DOI QR코드

DOI QR Code

Effects of Trunk Stability Exercise by using PNF on Trunk Control Ability and Balance, Gait in a Patient with Hemiplegia: A Single Case Study

PNF를 이용한 체간안정화운동이 뇌졸중 환자의 체간조절능력과 균형, 보행에 미치는 영향: 단일사례연구

  • Jung, Du-Kyo (Department of Physical Therapy, Soon Chun Hyang University Seoul Hospital)
  • 정두교 (순천향대학교 서울병원 물리치료실)
  • Received : 2015.11.30
  • Accepted : 2015.12.07
  • Published : 2015.12.30

Abstract

Purpose: Deficits in lower-extremity function and trunk control ability have a negative impact on individuals with hemiplegia. This case report aimed to describe the effect of trunk stability exercises using proprioceptive neuromuscular facilitation (PNF) on trunk control ability, balance, and gait in a patient with hemiplegia. Methods: A 77-year-old man with hemiplegia and trunk and lower extremity impairment participated in this four-week training intervention. Results: The patient demonstrated improvements in trunk control ability, balance, and gait performance. Outcome measures (Fugl-Meyer Assessment Lower Extremity (FMA-LE), Trunk Control Test, Berg Balance Scale, Timed Up and Go test, 10 Meter Walk test) were measured before and after the training program. Conclusion: The results of this case suggest that a trunk stability exercise using a PNF program may improve trunk control ability, balance, and gait in a patient with hemiplegia.

