Journal of Digital Convergence (디지털융복합연구)

The Society of Digital Policy and Management (한국디지털정책학회)
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Effects of 12-week balance training with visual feedback on balance and walking functions in patients with chronic stroke

12주 동안의 시각 되먹임 균형 훈련이 만성뇌졸중 환자의 균형 및 보행에 미치는 영향

  • Jeong, Myeong-Kyun (Dept. of Physical Therapy, Hong-Ik Hospital) ;
  • Oh, Duck-Won (Dept. of Physical Therapy, College of Health Science, Cheongju University)
  • 정명균 (홍익병원 물리치료실) ;
  • 오덕원 (청주대학교 보건의료대학 물리치료학과)
  • Received : 2013.09.06
  • Accepted : 2013.11.20
  • Published : 2013.11.28
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Abstract

This study was to determine the effect of 12-week balance training with visual feedback on balance and walking functions in patients with post-stroke hemiparesis. Twenty individuals with chronic stroke volunteered to participate in this study. They were randomly allocated to either experimental group (EG) or control group (CG), with 10 subjects in each group. Subjects from the group 1 underwent 15-min balance training with visual feedback and 15-min routine-scheduled physical therapy, and subjects from the group 2 performed 30-min routine-scheduled physical therapy only, which comprised mat exercise, strengthening, postural correction, and functional practice. Assessment tools were made with the Functional Reach Test (FRT), Timed Up and Go Test (TUGT), and 6 Min Walk Test (6MWT). In within-group comparison, the EG showed significant differences in all parameters (p<0.05), while significant differences were not found for the CG (p>0.05). In between-group comparison, the change values of the FRT and 6MWT appeared to be significantly greater for the EG than those of the CG (p<0.05). These findings suggest that balance training with visual feedback may be favorably used to improve balance and walking functions in patients with chronic post-stroke hemiparesis. Further studies with larger sample and long-term follow-up period need to generalize the results of this study.

본 연구는 만성뇌졸중 환자의 균형과 보행에 대한 12주간의 시각 되먹임 균형 훈련의 효과를 비교하기 위하여 시행되었다. 연구대상자는 총 20명으로 실험군과 대조군에 10명씩 무작위로 할당되었다. 실험군은 근력, 자세조절 그리고 기능적 훈련을 포함한 보존적 물리치료와 시각 되먹임을 이용한 균형훈련을 각각 15분씩 시행하였으며, 대조군은 30분안 보존적 물리치료를 시행하였다. 균형 및 보행 능력에 대한 측정은 기능적 도달 검사(Function Reach Test, FRT), 일어서서 걷기 검사(Timed Up and Go Test, TUGT), 6분 걷기 검사(6 Min Walk Test, 6MWT) 사용하여 시행되었다. 집단 내 비교에서 실험군은 모든 변수에서 통계학적으로 유의하게 향상되는 것으로 나타났으나(p<.05), 대조군은 모든 변수에서 통계학적으로 유의한 차이를 보이지 않았다(p>.05). 집단 간 비교에서 있어서는 FRT와 6MWT에서 통계학적으로 유의하게 향상되는 것으로 나타났다(p<.05). 본 연구의 결과는 시각 되먹임을 사용한 균형 훈련이 만성 뇌졸중 환자의 균형과 보행 향상을 위해 긍정적으로 사용될 수 있다는 것을 의미한다. 본 연구의 결과를 일반화하기 위해서는 보다 많은 대상자들을 포함시킨 장기간의 연구가 계속 이루어져할 것이다.

