the spine creates a closed kinematic chain through segmental configuration of the upper and 
 lower extremities and the pelvic girdle , influencing static and dynamic balance during 
 sports activities and the activities of daily life1 , 
 2 , while also having a direct effect on 
 postural alignment through musculoskeletal connections3 .
however , if a normal form can not be maintained due to internal and 
 external forces , any force applied to the spine can cause misalignment , causing lateral 
 imbalance and the accumulation of fatigue in the adjacent muscle , which often results in 
 chronic low back pain4 . treatment with a rigid thoracolumbosacral orthosis
is the most common non - operative 
 treatment for the prevention of curve progression .
there are many different brace designs , 
 but with all of them , the objective is to restore the normal contours and alignment of the 
 spine by means of external forces and , in some designs , the stimulation of active correction 
 as the patient moves the spine away from pressures within the brace5 .
a thoracolumbosacral orthosis ( tlso ) , a brace that extends 
 from the spine to the pelvis , has a direct impact on the movement of the spine during 
 walking and hence has a significant influence on the movement of the pelvis and the lower 
 limbs .
spinal orthoses are commonly used in the treatment of various conditions that affect the 
 spine .
therefore , in this study , we examined the impact on the pattern of walking on both 
 level ground and stairs after restricting the movement of the spine and the trunk of the 
 body through the use of a spinal orthosis .
in this study , 40 healthy males in their 20s were selected as a sample , which was randomly 
 and evenly divided into two groups : ( 1 ) the wt group ( with a tlso ) and ( 2 ) the wot group 
 ( without a tlso ) .
the inclusion criteria included ( 1 ) no neurologic disease history , ( 2 ) 
 capability to maintain independent standing , walking , and landing , ( 3 ) no surgical history 
 that could affect walking or landing , and ( 3 ) no inborn deformity or disease in the relevant 
 areas , including the foot , pelvis , and spine .
for the wt group , the average age was 24.9  2.4  years , the average height was 173.3  
 4.2  cm , and the average weight was 70.6  6.6  kg . for the wot group ,
the average age was 
 25.3  2.7  years , the average height was 175.6  4.4  cm , and the average weight was 69.1  
 6.8  kg . using levene s variance homogeneity test and a normality test on the general 
 physical characteristics , no statistically significant difference was found between the two 
 groups ( p>0.05 ) .
all of the patients understood the purpose of this study and provided 
 written informed consent prior to participation in accordance with the ethical principles of 
 the declaration of helsinki .
the spinal orthosis used in this study was a tlso called a plastic body jacket .
it is made 
 of lightweight polypropylene that has thermoplasticity , and is designed so that it is easy 
 to put on and take off .
it is a commercially available product that comes in four sizes 
 ( extra - large , large , medium , and small ) , and the appropriate size was used for the body 
 figure of each research subject .
more than any other tlso , this particular plastic body 
 jacket is known to be effective for maintaining the body s alignment and for effectively 
 restricting movement in three 3-dimensional planes : ( 1 ) flexion and extension of the body s 
 trunk in the sagittal plane , ( 2 ) lateral flexion in the frontal plane , and ( 3 ) rotation of 
 the trunk of the body in the horizontal plane .
the steps of the staircase fabricated and used in this study were 17  cm high , 28  cm wide , 
 61  cm across , and were fabricated according to housing construction standards ; four steps 
 were installed for this study . a motion analysis system composed of six infrared cameras 
 ( vicon motion capture system , vicon motion systems ltd . ,
oxford , uk ) was used for 
 measurement of the spatiotemporal variables and for the kinematic variables of walking , with 
 the sample collection rate of the infrared camera set at 120  hz .
the subjects were told to walk comfortably and naturally down a 10-m long straight walking 
 lane drawn on firm , even ground at their usual speed while looking straight ahead . walking 
 on level ground
was performed after oral instruction , and this was followed by ascending and 
 descending the stairs .
the measurement interval was not mentioned so that the subjects were 
 not aware of when the measurements began .
walking was measured after the first five 
 footsteps , and a 30-second rest period was given after each motion .
spss for windows 17.0 ( ibm spss , chicago , il , usa ) was used for the statistical data 
 analysis .
an independent t - test was used , given the homogenous nature of the subject ; the 
 difference wt and wot group was calculated and comparisons were made using an independent 
 t - test .
