• Journal of the Korean Society of Physical Medicine
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• v.5 no.3
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• pp.435-443
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• 2010

Purpose : The goal of this study was to identify the effects of treadmill walking training (TW) and ergometer bicycle training (EB) on gait and balance in stroke patients. Methods : The subjects consisted of 42 stroke patients. They were randomly divided to two groups: TW(n=20) and EB(n=22). Each group trained along with the conventional physical therapy, three times a week for six weeks. The ability of gait was assessed by the 10m walk test and Timed Up and Go test(TUG). The ability of balance was assessed by Berg Balance Scale(BBS) and Balance Performance Monitor(BPM). Results : There was no significant difference between the 10m walking test and TUG groups, but there was a statistical difference between before and after the training for all groups. The result of BBS that assessed balance showed a significant reduction between before and after the training for all groups, but there was no difference between the two groups. While the two groups showed no difference in the BPM assessment, only the EB showed a significant improvement of before and after the training in each group. Conclusion : The outcomes suggest that stroke patients can improve their gait and balance performance through the TW and EB trainings. Although dynamic mean balance showed significance from EB, no significant difference was found between two groups. Even though it cannot be determined through this study which training group is more effective among the above mentioned two, it could be suggested that each training is effective to gait ability and the ability of balance of stroke patients.

• Physical Therapy Rehabilitation Science
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• v.6 no.4
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• pp.159-163
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• 2017

Objective: Persons with stroke have a tendency to exhibit asymmetric weight-bearing during sit-to-stand because due to the attempt to support themselves with the non-paretic foot. However, there are few devices that can assist with sit-to-stand (STS) performance. This study was designed to investigate the use of the elastic band with rings (EBR) in improving weight-bearing effectively in persons with stroke during STS training. Design: Cross-sectional study. Methods: Thirteen stroke survivors participated in the study. An EBR was applied onto the patient during STS activity. The foot pressure was measured before and after wearing the EBR, with a 5-minute rest period between measurements. Subjects were asked to perform each test twice with and without the EBR. Bilateral feet pressures were measured with standing posture being divided into the forward and backward aspects. The foot contact pressure during STS activity was measured with the CONFORMat System. Results: With EBR, the forward pressure of the affected foot significantly increased while the less-affected forward foot pressure significantly decreased (p=0.015 and p=0.023, respectively). The backward foot pressure did not differ significantly in the two limbs, and there was no difference with and without the EBR in terms of the total pressure of the affected foot. There was a significant difference with and without the EBR in the total pressure of the less-affected foot (p<0.05). Conclusions: STS training with the EBR has been shown to improve weight-bearing of both feet while decreasing the total pressure of the less-affected foot in stroke survivors. Therefore, we suggest that the EBR is a useful tool for STS training for persons with stroke in the clinic.

• The Korean Journal of Health Service Management
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• v.5 no.3
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• pp.53-61
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• 2011

This study was to assess the differences in rehabilitation outcomes between the different facilities in Japan, and to determine if there was any variation in patients' functional recovery at hospital discharge across the different facilities. This study focused on acute patients in the rehabilitation ward using the data of 1,830 patients from 8 hospitals after adjusting for triage at admission obtained from the Rehabilitation Patients Databank in Japan (issued in February, 2011) and compared the therapeutic results of each hospital. We estimate the expected value of levels of activities of daily living(ADL) at discharge for rehabilitation patients using regression analysis and Cluster analysis. There were differences among hospitals in their therapeutic results. The differences in the participation of physicians registered as rehabilitation specialists, amount of exercise, self-exercise without therapist, and exercise in wards, were statistically significant differences between hospitals.

• Journal of the Korean Society for Precision Engineering
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• v.30 no.4
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• pp.450-458
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• 2013

The aim of this study was to develop and verify gait training system for post-stroke hemiplegia patients with step length asymmetry. Most post-stroke hemiplegic patients show gait asymmetry and weight shifting training has been suggested as a useful method for improving the walking ability. However, verbal cue by physical therapist may be not effective. Therefore, our weight shift training system was designed to give a feedback to patients through precise plantar pressure and center of pressure (COP) measurement. This weight shifting biofeedback training system is composed of F-Scan plantar pressure measurement system and software development kit (SDK) for Windows operating system. Two post-stroke patients with step length asymmetry were enrolled in this study. After training for six weeks, the weight shift score and step length ratio of two all patients were improved and approached to them of non-disabled. This system developed in this study may improve the step length asymmetry, and therefore this system is also expected to improve a walking ability in hemiplegic patients.