Keywords

References

  1. J. H. Cauraugh, and S. Kim, Two coupled motor recovery protocols are better than one: electromyogram-triggered neuromuscular stimulation and bilateral movements. Stroke, Vol. 33, No. 6, pp. 1589-1594, 2002. https://doi.org/10.1161/01.STR.0000016926.77114.A6
  2. D. Mahabir, L. Bickran, and M. C. Gullifort, Stroke in trinidad and tabago: Burden of illness and risk factors. Rev Panam Salud Publica, Vol. 4, No. 4, pp. 233-237, 1998.
  3. R. Bonita, N. Solomon, and J. B. Broad, Prevalence of stroke and stroke-related disability. Estimates from the Auckland stroke studies. Stroke, Vol. 28, No. 10, pp. 1898-1902, 1997. https://doi.org/10.1161/01.STR.28.10.1898
  4. S. A. Sharp, and B. J. Brouwer, Isokinetic strength training of the hemiparetic knee: Effect on function and spasticity. Arch Phys Med Rehabil, Vol. 78, No. 11, pp. 1231-1236, 1997. https://doi.org/10.1016/S0003-9993(97)90337-3
  5. V. S. Mercer, J. K. Freburger, S. H. Chang, and J. L. Purser, Measurement of paretic-lower-extremity loading and weight transfer after stroke. Phys Ther, Vol. 89, No. 7, pp. 653-664, 2009. https://doi.org/10.2522/ptj.20080230
  6. A. Shumway-Cook, D. Anson, and S. Haller, Postural sway biofeedback: its effect on reestablishing stance stability in hemiplegic patients. Arch Phys Med Rehabil, Vol. 69, No. 6, pp. 395-400, 1988.
  7. M. Patel, S. Gomez, D. Lush, and A. Fransson, Adaptation and vision change the relationship between muscle activity of the lower limbs and body movement during human balance perturbations. Clin Neurophysiol, Vol. 120, No. 3, pp. 601-609, 2009. https://doi.org/10.1016/j.clinph.2008.11.026
  8. S. Niam, W. Cheung, P. E. Sullivan, S. Kent, and X. Gu, Balance and physical impairments after stroke. Arch Phys Med Rehabil, Vol. 80, No. 10, pp. 1227-1233, 1999. https://doi.org/10.1016/S0003-9993(99)90020-5
  9. D. S. Nichols, Balance retraining after stroke using force platform biofeedback. Phys Ther, Vol. 77, No. 5, pp. 553-558, 1997. https://doi.org/10.1093/ptj/77.5.553
  10. C. A. Shumway, and M. Wollacott, Motor control: translating research into clinical practice. 3rd ed. Maryland, Lippincott Williams & Wilkins. 2007.
  11. C. M. Dean, C. Rissel, M. Sharkey, C. Sherrington, R. G. Cumming, R. N. Barker, S. R. Lord, S. D. O'Rourke, and C. Kirkham, Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial. BMC Neurol, Vol. 9, No. 38, 2009.
  12. G. Yavuzer, F. Eser, D. Karakus, B. Karaoglan, and H. J. Stam, The effects of balance training on gait late after stroke: a randomized controlled trial. Clin Rehabil, Vol. 20, No. 11, pp. 960-969, 2006. https://doi.org/10.1177/0269215506070315
  13. J. J. Eng, and K. S. Chu, Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. Arch Phys Med Rehabil, Vol. 83, No. 8, pp. 1138-1144, 2002. https://doi.org/10.1053/apmr.2002.33644
  14. R. A. Geiger, J. B. Allen, J. O'Keefe, and R. R. Hicks, Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Phys Ther, Vol. 81, No. 4, pp. 995-1005, 2001.
  15. S. F. Tyson, and L. H. DeSouza, Reliability and validity of functional balance tests post stroke. Clin Rehabil, Vol. 18, No. 8, pp. 916-923, 2004. https://doi.org/10.1191/0269215504cr821oa
  16. K. H. Cho, and W. H. Lee, The effects of Two Motor Dual Task Training on Balance and Gait in Patients with Chronic Stroke. J Korean Soc Phy Ther, Vol. 22, No. 4, pp. 7-14, 2010.
  17. D. J. Yang, S. K. Park, J. L. Kang, J. H. Lee, and Y. H. Uhm, Effect of Computerized Feedback Postural Training on Balance and Muscle Activity in Stroke Patients. J Korean Soc Phy Ther, Vol. 24, No. 5, pp. 348-354, 2012.
  18. T. G. Jeong, J. S. Park, J. D. Choi, J. Y. Lee, and J. S. Kim, The Effects of Sensorimotor Training on Balance and Muscle Activation During Gait in Older Adults. J Korean Soc Phy Ther, Vol. 23, No. 4, pp. 29-36, 2011.
  19. J. M. Kim, C. H. Yi, and Y. R. Goo, A study on the effects of weight-transfer training upon the gait patterns of hemiplegic patients through visual and auditory feedback. KAUPT, Vol. 2, No. 2, pp. 9-23, 1995.
