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The Effects of Task-Related Circuit Exercise Program Combined with Sensorimotor Training on Balance and Walking in Persons with Stroke : A pilot study

감각운동 훈련을 병행한 순환식 과제 지향 운동프로그램이 뇌졸중 환자의 보행 및 균형에 미치는 영향 : 예비연구

  • Kim, Sunmin (Dept. of Physical Therapy, Korea National University of Transportation) ;
  • Kang, Soonhee (Dept. of Physical Therapy, Korea National University of Transportation)
  • 김선민 (한국교통대학교 물리치료학과) ;
  • 강순희 (한국교통대학교 물리치료학과)
  • Received : 2016.10.12
  • Accepted : 2016.12.12
  • Published : 2016.12.30

Abstract

Purpose: The purpose of this study was to identify whether task-related circuit exercise program combined with sensorimotor training for 4 weeks could improve the balance and gait in stroke patients. Method: Fifteen stroke patients who had agreed with the study were randomly divided into 3 groups categorized as task-related circuit exercise program combined with sensorimotor training group (experimental group 1, n=5), task-related circuit exercise program group (experimental group 2, n=5), and control subjects performed conventional physical therapy (control group, n=5). The balance and gait were assessed by BT-4 force platform system, Berg Balance Scale, 10meter Walk Test and Smart Step at before training and after training. Wilcoxon signed rank test was used to analyze change before and after intervention in intra-group. Kruskal Wallis H test, Mann-Whitney U test and Bonfferoni correction were used to analyze changes of all variables in inter-groups. Result: The experimental group 1 showed significant improvements in postural sway area, BBS scores, walking velocity and plantar pressures of affected foot, whereas the experimental group 2 showed significant improvements in BBS scores, and the control group were no significantly different in all variables following training. The changes of postural sway area and BBS scores in the experimental group 1 were significantly greater than them of the control group. The changes of postural sway area in the experimental group 1 was significantly greater than that of the experimental group 2. Conclusion: The result of this study suggest the task-related circuit exercise program combined with sensorimotor training is an effective intervention to improve balance and gait in stoke patients.