table 1table 1.comparison of joint angle between with tlso group and without tiso group ( unit : 
 )gait conditionsagittal planefrontal planetransverse planewithout tlsowith tlsowithout tlsowith tlsowithout tlsowith tlsolevel walkingh147.1  9.151.9  5.9h52.9  1.42  1.6h93.6  1.33.4  1.1stair ascent64.9  10.268.2  9.14.9  1.63.8  1.5 * 7.3  1.76.6  2.1stair descent27.9  4.630.2  4.34.4  45.2  2.10.5  1.10.9  1.9level walkingh28.4  0.914.9  3.8*h62.3  0.91.2  1*h106  44.2  2.8stair ascent10.5  1.818.9  6.5 * 3.3  1.42.7  1.38.2  3.89.9  3stair descent30.2  7.335.4  5.9 * 4.6  1.55.1  1.54.2  3.83  2.3level walkingh318.9  5.217.7  5.1h78.5  1.77.7  2.3h113  1.72.2  2.8stair ascent10.9  2.516.5  4*7.8  2.05.9  2.15.6  26.6  2.4stair descent19.4  7.130.9  6.1*4.3  2.13.9  25.6  2.65.7  3.1level walkingh448.0  5.648.3  5.9h85.6  1.56.3  1.4h126.5  1.66.4  1.7stair ascent17.7  2.919.2  4.2 9.3  1.98  4.17.5  1.47.7  1.5stair descent40.6  8.142.2  9.45.6  2.64.6  1.85.9  1.85.6  1.6level walkingk116.1  4.319.2  5.4k52.4  13  1.9k98.4  1.87.9  2.2stair ascent60.8  9.166.6  8.4 * 5.7  1.95.9  2.110.3  1.811.2  2.9stair descent19.4  4.422.4  5.24.2  2.44.5  2.36.2  1.98  3.9level walkingk210.6  2.515.8  3.4*k65.2  1.76.1 
2.2k107.7  1.87.3  2.1stair ascent20.9  4.721.9  3.16.9  1.85.9  1.91.9  1.21.7  1.5stair descent11.5  3.217.7  3.5 * 7.3  2.35  2*5.1  2.25.5  2level walkingk332.6  11.733.4  8.2k71.8  11.3  0.9k113.1  1.83.2  1.9stair ascent28.7  6.925.7  8.13.7  0.73.4  0.95.5  1.55.7  1.9stair descent73.4  10.571.2  22.62.7  1.12.7  1.58  2.89.1  2.4level walkingk447.5  4.246.9  5.1k83.3  13.4  1.6k120.6  1.90.1  1.1stair ascent81.2 
12.381.1  11.44.3  14.4  1.515.8  6.413.9  3.1stair descent84.8  9.279.6  11.24.3  1.34.2  1.16.2  29.2  3.8*level walkinga13.4  1.92.7  1.2a53.9  1.63.1 
0.9a912.6  4.412.4  3.5stair ascent14.3  3.912.7  3.96.4  1.45.6  1.527.5  3.926.6  6.2stair descent16.0  5.621.2  4.93.3  1.23.7  1.313  4.613.6  7.3level walkinga25.8  1.45.7  1.1a64.7  2.15.4  1.5a1011.8  3.610.5  2.9stair ascent6.6  3.26.6  3.65.2  1.74.3  1.320.9  7.517.9  4.3stair descent15.3  5.613.8  4.13.7  1.43.9  2.214.9  517.5  4.2level walkinga311.8  2.813.6  3.7a73.6  1.43.3  1a119.1  2.28.9  2.4stair ascent9.4  1.910.4  2.64.6  1.55.4  2.37.6  2.76.7  2stair descent2.3  1.32.3  1.14.1  1.84.3  213.8  4.816.3  5.2level walkinga43.8  1.43.8  0.6a86.2  1.95.5  1.4a1224.4  5.322.2 
12.2stair ascent14.5  19.910.2  5.87.1  1.86.9  1.931.1  5.231.7  4.9stair descent12.4 
3.511.8  3.16.6  1.96.4  2.225.4  6.828.5  5.8*significantly different between with tlso and without tlso ( p<0.05 ) , tlso : 
 thoracolumbosacral orthosis .
