Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

The Effects of Water-based Gait Training Using Auditory Stimulation on Balance and Gait Abilities in Stroke Patients

  • Jaeho Park (Rehabilitation Center, Chungnam National University Hospital)
  • Received : 2025.03.22
  • Accepted : 2025.04.06
  • Published : 2025.04.20
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Balance disorder is a prevalent clinical manifestation following stroke, often causing considerable discomfort and gait disability. Various water-based therapeutic approaches have been developed to address balance and gait disorder. Objects: The purpose of this study was to investigate the effects of water-based gait training using auditory stimulation on balance and gait abilities in stroke patients. Methods: All subjects were randomly divided into three groups: water-based gait training using auditory stimulation group (WAG) (n = 24), water-based gait training group (WG) (n = 24), and control group (n = 22). Subjects in WAG and WG underwent water-based gait training for 30 minutes, 3 times a week for 6 weeks. All Subjects were assessed for muscle strength, balance, gait, motor function, and activity of daily living pre- and post-intervention. Results: Results showed that all outcome measures significantly improved post-intervention (p < 0.05). Additionally, WAG was found to significantly improve in Medical Research Council (MRC), Berg Balance Scale (BBS), and Timed Up and Go (TUG) test compared to WG, and WG showed significant differences compared to the control group in MRC and Fugl-Meyer Assessment (FMA) (p < 0.05). WAG exhibited significant differences in all areas except Modified Bathel Index (MBI) in the between-group comparison with the control group (p < 0.05). Conclusion: These results suggest that water-based gait training using auditory stimulation may be effective strategy to improve muscle strength, balance and gait ability for with stroke.

Keywords

Acknowledgement

We would like to thank the researchers who were involved in elements of evaluation or training session in Chungnam National University Hospital. We are also grateful to colleague and the participants for their time and efforts with this research.

