PNF and Movement

Korea Proprioceptive Neuromuscular Facilitation Association (대한고유수용성신경근촉진법학회)
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Self-Training Trunk Program for Improving Balance and Walking Ability in People with Chronic Stroke -A Preliminary Study-

만성 뇌졸중 환자의 균형 및 보행 증진을 위한 체간 자가 훈련 프로그램 -예비연구-

  • Na, Eun-Jin (Department of Physical Therapy, Dream Hospital) ;
  • Woo, Young-Keun (Department of Physical Therapy, College of Medical Sciences, Jeonju University)
  • 나은진 (드림병원 물리치료실) ;
  • 우영근 (전주대학교 의과학대학 물리치료학과)
  • Received : 2017.10.26
  • Accepted : 2017.11.10
  • Published : 2017.12.31
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Abstract

Purpose: Balance and walking ability are important elements of functional independence for people with stroke and are major goals in rehabilitation. These abilities require trunk performance, but most chronic stroke patients reach a plateau in their rehabilitation. Therefore, the purpose of this study was to investigate the effects of a self-training trunk program to improve balance and walking ability in people with stroke, and to suggest such a self-training program for integrated rehabilitation of people with stroke. Methods: The study recruited 7 people with stroke. The subjects performed trunk training for 30 min per day, 6 days per week, for 3 weeks. Participants were measured on the Trunk Impairment Scale (TIS), the Berg Balance Scale (BBS), the Korean Activities-specific Balance Confidence (K-ABC) scale, the Falls Efficacy Scale (FES), the Functional Gait Assessment (FGA), the 6 Minute Walk Test (6MWT) and a gait analysis to measure the training effects. Statistical analysis used the Wilcoxon signed-rank test as a non-parametric statistical test. Results: TIS was not significantly different after the self-training trunk program, but BBS (p>0.05), K-ABC, and FES were significantly improved after the training program (p<0.05). Furthermore, the 6MWT, stride/height %, and one-leg stance were significantly improved after the training program (p<0.05), but cadence, stance, and swing duration were not significantly different after the training (p>0.05). Conclusion: These results suggest that a self-training trunk program should be integrated into stroke rehabilitation to improve balance and walking ability, and further research is needed to develop the program to be more effective for chronic stroke patients.