h1 : hip flexion / extension at initial contact , h2 : hip maximum flexion / extension in 
 midstance phase , h3 : hip flexion / extension at toe off , h4 : hip maximum 
 flexion / extension
in midswing phase , k1 : knee flexion / extension at heel strike , k2 : 
 knee maximum flexion / extension in midstance phase , k3 : knee flexion / extension at toe 
 off , k4 : knee maximum flexion / extension in midswing phase , a1 : ankle 
 dorsflexion / plantarflexion at heel strike , a2 : ankle maximum 
 dorsiflexion / plantarflexion in midstance phase , a3 : ankle dorsiflexion / plantarflexion 
 at toe off , a4 : ankle maximum dorsiflexion / plantarflexion in midswing phase , h5 : hip 
 adduction / abduction at heel strike , h6 : hip maximum adduction / abduction in midstance 
 phase , h7 : hip adduction / abduction at toe off , h8 : hip maximum adduction / abduction in 
 midswing phase , k5 : knee varus / valgus at heel strike , k6 : knee maximum varus / valgus in 
 midstance phase , k7 : knee varus / valgus at toe off , k8 : knee maximum varus / valgus in 
 midswing phase , a5 : ankle inversion / eversion at heel strike , a6 : ankle maximum 
 inversion / eversion in midstance phase , a7 : ankle inversion / eversion at toe off , a8 : 
 ankle maximum inversion / eversion in midswing phase , h9 : hip int / external rotation at 
 heel strike , h10 : hip maximum int / external rotation in midstance phase , h11 : hip 
 int / external rotation at toe off , h12 : hip maximum int /external rotation in midswing 
 phase , k9 : knee int / external rotation at heel strike , k10 : knee maximum int / external 
 rotation in midstance phase , k11 : knee int / external rotation at toe off , k12 : knee 
 maximum int / external rotation in midswing phase , a9 : ankle int / external rotation at 
 heel strike , a10 : ankle maximum int / external rotation in midstance phase , a11 : ankle 
 int / external rotation at toe off , a12 : ankle maximum int / external rotation in midswing 
 phase shows the angle values ( mean and standard deviation ) for the lower extremities 
 at heel strike , midstance , toe off , and mid - swing in the sagittal plane . in the level ground 
 walking measurements , significance differences were found at the h2 and k2 phases between 
 the wt group and the wot group ( p<0.05 ) . in the stair
walking measurements , statistically 
 significant differences were found at the h2 , h3 , and k1 phases during stair ascent and at 
 the h2 , h3 , k2 , and a1 phases during stair descent between the two groups ( p<0.05 ) . * significantly different between with tlso and without tlso ( p<0.05 ) , tlso : 
 thoracolumbosacral orthosis .
h1 : hip flexion / extension at initial contact , h2 : hip maximum flexion / extension in 
 midstance phase , h3 : hip flexion / extension at toe off , h4 : hip maximum 
 flexion / extension in midswing phase , k1 : knee flexion / extension at heel strike , k2 : 
 knee maximum flexion / extension in midstance phase , k3 : knee flexion / extension at toe 
 off , k4 : knee maximum flexion / extension in midswing phase , a1 : ankle 
 dorsflexion / plantarflexion at heel strike , a2 : ankle maximum 
 dorsiflexion / plantarflexion in midstance phase , a3 : ankle dorsiflexion / plantarflexion 
 at toe off , a4 : ankle maximum dorsiflexion / plantarflexion in midswing phase , h5 : hip 
 adduction / abduction at heel strike , h6 : hip maximum adduction / abduction in midstance 
 phase , h7 : hip adduction / abduction at toe off , h8 : hip maximum adduction / abduction in 
 midswing phase , k5 : knee varus / valgus at heel strike , k6 : knee maximum varus / valgus in 
 midstance phase , k7 : knee varus / valgus at toe off , k8 : knee maximum varus / valgus in 
 midswing phase , a5 : ankle inversion / eversion at heel strike , a6 : ankle maximum 
 inversion / eversion in midstance phase , a7 : ankle inversion / eversion at toe off , a8 : 
 ankle maximum inversion / eversion in midswing phase , h9 : hip int / external rotation at 
 heel strike , h10 : hip maximum int / external rotation in midstance phase , h11 : hip 
 int / external rotation at toe off , h12 : hip maximum int /external rotation in midswing 
 phase , k9 : knee int / external rotation at heel strike , k10 : knee maximum int / external 
 rotation in midstance phase , k11 : knee int / external rotation at toe off , k12 : knee 
 maximum int / external rotation in midswing phase , a9 : ankle int / external rotation at 
 heel strike , a10 : ankle maximum int / external rotation in midstance phase , a11 : ankle 
 int / external rotation at toe off , a12 : ankle maximum int / external rotation in midswing 
 phase table 1 compares the angle values ( mean and 
 standard deviation ) for the lower extremities at heel strike , during stance , toe off , and 
 during swing in the frontal plane between the wt group and the wot group . in the level 

ground walking measurements , statistically significant differences were found at the h6 
 phase ; in the stair walking measurements , significant differences were found at the h5 and 
 h7 phases during ascent and at the k6 phase during descent ( p<0.05 ) .
