DOI QR코드

DOI QR Code

Effects of Proprioceptive Neuromuscular Facilitation Program Combined with Dynamic Neuromuscular Stabilization Approach on Balance in Patient with Cerebellum Atrophy -Case Report-

동적 신경근 안정화 접근법과 결합한 PNF 중재 프로그램이 소뇌 위축 환자의 균형에 미치는 영향 -사례보고-

  • Na, Eun-Jin (Department of Physical Therapy, Dream Hospital) ;
  • Moon, Sang-Hyun (Department of Physical Therapy, Dream Hospital) ;
  • Kim, Eun-Kyung (Department of Physical Therapy, Dream Hospital) ;
  • Park, Du-Jin (Department of Physical Therapy, College of Health Sciences, Kaya University)
  • Received : 2016.11.14
  • Accepted : 2016.11.22
  • Published : 2016.12.31

Abstract

Purpose: This case report examines the influence of proprioceptive neuromuscular facilitation (PNF) combined with a dynamic neuromuscular stabilization approach on balance in patients with cerebellar atrophy. Methods: The target subject of this case report was a 34-year-old woman who was informed of the purpose of this research and voluntarily agreed to participate in it. The case report conformed to research ethics based on the Helsinki Declaration. The target subject was confirmed to have cerebellar atrophy from an unknown cause in 2009 and was diagnosed with slight ataxia. At that time, she could carry out daily activities without physical therapy. On May 19, 2015, she suffered both a subdural hemorrhage (SDH) and subarachnoid hemorrhage (SAH) in a traffic accident. She was urgently moved to the emergency room and managed by nonsurgical treatment, and then, the cerebellar atrophy and ataxia gradually deteriorated. To evaluate the patient's balance capacity before and after intervention, the trunk impairment scale (TIS), trunk impairment scale (OLST) during eye-closing/opening, timed up and go test (TUG), and visual analogue scale (VAS) were conducted. The PNF intervention program was executed for 30 min, four times a week, for three weeks. Results: The TIS and OLST during eye-closing/opening were improved by as much as a point, by 8.15 s and 6.21 s, respectively, after applying the PNF program. TUG and VAS decreased by 1.33 s and 3 points, respectively, after intervention. According to the result, the OLST during eye-closing/opening and VAS improved remarkably in comparison with those before intervention. Conclusion: As the final result of the case report, PNF intervention combined with DNSA more effectively improved the static balance capacity, such as the OLST during eye-closing/opening and VAS, compared to the dynamic balance capacity. In addition, the intervention duration and period of the exercise program are recommended to be more than 1 h a day for four weeks considering the learning ability of a patient with cerebellar atrophy.

Keywords

References

  1. Boonstra AM, Preuper HRS, Reneman MF, et al. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International journal of rehabilitation research. 2008;31(2):165-169. https://doi.org/10.1097/MRR.0b013e3282fc0f93
  2. Fitts PM, Posner MI. Human performance. Oxford. Brooks/Cole. 1967.
  3. Fonteyn EM, Keus SH, Verstappen CC, et al. Physiotherapy in degenerative cerebellar ataxias: utilisation, patient satisfaction, and professional expertise. Cerebellum. 2013;12(6):841-847. https://doi.org/10.1007/s12311-013-0495-6
  4. Ilg W, Brotz D, Burkard S, et al. Long-term effects of coordinative training in degenerative cerebellar disease. Movement disorders. 2010;25(13):2239-2246. https://doi.org/10.1002/mds.23222
  5. Ilg W, Schatton C, Schicks J, et al. Video game-based coordinative training improves ataxia in children with degenerative ataxia. Neurology. 2012;79(20):2056-2260. https://doi.org/10.1212/WNL.0b013e3182749e67
  6. Ilg W, Timmann D. Gait ataxia-specific cerebellar influences and their rehabilitation. Movement disorders. 2013;28(11):1566-1575. https://doi.org/10.1002/mds.25558
  7. Kim JM, Gong MJ, Goo HM, et al. Neuroanatomy & neurophysiology, 5th ed. Seoul. Jungdam Media. 2015.
  8. Kristensen MT, Nielsen AO, Topp UM, et al. Number of test trials needed for performance stability and interrater reliability of the one leg stand test in patients with a major non-traumatic lower limb amputation. Gait posture. 2014;39(1):424-429. https://doi.org/10.1016/j.gaitpost.2013.08.017
  9. Miyai I, Ito M, Hattori N, et al. Cerebellar ataxia rehabilitation trial in degenerative cerebellar diseases. Neurorehabilitation and neural repair. 2012;26 (5):515-522. https://doi.org/10.1177/1545968311425918
  10. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. Journal of the American geriatrics society. 1991;39(2):142-148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  11. Richardson C, Hodges P, Hides J. Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain, 2nd ed. Edinburgh. Churchill-Livingstone. 2004.
  12. Schwabe A, Drepper J, Maschke M, et al. The role of the human cerebellum in short-and long-term habituation of postural responses. Gait posture. 2004;19(1):16-23. https://doi.org/10.1016/S0966-6362(03)00006-7
  13. Song YK, Park JH. Strategy and principle of rehabilitation for functional motor recovery in patients with cerebellar disease. Korean journal of adapted physical activity. 2015;23(4):101-126. https://doi.org/10.17006/kjapa.2015.23.4.101
  14. Van de Warrenburg BP, Steijns JA, Munneke M, et al. Falls in degenerative cerebellar ataxias. Movement disorders. 2005;20(4):497-500. https://doi.org/10.1002/mds.20375
  15. Vaz DV, de Carvalho Schettino R, de Castro TRR, et al. Treadmill training for ataxic patients: a single-subject experimental design. Clinical rehabilitation. 2008;22(3):234-241. https://doi.org/10.1177/0269215507081578
  16. 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
  17. Verheyden G, Nuyens G, Nieuwboer A, et al. Reliability and validity of trunk assessment for people with multiple sclerosis. Physical therapy. 2006;86(1):66-76. https://doi.org/10.1093/ptj/86.1.66
  18. Verheyden G, Willems AM, Ooms L, et al. Validity of the trunk impairment scale as a measure of trunk performance in people with parkinson's disease. Archives of physical medicine and rehabilitation. 2007;88(10):1304-1308. https://doi.org/10.1016/j.apmr.2007.06.772