References

  1. Doria JW, Forgacs PB. Incidence, implications, and management of seizures following ischemic and hemorrhagic stroke. Curr Neurol Neurosci Rep 2019;19(7):37. https://doi.org/10.1007/s11910-019-0957-4
  2. Kim E, Min K, Song C. The effects of balance training with functional electrical stimulation on balance and gait in patients with chronic stroke. Phys Ther Rehabil Sci 2021;10(1):55-63. https://doi.org/10.14474/ptrs.2021.10.1.55
  3. No SM, Hwang YT, Son SM. The effect of postural balance and fall efficacy on bilateral visual feedback training with visual targets in stroke patients. J Korean Phys Ther 2022;34(2):57-62. https://doi.org/10.18857/jkpt.2022.34.2.57
  4. Bergamin M, Gobbo S, Zanotto T, Sieverdes JC, Alberton CL, Zaccaria M, et al. Influence of age on postural sway during different dual-task conditions. Front Aging Neurosci 2014;6:271. https://doi.org/10.3389/fnagi.2014.00271
  5. Punt M, Bruijn SM, Wittink H, van de Port IG, Wubbels G, van Dieën JH. Virtual obstacle crossing: reliability and differences in stroke survivors who prospectively experienced falls or no falls. Gait Posture 2017;58:533-8. https://doi.org/10.1016/j.gaitpost.2017.09.013
  6. Park J, Kim T. Effects of walking training according to rhythmic auditory stimulation speed control balance of stroke patients. J Korean Phys Ther 2023;35(6):213-9. https://doi.org/10.18857/jkpt.2023.35.6.213
  7. Thaut MH, Leins AK, Rice RR, Argstatter H, Kenyon GP, McIntosh GC, et al. Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial. Neurorehabil Neural Repair 2007;21(5):455-9. https://doi.org/10.1177/1545968307300523
  8. Choi KS, Kwon IH, Shin WS. Comparison of effects on static balance in stroke patients according to visual biofeedback methods. Phys Ther Rehabil Sci 2023;12(3):320-6. https://doi.org/10.14474/ptrs.2023.12.3.320
  9. Kim SJ, Kwak EE, Park ES, Cho SR. Differential effects of rhythmic auditory stimulation and neurodevelopmental treatment/Bobath on gait patterns in adults with cerebral palsy: a randomized controlled trial. Clin Rehabil 2012;26(10):904-14. https://doi.org/10.1177/0269215511434648
  10. Thaut MH. Rhythm, music, and the brain: scientific foundations and clinical applications. Routledge; 2008.
  11. Thaut MH. Neural basis of rhythmic timing networks in the human brain. Ann N Y Acad Sci 2003;999(1):364-73. https://doi.org/10.1196/annals.1284.044
  12. Thaut MH, McIntosh GC, Rice RR. Rhythmic facilitation of gait training in hemiparetic stroke rehabilitation. J Neurol Sci 1997;151(2):207-12. https://doi.org/10.1016/S0022-510X(97)00146-9
  13. Schauer M, Mauritz KH. Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement. Clin Rehabil 2003;17(7):713-22. https://doi.org/10.1191/0269215503cr668oa
  14. Cha Y, Kim Y, Hwang S, Chung Y. Intensive gait training with rhythmic auditory stimulation in individuals with chronic hemiparetic stroke: a pilot randomized controlled study. NeuroRehabilitation 2014;35(4):681-8. https://doi.org/10.3233/NRE-141182
  15. Lee S, Lee K, Song C. Gait training with bilateral rhythmic auditory stimulation in stroke patients: a randomized controlled trial. Brain Sci 2018;8(9):164. https://doi.org/10.3390/brainsci8090164
  16. Lee DK, Hwang TY. Effects of aquatic proprioceptive neuromuscular facilitation pattern exercise on balance, gait ability and depression in patients with chronic stroke. J Korean Phys Ther 2019;31(4):236-41. https://doi.org/10.18857/jkpt.2019.31.4.236
  17. Matsumoto S, Uema T, Ikeda K, Miyara K, Nishi T, Noma T, et al. Effect of underwater exercise on lower-extremity function and quality of life in post-stroke patients: a pilot controlled clinical trial. J Altern Complement Med 2016;22(8):635-41. https://doi.org/10.1089/acm.2015.0387
  18. Park J, Chung Y. The effects of an additional weight aquatic exercise program on balance and lower extremity strength in persons with stroke: randomized controlled study. Phys Ther Rehabil Sci 2018;7(1):6-12. https://doi.org/10.14474/ptrs.2018.7.1.6
  19. Melzer I, Elbar O, Tsedek I, Oddsson LIe. A water-based training program that include perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross-over trial. BMC Geriatr 2008;8:19. https://doi.org/10.1186/1471-2318-8-19
  20. Park JH, Chung YJ. Comparison of aquatic treadmill and anti-gravity treadmill gait training to improve balance and gait abilities in stroke patients. J Korean Phys Ther 2018;30(2):67-72. https://doi.org/10.18857/jkpt.2018.30.2.67
  21. Park RJ, Kim SS, Kim YG, Park DM, Hanm DW. The effects of aqua-exercise on the balance of one leg stance in the elderly women. J Korean Phys Ther 2002;14(1):89-98.
  22. Jung T, Lee D, Charalambous C, Vrongistinos K. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke. Arch Phys Med Rehabil 2010;91(1):129-36. https://doi.org/10.1016/j.apmr.2009.09.012
  23. Park J. Comparison of robot-assisted gait training using auditory stimulation versus overground gait training for stroke patients. Phys Ther Rehabil Sci 2024;13(4):562-70. https://doi.org/10.14474/ptrs.2024.13.4.562
  24. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing 2006;35 Suppl 2:ii7-11. https://doi.org/10.1093/ageing/afl077
  25. Geiger RA, Allen JB, O'Keefe J, Hicks RR. Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Phys Ther 2001;81(4):995-1005. https://doi.org/10.1093/ptj/81.4.995
  26. Barela AM, Stolf SF, Duarte M. Biomechanical characteristics of adults walking in shallow water and on land. J Electromyogr Kinesiol 2006;16(3):250-6. https://doi.org/10.1016/j.jelekin.2005.06.013
  27. Masumoto K, Shono T, Hotta N, Fujishima K. Muscle activation, cardiorespiratory response, and rating of perceived exertion in older subjects while walking in water and on dry land. J Electromyogr Kinesiol 2008;18(4):581-90. https://doi.org/10.1016/j.jelekin.2006.12.009
  28. Park JH, Chung Y. A comparison of underwater gait training with additional weight application and over-ground gait training to improve balance and lower extremity strength in persons with stroke. J Korean Phys Ther 2017;29(2):101-7. https://doi.org/10.18857/jkpt.2017.29.2.101
  29. Thaut MH, Kenyon GP, Hurt CP, McIntosh GC, Hoemberg V. Kinematic optimization of spatiotemporal patterns in paretic arm training with stroke patients. Neuropsychologia 2002;40(7):1073-81. https://doi.org/10.1016/S0028-3932(01)00141-5
  30. Roerdink M, Lamoth CJ, Kwakkel G, van Wieringen PC, Beek PJ. Gait coordination after stroke: benefits of acoustically paced treadmill walking. Phys Ther 2007;87(8):1009-22. https://doi.org/10.2522/ptj.20050394
  31. Arias P, Cudeiro J. Effects of rhythmic sensory stimulation (auditory, visual) on gait in Parkinson's disease patients. Exp Brain Res 2008;186(4):589-601. https://doi.org/10.1007/s00221-007-1263-y
  32. Brincks J, Nielsen JF. Increased power generation in impaired lower extremities correlated with changes in walking speeds in sub-acute stroke patients. Clin Biomech (Bristol) 2012;27(2):138-44. https://doi.org/10.1016/j.clinbiomech.2011.08.007
  33. Shin YK, Chong HJ, Kim SJ, Cho SR. Effect of rhythmic auditory stimulation on hemiplegic gait patterns. Yonsei Med J 2015;56(6):1703-13. https://doi.org/10.3349/ymj.2015.56.6.1703