목적: 본 연구는 인지가 건강한 지역사회 중고령자 인구를 대상으로 한 인지적 여가활동 중재연구를 분석하여 국내 지역사회 적용을 위한 근거를 마련하고자 한다. 연구방법: 본 연구에서는 2013년 1월부터 2023년 12월까지 최근 10년간 국외 학술지에 게재된 문헌을 대상으로 PRISMA 지침에 따라 문헌고찰을 진행하였다. PubMed, EMBASE, Web of Science, CINAHL, APA PsycInfo 데이터베이스를 사용하였으며, 주요 검색어로 (“elderly” OR “older*”) AND (“leisure*” OR “leisure activities”) AND (“cognitive*”AND “dementia”)를 사용하였다. 대조군이 있는 실험연구를 선정하였으며, Physiotherapy Evidence Database (PEDro) scale을 통해 선정된 문헌의 질을 평가하였다. 결과: 최종 6편의 연구 분석결과, 인지적 여가활동 중재는 악기 연주, 독서, 보드게임, 직소 퍼즐의 네 가지 범주로 구분되었으며, 악기 연주와 보드게임 중재가 각 2편으로 가장 많았다. 직소 퍼즐을 제외한 중재에서 실험군은 대조군에 비해 인지기능에서 유의한 향상을 보였으며, 이는 음운언어 및 범주언어 유창성, 언어 및 시각 작업기억, 집행기능과 억제조절, 분리주의력, 시각적 스캐닝, 전반적인 인지기능 개선을 포함한다. 또한, 여가활동 수행기술, 기분상태, 신체적 및 심리적 건강 영역에서의 삶의 질의 개선 효과도 관찰되었다. 결론: 본 연구는 일부 인지적 여가활동 중재가 지역사회 중고령층부터 고령층에 이르는 지역사회 인구의 인지기능 및 심리사회적 영역에 긍정적인 영향을 줄 수 있음을 확인하였다. 향후 작업치료 분야에서 인지 건강 강화를 위해 다양한 인지적 여가활동이 일상생활의 일부로서 적극적으로 활용되기를 기대한다.

This study aimed to determine the association between household types and healthy dietary practices among Korean adults. A cross-sectional analysis was performed using nationwide data on 23,488 participants from the 2017-2021 Korea National Health and Nutrition Examination Survey (KNHANES). Based on self-reported data, the participant household types were classified into single- and multi-person households. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for healthy dietary practices according to household types were calculated by applying multivariable logistic regression analysis after adjusting for confounders. Of total, 11.21% and 88.79% were single- and multi-person households, respectively. Compared with individuals living in multi-person households, those in single-person households had lower odds of adhering to healthy dietary practices (AOR: 0.88, 95% CI: 0.79-0.98) and consuming adequate saturated fatty acids (<7% of energy) (AOR: 0.78, 95% CI: 0.69-0.88). In addition, men and individuals aged 65 years living in single-person households exhibited lower odds of consuming adequate saturated fatty acids and 500 g of fruit and vegetables per day than those in multi-person households. Single-person households often find it a challenge to practice a healthy diet. Hence, nutritional policies and educational support that help individuals living alone consume healthier diets are warranted.

Background: Proprioception in the ankle joint is important for maintaining balance. There is a correlation between joint position sense (JPS), balance and ankle dorsiflexion range of motion (DF-ROM). Objectives: The purpose of this study was to compare the effects of talocrural joint mobilization (TJM) and muscle energy technique (MET) of plantar flexor muscle (PF) on improving joint position sense (JPS) and static balance. Design: Cross-over randomized trial research. Methods: Sixteen participants (male 10, female 6; 20’s of their age) without ankle instability were recruited. In a randomized, three conditions, no intervention, talocalcaneal mobilization, and PF-MET were all applied to 16 participants. For TJM, the Kaltenborn grade 3 joint gliding method, in which the talus moves posteriorly perpendicular to the tacrocrural joint plane, were used. In the PF-MET, MET method were applied gastrocnemius muscle and soleus muscle with 25% of 1 Repeat Maximum of each muscle. The all participants performed PF-MET and TJM for 18 minutes. DF-ROM measured the weightbearing lunge test. JPS measured using the active joint angle reproduction test. Static balance was measured displacement of center of pressure parameter. Results: PF-MET and TJM had significant differences in DF-ROM and AP displacements. PF-MET significantly increased at 5° and 15° of plantar flexion and 5° of dorsiflexion, and COP velocity significantly decreased in JPS compared to TJM. Conclusion: PF-MET and TJM are effective in increasing DF-ROM. However, PF-MET has a more positive effect on improving JPS and static balance than on talocrural joint mobilization.