  20. J. L. Spira, J. M. Pyne, B. Wiederhold, M. Wiederhold, K. Graap, and A. Rizzo, Virtual reality and other experiential therapies for combat-related post traumatic stress disorder. Primary Psychiatry, Vol. 13, No. 3, pp. 58-64, 2006.
  21. D. K. Seo, D. W. Oh, and S. H. Lee, Effectiveness of ankle visuoperceptual feedback training on balance and gait functions in hemiparetic patients. J Korean Soc Phy Ther, Vol. 22, No. 4, pp. 35-41, 2010.
  22. A. Srivastava, A. B. Taly, A. Gupta, S. Kumar, and T. Murali, Post-stroke balance training: role of force platform with visual feedback technique. J Neurol Sci, Vol. 287, No. 1-2, pp. 89-93, 2009. https://doi.org/10.1016/j.jns.2009.08.051
  23. C. Walker, B. J. Brouwer, and E. G. Culham, Use of visual feedback in retraining balance following acute stroke. Phys Ther, Vol. 80, No. 9, pp. 886-895, 2000.
  24. C. J. Winstein, E. R. Gardner, D. R. McNeal, P. S. Barto, and D. E. Nicholson, Standing balance training: effect on balance and locomotion in hemiparetic adults. Arch Phys Med Rehabil, Vol. 70, No. 10, pp. 755-762, 1989.
  25. P. W. Duncan, D. K. Weiner, J. Chandler, and S. Studenski, Functional reach: A new clinical measure of balance. J Gerontol, Vol. 45, No. 6, pp. 192-197, 1990.
  26. D. Podsiadlo, and S. Richardson, The timed ""Up & Go"": A test of basic functional mobility for frail elderly person. J Am Geriatr Soc, Vol. 39, No. 2, pp. 142-148, 1991. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  27. K. A. Mossberg, Reliability of a timed walk test in persons with acquired brain injury. Am J Phys Med Rehabil, Vol. 82, No. 5, pp. 385-390, 2003.
  28. J. S. Lee, K. W. Nam, K. Y. Kim, J. W. Yoon, and J. H. Park, Effect of Weight Bearing Exercise on Weight Bearing and Balance for Patients with Chronic Stroke. J Korean Soc Phy Ther, Vol. 24, No. 4, pp. 253-261, 2012.
  29. K. H. Cho, S. K. Bok, Y. J. Kim, and S. L. Hwang, Effect of Lower Limb Strength on Falls and Balance of the Elderly. Ann Rehabil Med, Vol. 36, pp. 386-393, 2012. https://doi.org/10.5535/arm.2012.36.3.386
  30. N. Genthon, P. Rougier, A. S. Gissot, J. Froger, J. Pelissier, and D. Perennou, Contribution of each lower limb to upright standing in stroke patients. Stroke, Vol. 39, No. 6, pp. 1793-1799, 2008. https://doi.org/10.1161/STROKEAHA.107.497701
  31. S. Y. Lee, and S. S. Bae, The studies on the foot stability and kinesiology by direction of carry a load during gait. J Korean Soc Phy Ther, Vol. 21, No. 2, pp. 97-101, 2009.
  32. L. Johannsen, D. Broetz, and H. O. Karnath, Leg orientation as a clinical sign for pusher syndrome. BMC Neurol, Vol. 6, No. 30, 2006.
  33. K. K. Patterson, L. Parafianowicz, C. J. Danells, V. Closson, M. C. Verrier, W. Richard Staines, S. E. Black, and W. E. Mcllroy, Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil, Vol. 89, No. 2, pp. 304-310, 2008. https://doi.org/10.1016/j.apmr.2007.08.142
  34. G. Rode, C. Tiliket, and D. Boisson, Predominance of postural imbalance in left hemiparetic patients. Scand J Rehabil Med, Vol. 29, No. 1, pp. 11-16, 1997.
  35. J. C. Rothwell, Control of human voluntary movement. 2nd ed. London, Chapman and Hall, pp. 68-86, 1994.
  36. G. I. Turnbull, J. Charteris, and J. C. Wall, A comparison of the range of walking speeds between normal and hemiplegic subjects. Scand J Rehabil Med, Vol. 27, No. 3, pp. 175-182, 1995.
  37. J. E. Lateiner, and R. L. Sainburg, Differential contributions of vision and proprioception to movement accuracy. Exp Brain Res, Vol. 151, No. 4, pp. 446-454, 2003. https://doi.org/10.1007/s00221-003-1503-8
  38. W. De Weerdt, S. M. Grossley, N. B. Lincoln, and M. A. Harrison, Restoration of balance in stroke patients: a single case design. Clin Rehabil, Vol. 3, No. 2, pp. 139-147, 1989. https://doi.org/10.1177/026921558900300209
  39. S. H. Jang, J. H. Ann, and J. S. Kim, Effect of Trunk Control Training on Labile Surface on Relative Impulse in the Persons with Stroke. J Korean Soc Phy Ther, Vol. 24, No. 2, pp. 163-169, 2012.
  40. J. W. Park, K. S. Nam, and M. Y. Back, The Relationship between the plantar center of pressure displacement and dynamic balance measures in hemiplegic gait. The Korean Academy of University Trained Phsical Therapists, Vol. 12, No. 1, pp. 11-21, 2005.