PURPOSE: The initiation of the trunk muscles in stroke patients is delayed because the muscles involved in reach arm are activated earlier than the trunk muscles. The objective of this study was to examine the effects of mobility, balance, and trunk control ability through selective trunk exercise (...
PURPOSE: The initiation of the trunk muscles in stroke patients is delayed because the muscles involved in reach arm are activated earlier than the trunk muscles. The objective of this study was to examine the effects of mobility, balance, and trunk control ability through selective trunk exercise (STE) in patients with chronic stroke. METHODS: A randomized pre-test and post-test control group design was initially used, with subjects randomly assigned to the STE group (n=15) and a control group (n=14). All groups underwent physical therapy based on the neuro-developmental therapy (NDT) for 30 minutes a day, five times per week for four weeks. Additionally, the STE group did the trunk exercise for 30 minutes a day, three times per week for four weeks. The timed up and go test (TUG), Berg balance scale (BBS), and trunk impairment scale (TIS) were used for assessment. RESULTS: The scores of the TUG, BBS, dynamic sitting balance subscale, and coordination subscale of TIS improved significantly in both groups but the improvement was more pronounced in the STE group (p<.05). This study showed a large effect on the scores of the TIS coordination subscale (d=.93) (p<.05), TIS dynamic balance subscale (d=.81) (p<.05), TUG (d=.75) (p<.05), and BBS (d=.73) (p<.05). CONCLUSION: The combined STE and NDT program showed improvements in measures of mobility, balance, and trunk control in chronic stroke patients. These results suggest that STE should be considered to be included in the treatment program for patients with chronic stroke.
PURPOSE: The initiation of the trunk muscles in stroke patients is delayed because the muscles involved in reach arm are activated earlier than the trunk muscles. The objective of this study was to examine the effects of mobility, balance, and trunk control ability through selective trunk exercise (STE) in patients with chronic stroke. METHODS: A randomized pre-test and post-test control group design was initially used, with subjects randomly assigned to the STE group (n=15) and a control group (n=14). All groups underwent physical therapy based on the neuro-developmental therapy (NDT) for 30 minutes a day, five times per week for four weeks. Additionally, the STE group did the trunk exercise for 30 minutes a day, three times per week for four weeks. The timed up and go test (TUG), Berg balance scale (BBS), and trunk impairment scale (TIS) were used for assessment. RESULTS: The scores of the TUG, BBS, dynamic sitting balance subscale, and coordination subscale of TIS improved significantly in both groups but the improvement was more pronounced in the STE group (p<.05). This study showed a large effect on the scores of the TIS coordination subscale (d=.93) (p<.05), TIS dynamic balance subscale (d=.81) (p<.05), TUG (d=.75) (p<.05), and BBS (d=.73) (p<.05). CONCLUSION: The combined STE and NDT program showed improvements in measures of mobility, balance, and trunk control in chronic stroke patients. These results suggest that STE should be considered to be included in the treatment program for patients with chronic stroke.
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문제 정의
, 2011b) about the effectiveness of trunk exercise using a plinth in chronic stroke patients, the results cannot be generalized as it did not have a control group. Therefore, this study aims to explore how additional trunk muscle training can be effective for mobility, balance, and trunk control of chronic stroke patients.
제안 방법
Allocated into two groups; 19 participants were in the selective trunk exercise (STE) group and 19 in the control group. All groups received conventional physical therapy based on the neuro-development therapy 30 minutes per day, five times per week for four weeks. It applied that stretching exercise, strengthening of lower extremity muscle, progressive gait training, balance control, weight shifting, bearing.
The assessment for trunk impairment such as paresis was carried out on the TIS. The TIS consists of three subscales: static sitting balance, dynamic sitting balance and coordination, containing 3, 10, and 4 items.
, 2011a; 2011b). The exercise program consisted of four supine exercises and seven sitting exercises. The four supine exercises were lifting the pelvis with crook-lying, unilateral pelvic bridge, upper trunk flexion rotation, and lower trunk flexion rotation.
