Objective: The effect of abdominal expansion maneuver (AEM) and abdominal draw-in maneuver (ADIM) on postural control in an unsupported position in stroke patients. Design: Randomized controlled trial. Methods: A total of 36 persons with hemiplegic stroke participated in this study. The subjects wer...
Objective: The effect of abdominal expansion maneuver (AEM) and abdominal draw-in maneuver (ADIM) on postural control in an unsupported position in stroke patients. Design: Randomized controlled trial. Methods: A total of 36 persons with hemiplegic stroke participated in this study. The subjects were randomly divided into an AEM experimental group (n=12), an experimental ADIM group (n=12), and a control group (n=12). We collected the general characteristics of all subjects and the pre-test results before the intervention and after 4 weeks of the intervention. The trunk stabilization training of the ADIM and AEM group were performed 15 minutes a day, 3 times a week for 4 weeks, and general physical therapy was performed 2 times a day, 30 minutes per session, 5 times a week for all three groups. The control group received joint mobilizations, muscle strengthening, endurance strengthening, and gait exercises along with treatment of the central nervous system, such as neuro-developmental treatment, mat, and gait training. The AEM is an inspiratory phase of tidal breathing expanding the lateral lower ribcage in a lateral direction with minimal superior movements of the chest. Then the lower abdomen expands and the navel moves in an anterior-caudal direction. The ADIM is a repeated contraction and relaxation of the anal sphincter during inspiration. The navel pulls the lower abdomen to the direction of the spine without the movement of the trunk and pelvis. Results: Before and after the interventions, medial-lateral axis movement distance, anterior-posterior axis movement distance, sway mean velocity, and sway area 95% was a statistically significant change in all three groups (p<0.05). The post-hoc test showed a significant improvement in medial-lateral axis movement distance, anterior-posterior axis movement distance, sway mean velocity, and sway area in the AEM group compared with the control group, and in the ADIM group compared with the control group (p<0.05). Conclusions: In conclusion, both AEM training and ADIM training are necessary interventions to maintain the independent sitting position according to the characteristics of the patient.
Objective: The effect of abdominal expansion maneuver (AEM) and abdominal draw-in maneuver (ADIM) on postural control in an unsupported position in stroke patients. Design: Randomized controlled trial. Methods: A total of 36 persons with hemiplegic stroke participated in this study. The subjects were randomly divided into an AEM experimental group (n=12), an experimental ADIM group (n=12), and a control group (n=12). We collected the general characteristics of all subjects and the pre-test results before the intervention and after 4 weeks of the intervention. The trunk stabilization training of the ADIM and AEM group were performed 15 minutes a day, 3 times a week for 4 weeks, and general physical therapy was performed 2 times a day, 30 minutes per session, 5 times a week for all three groups. The control group received joint mobilizations, muscle strengthening, endurance strengthening, and gait exercises along with treatment of the central nervous system, such as neuro-developmental treatment, mat, and gait training. The AEM is an inspiratory phase of tidal breathing expanding the lateral lower ribcage in a lateral direction with minimal superior movements of the chest. Then the lower abdomen expands and the navel moves in an anterior-caudal direction. The ADIM is a repeated contraction and relaxation of the anal sphincter during inspiration. The navel pulls the lower abdomen to the direction of the spine without the movement of the trunk and pelvis. Results: Before and after the interventions, medial-lateral axis movement distance, anterior-posterior axis movement distance, sway mean velocity, and sway area 95% was a statistically significant change in all three groups (p<0.05). The post-hoc test showed a significant improvement in medial-lateral axis movement distance, anterior-posterior axis movement distance, sway mean velocity, and sway area in the AEM group compared with the control group, and in the ADIM group compared with the control group (p<0.05). Conclusions: In conclusion, both AEM training and ADIM training are necessary interventions to maintain the independent sitting position according to the characteristics of the patient.
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문제 정의
The purpose of this study was to investigate the effects of the trunk stabilization exercises such as ADIM and AEM in upright undisturbed stance with unsupported sitting position in stroke patients. In addition, we analyzed the change of COP displacement in the sitting posture of the stroke patients according to trunk stabilization exercises in biomechanics.
However, studies with ADIM and AEM training interventions being implemented in trunk stabilization training with a quantitative evaluation of the impact on postural stability in unsupported sitting is not enough. Therefore, in this study, in order to understand the impact of unsupported sitting postural control when applying the AEM and ADIM to stroke patients, we performed this study.
This study was performed to present a more effective method intervention and improvement of safe upright undisturbed posture in an unsupported sitting position. This research is difficult to generalize for all stroke patients because we used subjects with chronic stroke, the number of subjects was small, and in the case of AEM training, feedback and quantification is difficult it has the limitation that require continuous observation of the therapist during intervention.