Keywords

References

  1. 김경태, 안재두, 김범영 등(2003). 뇌졸중의 최근 역학적 동향. 대한재활의학회지, 27(2), 178-185.
  2. 김영록, 박종욱, 이상헌 등(2005). 정신지체아동의 감각통합훈련과 중단이 대근육 운동능력 및 균형능력에 미치는 영향. 한국특수체육학회지, 13(4), 75-89.
  3. 김재욱, 김수민, 박래준(2003). 과제 지향적 기능 훈련이 뇌졸중 환자의 균형에 미치는 영향. 대한물리치료학회지, 15(4), 923-936.
  4. 박유형(2008). 발목 관절 고유수용성 운동조절프로그램이 뇌졸중 환자의 균형 및 보행에 미치는 효과. 삼육대학교 대학원, 미출판 석사학위 논문.
  5. 박재국, 류정숙, 강대옥(2006). 감각통합 훈련이 발달장애 유아의 운동기획 및 공간지각 능력에 미치는 효과. 특수아동교육연구, 8(1), 1-23.
  6. 박현식(2005). 집단순환식 과제지향훈련이 뇌졸중환자의 기능적 독립성과 삶의 질에 미치는 영향. 단국대학교 대학원, 석사학위 논문.
  7. 서흥원(2012). 만성 뇌졸중 환자의 지지면에 따른 체중이동 훈련이 하지 고유수용성 감각에 미치는 영향. 을지대학교 대학원, 석사학위 논문.
  8. 신은경(2007). 순환식 과제지향 운동프로그램이 뇌성마비 아동의 기능향상에 미치는 효과. 단국대학교 대학원, 석사학위 논문.
  9. 조규행, 이석민, 우영근(2004). 뇌졸중 환자에서 순환식 과제지향 프로그램이 기능증진에 미치는 효과. 한국전문물리치료학회지, 11(3), 59-70.
  10. 지상구, 김명권, 차현규(2013). The effect of dual motor task training on balance of subacute stroke patients. J Korean Soc Phys Med, 8(1), 1-9. https://doi.org/10.13066/kspm.2013.8.1.001
  11. 통계청(2013). 2013년 사망원인별 통계보고서. http://www.nso. go.kr
  12. 황병용(2002). 고유수용성 운동조절 프로그램이 만성 뇌졸중 환자의 균형과 보행에 미치는 효과. 계명대학교 보건대학원, 박사학위 논문.
  13. Beninato M, Portney LG, Sullivan PE(2009). Using the international classification of functioning, disability and health as a framework to examine the association between falls and clinical assessment tools in people with stroke. Phys Ther, 89(8), 816-825. https://doi.org/10.2522/ptj.20080160
  14. Borg FG, Laxaback G(2010). Entropy of balance-some recent results. J Neuroeng Rehabil, 7(1), 1. https://doi.org/10.1186/1743-0003-7-1
  15. Boyle M(2016). New functional training for sports. Human Kinetics, USA,
  16. Bruhn S, Kullmann N, Gollhofer A(2004). The effects of a sensorimotor training and a strength training on postural stabilisation, maximum isometric contraction and jump performance. Int J Sports Med, 25(1), 56-60. https://doi.org/10.1055/s-2003-45228
  17. Carr JH, Shepherd RB(2003). Stroke rehabilitation: guidelines for exercise and training to optimize motor skill. 1$^{st}$ ed, New York, Butterworth Heinemann Medical.
  18. Coote S, Stokes EK(2013). Physiotherapy for upper extremity dysfunction following stroke. Phys Ther Rev, 6(1), 63-69. https://doi.org/10.1179/108331901786161609
  19. Davies PM(1985). Steps to follow: a guide to the treatment of adult hemiplegia. based on the concept of K. and B. Bobath. New York, Springer-Verlag.
  20. Dean CM, Richards CL, Malouin F(2000). Task-related circuit training improves performance of locomotor task in chronic stroke: a randomized, controlled pilot study. Arch Phys Med Rehabil, 81(4), 409-417. https://doi.org/10.1053/mr.2000.3839
  21. Edwards S(2002). Neurological Physiotherapy: A problem-solving approach. 2$^{nd}$ed, New York, Churchill Livingstone.
  22. Geiger RA, Allen JB, O'Keefe J, et al(2001). Balance and mobility following stroke : effects of physical therapy interventions with and with out biofeedback force plate training. Phys Ther, 81(4), 995-1005.
  23. Granacher U, Gollhofer A, Strass A(2006). Training induced adaptations in characteristics of postural reflexes in elderly men. Gait & Posture, 24(4), 459-466. https://doi.org/10.1016/j.gaitpost.2005.12.007
  24. Heitkamp HC, Horstmann T, Mayer F, et al(2001). Gain in strength and muscular balance after balance training. Int J Sports Med, 22(4), 285-290. https://doi.org/10.1055/s-2001-13819
  25. Hiengkaew V, Jitaree K, Chaiyawat P(2012). Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Arch Phys Med Rehabil, 93(7), 1201-1208. https://doi.org/10.1016/j.apmr.2012.01.014
  26. Hocherman S, Dickstein R, Pillar T(1984). Platform training and postural stability in hemiplegia. Arch Phys Med Rehabil, 65(10), 588-592.
