선택한 단어 수는 입니다.
최소 단어 이상 선택하여야 합니다.
최소 단어 이상 선택하여야 합니다.
선택한 단어 수는 30입니다.
최대 10 단어까지만 선택 가능합니다.
최대 10 단어까지만 선택 가능합니다.
문제 정의
- The purpose of this study was to investigate the effect of performing hip strengthening exercises using PNF techniques in a patient with TBI and to investigate the clinical features and treatment effects that are associated with balance and gait. Symptoms of motor impairment in children with TBI, such as delayed movement, lead to long-term disability of exercise skills [18].
- Therefore, the purpose of this study was to investigate the effects of hip strengthening exercises with PNF techniques on balance, sit to stand, and gait abilities in children with TBI.
제안 방법
- Although weakness of the hip muscles were observed in this study, the relaxation techniques applied onto the hip flexors worked to lower muscle tension and improve hip flexor and abductor muscle strength. High intensity training was performed to elicit the potential of the patient during treatment since recent reports have suggested that patients with TBI may benefit from high-intensity training treatment programs [24,25].
- For children, it is important for work to be in a form of play and that the environment must be fun, rigorous, and motivating for the therapeutic training [29], and sensory play groups, which can be trained in developmental skills, should be motivating and enjoyable [30]. During this study, although the subject had become bored and had lost interest in the exercise, and exhibited endurance issues, however, a soccer ball was used to promote walking and balance ability and to create active interest in the treatment of the subject. The physical function and structural problem of the subject was attempted to be solved according to the treatment, activity and participation part of the international classification of functioning, disability and health model.
- Patients sometime showed endurance difficulties and promoted patient motivation through their favorite soccer to promote patient motivation. Finally, in order to improve the walking ability, weight training to the right was performed, followed by training to the left, and gait training while adjusting the ball using a soccer ball and practical gait training was repeated. In order to improve the patient’s potential ability using the philosophical mobility storage, after the treatment time, the subject was given the task of lifting the buttocks and when the patient was viewed as a whole based on their environmental and personal characteristics, the subject could not use the time efficiently after the treatment time or on the weekend.
- For the seventh method, based on the functional approach which is the philosophy of PNF, a combination of isotonic was applied using practical functional movements while moving from a standing position to a sitting position in order to emphasize the exoskeleton of the hip joint. For the eighth method, to stabilize the trunk and to improve the weight support ability of the right lower limb, and after establishing a posterior tilted pelvis in standing posture, a combination of isotonic was applied while the weight of the right lower extremity was supported and the left foot was moved forward to improve walking ability after sufficient weight support training. For the ninth method, in order to promote more weight-bearing capacity and motivation of the right foot using more realistic task, such as soccer, after weight shifting to the right, the exercise that consisted of controlling the movement of a ball forward and backward was performed.
- For the third method, to increase the hip flexion range of motion, and to increased hip range of motion, hip flexion adduction with external rotation and knee flexion pattern while side-lying and after applying the contract-relax technique, in order to increase hip flexor muscle strength, hip flexion, abduction, and internal rotation with knee extension pattern was used with the timing for emphasis and combination of isotonic applied. For the fourth method, the pelvic anterior elevation and pelvic posterior depression pattern was used to increase hip joint muscle strength and a combination of isotonic and stabilizing reversals were applied.
- The first exercise method was based on the philosophy of PNF, using the strong left side of the patient in order to increase the strength of the body flexor muscles, scapular anterior depression pattern and pelvic anterior elevation patterns were used to roll forward and a combination of isotonic were applied. For the second method, in order to increase the lower trunk muscle strength, the contraction relaxation technique while lying supine and respiration was used to increase the body flexion range during the contract-relax application and to increase the strength of the lower body, a combination of isotonic was applied using bilateral lower extremity flexion with a knee flexion pattern to bend the knee.
- For the third method, to increase the hip flexion range of motion, and to increased hip range of motion, hip flexion adduction with external rotation and knee flexion pattern while side-lying and after applying the contract-relax technique, in order to increase hip flexor muscle strength, hip flexion, abduction, and internal rotation with knee extension pattern was used with the timing for emphasis and combination of isotonic applied. For the fourth method, the pelvic anterior elevation and pelvic posterior depression pattern was used to increase hip joint muscle strength and a combination of isotonic and stabilizing reversals were applied.
- For this study, in order to investigate the changes in physical examination, sit to stand, balance after intervention, the results of the subject before and after the experiment using the result and mean values were compared at each time point to determine the changes in gait ability. In addition, the difference before and after treatment was assessed as a percent change (%improvement=(pre-treatment assessment-post-treatment assessment/pre-treatment evaluation×100).
- In order to improve the patient’s potential ability using the philosophical mobility storage, after the treatment time, the subject was given the task of lifting the buttocks and when the patient was viewed as a whole based on their environmental and personal characteristics, the subject could not use the time efficiently after the treatment time or on the weekend.
- In order to perform a physical examination, the MMT was used to assess for strength, the MAS was used to assess spasticity and tension, a sensory assessment was used to assess sensation of the feet, and the coordination assessment was performed to evaluate the body function and structure of the subject. The strength test is used to assess the degree of muscle strength using gravity and resistance provided by the examiner [11].
- In the first week of the training period, in order to solve the physical function and structural problem and patient’s lack of endurance and motivation, the activity in which the subject enjoyed, such as soccer, was used as a participation method.
- The above 11 exercises and home exercises were performed for 4 weeks, 5 days a week, for 60 minutes with the exercise intensity gradually increased according to the subject’s physical abilities, and to improve jumping ability and motivation, the patient’s favorite dance was used.
- This study focused on the environmental, individual, and background factors that created patient motivation and were used to solve the body function and structural problem. The factor to this problem was due to the lack of cognitive ability, lack of motivation, and depression in the patient, and therefore disallowed the patient to actively participate in the treatment sessions.
대상 데이터
- Onset of injury occurred in January 9, 2016. The 13-year-old male patient had a height of 164 cm, weight of 44 kg, and no previous medical history. The patient’s mini mental state examination score was 14 and although consciousness was clear, the patient showed problems with cognitive function and showed comprehension, orientation due to post-traumatic stress, psychiatric examination was also performed.
- This study included one patient who was admitted and diagnosed with TBI at Soon Chun Hyang University Seoul Hospital was enrolled for the study for four weeks from April 25, 2016 to May 18, 2016. The subject provided their voluntary consent after being informed of the purpose and details of the study (IRB No.
성능/효과
- As a result of 1 week of treatment, the patient’s endurance and motivation problems allowed the patient to be more activated and motivated and using a likeable activity, such as soccer, was considered as a more functional approach.
- In this study, increased tension in the hip flexor and adductor muscles exhibited decreased balance and gait scores, decreased hip extensor and abductor muscle strength had a negative effect on balance and gait. After intervention, there was a positive effect on balance and gait as the tension in the hip flexor and adductor muscles decreased and increased hip extensor and abductor muscle strength showed a positive effect on balance and gait.
후속연구
- The study is limited by the inclusion of one TBI patient, and since the PNF method was used along with multiple treatments such as occupation therapy, bicycle riding, and FES, it would be difficult to estimate the effect of the PNF method only.
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