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References

  1. Allen L, Richardson M, McIntyre A, et al. Community stroke rehabilitation teams: providing home-based stroke rehabiitation in Ontario, Canada. The Canadian Journal of Neurological Sciences. 2014;41(6):697-703. https://doi.org/10.1017/cjn.2014.31
  2. Balaban B, Tok F. Gait disturbances in patients with stroke. The American Academy of Physical Medicine and Rehabilitation. 2014;6(7):635-642.
  3. Balke B. A simple field test for the assessment of physical fitness. Civil Aeromedical Research Institute (U.S.). 1963;53:1-8.
  4. Berg K, Wood-Dauphinee S, Williams JI. The balance scale: reliability assessment with elderly residents and patients with an acute stroke. Scandinavian Journal of Rehabilitation Medicine. 1995;27(1):27-36.
  5. Bernocchi P, Vanoglio F, Baratti D, et al. Home-based telesurveillance and rehabilitation after stroke: a real-life study. Topics in Stroke Rehabilitation. 2016;23(2):106-115. https://doi.org/10.1080/10749357.2015.1120453
  6. Blum L, Korner-Bitensky N. Usefulness of the Berg balance scale in stroke rehabilitation: a systematic review. Physical Therapy. 2008;88(5):559-566. https://doi.org/10.2522/ptj.20070205
  7. Botner EM, Miller WC, Eng JJ. Measurement properties of the activities-specific balance confidence scale among individuals with stroke. Disability and Rehabilitation. 2005;27(4):156-163. https://doi.org/10.1080/09638280400008982
  8. Butland RJ, Pang JACK, Gross ER, et al. Two-, six-, and 12-minute walking tests in respiratory disease. British Medical Journal. 1982;284(6329):1607-1608. https://doi.org/10.1136/bmj.284.6329.1607
  9. Cabanas-Valdés R, Cuchi GU, Bagur-Calafat C. Trunk training exercises approaches for improving trunk performance and functional sitting balance in patients with stroke: a systematic review. NeuroRehabilitation. 2013;33(4):575-692.
  10. Chaiyawat P, Kulkantrakorn K. Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial. Clinical Neurology and Neurosurgery. 2012; 114(7):866-870. https://doi.org/10.1016/j.clineuro.2012.01.018
  11. Chung EJ, Lee JS, Kim SS, et al. The relationships among trunk control ability, dynamic balance and gait in stroke patients. Journal of Korean Oriental Medicine. 2012;33(1):148-159.
  12. Dean CM, Shepherd RB. Task-related training improves performance of seated reaching tasks after stroke a randomized controlled trial. Stroke. 1997;28(4):722-728. https://doi.org/10.1161/01.STR.28.4.722
  13. Dickstein R, Shefi S, Marcovitz E, et al. Anticipatory postural adjustment in selected trunk muscles in poststroke hemiparetic patients. Archives of Physical Medicine and Rehabilitation. 2004;85(2):261-267. https://doi.org/10.1016/j.apmr.2003.05.011
  14. Donoso Brown EV, Dudgeon BJ, Gutman K, et al. Understanding upper extremity home programs and the use of gaming technology for persons after stroke. Disability and Health Journal. 2015;8(4):507-513. https://doi.org/10.1016/j.dhjo.2015.03.007
  15. Eng JJ, Pang MY, Ashe MC. Balance, falls, and bone health: role of exercise in reducing fracture risk after stroke. Journal of Rehabilitation Research and Development. 2008;45(2):297-313. https://doi.org/10.1682/JRRD.2007.01.0014
  16. Geurts AC, de Haart M, van Nes I, et al. A review of standing balance recovery from stroke. Gait & Posture. 2005;22(3):267-281. https://doi.org/10.1016/j.gaitpost.2004.10.002
  17. Gillen G, Boiangiu C, Neuman M, et al. Trunk posture affects upper extremity function of adults. Perceptual and Motor Skills. 2007;104(2):371-380. https://doi.org/10.2466/pms.104.2.371-380
  18. Granacher U, Lacroix A, Muehlbauer T, et al. Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology. 2013;59(2): 105-113. https://doi.org/10.1159/000343152
  19. Hacmon RR, Krasovsky T, Lamontagne A, et al. Deficits in intersegmental trunk coordination during walking are related to clinical balance and gait function in chronic stroke. Journal of Neurologic Physical Therapy. 2012;36(4):173-181. https://doi.org/10.1097/NPT.0b013e31827374c1
  20. Han GC, Lee EJ, Lee JH, et al. The study of standardization for a Korean adaptation of self-report measures of dizziness. Journal of the Korean Balance Society. 2004;3(2):307-325.
  21. Haruyama K, Kawakami M, Otsuka T. Effect of core stability training on trunk function, standing balance, and mobility in stroke patients. Neurorehabilitation and Neural Repair. 2017;31(3):240-249. https://doi.org/10.1177/1545968316675431
  22. Huh JS, Lee YS, Kim CH, et al. Effects of balance control training on functional outocmes in subacute hemiparetic stroke patients. Annals of Rehabilitation Medicine. 2015;39(6):995-1001. https://doi.org/10.5535/arm.2015.39.6.995
  23. Huang HC, Huang YC, Lin MF, et al. Effects of home-based supportive care on improvements in physical function and depressive symptoms in patients with stroke: a meta-analysis. Archives of Physical Medicine and Rehabilitation. 2017;98(8):1666-1677. https://doi.org/10.1016/j.apmr.2017.03.014
  24. Huang Y, Meijer OG, Lin J, et al. The effects of stride length and stride frequency on trunk coordination in human walking. Gait & Posture. 2010;31(4):444-449. https://doi.org/10.1016/j.gaitpost.2010.01.019
