor 의 근력강화와 기능회복에 유용한 치료법으로 사료된다.
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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.
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