Background: Changes in foot sole shape can result in plantar muscle weakness, lack of proprioception, increased ankle instability, and an inability to balance. Objectives: To investigated whether different floor surfaces influenced the effect that short-foot exercises have on the foot core system of healthy individuals. Design: Pretest-posttest control group experimental design. Methods: This exercise shortens the length of the foot by raising the medial longitudinal arch, strengthening the intrinsic muscle of the sole, and maintaining the shape of the medial longitudinal arch. Results: There was a significant difference in the angle of the medial longitudinal arch in the mat exercise group (MEG) and vibration exercise group (VEG) before and after the intervention (P<.05). As the arch angle decreased, the arch height increased. Post hoc analysis showed that there was no difference between the floor exercise group (FEG) and MEG or between the MEG and VEG (P>.05). In terms of the weight distribution index (WDI, there was a significant difference in the MEG and VEG (P<.05) but not in the FEG before and after the intervention (P>.05). The post hoc analysis results showed that there was no difference between the FEG and MEG (P>.05). Conclusion: Various methods to improve the strength of intrinsic muscles of the sole are more effective than no stimulation, and that short-foot exercise combined with sensory stimulation can be recommended for maintaining and increasing the medial longitudinal arch.

Background: It is known that hand strength and fingertip force are used as an indicator of muscle strength and are also highly related to the various chronic symptoms and even lifespan. To use the individual fingertip force (IFF) as a quantitative index for clinical evaluation, the IFF should be measured and analyzed with various variables from various subjects, such as the normal range of fingertip force and the difference in its distribution by disease. Objects: We tried to measure and analyze the mean maximum IFF distribution during grasping a cylindrical object in healthy adults and patients with spinal cord injury (SCI). Methods: Five Force-sensitive resistor (FSR) sensors were attached to the fingertips of 24 healthy people and 13 patients with SCI. They were asked to grip the object three times for five seconds with their maximum effort. Results: The mean maximum IFF of the healthy adult group’s thumb, index, and middle finger was similar statistically and showed relatively larger than IFF of the ring and small finger. It is a 3-point pinch grip pattern. All fingertip forces of patients with SCI decreased by more than 50% to the healthy group, and their IFF of the middle finger was relatively the largest among the five fingertip forces. The cervical level injured SCI patients showed significantly decreased IFFs compared to thoracic level injured SCI patients. Conclusion: We expect that this study results would be helpful for rehabilitation diagnosis and therapy goal decision with robust further study.

Background: Bridging exercises are used to enhance the functional stability of the lumbopelvic region in clinical settings. Although most of the studies on bridging exercises have compared the complete activation of the trunk muscles, some recent studies have examined the functional stability of the trunk and the lumbopelvic region and assessed the appropriate recruitment of the local and global muscles during different task levels. Objects: The purpose of this study was to investigate the changes in muscle thickness in the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles during a common bridging exercise on an unstable surface and to determine whether these changes differ based on the surface used. Methods: Twenty-five healthy young adults (8 males, 17 females) were recruited. The subjects were randomly assigned to either the exercise progression with a sling bridge group or the ball bridging exercise progression group, each with three stages of increasing difficulty. Each position was measured three times with an ultrasonic diagnostic imaging system, and the mean values were recorded for analysis. Results: No significant differences were observed between the TrA, IO, or EO muscle thickness ratios between the sling and ball exercise groups (p > 0.05). There were also no significant differences in the EO muscle thickness ratios between the tasks irrespective of whether the sling or ball was used. However, the TrA and IO thickness ratios in both groups were significantly greater during stages 2 and 3 compared to stage 1. Conclusion: The results suggest that the use of slings and balls during bridging exercises is effective in activating the deep abdominal muscles.