table 1 shows the angle values ( mean and standard deviation ) for 
 the lower extremities at heel strike , during stance , toe off , and during swing in the 
 horizontal plane between the wt group and the wot group .
the angle values for the hip 
 joints , knee joints , and ankle joints between the two groups did not show significant 
 differences in any of the walking phases in level ground walking ( p>0.05 ) , while a 
 significant difference was found only at the k12 phase while descending the stairs .
when the kinematic variables in the lower extremities were compared in the sagittal plane , 
 the flexion angles of the hip joints were considerably increased in h2 during both the level 
 ground and the stair walking , an increase that seemed to compensate for restricted pelvic 
 movements due to the spinal orthosis .
increase in the flexion angle at k1 and k2 and in the 
 plantarflexion angle at a1 in the stair walking may serve as compensation for shock 
 absorption against the ground reaction .
a research by konz reported that pelvic obliquity 
 and pelvic rotation were remarkably reduced when a tlso was applied and such pelvic 
 reduction in the frontal and the horizontal planes affected the lower extremity movements 
 during gait6 .
another research reported 
 that plantar flexion of the ankle joints in the loading response and knee joint flexion in 
 the stance phase decreased the shock from the ground reaction7 . in this
context , restriction in pelvic movements due to the spinal 
 orthosis induced increased flexion in the ankle , knee , and hip joints in the sagittal plane 
 in order to alleviate the vertical ground reaction .
as for changes in the ankle joint angles 
 in the sagittal plane in stair walking , dorsiflexion occurred between the initial contact 
 and the initial phase of ascent , followed by gradual plantar flexion and then sudden plantar 
 flexion at the middle phase , while maximal plantar flexion was shown at initial descent , 
 followed by rapid dorsiflexion until the early part of the gaiting phase and then gradual 
 dorsiflexion during the rest of the phase , a change that seemed to absorb the shock of the 
 body load8 .
changes in the angles of the lower extremities in the sagittal plane in this study showed 
 significant differences in stair gaiting rather than in level ground walking ; thus , the wt 
 group showed increased flexion in their lower extremities . in the angles of the lower extremity motions in the frontal plane ,
the internal rotation 
 was reduced at h6 during level ground walking , at h5 , and at h7 during stair ascent , and at 
 k6 during stair descent , a reduction that may be consistent with the results of the research 
 by konz , which reported that changes in the motion angles in the thigh and the pelvic 
 segment in the frontal plane due to spinal orthosis application were directly associated 
 with reduction in the pelvic oblique . in the angles of the lower extremity motions in the horizontal plane ,
the internal rotation 
 was increased at k12 only during stair descent , an increase that is consistent with the 
 results of the research by konz , which reported that no differences were found in the angles 
 of the lower extremity motions in the horizontal plane during level ground walking . in the present study ,
significant differences in the sagittal plane were shown in stair 
 walking rather than in level ground walking .
the increase in flexion in the lower 
 extremities might be caused by an increase in the knee joint flexion and the plantar flexion 
 of the ankle joints to compensate for reduced shock absorption against the ground reaction 
 due to the restriction in trunk movements caused by the application of the spinal orthosis . 

it can be concluded that a spinal orthosis is useful in stabilizing the lower extremities 
 during stair gaiting , and that appropriate application of the orthosis plays a supporting 
 role in the activities of daily life and therapeutic intervention .
 [ purpose ] the purpose of this study was to investigate the effect of restricted spinal 
 motion on kinematic changes in the lower extremities using a rigid thoracolumbosacral 
 orthosis . 
 [ subjects and methods ] forty healthy males in their 20s were selected as the 
 sample , which was randomly and evenly divided into two groups : ( 1 ) the wt group ( with a 
 thoracolumbosacral orthosis ) and ( 2 ) the wot group ( without a thoracolumbosacral 
 orthosis ) . 
 the spinal orthosis used in this study was a thoracolumbosacral orthosis called 
 a plastic body jacket . 
 [ results ] the sagittal plane ; in the level ground walking 
 measurements , significance differences were found at the h2 ( hip maximum flexion / extension 
 in midstance phase ) and k2 ( knee maximum flexion / extension in midstance phase ) between the 
 wt group and the wot group . 
 [ conclusion ] it can be concluded that a spinal orthosis is 
 useful in stabilizing the lower extremities during stair gaiting , and that appropriate 
 application of the orthosis plays a supporting role in the activities of daily life and 
 therapeutic intervention . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION