Effects of Ankle Joint Position during Closed Kinetic Chain Exercise on Strength and Balance in Chronic Stroke

  • Kim, Ye-Eun (Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University) ;
  • Bang, Dae-Hyouk (Department of Physical Therapy, Graduate School of Daejeon University) ;
  • Shin, Won-Seob (Department of Physical Therapy, College of Health and Medical Science, Daejeon University)
  • 투고 : 2015.09.16
  • 심사 : 2015.10.19
  • 발행 : 2015.10.25

초록

Purpose: This study was conducted to determine the effects of ankle joint position during closed kinetic chain (CKC) exercise on knee extensor strength and balance in patients with chronic stroke. Methods: Sixteen patients with chronic stroke participated in the study. Participants were randomly assigned to two groups: $15^{\circ}$ ankle joint plantar flexion group (n=8) and ankle joint neutral group (n=8) during CKC exercise. All participants underwent conventional physical therapy for 30 minutes. In addition, the experimental group ($15^{\circ}$ ankle joint plantar flexion group) and control group (ankle joint neutral group) participated in a 20-minute CKC exercise program. In both groups exercise was performed three times a week for four weeks. Outcomes including knee extensor strength and balance ability (Five times sit-to-stand test, Timed up and go test, and Balancia) were measured before and after exercise. Results: Significant differences in knee extensor strength and balance ability were observed between pre- and post-exercise in all groups (p<0.05). The improvement of knee extensor strength and dynamic balance was significantly higher in the experimental group than in the control group (p<0.05). Conclusion: These findings demonstrated that $15^{\circ}$ ankle joint plantar flexion during closed kinetic chain exercise is effective in improvement of knee extensor strength and dynamic balance in patients with chronic stroke.

키워드

참고문헌

  1. Farqalit R, Shahnawaz A. Effect of foot position during sit-to-stand training on balance and upright mobility in patients with chronic stroke. Hong Kong Physiotherapy Journal. 2013;31(2):75-80. https://doi.org/10.1016/j.hkpj.2013.06.001
  2. Flansbjer UB, Downham D, Lexell J. Knee muscle strength, gait performance, and perceived participation after stroke. Arch Phys Med Rehabil. 2006;87(7):974-80. https://doi.org/10.1016/j.apmr.2006.03.008
  3. Kim BY, Choi WH. The effects of interferential current therapy on spasticity, range of motion, and balance ability in stroke patient. J Kor Phys Ther. 2013;25(4):187-94.
  4. Flansbjer UB, Miller M, Downham D et al. Progressive resistance training after stroke: Effects on muscle strength, muscle tone, gait performance and perceived participation. J Rehabil Med. 2008;40(1):42-8. https://doi.org/10.2340/16501977-0129
  5. Son SM. Effects of constrained-weight shifting train on postural balance and gait parameter and muscle activation of patients with hemiplegia in standing posture. Daegu University. Dissertation of Doctorate Degree. 2014.
  6. Ki KI, Choi JD, Cho HS. The effect of ground tilt on the lower extremity muscle activity of stroke patients performing squat exercises. J Phys Ther Sci. 2014;26(7):965. https://doi.org/10.1589/jpts.26.965
  7. Bang DH, Shin WS, Kim SY et al. The effects of action observational training on walking ability in chronic stroke patients: A double-blind randomized controlled trial. Clin Rehabil. 2013;27(12):1118-25. https://doi.org/10.1177/0269215513501528
  8. Choi KW. Effects of progressive task-oriented resistive training on lower extremity strength, balance and gait in stroke. Sahmyook University. Dissertation of Master's Degree. 2010.
  9. Lee NK. The effects of closed and open kinetic chain exercises on lower limb muscle activity, balance and gait in stroke patients. Daegu University. Dissertation of Master's Degree. 2011.
  10. Lee KY, Shin WS. The effects of closed kinetic and open kinetic chain exercises using knee reposition sense in chronic stroke patients. J Kor Phys Ther. 2014;26(3):182-90.
  11. Tang SF, Chen CK, Hsu R et al. Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: An electromyographic study. Arch Phys Med Rehabil. 2001;82(10):1441-5. https://doi.org/10.1053/apmr.2001.26252
  12. Lee JH. A study isokinetic strength characteristics of low extremity extensors according to ankle joint position in stroke patients. Catholic University of Daegu. Dissertation of Master's Degree. 2014.
  13. Kwon OK, Shin WS. Effects of closed and open kinetic chain exercises on knee extensor strength and balance in patients with early stroke. J Korean Soc Phys Med. 2014;9(2):223-31. https://doi.org/10.13066/kspm.2014.9.2.223
  14. Bang DH, Shin WS, Noh HJ et al. Effect of unstable surface training on walking ability in stroke patients. J Phys Ther Sci. 2014;26(11):1689-91. https://doi.org/10.1589/jpts.26.1689
  15. 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): 539-43. https://doi.org/10.1093/gerona/57.8.M539
  16. Mehrholz J, Wagner K, Rutte K et al. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil. 2007;88(10):1314-9. https://doi.org/10.1016/j.apmr.2007.06.764
  17. Kobayashi T, Leung AK, Hutchins SW. Correlations between knee extensor strength measured by a hand-held dynamometer and functional performance in patients with chronic stroke. Isokinet Exerc Sci. 2011;19(1):33-7.
  18. Knols RH, Aufdemkampe G, De Bruin ED et al. Hand-held dynamometry in patients with haematological malignancies: Measurement error in the clinical assessment of knee extension strength. BMC Musculoskelet Disord. 2009;10(1):31. https://doi.org/10.1186/1471-2474-10-31
  19. Clark RA, Bryant AL, Pua Y et al. Validity and reliability of the nintendo wii balance board for assessment of standing balance. Gait Posture. 2010;31(3):307-10. https://doi.org/10.1016/j.gaitpost.2009.11.012
  20. Park DS, Lee DY, Choi SJ et al. Reliability and validity of the balancia using wii balance board for assessment of balance with stroke patients. Journal of the Korea Academia-Industrial Cooperation Society. 2013;14(6):2767-72. https://doi.org/10.5762/KAIS.2013.14.6.2767
  21. Lockie RG, Schultz AB, Callaghan SJ et al. The effects of isokinetic knee extensor and flexor strength on dynamic stability as measured by functional reaching. Isokinet Exerc Sci. 2013;21(4):301-9.
  22. Roerdink M, Geurts AC, de Haart M et al. On the relative contribution of the paretic leg to the control of posture after stroke. Neurorehabilitation and neural repair. 2008.
  23. Sousa N, Sampaio J. Effects of progressive strength training on the performance of the functional reach test and the timed get-up-and-go test in an elderly population from the rural north of portugal. Am J Hum Biol. 2005;17(6):746-51. https://doi.org/10.1002/ajhb.20446
  24. Kwon YJ, Park SJ, Jefferson J et al. The effect of open and closed kinetic chain exercises on dynamic balance ability of normal healthy adults. J Phys Ther Sci. 2013;25(6):671. https://doi.org/10.1589/jpts.25.671
  25. Jung JH, Kim JH. Correlation between bilateral reciprocal leg press test and the balance in chronic stroke patient. J Kor Phys Ther. 2013;25(4):180-6.
  26. Kim JH. The effects of whole body vibration exercise on balance and lower extremity muscle activity in stroke patients. J Kor Phys Ther. 2013;25(5):266-72.
  27. Park SY. Assessment of isokinetic muscle strength in lower limb extensor through the ankle joint position. Daegu University Dissertation of Master's Degree. 2009.