Background: Whole body-electromyostimulation (WB-EMS) is widely used for the rehabilitation and recovery of patients with various neuromusculoskeletal disorders. Objects: To objectively measure changes in lower extremity and abdominal muscles after sit-to-stand dynamic movement training using WB-EMS. Methods: A total of 46 healthy adults (23 experimental and 23 control subjects) performed sit-to-stand exercise; the experimental group with WB-EMS, and the control group without WB-EMS. The muscle activity of the lower extremity, and the muscle thickness of the lower extremity and abdominal muscles were measured before and after the intervention. Results: In terms of electromyographic activity, there was a significant interaction effect for the rectus femoris (RF) muscle (F=30.212, p=.000). With regards to ultrasonographic imaging, the muscle thickness of the RF muscle had a significant interaction effect at the muscle contraction ratio (F=8.071, p=.007). The deep abdominal muscles, such as the transverse abdominal (TrA) and internal oblique (IO) muscles, also showed significant interaction effects at the muscle contraction ratio (F=5.474, p=.024, F=24.151, p=.000, respectively) Conclusion: These findings suggest that WB-EMS may help to improve the muscular activity of the RF muscle, and the muscle thickness of the RF muscle and deep muscles such as the TrA and IO muscles.

Background: Breathing is the essential step of Pilates exercise and can be used to activate core muscles. Although the effects of breathing exercise on pain, breathing muscles, and cervical posture have been extensively studied, little is known about the impact of Pilates breathing on spinal posture and alignment. Purpose: To determine the effect of 3D-Pilates breathing exercise on spinal curvature and alignment of healthy adults during corrected to normal alignment. Design: One group pre-post test design Methods: Eighteen participants were given a 3D-pilates breathing exercise twice a week (20 minutes per session) for three weeks and warmed up for 10 minutes before each exercise session. To examine spinal curvature and alignment of each subject, this study used radiation free rasterstereography (Formetric Ⅲ, Germany). Paired t-test and Wilcoxon signed rank test were performed to determine the difference between pre and post exercise. Results: There were statistically significant differences in height (p<.001), kyphosis angle (p<.05), trunk imbalance (p<.05), kyphotic apex (p<.01), cervical fleche (p<.05), pelvic tilt (p<.01), and lateral deviation (p<.05) between before and after 3D Pilates breathing exercise. However, there was no significant difference in lordosis angle. Conclusions: The study results indicated that three week 3D-pilates breathing exercise program could be presented as an effective rehabilitation method for improving spinal curvature and alignment.

The purpose of this study is to investigate the effect of pelvic, Lumbar spine and Cervical spine manipulation on the joint position sense in normal adults. Thirty normal adults were divided into an experimental group of 15 subjects and a control group of 15 subjects. The experimental group was treated with pelvic, Lumbar spine and Cervical spine manipulation with massage, whereas the control group received only massage. Both groups were evaluated in terms of joint position errors (JPEs) using a digital dual clinometer before and after the experiment. The comparison of the JPEs of the experimental group and the control group before and after the experiment showed that the experimental group’s cervical spine results were significantly different in the flexion, left lateral flexion, and right rotation (p < .05) and lumbar spine results were significantly different in the flexion and extension (p < .05), but the control group’s results were not statistically significant in all items (p > .05). The pelvic, lumbar spine and cervical spine manipulation makes an effect on the joint position sense in normal adults. The findings of this study suggest that the pelvis, lumbar spine and cervical spine manipulation improve the motor ability in people with low joint position sense.

Background: Abdominal bracing exercise (ABE) and abdominal hollowing exercise (AHE) improve the lumbar flexibility and pulmonary function in various patients, yet the efficacy of ABE or AHE have not yet been evaluated. Objects: The purpose of this study was to compare the lumbar flexibility and pulmonary function during both ABE and AHE in healthy adults. Methods: The study included 40 healthy adults, who were randomly divided into the experimental group and control group, each with 20 subjects. All subjects performed ABE (experimental group) and AHE (control group). The lumbar flexibility such as trunk flexion test (sitting and standing position) and schober test and pulmonary function such as the spirometer including forced vital capacity (FVC) and force expiratory volume in one second (FEV1) and chest circumference measurement (middle and lower chest) were measured, respectively. Two-way repeated analysis of variance was used to compare the lumbar flexibility and pulmonary function, respectively. Results: No significant effects of lumbar flexibility were observed on trunk flexion test from the sitting position (P=.478) and standing position (P=.096) in the ABE than in the AHE. However, the length of ABE was longer significantly than it of AHE (P=.024). No significant effects of lung function were observed on the FVC (P=.410) and FEV1 (P=.072) in the ABE group than in the AHE group. And also, no significant effects of chest circumference measurement were observed on the inspiration (P=.468) and expiration (P=.563) in middle chest circumference and inspiration (P=.104) and expiration (P=.346) in lower chest circumference. Conclusion: This study indicated that the ABE is only more effective in lumbar flexibility by lumbar length difference than AHE in healthy adults.

