DOI QR코드

DOI QR Code

The Effects of PNF and Trunk Stabilization Robot Training on Trunk Stability and Balance in Patients with Chronic Stroke

PNF 목 패턴을 병행한 체간안정로봇훈련이 만성 뇌졸중 환자의 체간 안정성 및 균형능력에 미치는 영향

  • Moon, Hyun-Min (Department of Physical Therapy, Bundang Jesaeng Hospital) ;
  • Kim, Dong-Hoon (Department of Physical Therapy, Gimcheon University)
  • 문현민 (분당제생병원 물리치료실) ;
  • 김동훈 (김천대학교 물리치료학과)
  • Received : 2020.12.04
  • Accepted : 2021.02.01
  • Published : 2021.04.30

Abstract

Purpose: The purpose of the study was to identify the effects of proprioceptive neuromuscular facilitation (PNF) training and robot rehabilitation training on trunk stability and standing balance in individuals with chronic stroke. Methods: There were 30 patients with chronic stroke, divided into two groups: 15 subjects who received PNF and robot training (the experimental group) and 15 subjects who received standard conservative training (the control group), that participated. The experimental group received treatment for 60 min: 30 min of conventional physical therapy, 15 min of PNF training, and 15 min of robot training. The control group received conventional physical therapy for 60 min. Trunk stabilization (trunk impairment scale) and standing balance (center of pressure, limit of stability, modified functional reach test, and Berg balance scale) were measured before and after intervention. Results: Within each group, both the experimental and control groups significantly improved after the intervention in all tests; however, the experimental group showed greater improvement in scores on the trunk impairment scale, the center of pressure, the limit of stability, the modified functional reach test, and the Berg balance scale. Conclusion: The study verified that PNF training and robot training had a positive influence on trunk stability and standing balance indices in patients with chronic stroke.

