Effects of Cross Training with Bilateral Ankle Dorsiflexor Strengthening Exercise on the Muscle Activity of the Paralytic Tibialis Anterior, Balancing Ability, and Gait Function in Patients with Chronic Stroke: A Preliminary Randomized, Controlled Study원문보기
Park, Sung-Chan
(Department of Physical Therapy, Daejeon Rehabilitation Hospital)
,
Ryu, Jun-Nam
(Department of Physical Therapy, Yeoju University)
,
Park, Jae-Man
(Department of Physical Therapy, Daejeon Rehabilitation Hospital)
,
Seo, Byoung-Do
(Department of Physical Therapy, Kyungwoon University)
,
Ryu, In-Tae
(Department of Physical Therapy, Daejeon Rehabilitation Hospital)
,
Cha, Yong-Jun
(Department of Physical Therapy, College of Health and Medical Science, Dajeon University)
PURPOSE: This study examined the effects of bilateral ankle dorsiflexors-strengthening exercise on the paralytic tibialis anterior activity, balance ability, and gait function of patients with chronic stroke. METHODS: Nineteen patients with chronic stroke were assigned randomly to the experimental a...
PURPOSE: This study examined the effects of bilateral ankle dorsiflexors-strengthening exercise on the paralytic tibialis anterior activity, balance ability, and gait function of patients with chronic stroke. METHODS: Nineteen patients with chronic stroke were assigned randomly to the experimental and control groups. All participants received general physical therapy for 60-minutes per session, five times a week, for 6 weeks. In addition, the experimental group (n = 9) performed bilateral ankle dorsiflexion muscle-strengthening training three times a week, 30 minutes per session, for six weeks. The control group (n=10) performed the paraplegic ankle dorsiflexion muscle- strengthening training in the same manner. Before and after the intervention, the paralytic tibialis anterior muscle activity, timed up and go test (TUG), and 10m walking test (10 MWT) were performed. RESULTS: Both groups showed significant improvement in the post-intervention muscle activity of the paralytic tibialis anterior, TUG, and 10MWT compared to that before the intervention (p.05). CONCLUSION: Bilateral ankle dorsiflexors strengthening exercise is an effective cross-training method to improve the muscle activity of the paraplegic tibialis anterior, balance ability, and walking function in chronic stroke patients.
PURPOSE: This study examined the effects of bilateral ankle dorsiflexors-strengthening exercise on the paralytic tibialis anterior activity, balance ability, and gait function of patients with chronic stroke. METHODS: Nineteen patients with chronic stroke were assigned randomly to the experimental and control groups. All participants received general physical therapy for 60-minutes per session, five times a week, for 6 weeks. In addition, the experimental group (n = 9) performed bilateral ankle dorsiflexion muscle-strengthening training three times a week, 30 minutes per session, for six weeks. The control group (n=10) performed the paraplegic ankle dorsiflexion muscle- strengthening training in the same manner. Before and after the intervention, the paralytic tibialis anterior muscle activity, timed up and go test (TUG), and 10m walking test (10 MWT) were performed. RESULTS: Both groups showed significant improvement in the post-intervention muscle activity of the paralytic tibialis anterior, TUG, and 10MWT compared to that before the intervention (p.05). CONCLUSION: Bilateral ankle dorsiflexors strengthening exercise is an effective cross-training method to improve the muscle activity of the paraplegic tibialis anterior, balance ability, and walking function in chronic stroke patients.
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문제 정의
As a result, the muscle activity of the tibialis anterior muscle after the interventions was increased significantly in the experimental and control group compared to that before the intervention. Therefore, the strengthening training method performed in this study is an effective intervention method for improving the muscle strength of the paralytic ankle dorsiflexion muscle. Sousa et al.
On the other hand, previous studies on the effectiveness of cross-training focusing on strengthening exercise in the non-paralytic lower extremities in chronic stroke patients have been insufficient. Therefore, this study examined the effects of bilateral ankle dorsiflexion muscle-strength exercise using cross-training on chronic stroke patients. This study hypothesized that bilateral ankle dorsiflexion muscle-strengthening exercise would be more effective in improving the function of stroke patients than paraplegic dorsiflexion muscle strengthening exercise.
