Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
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Four-Week Comparative Effects of Abdominal Drawing-In and Diaphragmatic Breathing Maneuvers on Abdominal Muscle Thickness, Trunk Control, and Balance in Patients With Chronic Stroke

  • Kim, Su-kyung (Dept. of Physical Therapy, The Graduate School, Yonsei University) ;
  • Kang, Tae-woo (Dept. of Physical Therapy, The Graduate School, Yonsei University) ;
  • Park, Dong-hwan (Dept. of Physical Therapy, The Graduate School, Yonsei University) ;
  • Lee, Ji-hyun (Dept. of Physical Therapy, The Graduate School, Yonsei University) ;
  • Cynn, Heon-seock (Dept. of Physical Therapy, College of Health Science, Yonsei University)
  • Received : 2017.04.28
  • Accepted : 2017.06.09
  • Published : 2017.09.17
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Abstract

Background: Patients with chronic stroke often shows decreased trunk muscle activity and trunk performance. To resolve these problems, many trunk stabilizing techniques including the abdominal drawing-in maneuver (ADIM) and the diaphragmatic breathing maneuver (DBM) are used to improve trunk muscle strength. Objects: To compare the effects of the ADIM and the DBM on abdominal muscle thickness, trunk control, and balance in patients with chronic stroke. Methods: This was a randomized controlled trial. Nineteen patients were randomly allocated to the ADIM ($n_1=10$) and DBM ($n_2=9$) groups. The ADIM and DBM techniques were performed three times per week for 4 weeks. The thicknesses of the transversus abdominis (TrA), internal oblique muscle, and external oblique muscles on the paretic and non-paretic sides, Trunk Impairment Scale (TIS) score, and Berg Balance Scale (BBS) score were used to assess changes in motor development after 4 weeks of training. Results: After the training periods, the TrA thickness on the paretic side, TIS score, and BBS score improved significantly in both groups compared to baseline (p<.05). TIS score was significantly greater in the DBM group than in the ADIM group (p<.05). Conclusion: This study demonstrated that ADIM and DBM are beneficial for improving TrA muscle thickness in the paretic side, trunk control, and balance ability. Intergroup comparison revealed that TIS score was significantly improved in the DBM group versus the ADIM group. Thus, DBM may be an effective treatment for low trunk muscle activity and performance in patients with chronic stroke.