This study examined the socioeconomic factors that affect self-rated health (SRH) in healthy adults, and the relationship of SRH to health-related habits, serum biochemical indices, and nutritional intakes. Subjects consisted of 1,154 healthy adults without any known disease, aged 19 to 65 years (average age of 36.7), whose information was obtained from the 2013 Korean National Health and Nutritional Examination Survey data. Of these subjects, 73 rated themselves as ‘very healthy,’ 460 indicated that they were ‘healthy,’ 568 self-identified as ‘ordinary’, and 53 put themselves in the ‘unhealthy’ category. The proportion of subjects who chose ‘unhealthy’ was significantly increased with higher frequencies of disruptions in their daily lives (p<0.05), regret after drinking (p<0.05), smoking (p<0.001), and higher levels of stress (p<0.001). On the other hand, the proportion of subjects reported as ‘very healthy’ was significantly higher with regular intense (p<0.001) or moderate physical activities (p<0.05), regular walking (p<0.05), a perception of being ‘normal’ in their body image (p<0.01), a decrease of body weight more than 3 kg in the past year (p<0.05), and without risk factors for metabolic syndrome (p<0.05). Serum triglyceride level was lower, and 25-(OH) vitamin D content was significantly higher, in the ‘very healthy’ group as compared to the ‘unhealthy’ group (p<0.05). Dietary fiber and vitamin C intakes were significantly higher in the ‘very healthy’ group than ‘unhealthy’ group (p<0.05). The overall results suggest that a healthy lifestyle, including regular exercise, non-smoking, good stress management, and higher intakes of fiber and vitamin C, may be potential factors that affect one’s positive perception of health.

As an indicator of skin health, acidified skin surface pH ranging from 5 to 7 is crucial for maintaining skin barrier. In this study, we evaluated the relationship between skin pH and dietary pattern (DP) as well as nutrient or food intake in 48 healthy middle aged adults. Skin pH was measured in the skin surface of the inner arm, and blood lipid profile was analyzed. Dietary intake data were obtained using 1 day 24 hour recall method, and DP was extracted using factor analysis. Results revealed that skin pH ranged from 5.15 to 6.88 in all subjects. There was no significant difference in skin pH between males and females. When subjects were grouped by tertile of skin pH, the food intake of fruit, and the nutrient intake of omega 6 fatty acid, potassium, vitamin A, vitamin C, β-carotene, and riboflavin in the first tertile group with skin pH ranging from 5.15 to 5.68 were significantly higher than in the third tertile group with skin pH ranging from 6.26 to 6.88. There was no difference in blood lipid profile between the first and the third tertile group. Among 5 DP extracted by factor analysis, DP5 characterized by a high intake of nuts and fruits as well as a low intake of beverages and alcohol was inversely correlated with skin pH after adjusting for gender and age. DP5 was positively correlated with nutrient intake of carbohydrate, fiber, potassium, iron, vitamin A, vitamin C, β-carotene, thiamine, and riboflavin but negatively correlated with sodium after adjusting for gender, age, smoking, and energy intake. Therefore, acidified skin pH could be maintained by these DP and nutrients.

This study aimed to evaluate the surface area and velocity of center of pressure (COP) during one leg standing by stimulating the sensory system in normal adults. Thirty subjects were enrolled in this study. Subjects were asked to stand on one leg during testing conditions. Testing conditions included 6 different sensory stimulations as follows: eyes opened, eyes closed, eyes opened with vibrator, eyes opened with head-mounted display (HMD), eyes opened with vibrator and HMD, and eyes closed with vibrator. During each testing condition, the surface area and velocity of center of pressure were measured. There were significant differences in the mean surface area and the mean velocity of COP between the “eyes opened” condition and the other five testing conditions (p<.05). However, in the comparison between the “eyes closed” and “eyes opened with HMD” conditions, there were no significant differences in the tested parameters. This study shows that closing eyes or keeping eyes opened while using HMD to experience virtual reality has the same effect on one leg standing balance. This finding should be considered in the evaluation or intervention of balance, especially one leg standing balance and balance while standing with a small base of support.