  25. Jurkiewicz MT, Marzolini S, Oh P. Adherence to a home-based exercise program for individuals after stroke. Topics in Stroke Rehabilitation. 2011;18(3):277-284. https://doi.org/10.1310/tsr1803-277
  26. Karthikbabu S, John MS, Manikandan N, et al. Role of trunk rehabilitation on trunk control, balance and gait in patients with chronic stroke: a pre-post design. Neuroscience and Medicine. 2011;(2):61-67.
  27. Kilinc M, Avcu F, Onursal O, et al. The effects Bobath-based trunk exercise on trunk control, functional capacity, balance, and gait: a pilot randomized controlled trial. Topics in Stroke Rehabilitation. 2016;23(1):50-58. https://doi.org/10.1179/1945511915Y.0000000011
  28. Korean statistical information service. 2014.
  29. Langan J, DeLave K, Phillips L, et al. Home-based telerehabilitation shows improved upper limb function in adults with chronic stroke: a pilot study. Journal of Rehabilitation Medicine. 2013;45(2):217-220. https://doi.org/10.2340/16501977-1115
  30. Lin JH, Hsu MJ, Hsu HW, et al. Psychometric comparisons of 3 functional ambulation measures for patients with stroke. Stroke. 2010;41(9):2021-2025. https://doi.org/10.1161/STROKEAHA.110.589739
  31. Miyake Y, Nakamura S, Nakajima M. The effect of trunk coordination exercise on dynamic postural control using a core noodle. Journal of Bodywork and Movement Therapies. 2014;18(4):519-525. https://doi.org/10.1016/j.jbmt.2013.12.005
  32. Morishita M, Amimoto K, Matsuda T, et al. Analysis of dynamic sitting balance on the independence of gait in hemiparetic patients. Gait & Posture. 2009;29(4): 530-534. https://doi.org/10.1016/j.gaitpost.2008.12.005
  33. Ng SS, Tsang WW, Cheung TH, et al. Walkway length, but not turning direction, determines the six-minute walk test distance in individuals with stroke. Archives of Physical Medicine and Rehabilitation. 2011;92(5): 806-811. https://doi.org/10.1016/j.apmr.2010.10.033
  34. O'Sullivan SB, Schmitz TJ, Fulk G. Physical rehabilitation. Philadelphia. FA Davis. 2013.
  35. Reunanen MA, Jarvikoski A, Talvitie U, et al. Individualised home-based rehabilitation after stroke in eastern Finland-the client's perspective. Health and Social Care in the Community. 2016;24(1):77-85. https://doi.org/10.1111/hsc.12190
  36. Schmid A, Duncan PW, Studenski S, et al. Improvements in speed-based gait classifications are meaningful. Stroke. 2007;38(7):2096-2100. https://doi.org/10.1161/STROKEAHA.106.475921
  37. Sorinola IO, Powis I, White CM. Does additional exercise improve trunk function recovery in stroke patients? A meta-analysis. NeuroRehabilitation. 2014;35(2): 205-213.
  38. Tessem S, Hagstrom N, Fallang B. Weight distribution in standing and sitting positions, and weight transfer during reaching tasks, in seated stroke subjects and healthy subjects. Physiotherapy Research International. 2007;12(2):82-94. https://doi.org/10.1002/pri.362
  39. Legg L, Langhome, Outpatient service trialists. Rehabilitation therapy services for stroke patients living at home: systematic review of randomised trials. The Lancet. 2004;363(9406):352-356. https://doi.org/10.1016/S0140-6736(04)15434-2
  40. Verheyden G, Vereeck L, Truijen S, et al. Additional exercises improve trunk performance after stroke: a pilot randomized controlled trial. Neurorehabiltation and Neural Repair. 2009;23(3):281-286. https://doi.org/10.1177/1545968308321776
  41. Verheyden G, Nieuwboer A, De Wit L, et al. Trunk performance after stroke: an eye catching predictor of functional outcome. Journal of Neurology, Neurosurgery & Psychiatry. 2007;78(7):694-698. https://doi.org/10.1136/jnnp.2006.101642
  42. Verheyden G, Nieuwboer A, Feys H, et al. Discriminant ability of the trunk impairment scale: a comparison between stroke patients and healthy individuals. Disability and Rehabilitation. 2005;27(17):1023-1028. https://doi.org/10.1080/09638280500052872
  43. Verheyden G, Nieuwboer A, Mertin J, et al. The trunk impairment scale: a new tool to measure motor impairment of the trunk after stroke. Clinical Rehabilitation. 2004;18(3): 326-334. https://doi.org/10.1191/0269215504cr733oa
  44. Wagenaar RC, Beek WJ. Hemiplegic gait: a kinematic analysis using walking speed as a basis. Journal of Biomechanics. 1992;25(9):1007-1015. https://doi.org/10.1016/0021-9290(92)90036-Z
  45. Wang CH, Hsueh IP, Sheu CF, et al. Discriminative, predictive, and evaluative properties of a trunk control measure in patients with stroke. Physical Therapy. 2005; 85(9):887-894.
  46. Wang RY. Effect of proprioceptive neuromuscular facilitation on the gait of patients with hemiplegia of long and short duration. Physical Therapy. 1994;74(12): 1108-1115. https://doi.org/10.1093/ptj/74.12.1108
  47. Wee SK, Hughes AM, Warner MB, et al. Impact of trunk support on upper extremity function in people with chronic stroke and healthy controls. Physical Therapy. 2015;95(8):1163-1171. https://doi.org/10.2522/ptj.20140487
  48. Wrisley DM, Marchetti GF, Kuharsky DK, et al. Reliability, internal consistency, and validity of data obtained with the functional gait assessment. Physical Therapy. 2004;84(10): 906-918.
  49. Yardley L, Beyer N, Hauer K, et al. Development and initial validation of the falls efficacy scale-international (FES-I). Age and Ageing. 2005;34(6):614-619. https://doi.org/10.1093/ageing/afi196