Keywords

References

  1. Adler SS, Beckers D, Buck M. PNF in practice an illustrated guide, 4th ed. Heidelberg. Spinger. 2016.
  2. An SH, Kim DH, Jang YM. The test-retest reliability and criterion-related validity of a trunk stability robot when measuring static sitting and standing symmetry in stroke patients. PNF and Movement. 2018;16(3):405-14.
  3. Bang DH, Shin WS, Kim SY, et al. The effects of action observational training on walking ability in chronic stroke patients: a double-blind randomized controlled trial. Clinical Rehabilitation. 2013;27(12):1118-1125. https://doi.org/10.1177/0269215513501528
  4. Bank J, Charles K, Morgan, P. What is the effect of additional physiotherapy on sitting balance following stroke compared to standard physiotherapy treatment: a systematic review. Topics in stroke rehabilitation. 2016;23(1): 15-25. https://doi.org/10.1179/1945511915y.0000000005
  5. Baratto L, Morasso PG, Re C, et al. A new look at posturographic analysis in the clinical context Sway-density versus other parameterization techniques. Motor Control. 2002;6(3):246-270 https://doi.org/10.1123/mcj.6.3.246
  6. Berg KO, Wood-Dauphinee SL, Williams JI, et al. Measuring balance in the elderly: validation of an instrument. Canadian journal of public health. 1992; 83(Suppl 2): S7-S11.
  7. Black K, Zafonte R, Millis S, et al. Sitting balance following brain injury: does it predict outcome. Brain Injury. 2000;14(2):141-152. https://doi.org/10.1080/026990500120808
  8. Butler DP, Willett K. Wii-habilitation: is there a role in trauma? Injury. 2010;41(9):883-885. https://doi.org/10.1016/j.injury.2010.03.024
  9. Cabanas-Valdes R, Bagur-Calafat C, Girabent-Farres M, et al. The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: a randomized controlled trial. Clinical rehabilitation. 2016;30(10):1024-1033. https://doi.org/10.1177/0269215515609414
  10. Chu KS, Eng JJ, Dawson AS, et al. Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. Archives of physical medicine and rehabilitation. 2004;85:870-874. https://doi.org/10.1016/j.apmr.2003.11.001
  11. Dean CM, Channon EF, Hall JM. Sitting training early after stroke improves sitting ability and quality and carries over to standing up but not to walking: a randomised controlled trial. Australian Journal of Physiotherapy, 2007;53(2):97-102. https://doi.org/10.1016/S0004-9514(07)70042-9
  12. Dickstein R, Shefi S, Marcovitz E, et al. Anticipatory postural adjustment in selected trunk muscles in poststroke hemiparetic patients. Archives of physical medicine and rehabilitation. 2004a;85(2):261-267. https://doi.org/10.1016/j.apmr.2003.05.011
  13. Dickstein R, Shefi S, Marcovitz E, et al. Electromyographic activity of voluntarily activated trunk flexor and extensor muscles in post-stroke hemiparetic subjects. Clinical neurophysiology. 2004b;115(4):790-796. https://doi.org/10.1016/j.clinph.2003.11.018
  14. Esquenazi A, Packel A. Robotic-assisted gait training and restoration. American journal of physical medicine & rehabilitation. 2012;91(11):S217-S231. https://doi.org/10.1097/phm.0b013e31826bce18
  15. Fraizer E, Mitra S. Methodological and interpretive issues in posture-cognition dual-tasking in upright stance. Gait & P osture. 2008;27(2):271-279. https://doi.org/10.1016/j.gaitpost.2007.04.002
  16. Gil-Gomez JA, Llorens R, Alcaniz M, et al. Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. Journal of neuroengineering and rehabilitation. 2011;8(1):1-10. https://doi.org/10.1186/1743-0003-8-1
  17. Jack D, Boian R, Merians AS, et al. Virtual reality-enhanced stroke rehabilitation. IEEE transactions on neural systems and rehabilitation engineering. 2001;9(3):308-318. https://doi.org/10.1109/7333.948460
  18. Jung K, Kim Y, Chung Y, et al. Weight-shift training improves trunk control, proprioception, and balance in patients with chronic hemiparetic stroke. The Tohoku journal of experimental medicine. 2014;232(3):195-199. https://doi.org/10.1620/tjem.232.195
  19. Katz-Leurer M, Fisher I, Neeb M, et al. Reliability and validity of the modified functional reach test at the sub-acute stage post-stroke. Disability and rehabilitation. 2009;31(3):243-248. https://doi.org/10.1080/09638280801927830
  20. Kim BS, Bang DH, Shin WS. Effects of pressure sense perception training on unstable surface on somatosensory, balance and gait function in patients with stroke. Journal of Korean Society Physical Medicine. 2015;10(3):237-245.
  21. Kim WJ. The effects of core stabilization exercise based on virtual reality on upper extremity function, postural control and depression in stroke patients. Sahmyook University. Dissertation of Master's Degree. 2017.
  22. Kim Yk. Development of robot system focusing postural control and balance reaction for stroke patients and clinical feasibility. Yeungnam University. Dissertation of Doctorate Degree. 2014.
  23. Latash ML, Ferreira SS, Wieczorek SA, et al. Movement sway: changes in postural sway during voluntary shifts of the center of pressure. Experimental brain research. 2003;150(3):314-324. https://doi.org/10.1007/s00221-003-1419-3
  24. Lee BH, Kim SY, Lee JS. The effects of core stability on postural control, balance and upper motor function in patients with stroke. Journal of Korean Medicine Rehabilitation. 2009;19(3):69-80.
  25. Lee HJ, Lee KE, Yi TI, et al. Feedback facility- assisted balance training in a patient with multiple system atrophy: a case presentation. physical medicine and rehabilitation physician. 2018;10(5):555-559.
  26. Lee JH. The effects of core stability strengthening exercise for trunk control and spine allignment in patients with stroke. Yongin University. Dissertation of Master's Degree. 2015.
  27. Morishita M, Amimoto K, Matsuda T, et al. Analysis of dynamic sitting balance on the independence of gait in hemiparetic patients. Gait & Posture. 2009;29(4):530-534. https://doi.org/10.1016/j.gaitpost.2008.12.005
  28. Oh KB. The effects of core stability training on postural control and activity of daily living of stroke patients. Dankook University. Dissertation of Master's Degree. 2005.
  29. Park SE, Lim WT, Moon SH. The effects of a neck exercise using a PNF neck pattern on the balance and numbness of both the upper extremities and neck motions in patients with cervical myelopathy - single subject design-. PNF and Movement. 2018;16(3):333-343.
  30. Park SE, Min KO, Lee SB, et al. Effect of eye movements and proprioceptive neuromuscular facilitation on balance and head alignment in stroke patients with neglect syndrome. Journal of Physical Therapy Science. 2016;28(2): 596-601. https://doi.org/10.1589/jpts.28.596
  31. Park YS. The effects of a robot-assisted game training focusing on the trunk stabilization on balance, gait and rehabilitation participation for acute stroke patient. Sahmyook University. Dissertation of Master's Degree. 2015.
  32. Shepherd RB. Exercise and training to optimize functional motor performance in stroke: driving neural reorganization? Neural plasticity. 2001;8(1-2):121-129. https://doi.org/10.1155/NP.2001.121
  33. Shin KH. A study on the three-dimensional rehabilitation robot system for upper extremities. Ulsan University. Dissertation of Doctorate Degree.
  34. Thieme H, Ritschel C, Zange C. Reliability and validity of the functional gait assessment (German version) in subacute stroke patients. Archives of Physical Medicine and rehabilitation. 2009;90(9):1565-1570. https://doi.org/10.1016/j.apmr.2009.03.007
  35. Thompson M, Medley A. Forward and lateral sitting functional reach in younger, middle aged, and older adults. Journal of Geriatric Physical Therapy. 2007;30(2):43-48. https://doi.org/10.1519/00139143-200708000-00002
  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. Clinical Rehabilitation. 2004;18(3):326-334. https://doi.org/10.1191/0269215504cr733oa
  37. Verheyden G, Vereeck L, Truijen S, et al. Additional exercises improve trunk performance after stroke: a pilot randomized controlled trial. Neurorehabilitation and neuralrepair. 2009;23(3):281-286. https://doi.org/10.1177/1545968308321776
  38. Yoo WG. Effect of wearing tight pants on the trunk flexion and pelvic tilting angles in the stand-to-sit movement and a seated posture. Journal of Physical Therapy Science. 2016;28(1):93-95. https://doi.org/10.1589/jpts.28.93