  27. Hoffman M, Payne VG(1995). The effects of proprioceptive ankle disk training on healthy subjects. J Orthop Sports Phys Ther, 21(2), 90-93. https://doi.org/10.2519/jospt.1995.21.2.90
  28. Horak FB, Diener HC(1994). Cerebellar control of postural scaling and central set in stance. J Neurophysiol, 72(2), 479-493. https://doi.org/10.1152/jn.1994.72.2.479
  29. Isakov E(2007). Gait rehabilitation: a new biofeedback device for monitoring and enhancing weight-bearing over the affected lower limb. Eura Medicophys, 43(1), 21-26.
  30. Laufer Y, Sivan D, Schwarzmann R, et al(2003). Standing balance and functional of patients with right and left hemiparesis in the early stages of rehabilitation. Neurorehabil Neural Repair, 17(4), 207-213. https://doi.org/10.1177/0888439003259169
  31. Lin SI(2005). Motor function and joint position sense in relation to gait performance in chronic stroke patients. Arch Phys Med Rehabil, 86(2), 197-203. https://doi.org/10.1016/j.apmr.2004.05.009
  32. Mudge S, Barber PA, Stott NS(2009). Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil, 90(12), 1989-1996. https://doi.org/10.1016/j.apmr.2009.07.015
  33. Perera S, Mody SH, Woodman RC, et al(2006). Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc, 54(5), 743-749. https://doi.org/10.1111/j.1532-5415.2006.00701.x
  34. Piirainen JM, Avela J, Sippola N, et al(2010). Age dependency of neuromuscular function and dynamic balance control. Eura J Sport Sci, 10(1), 69-79. https://doi.org/10.1080/17461390903100254
  35. Plummer-D'Amato P, Altmann LJ, Behrman AL, et al(2010). Interference between cognition, double-limb support, and swing during gait in community-dwelling individuals post stroke. Neurorehabil Neural Repair, 24(6), 542-549. https://doi.org/10.1177/1545968309357926
  36. Plummer-D'Amato P, Altmann LJ, Saracino D, et al(2008). Interactions between cognitive tasks and gait after stroke: A dual task study. Gait & Posture, 27(4), 683-688. https://doi.org/10.1016/j.gaitpost.2007.09.001
  37. Rothwell J, Lennon S(1994). Control of human voluntary movement. Physiother, 80(12), 869.
  38. Ryerson S, Byl NN, Brown DA, et al(2008). Altered trunk position sense and its relation to balance functions in people post-stroke. J Neurol Phys Ther, 32(1), 14-20. https://doi.org/10.1097/NPT.0b013e3181660f0c
  39. Shumsway-Cook A, Woollacott MH(2007). Motor control: translating research into clinical practice. Lippincott, Williams & Wilkins.
  40. Taube W, Gruber M, Beck S, et al(2007). Cortical and spinal adaptations induced by balance training: correlation between stance stability and corticospinal activation. Acta Physiol, 189 (4), 347-358. https://doi.org/10.1111/j.1748-1716.2007.01665.x
  41. Tilson JK, Sullivan KJ, Cen SY, et al(2010). Meaningful gait speed improvement during the first 60 days post stroke: Minimal clinically important difference. Phys Ther, 90(2), 196-208. https://doi.org/10.2522/ptj.20090079
  42. Verhahen E, Bobbert M, Inklaar M, et al(2005). The effect of a balance training program me on centre of pressure excursion in one-leg stance. Clin Biomech, 20(10), 1094-1100. https://doi.org/10.1016/j.clinbiomech.2005.07.001
  43. Winter DA(1995). Human balance and posture control during standing and walking. Gait & Posture, 3(4), 193-214. https://doi.org/10.1016/0966-6362(96)82849-9
  44. Wollacott M, Shumway-Cook A(2002). Attention and the control of posture and gait: a review of an emerging area of research. Gait & Posture, 16(1), 1-14.
  45. Wu G, Chiang JH(1996). The effects of surface compliance on foot pressure in stance. Gait & Posture, 4(2), 122-129. https://doi.org/10.1016/0966-6362(95)01041-6
  46. Yang YR, Wang RY, Chen YC, et al(2007). Dual-task exercise improves walking ability in subjects with chronic stroke. Arch Phys Med Rehabil, 88(10), 1236-1240. https://doi.org/10.1016/j.apmr.2007.06.762