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References

  1. Berg K, Wood-Dauphinee S, Williams JI. The balance scale: Reliability assessment with elderly residents and patients with an acute stroke. Scand J of Rehabil Med. 1995;27(1):27-36.
  2. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Phys Ther. 2008;88(5):559-566. https://doi.org/10.2522/ptj.20070205
  3. Bohannon RW, Andrews AW, Smith MB. Rehabilitation goals of patients with hemiplegia. Int J Rehabil Res. 1988;11(2):181-184. https://doi.org/10.1097/00004356-198806000-00012
  4. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: Methods, reproducibility, and normal values. Chest. 2009;135(2):391-400. https://doi.org/10.1378/chest.08-1541
  5. Bunn JY. Real-time ultrasound feedback and abdominal hollowing exercises for people with low back pain. N Z J Physiother. 2007;35(1):4-11.
  6. Chan BK, Ng SS, Ng GY. A home-based program of transcutaneous electrical nerve stimulation and task-related trunk training improves trunk control in patients with stroke: A randomized controlled clinical trial. Neurorehabilitation and Neural Repair. 2015;29(1):70-79. http://doi.org/10.1177/1545968314533612
  7. Choi HS, Shim YJ, Shin WS. Comparison on postural control between abdominal draw-in maneuver and abdominal expansion maneuver in persons with stroke. Physi Ther Rehabil Sci. 2016;5(3):113-119. https://doi.org/10.14474/ptrs.2016.5.3.113
  8. Chung E, Lee BH, Hwang S. Core stabilization exercise with real-time feedback for chronic hemiparetic stroke: A pilot randomized controlled trials. Restor Neuro Neurosci. 2014;32(2):313-321. http://doi.org/10.3233/RNN-130353
  9. Downs S, Marquez J, Chiarelli P. The Berg balance scale has high intra-and inter-rater reliability but absolute reliability varies across the scale: A systematic review. J Physiother. 2013;59(2):93-99. https://doi.org/10.1016/S1836-9553(13)70161-9
  10. Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int Sports Phys Ther. 2013;8(1):62-73.
  11. Haruyama K, Kawakami M, Otsuka T. Effect of core stability training on trunk function, standing balance, and mobility in stroke patients a randomized controlled trial. Neurorehabil and Neural Repair. 2017:31(3):240-249. https://doi.org/10.1177/1545968316675431
  12. Henry SM, Westervelt KC. The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects. J Orthop Sports Phys Ther. 2005;35(6):338-345. https://doi.org/10.2519/jospt.2005.35.6.338
  13. Hides J, Wilson S, Stanton W, et al. An MRI investigation into the function of the transversus abdominis muscle during "drawing-in" of the abdominal wall. Spine (Phila Pa 1976). 2006;31(6):E175-E178. https://doi.org/10.1097/01.brs.0000202740.86338.df
  14. Hodges P, Gurfinkel V, Brumagne S, et al. Coexistence of stability and mobility in postural control: Evidence from postural compensation for respiration. Exp Brain Res. 2002;144(3):293-302. https://doi.org/10.1007/s00221-002-1040-x
  15. Hodges PW, Pengel LH, Herbert RD, et al. Measurement of muscle contraction with ultrasound imaging. Muscle Nerve. 2003;27(6):682-692. https://doi.org/10.1002/mus.10375
  16. Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol (1985). 2000;89(3):967-976. https://doi.org/10.1152/jappl.2000.89.3.967
  17. Hsieh CL, Sheu CF, Hsueh IP, et al. Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke. 2002;33(11):2626-2630. https://doi.org/10.1161/01.STR.0000033930.05931.93
  18. Jijimol G, Fayaz RK, Vijesh PV. Correlation of trunk impairment with balance in patients with chronic stroke. Neuro Rehabilitation. 2013;32(2):323-325. https://doi.org/10.3233/NRE-130851
  19. Jung KS, Cho HY, In TS. Trunk exercises performed on an unstable surface improve trunk muscle activation, postural control, and gait speed in patients with stroke. J Phys Ther Sci. 2016;28(3):940-944. http://doi.org./10.1589/jpts.28.940
  20. Jung KS, Kim Y, Chung YJ, et al. Weight-shift training improves trunk control, proprioception, and balance in patients with chronic hemiparetic stroke. Tohoku J Exp Med. 2014;232(3):195-199. https://doi.org/10.1620/tjem.232.195
  21. Karatas M, Cetin N, Bayramoglu M, et al. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Ame J Phys Med & Rehabil. 2004;83(2):81-87. https://doi.org/10.1097/01.PHM.0000107486.99756.C7