제안 방법
For the AEM training conducted in this study, the diaphragm, pelvic lower muscles and the rectus abdominis regulate the IAP and provide the stability required for pelvic posture. Thus inherent spinal stabilization muscles with IAP cooperatively provide spine rigidity, which serves to provide dynamic stability of the spine.
, Armonk, NY, USA) for the statistical processing of the data. General characteristics of the subjects were presented as mean and standard deviation (SD) using descriptive statistics. Chisquare test was used to investigate the change before and after in each group was used for paired t-test.
The purpose of this study was to investigate the effects of the trunk stabilization exercises such as ADIM and AEM in upright undisturbed stance with unsupported sitting position in stroke patients. In addition, we analyzed the change of COP displacement in the sitting posture of the stroke patients according to trunk stabilization exercises in biomechanics.
Sampling rate of the collected data was controlled by the associated software. In this study, the COP movement distance of medial-lateral (ML) and anterior-posterior (AP) axes (cm), sway mean velocity (cm/s) and sway area 95% (cm2) were all collected and measured, and all data were sampled is at 100 Hz, and performed at 10 Hz low-pass filter. COP measurements was 30 seconds when measured once measured, the collected data was analyzed with the Valencia program (Mintosys, Seoul, Korea), after measuring the average value of 3 trials [23].
In this study, the subjects were randomly divided into three groups to study the effect of stabilizing the trunk and pulmonary function in accordance with the kind of breathing method. Subjects were randomly selected by drawing out of a box pieces of paper labelled 1, 2, or 3.
Subjects who picked group 1 were assigned to the AEM experimental group, the subjects picked group 2 were assigned to the ADIM experimental group, and the subjects picked group 3 were assigned to the control group. The data in the experiment was collected to investigate the general characteristics and pre-test and perform the post-test after intervention of four weeks and analyzed the measured value of each. The trunk stabilization training of ADIM group and AEM group were performed 15 minutes a day, 3 times a week, and for 4 weeks, and the general physical therapy was performed 2 times a day, 30 minutes per session, 5 times a week to all three groups.
The purpose and procedures of the study were fully informed to the subjects who participated and all the subjects voluntarily signed a consent to participate. The subjects were randomly divided into the AEM experimental group (n=12), the ADIM experimental group (n=12), and a control group (n=12) to receive general neurological rehabilitation physiotherapy. The selection criteria of the subjects were persons with more than six months after being diagnosed with stroke, and persons who do not have cognitive impairment and obtained more than 24 points in the Korean version of the mini-mental status examination.
, Chattanooga, TN, USA) was in the prone position, the gauge was used to indicate the pressure to 70 mmHg. The subjects were trained pressures that are connected to the pressure bio-feedback device to pull the abdomen towards the spine so that the degree of reduction was about 6-10 mmHg. In this state, the subjects held the breathing position and maintained the posture for 10 seconds.
The data in the experiment was collected to investigate the general characteristics and pre-test and perform the post-test after intervention of four weeks and analyzed the measured value of each. The trunk stabilization training of ADIM group and AEM group were performed 15 minutes a day, 3 times a week, and for 4 weeks, and the general physical therapy was performed 2 times a day, 30 minutes per session, 5 times a week to all three groups.
Thirty-six subjects participated in this study, and were randomly divided to AEM experimental group (n=12), ADIM experimental group (n=12), and a control group (n=12). There was no significant difference (p>0.
대상 데이터
The subjects of this study were 36 people in hemiplegic stroke patients receiving inpatient care at Daejeon Hospital located in Daejeon. The purpose and procedures of the study were fully informed to the subjects who participated and all the subjects voluntarily signed a consent to participate.
이론/모형
General characteristics of the subjects were presented as mean and standard deviation (SD) using descriptive statistics. Chisquare test was used to investigate the change before and after in each group was used for paired t-test. One-way analysis of variance (one-way ANOVA) was conducted to investigate the difference among the groups of the movement distance of ML and AP axes, sway velocity and sway area at 95% according to the type of breathing exercise.
This method was used to push the abdomen outward with the abdominal breathing method using the diaphragm to increase the IAP during trunk stabilization exercises [22].
성능/효과
Mostly, damage to the left and right side of the obliqus abdominus externi and obliqus abdominus interni that is responsible for the movement of the trunk side indicates that damage of both sides are antagonistic of the rectus abdominis and latissimus dorsi muscles to control trunk flexion and extension is greater [29]. In this study, no significant differences were found in the comparison of ADIM experimental group, AEM experimental group, and control group in the changes of the ML and AP axes. This is the result due to improved low range of the chronic stroke patients used in this study compared to acute or subacute stroke patients.
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