• The Journal of Korean Physical Therapy
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• v.25 no.1
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• pp.36-41
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• 2013

Purpose: To investigate whether the long-term use of a cane induces pain in the unaffected lower limb of stroke patients. Methods: A total of 107 stroke patients with chronic hemiparesis were recruited in this study and classified into two groups; a cane-use group (n=49) and non-cane-use group (n=58). The existence of pain in the unaffected lower limb was assessed on a visual analog scale in the hip, knee, and ankle joint, and the University of Alabama pain behaviors scale (UAB pain behavior scale) used to measure the intensity of pain. In addition, the Motricity Index (MI) was tested in the upper and lower extremities. Results: The proportion of pain in each joint of the lower limb was significantly higher in the cane-use group, compared to the non-cane-use group (p<0.05). In addition, significant differences were observed on the UAB pain behavior scale between the two groups. The lower MI score was significantly lower in the cane-use group, compared with the control group. However, no difference was observed in MI scores of the upper limb between the two groups. Conclusion: These findings reveal that long-term cane usage can induce pain in the unaffected lower limb of stroke patients. We suggest careful consideration when prescribing a cane, depending on functional ability in hemiparetic patients, and recommend continuous evaluation for pain in the affected lower limb.

• Physical Therapy Rehabilitation Science
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• v.9 no.2
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• pp.67-73
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• 2020

Objective: The purpose of this study was determine the effect of Balance Trainer training with Transcutaneous Electrical Nerve Stimulation (TENS) on spasticity and balance in persons with chronic stroke. Design: Randomized controlled trial. Methods: A total of 30 subjects with hemiparetic stroke were recruited and randomly divided into the Balance Trainer training with TENS group (n=15) and Balance Trainer training with placebo TENS group (n=15). The Balance Trainer training with TENS group practiced additional Balance Trainer training with TENS for 30 minutes a day, 5 days per a week during 4 weeks and the Balance Trainer training with placebo TENS group practiced additional Balance Trainer training with placebo TENS for the same period. Spasticity and balance were assessed by ability (static balance, dynamic balance) and were measured before and after the 4-week programs. Results: The result of spasticity and dynamic balance were improved significantly in both groups (p<0.05). The Balance Trainer training with TENS group showed significantly greater improvement in spasticity of the gastrocnemius & dynamic balance, compared to the Balance Trainer training with placebo TENS group (p<0.05). The Balance trainer training with TENS group showed a significant improvement in static balance, especially during the eye-closed condition (p<0.05). Conclusions: The Balance Trainer training with TENS was effective in improving spasticity and balance in subjects with chronic stroke. Based on these results, it is suggested that Balance Trainer training with TENS could clinically be used more actively in conjunction with conventional physical therapy.

• Physical Therapy Rehabilitation Science
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• v.8 no.2
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• pp.93-98
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• 2019

Objective: The purpose of this study was to investigate the effect of robot arm reach training on upper extremity functional movement in chronic stroke survivors. Design: One group pretest-posttest design. Methods: Thirteen chronic stroke survivors participated in this study. Robot arm reach training was performed with a Whole Arm Manipulator (WAM) and a 120-inch projective display to provide visual and auditory feedback. During the robotic arm reach training, WAM provided gravity compensation and assist-as-needed (AAN) force according to the robot control mode. When a participant could not move the arm toward the target for more than 2 seconds, WAM provided AAN force to reach the desired targets. All patients participated in the training for 40 minutes per day, 3 times a week, for 4 weeks. Main outcome measures were the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT) and Box and Block Test (BBT) to assess upper extremity functional movement. Results: After 4 weeks, significant improvement was observed in upper extremity functional movement (FMA: 42.15 to 46.23, BBT: 12.23 to 14.00, p<0.05). In the subscore analysis of the FMA upper extremity motor function domains, significant improvement was observed in upper extremity and coordination/speed units (p<0.05). However, there were no significant differences in the ARAT. Conclusions: This study showed the positive effects of robot arm reach training on upper extremity functional movement in chronic stroke survivors. In particular, we confirmed that robot arm reach training could have a positive influence by leading to improvement of motor recovery of the proximal upper extremity.