The purpose of this study was to evaluate the differences in electromyographic (EMG) activities of upper limb muscles between cross- and parallel-aligned taping and to compare the effects of these 2 taping methods in healthy adults. Thirty subjects, who volunteered for this study, were tested under 3 taping conditions in random order: (1) no taping, (2) cross-aligned taping, and (3) parallel-aligned taping. EMG activities of the biceps brachii, triceps brachii, flexor carpi ulnaris, and extensor carpi radialis muscles were measured. All muscles showed significant differences in EMG activity among the 3 conditions (p<.05). In the post hoc test, biceps brachii and triceps brachii muscles showed significant differences in EMG activity between the no taping and the cross-aligned taping conditions and between the no taping and the parallel-aligned taping conditions. Additionally, the EMG activities of the flexor carpi radialis and extensor carpi radialis muscles appeared to be significantly different between the no taping and parallel-aligned taping conditions. These findings demonstrate that taping may be helpful for decreasing muscle activity, regardless of the direction of tape application. This study provides useful information to future researchers regarding the effects of taping on muscle activity.

The purpose of this study was to determine the reliability and validity of the postural balance program which uses the movement accelerating field principles of posture balance training and evaluation equipment and smartphone movement accelerometer program (SMAP) in healthy young adults. A total of 34 people were appointed as the subject among the healthy young adults. By using Biodex stability system (BSS) and SMAP on the subject, the posture balance capability was evaluated. For the test-retest reliability, SMAP showed the intra-class correlation (ICC: .62~.91) and standard error measurement (SEM: .01~.08). BSS showed the moderate to high reliability of ICC (.88~.93) and SEM (.02~.20). In the reliability of inter-rater, ICC (.59~.73) as to SMAP, showed the reliability of moderate in eyes open stability all (EOSA), eyes open stability anterior posterior (EOSAP), eyes open stability medial lateral (EOSML) and eyes open dinamic all (EODA), eyes open danamic anterior posterior (EODAP), and eyes open danamic medial lateral (EODML). However, ICC showed reliability which was as low as .59 less than in other movements. In addition, BSS showed the reliability of high as ICC (.70~.75). It showed reliability which was as low as ICC (.59 less than) in other movements. In correlation to the balance by attitudes between SMAP and BSS, EOSML (r=.62), EODA (r=.75), EODML (r=.72), ECDAP (r=.64), and ECDML (r=.69) shown differ significantly (p<.05). However, the correlation noted in other movements did not differ significantly. Therefore, SMAP and BSS can be usefully used in the posture balance assessment of the static and dynamic condition with eyes opened and closed.

This study aimed to investigate whether isometric lower limb exercise can activate contralateral trunk muscles and whether the magnitude of muscle activation is related to lower limb movement in sitting. This study included 25 healthy young subjects (20 males and 5 females). The magnitude of trunk muscle activation was measured using surface electromyography (EMG) during hip flexion, extension, adduction, and abduction, and a significant difference was observed in the activation levels of trunk muscles among the tests (p<.01). The EMG activity of the multifidus (MF) and erector spinae (ES) muscles on the contralateral side were significantly greater during hip extension. However, the activation levels of the contralateral internal oblique (IO) and rectus abdominis (RA) muscles were greatest during hip flexion. The MF : ES EMG ratio was significantly greater during hip isometric during hip isometric flexion and abduction compared to hip extension and adduction. There was no significantly difference in the IO : RA ratio during the isometric contractions toward different directions. These findings indicate that isometric lower limb exercise can elicit trunk muscle contraction on the contralateral side and may therefore be helped for developing contralateral trunk muscle strength in individuals undergoing rehabilitation.

The purpose of this study was to investigate the influence of the static pelvic inclination and declination in the static standing position on weight bearing rate and gait elements. Fourteen healthy adults in their twenties were participated. Two groups of healthy adults were allocated in this study: above and below the average of pelvic tilt. The correlation between the pelvic inclination, weight bearing rate and gait elements were measured. There was a statistical correlation between the pelvic tilt and step. Also, there was a statistical difference when we compared anterior declination with swing period and posterior declination with step. There was an asymmetric correlation between pelvic tilt and step. However, there was no statistical difference between the groups above and below the average of pelvic tilt. This result indicates that dipper pelvic inclination doesn't affect the asymmetry of step.

