The Effects of Repetitive Sit-to-Stand Training with a Paretic-side Asymmetrical Foot Position on the Balance of Chronic Stroke Subjects

  • Park, Jae Hyo (Department of Physical Therapy, College of Biomedical Science, Daegu Haany University) ;
  • Kim, Young Mi (Department of Rehabilitation Science, Graduate School, Daegu University) ;
  • Lee, Na Kyung (Department of Rehabilitation Science, Graduate School, Daegu University)
  • Received : 2015.05.30
  • Accepted : 2015.06.18
  • Published : 2015.06.25

Abstract

Purpose: This study aimed to improve the asymmetrical weight-bearing ratio, by applying different repetitive sit-to-stand training methods to the paretic-side foot of hemiplegic patients, as well as to provide the necessary information for applying balance training with hemiplegic patients. Methods: The subjects were divided into two groups: a spontaneous foot group and an asymmetrical foot group. They all performed repetitive sit-to-stand training five times a week for a total of six weeks. The sit-to-standing movement was studied using standardized clinical tests. The Biodex Balance System, Time up and go test (TUG), 5 times sit-to-stand test (5XSST), and functional reach test (FRT) were used to measure the static and dynamic standing balance of the patients. Results: In the balance system measurement, the results for the overall index, ant-post index, med-lat index, fall risk index, 5XSST, and FRT after the training differed significantly between the comparison groups (p<0.05). In the evaluation of dynamic balance, the differences in TUG did not differ significantly between the comparison groups after the training (p>0.05). Conclusion: The study found that the asymmetrical group showed significant increases in static and dynamic balance in comparison to the spontaneous group after repetitive sit-to-stand training. Based on this result, it is clear that training in an asymmetrical position with the paretic foot back can increase the left-right stability limit and the anterior-posterior stability limit, thus improving balance control.