The limitations of this study were a short period of exercise, a small sample size (n =15) and it consisted only of patients diagnosed with the disease for 13 months. The study ascertained that the functional mobility, balance, and trunk control ability were improved by the effect of STE.
The four supine exercises were lifting the pelvis with crook-lying, unilateral pelvic bridge, upper trunk flexion rotation, and lower trunk flexion rotation. The seven sitting exercises were as follows: selective flexion extension of the lower trunk, upper trunk lateral flexion, lower trunk lateral flexion, upper trunk rotation, lower trunk rotation, forward reach, and lateral reach. The forward and lateral reach were performed at shoulder height.
This research was conducted between May 2014 and November 2014. The twenty-eight patients with chronic stroke participated for the study were observer-blinded, randomized through the block randomization method, block size of 2 x 2. The method of allocation was concealed in sequentially numbered, sealed envelopes.
대상 데이터
The assessment for trunk impairment such as paresis was carried out on the TIS. The TIS consists of three subscales: static sitting balance, dynamic sitting balance and coordination, containing 3, 10, and 4 items. The TIS score ranges from a minimum of 0 to a maximum of 23, with a higher score indicating a better trunk performance.
One patient in control group was lost to follow up at three weeks. The data collected in this study was from 15 participants in the intervention group and 14 from the control group. Table 1 shows the participants demographic characteristics.
This research was conducted between May 2014 and November 2014. The twenty-eight patients with chronic stroke participated for the study were observer-blinded, randomized through the block randomization method, block size of 2 x 2.
Twenty-seven patients completed the study. One patient in control group was lost to follow up at three weeks.
데이터처리
We compared general characteristics between the STE group and the control group using the chi-square test. The independent t-test was conducted to analysis the change of different between the two groups. The paired t-test was used to compare the difference between pre- and post-intervention scores within the group.
The independent t-test was conducted to analysis the change of different between the two groups. The paired t-test was used to compare the difference between pre- and post-intervention scores within the group. The level of significance was set at p<.
We compared general characteristics between the STE group and the control group using the chi-square test. The independent t-test was conducted to analysis the change of different between the two groups.
성능/효과
The participants of the study were recruited from “M” hospital. The criteria for subjects included patients with chronic stroke after six months of diagnosis, having a higher score than 24 in mini mental state examination-korean version (MMSE-K), being able to walk 10 meters independently, and scoring less than 21 on the trunk impairment scale (TIS). Therefore, patients with scores higher than 21 on the TIS were excluded from this study as it indicates that they can perform everyday activities independently (Verheyden et al.
, 2005). The highest record among the participants of the study was 10 seconds, compared to the average MDC, 1 second (less than 10%), improving in the actual changes of 4.1 seconds. The change of BBS in the STE group scored 3.
The highest score of BBS in this study was 43 points by showing 4.3 of the effectiveness on average MDC and 3.07 of the actual changes.
The disorders among stroke patients cause negative impacts on performing functional movements of the body. The result of the study shows that the total effect size of the trunk exercise is Cohen d =.66 and is effective on TIS-coordination (d =.93), TIS-dynamic (d =.81), TUG (d =.75) and BBS (d =.73). The training of trunk control accompanied with functional exercises have positive effects on separate movements of the upper and lower trunk and lateral rotation, coordinated movements of limbs.
The limitations of this study were a short period of exercise, a small sample size (n =15) and it consisted only of patients diagnosed with the disease for 13 months. The study ascertained that the functional mobility, balance, and trunk control ability were improved by the effect of STE.
후속연구
The training of trunk control accompanied with functional exercises have positive effects on separate movements of the upper and lower trunk and lateral rotation, coordinated movements of limbs. Further future studies should be conducted with randomization and a larger sample in order to investigate the effectiveness of trunk exercise by using surface electromyography.
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