• Journal of the Korean Society of Physical Medicine
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• v.17 no.4
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• pp.93-101
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• 2022

PURPOSE: This study sought to investigate the effects of treadmill gait training combined with a thoracic mobility exercise on gait and balance in patients with stroke. METHODS: In this single-blinded, randomized, controlled, comparative study, a total of 20 patients at a rehabilitation hospital who had suffered a hemiplegic stroke were randomly assigned to the experimental group (treadmill gait training combined with a thoracic mobility exercise, n = 11) or control group (treadmill gait training without the thoracic mobility exercise, n = 9). All the participants underwent comprehensive rehabilitation therapy (5 × /week for 4 weeks). Additionally, the experimental group underwent 20 min of treadmill gait training combined with 10 min of a thoracic mobility exercise (3 × / week for 4 weeks) and the control group underwent the former but not the latter. Gait and balance were measured before and after the 4-week training. RESULTS: Significant improvements were observed in the 10-m walking test (10 MWT), timed up-and-go (TUG) test, center of pressure (COP) velocity, and COP length in the experimental group (p < .05). This group also showed a larger decrease in the 10 MWT and COP velocity than the control group (10 MWT, -3.02 sec vs. -1.68 sec, p < .05; COP velocity, -.07 mm/sec vs. .08 mm/sec, p < .05). CONCLUSION: Treadmill gait training, combined with the thoracic mobility exercise, could be effective in improving the gait and balance of stroke patients. It could also be more effective in improving walking speed and static balance than the treadmill gait training alone.

• Physical Therapy Rehabilitation Science
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• v.12 no.1
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• pp.62-71
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• 2023

Objective: Stroke patients need the training to adjust their posture and maintain balance is necessary to restore movement function, and unstable support training is one of the appropriate training. In this study, a systematic review and meta-analysis were conducted to find out the effects of unstable surface training on balance and gait in stroke patients. Design: Systematic review and meta-analysis Methods: After creating a search expression referring to MeSH and EMTREE, the literature from 1976 to February 2022 was searched in the databases of PubMed, EMBASE, and Cochrane Library CENTRAL. A total of 331 studies were searched from three databases, and 11 studies were finally selected according to the inclusion criteria. Unstable surface training included studies using balance trainer, Whole-body vibration, and sand surfaces. Results: The results were found to be d=2.28 (p=0.02) and the effect size was 0.36 (95% CI: 0.05, 0.67) on the Berg Balance Scale. In the Kinesthetic Ability Trainer static balance, d=2.59 (p=0.01) and the effect size was 1.01 (95% CI: 0.24, 1.78). Timed Up and Go test showed that d=2.18 (p=0.03) and the effect size was 0.38 (95% CI: 0.04, 0.72). At the gait speed, d=0.99 (p=0.32) and the effect size was 0.15 (95% CI: -0.15, 0.45). In the 6-minute walk test, d=0.14 (p=0.89) and the effect size was 0.04 (95% CI: -0.47, 0.55). Conclusions: In this study was found that training was effective in balance if it became unstable in standing posture. Therefore, unstable surface training can be used to improve the balance of stroke patients in clinical practice.

• Physical Therapy Korea
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• v.22 no.3
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• pp.91-97
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• 2015

This study was conducted to investigate the effects of the removable ankle-foot orthosis (RAFO) which was developed to improve the gait of stroke patients. The subjects of this study were five stroke patients who agreed to participate in this study by signing a written consent form. To verify gait improvement after wearing the orthosis, a Timed Up and Go test and Functional Gait Assessment were performed, and spatiotemporal gait variables such as gait speed, cadence, stride length, double limb support, and the efficient gait test of body sway angle were performed. For every variable, the differences prior to and after wearing the RAFO were compared using the Wilcoxon signed-rank test. Every gait variable improved significantly after wearing the RAFO compared to prior to wearing it. The pilot study will enhance future efforts to evaluate orthotic function objectively during gait in stroke patients.