Keywords

References

  1. Peurala SH, Kononen P, Pitkanen K, et al. Postural instability in patients with chronic stroke. Restor Neurol Neurosci. 2007;25(2):101-8.
  2. Lee KS, Kim CS. The effect of medio-lateral balance to head rotation in stroke patient. J Korean Soc Phys Ther. 2012;24(5):334-9.
  3. Jung KS, Chung YJ. The effect of changes in walking aids on weight bearing on the cane and foot in stroke. J Korean Soc Phys Ther. 2012; 24(2):113-7.
  4. Kusoffsky A, Apel I, Hirschfeld H. Reaching-lifting-placing task during standing after stroke: Coordination among ground forces, ankle muscle activity, and hand movement. Arch Phys Med Rehabil. 2001;82(5):650-60. https://doi.org/10.1053/apmr.2001.22611
  5. Turnbull GI, Charteris J, Wall JC. Deficiencies in standing weight shifts by ambulant hemiplegic subjects. Arch Phys Med Rehabil. 1996;77(4): 356-62. https://doi.org/10.1016/S0003-9993(96)90084-2
  6. Lee SY, Lee MH, Park MC, et al. The effects the type of canes handle affects in recovering-balance of hemiplegic patients. . J Korean Soc Phys Ther. 2008;20(4):7-14.
  7. Lee SW, In TS, et al. Immediate effects of load stimulation on static balance and muscle activities in chronic stroke patients. J Korean Soc Phys Ther. 2009;21(1):19-26.
  8. Engberg W, Lind A, Linder A, et al. Balance-related efficacy compared with balance function in patients with acute stroke. Physiother Theory Pract. 2008;24(2):105-11. https://doi.org/10.1080/09593980701389576
  9. Malouin F, Richards CL, Doyon J, et al. Training mobility tasks after stroke with combined mental and physical practice: A feasibility study. Neurorehabil Neural Repair. 2004;18(2):66-75. https://doi.org/10.1177/0888439004266304
  10. Hesse S, Bertelt C, Schaffrin A, et al. Restoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support. Arch Phys Med Rehabil. 1994;75(10):1087-93. https://doi.org/10.1016/0003-9993(94)90083-3
  11. Cheng PT, Liaw MY, Wong MK, et al. The sit-to-stand movement in stroke patients and its correlation with falling. Arch Phys Med Rehabil. 1998;79(9):1043-6. https://doi.org/10.1016/S0003-9993(98)90168-X
  12. Eng JJ, Chu KS. Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. Arch Phys Med Rehabil. 2002;83(8):1138-44. https://doi.org/10.1053/apmr.2002.33644
  13. Brunt D, Greenberg B, Wankadia S, et al. The effect of foot placement on sit to stand in healthy young subjects and patients with hemiplegia. Arch Phys Med Rehabil. 2002;83(7):924-9. https://doi.org/10.1053/apmr.2002.3324
  14. Cheng PT, Wu SH, Liaw MY, et al. Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Arch Phys Med Rehabil. 2001;82(12):1650-4. https://doi.org/10.1053/apmr.2001.26256
  15. Podsiadlo D, Richardson S. The timed "up & go": A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2): 142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  16. Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the timed “up & go” test in people with parkinson disease. Phys Ther. 2001;81(2):810-8. https://doi.org/10.1093/ptj/81.2.810
  17. Lord SR, Murray SM, Chapman K, et al. Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol A Biol Sci Med Sci. 2002;57(8): M539-43. https://doi.org/10.1093/gerona/57.8.M539
  18. Duncan PW, Weiner DK, Chandler J, et al. Functional reach: A new clinical measure of balance. J Gerontol. 1990;45(6):M192-7. https://doi.org/10.1093/geronj/45.6.M192
  19. Roy G, Nadeau S, Gravel D, et al. Side difference in the hip and knee joint moments during sit-to-stand and stand-to-sit tasks in individuals with hemiparesis. Clin Biomech (Bristol, Avon). 2007;22(7):795-804. https://doi.org/10.1016/j.clinbiomech.2007.03.007
  20. Rocha Ade S, Knabben RJ, Michaelsen SM. Non-paretic lower limb constraint with a step decreases the asymmetry of vertical forces during sit-to-stand at two seat heights in subjects with hemiparesis. Gait Posture. 2010;32(4):457-63. https://doi.org/10.1016/j.gaitpost.2010.07.001
  21. Kawagoe S, Tajima N, Chosa E. Biomechanical analysis of effects of foot placement with varying chair height on the motion of standing up. J Orthop Sci. 2000;5(2):124-33. https://doi.org/10.1007/s007760050139
  22. Stevens C, Bojsen-Moller F, Soames RW. The influence of initial posture on the sit-to-stand movement. Eur J Appl Physiol Occup Physiol. 1989;58(7):687-92. https://doi.org/10.1007/BF00637377
  23. Roy G, Nadeau S, Gravel D, et al. The effect of foot position and chair height on the asymmetry of vertical forces during sit-to-stand and standto- sit tasks in individuals with hemiparesis. Clin Biomech (Bristol, Avon). 2006;21(6):585-93. https://doi.org/10.1016/j.clinbiomech.2006.01.007
  24. Yang YR, Chen IH, Liao KK, et al. Cortical reorganization induced by body weight-supported treadmill training in patients with hemiparesis of different stroke durations. Arch Phys Med Rehabil. 2010;91(4):513-8. https://doi.org/10.1016/j.apmr.2009.11.021
  25. Duclos C, Nadeau S, Lecours J. Lateral trunk displacement and stability during sit-to-stand transfer in relation to foot placement in patients with hemiparesis. Neurorehabil Neural Repair. 2008;22(6):715-22. https://doi.org/10.1177/1545968308316000
  26. Gray CK, Culham E. Sit-to-stand in people with stroke: Effect of lower limb constraint-induced movement strategies. Stroke Res Treat. 2014; Article ID 683681:1-8.