Foot posture is important in the development of the musculoskeletal structure in the lower limbs because it can change the mechanical alignment. Although foot orthotics are widely used for the correction of malalignments in the lower extremities, the biomechanical effects of wedges have not yet been cleared. The aim of this study was to investigate whether medial wedges affect the electromyographic (EMG) activity of the knee and hip joints in healthy adults that are performing one leg standing. Seventeen healthy volunteers performed the one leg standing under two foot conditions: A level surface, and a medial wedge. The subjects' EMG data for the gluteus maximus (Gmax), gluteus medius (Gmed), tensor fasciae latae (TFL), biceps femoris (BF), vastus lateralis (VL), and vastus medialis oblique (VMO) were recorded, along with the surface EMG, and all were analyzed. The EMG activity of the Gmed and TFL had significantly decreased under the medial wedge condition during one leg standing. Further study is needed in order to investigate whether medial wedges influence the EMG activity and kinematic data of the knee and hip joints as well as the ankle joints in adults with flexible flatfoot, while they are performing one leg standing.

The purpose of this study was to produce the regression equation from non-exercise of healthy young adults and to develop a maximal oxygen consumption () regression model. This model was based on heart rate non-exercise predictor variables (rest heart rate, maximal heart rate/rest heart rate), as an extra addition to the general regression which can reflect an individual's inherent or acquired cardiorespiratory fitness. The subjects were 101 healthy young adults aged 19 to 35 years. Exercise testing was measured by using a Balke protocol for treadmill and indirect calorimetry. The prediction equation was analyzed by using stepwise multiple regression procedures. The mean of was (meanSD). The greatest variable correlated to was %fat. The predictor variable used in the non-exercise included %fat, gender, habitual physical activity and . The non-exercise estimation was as follows: ()=55.58-.41(%fat)+.59(physical activity rating)-2.69()-5.36 (male=0, female=1); (R=.85, SEE=3.64, R2=.72: including heart rate variable); ()=48.47-.41(%fat)+.45(physical activity rating)-5.12 (male=0, female=1); (R=.84, SEE=3.74, R2=.70: with the exception of heart rate variable). As an added heart rate variable, there was only a 2% coefficient of determination improved. Therefore, these results demonstrated that heart rate variable correlation with a non-exercise regression model was very low. In conclusion, for healthy young korean adults, those variables that can affect non-exercise estimation turned out to be only % fat, gender, and physical activity. We suggest that further research of predictor variables for non-exercise is necessary for different patient groups who cannot perform maximal exercise or submaximal exercise.

This simulation study investigated the characteristics of normal gait, crouch gait, crouch/equinus gait, crouch gait, crouch/equinus gait. The knee flexion angles were restricted using a specially designed orthosis. This study was carried out in a motion analysis laboratory of the National Rehabilitation Center. Fifteen healthy male subjects were recruited for the study. The purposes of this study were (1) to compare spatiotemporal parameters, kinematics, and kinetic variables in the sagittal plane among the different gait, (2) to investigate the secondary compensatory strategy, and (3) to suggest biomechanical physical therapy treatment methods. The pattern and magnitude observed in each condition were similar to those of normal gait, except the peak knee extension moment of the unrestricted ankle motion-crouch gait. However, the speed of the crouch gait was half that of a normal gait. The ankle joint moment in the crouch/equinus gait showed the double-bump pattern commonly observed in children with spastic cerebral palsy, and there was no significant difference in gait speed as compared with normal gait. The peak ankle plantar-flexor moment and ankle power generated during the terminal stance in the crouch/equinus conditions were reduced as compared with normal and crouch gaits (p<.05). The crouch/equinus gait at the ankle joint was an effective compensatory mechanism. Since ankle plantarflexion contracture can be exacerbated secondary to the ankle compensatory strategy in the crouch/equinus gait, it is necessary to increase the range of ankle dorsiflexion and the strength of plantarflexion simultaneously to decrease the abnormal biomechanical advantages of the ankle joint.