Keywords

References

  1. Adler S, Beckers D, Buck M. PNF in Practice: An Illustrated Guide, 3rd ed. Heidelberg. Springer. 2008.
  2. Agarwal V, Kumar M, Kumar, MR, et al. Effect of number of repetitions of weight bearing exercises on time-distance parameters in stroke. Indian Journal Physiotherapy. Occupational. Therapy. 2008;2(1): 57-63.
  3. Anderson M, Lough S. A psychological framework for neurorehabilitation. Physiotherapy Practice. 1986; 2(2):74-82. https://doi.org/10.3109/09593988609022421
  4. Aruin AS, Latash ML. Directional specificity of postural muscles in feedforward postural reactions during fast voluntary arm movements. Experimental Brain Research. 1995;103(2):323-332.
  5. Bobath B. Adult hemiplegia: evaluation and treatment, 2nd ed. London. Butterworth-Heinemann. 1990.
  6. Bohannon RW. Lateral trunk flexion strength: impairment, measurement reliability and implications following unilateral brain lesion. International Journal Rehabilitation Research. 1992;15(3):249-251. https://doi.org/10.1097/00004356-199209000-00010
  7. Bohannon RW, Andrews AW, Thomas MW. Walking speed: reference values and correlates for older adults. Journal Orthopaedic Sports Physical Therapy. 1996;24(2):86-90. https://doi.org/10.2519/jospt.1996.24.2.86
  8. Brunnstrom S. Movement therapy in hemiplegia. London. Harper and Row. 1970.
  9. Carr JH, Shepherd RB. Neurological rehabilitation. Optimising motor performance. Oxford. Butterworth- Heinemann. 1998.
  10. Cirstea MC, Levin MF. Compensatory strategies for reaching in stroke. Brain. 2000;123(5):940-953. https://doi.org/10.1093/brain/123.5.940
  11. Collin C, Wade D. Assessing motor impairment after stroke: a pilot reliability study. Journal Neurology Neurosurgery Psychiatry. 1990;53(7):576-79. https://doi.org/10.1136/jnnp.53.7.576
  12. Cowan SM, Bennell KL, Hodges PW, et al. Simultaneous feedforward recruitment of the vasti in un-trained postural tasks can be restored by physical therapy. Journal of Orthopaedic Research. 2003;21(3):553-558 https://doi.org/10.1016/S0736-0266(02)00191-2
  13. Davis PM. Problems associated with the loss of selective trunk activity in hemiplegia: In: Right in the Middle. Selective trunk activity in the treatment of adult hemiplegia. Heidelberg. Springer. 1990.
  14. Dickstein R, Sheffi S, Ben Haim Z, et al. Activation of flexor and extensor trunk muscles in hemiparesis. American Physical Medicine Rehabilitation. 2000;79(3):228-234. https://doi.org/10.1097/00002060-200005000-00003
  15. Dickstein R, Shefi S, Marcovitz E, et al. Anticipatory postural adjustment in selected trunk muscles in post stroke hem- iparetic patients. Archives Physical Medicine Rehabilitation. 2004;85(2):261-267 https://doi.org/10.1016/j.apmr.2003.05.011
  16. Dildip K, Singaravelan RM. Subhash MK. Effectiveness of pelvic proprioceptive neuromuscular facilitation technique on facilitation of trunk movement in hemiparetic stroke patients. IOSR Journal of Dental and Medical Sciences. 2013;3(6):29-37. https://doi.org/10.9790/0853-0362937
  17. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Physical Therapy. 1983; 63(10):1606-1610. https://doi.org/10.1093/ptj/63.10.1606
  18. Edwards S. Analysis of normal movement as the basis for the development of treatment techniques. In: Neurological physiotherapy. A problem solving approach. Churchill Livingstone. 1996.
  19. Fugl-Meyer AR, Jaasko L, Leyman I, et al. The post-stroke hemiplegic patient. Scandinavian Journal Rehabilitation Medicine. 1975;7(1):13-31.
  20. Goff B. Appropriate afferent stimulation. Physiotherapy. 1969;55(1):9-17.
  21. Helene C, Rejean H, Michel R, et al. Evaluation of postural stability in the elderly with stroke. Archives Physical Medicine Rehabilitation. 2004;85(7):1095-1101. https://doi.org/10.1016/j.apmr.2003.09.023
  22. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine. 1996;21(22):2640-2650. https://doi.org/10.1097/00007632-199611150-00014
  23. Karthikbabu S, Rao BK, Manikandan N, et al. Role of trunk rehabilitation on trunk Control, balance and gait in patients with chronic stroke: a pre-post design. Neuroscience & Medicine. 2011;2(2):61-67. https://doi.org/10.4236/nm.2011.22009
  24. Kumar1 S, Kumar A, Kaur J. Effect of PNF technique on gait parameters and functional mobility in hemiparetic patients. Journal of Exercise Science and Physiotherapy. 2012;8(2):67-73.
  25. McGill SM. Low back stability: from formal description to issues for performance and rehabilitation. Exercise and Sport Sciences Reviews. 2001;29(1):26. https://doi.org/10.1097/00003677-200101000-00006
  26. McGill SM, Grenier SG, Kavcic N, et al. Coordination of muscle activity to assure stability of the lumbar spine. Electromyographykinesiology. 2003;13(4):353-359.
  27. Messier S, Bourbonnais D, Desrosiers J, et al. Dynamic analysis of trunk flexion after stroke. Archives of Physical Medicine and Rehabilitation. 2004;85(10):1619-24. https://doi.org/10.1016/j.apmr.2003.12.043
  28. Podsiadle D, Richardson S. The timed "up & go" : a test of basic functional mobility for frail elderly persons. Journal American Geriatrics Society. 1991;39(2):142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  29. Ryerson S, Byl NN, Brown DA, et al. Altered trunk position sense and its relation to balance functions in people post-stroke. Journal Neurologic Physical Therapy. 2008;32(1):14-20. https://doi.org/10.1097/NPT.0b013e3181660f0c
  30. Shanmugananth1 E, Nagendran T, Dipika I, et al. A comparative study between the upper trunk and lower trunk proprioceptive neuromuscular facilitation techniques on improving postural control in hemiplegic patients. International Peer Reviewed Refereed Journal. 2015;2(8):51-64.
  31. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: six-minute walk test, Berg balance scale, timed up & go test, and gait speeds. Physical Therapy. 2002;82(2):128-137. https://doi.org/10.1093/ptj/82.2.128
  32. Stroke. Assessment of the burden of Non-communicable diseases: Final project report, New Delhi. Indian Council of Medical Research. 2004;18-22.
  33. Sullivan SBO, Schmitz TJ. Physical rehabilitation, 5th ed. New Delhi. Jaypee Brothers Publication. 2007.
  34. Tanaka S, Hachisuka K, Ogata H. Trunk rotatory muscle performance in post-stroke hemiplegic patients. American Journal Physical Medicine Rehabilitation. 1997;76(5):366-369. https://doi.org/10.1097/00002060-199709000-00003
  35. Tanaka S, Hachisuka K, Ogata H. Muscle strength of trunk flexion-extension in post-stroke hemiplegic patients. American Journal Physical Medicine Rehabilitation. 1998;77(4):288-290. https://doi.org/10.1097/00002060-199807000-00005
  36. Tyson S, De Souza L. Development of the brunel balance assessment: A new measure of balance disability poststroke. Clinical Rehabilitation. 2004;18(7):801-810. https://doi.org/10.1191/0269215504cr744oa
  37. 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):326-34. https://doi.org/10.1191/0269215504cr733oa
  38. Verheyden G, Vereeck L, Truijen S, et al. Trunk performance after stroke and the relationship with balance, gait and functional ability. Clinical Rehabilitation. 2006;20(5):451-458. https://doi.org/10.1191/0269215505cr955oa
  39. Verheyden G, Vereeck L, Truijen S. Additional exercises improve trunk performance after stroke: A pilot randomized controlled trial. Neurorehabilitation Neural Repair. 2009;23(3):281-6. https://doi.org/10.1177/1545968308321776
  40. Wade DT, Wood VA, Heller A, et al. Walking after stroke: measurement and recovery over the first 3 months. Scandinavian Journal Rehabilitation Medicine. 1987;19(1):25-30.
  41. Whitney SL, Poole JL, Cass SP. A review of balance instruments for older adults. American Journal Occupational Therapy. 1998;52:666-671. https://doi.org/10.5014/ajot.52.8.666
  42. Yonghun K, Eunjung K, Wontae G. The effects of trunk stability exercise using PNF on the functional reach test and muscle activities of stroke patients. Journal Physical Therapy Science. 2011;23(5):699-702. https://doi.org/10.1589/jpts.23.699