  22. Kolar P, Kovesova A, Valouchova P, et al. Dynamic neuromuscular stabilization: Assessment methods. In: Chaitow L, Bradley D, Gilbert C eds. Recognizing and Treating Breathing Disorders: A multidisciplinary approach. 2nd ed, Elsevier Health Sciences, London, 2014.
  23. Lee JH, Cynn HS, Yoon TL, et al. The effect of scapular posterior tilt exercise, pectoralis minor stretching, and shoulder brace on scapular alignment and muscles activity in subjects with round-shoulder posture. J Electromyogr Kinesiol. 2015;25(1):107-114. https://doi.org/10.1016/j.jelekin.2014.10.010
  24. Lee NG, Jung JH, You JSH, et al. Novel augmented ADIM training using ultrasound imaging and electromyography in adults with core instability. J Back Musculoskelet Rehabil. 2011;24(4):233-240 https://doi.org/10.3233/BMR-2011-0300
  25. Liao CF, Liaw LJ, Wang RY, et al. Electromyography of symmetrical trunk movements and trunk position sense in chronic stroke patients. J Phys Ther Sci. 2015;27(9):2675-2681. https://doi.org/10.1589/jpts.27.2675
  26. Lim JS, Lee SY, Lee DH, et al. The effect of a bridge exercise using the abdominal drawing-in maneuver on the balance of chronic stroke patients. J Phys Ther Sci. 2012;24(8):651-653. https://doi.org/10.1589/jpts.24.651
  27. Marshall PW, Murphy BA. Core stability exercises on and off a swiss ball. Arch Phys Med Rehabil. 2005;86(2):242-249. https://doi.org/10.1016/j.apmr.2004.05.004
  28. O'sullivan PB. Masterclass. Lumbar segmental ‘instability': Clinical presentation and specific stabilizing exercise management. Man Ther. 2000;5(1):2-12. https://doi.org/10.1054/math.1999.0213
  29. O'Sullivan PB, Twomey L, Allison GT. Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention. J Orthop Sport Phys Ther. 1998;27(2):114-124. https://doi.org/10.2519/jospt.1998.27.2.114
  30. Peterson C. The use of electrical stimulation and taping to address shoulder subluxation for a patient with central cord syndrome. Phys Ther. 2004;84(7):634-643.
  31. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to practice. 2nd ed. Upper Saddle River, NJ, Prentice Hall, 2000:113-116.
  32. Saeys W, Vereeck L, Truijen S, et al. Randomized controlled trial of truncal exercises early after stroke to improve balance and mobility. Neurorehabil Neural Repair. 2012;26(3):231-238. https://doi.org/10.1177/1545968311416822
  33. Saunders SW, Rath D, Hodges PW. Postural and respiratory activation of the trunk muscles changes with mode and speed of locomotion. Gait Posture. 2004;20(3):280-290. https://doi.org/10.1016/j.gaitpost.2003.10.003
  34. Seo DK, Lee SY, Lee YS. Identifying symmetry and contracted ratio of lateral abdominal muscles in stroke survivors. J Bio Sci Biotechnol. 2015;7(3):199-206.
  35. Seo DK, Kwon OS, Kim JH, et al. The effect of trunk stabilization exercise on the thickness of the deep abdominal muscles and balance in patients with chronic stroke. J Phys Ther Sci. 2012;24(2):181-185. https://doi.org/10.1589/jpts.24.181
  36. Verheyden G, Nieuwboer A, Mertin J, et al. The trunk impairment scale: A new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004;18(3):326-334. https://doi.org/10.1191/0269215504cr733oa
  37. Verheyden G, Vereeck L, Truijen S, et al. Trunk performance after stroke and the relationship with balance, gait and functional ability. Clin Rehabil. 2006;20(5):451-458. https://doi.org/10.1191/0269215505cr955oa
  38. Verheyden G, Vereeck L, Truijen S, et al. Additional exercises improve trunk performance after stroke: A pilot randomized controlled trial. Neurorehabil Neural Repair. 2009;23(3):281-286. https://doi.org/10.1177/1545968308321776
  39. Weightman MM. Motor unit behavior following cerebrovascular accident. J Neurol Phys Ther. 1994;18(1):26-28
  40. Yoon MR, Choi HS, Shin WS. Effects of the abdominal drawing-in maneuver and the abdominal expansion maneuver on grip strength, balance and pulmonary function in stroke patients. Phys Ther Korea. 2015;27(3):147-153. https://doi.org/10.18857/jkpt.2015.27.3.147
  41. Yu SH, Park SD. The effects of core stability strength exercise on muscle activity and trunk impairment scale in stroke patients. J Exer Rehabil. 2013;9(3):362-367. https://doi.org/10.12965/jer.130042

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