Weakened ankle joint dorsiflexor muscles in stroke patients are a major factor causing difficulty in lifting toes during walking, which is a major factor causing circumduction gait [8]. Therefore, this study focused on strengthening the ankle dorsiflexion muscle. As a result, the muscle activity of the tibialis anterior muscle after the interventions was increased significantly in the experimental and control group compared to that before the intervention.
This study examined the effects of cross-training as a strengthening exercise in chronic stroke patients. The results revealed a similar effect in both the muscle strengthening exercise applied to the paralyzed side as well as the non-paralyzed side.
This study examined the effects of cross-training by comparing the bilateral dorsiflexion muscle strengthening exercise and paralytic dorsiflexion muscle-strengthening exercise in patients with chronic stroke. As a result, significant improvements in the muscle activity, balance ability, and walking ability were observed after the intervention in both the experimental and control groups, but there was no significant difference between the groups.
가설 설정
Therefore, this study examined the effects of bilateral ankle dorsiflexion muscle-strength exercise using cross-training on chronic stroke patients. This study hypothesized that bilateral ankle dorsiflexion muscle-strengthening exercise would be more effective in improving the function of stroke patients than paraplegic dorsiflexion muscle strengthening exercise.
제안 방법
To perform the exercise, the non-paralytic ankle dorsiflexion muscle strengthening exercise was performed, and the paraplegic ankle dorsiflexion muscle strengthening exercise was then carried out alternately on one set of each. A physiotherapist, who had no information on the study, supervised the muscle-strengthening exercise at the fifth year of the clinical trial. The strength of the power resistance was set to the intensity (10 RM) at which the subject can repeat the operation for up to 10 times.
All 24 subjects selected underwent general neurodevelopmental rehabilitation therapy five times a week for 30 minutes per session, for six weeks. In addition, the experimental group performed bilateral ankle dorsiflexion muscle-strengthening training three times a week, 30 minutes per session, for six weeks.
[21]. Bilateral ankle dorsiflexion muscle-strengthening exercise was applied for five sets for 30 minutes with 10 repetitions set as a single set; a three to five minute rest period was provided between each set. The type of muscle contraction and contraction time applied to the strengthening exercise consisted of two seconds of concentric contraction, two seconds of isometric contraction, and two seconds of eccentric contraction.
All 24 subjects selected underwent general neurodevelopmental rehabilitation therapy five times a week for 30 minutes per session, for six weeks. In addition, the experimental group performed bilateral ankle dorsiflexion muscle-strengthening training three times a week, 30 minutes per session, for six weeks. The control group performed the paraplegic ankle dorsiflexion muscle-strengthening training in the same manner.
On the other hand, no significant differences in terms of gender, injury factors, and height, which could affect the group homogeneity in addition to body weight, were observed between the two groups. Nevertheless, this pilot study has limitations in generalizing the results of this study. The relatively short duration of the intervention (six weeks) and the lack of follow-up after the end of the intervention is a factor limiting the generalization of the findings to patients with chronic stroke.
The 10m walking speed test (10 MWT) was performed to evaluate the gait function of the subjects. To provide the distance for the acceleration and deceleration of walking, the 10 MWT marked the start point and end point on the floor by adding an additional 2m from the 10m distance [26].
The subjects were chronic adult hemiplegic patients who were diagnosed with stroke and were hospitalized at the D rehabilitation hospital. The criteria for selection of the subjects were as follows: those six months or more after being diagnosed with a stroke, could walk more than 10m independently without assistive devices indoors, had an ankle joint manual movement range of five degrees or more with the knee joint extended, and had a score of 24 or higher on the Mini-Mental Status Examination-Korean version (MMSE-K). The exclusion criteria were those with a history of orthopedic injuries that may affect walking, visual or auditory deficits, severe cardiovascular problems, and below Trace in the ankle joint anterior muscle strength test.
The type of muscle contraction and contraction time applied to the strengthening exercise consisted of two seconds of concentric contraction, two seconds of isometric contraction, and two seconds of eccentric contraction. To perform the exercise, the non-paralytic ankle dorsiflexion muscle strengthening exercise was performed, and the paraplegic ankle dorsiflexion muscle strengthening exercise was then carried out alternately on one set of each. A physiotherapist, who had no information on the study, supervised the muscle-strengthening exercise at the fifth year of the clinical trial.
대상 데이터
Twenty-four subjects participated in this study, but five dropped out (three in the experimental group and two in the control group) due to discharge. Table 1 lists the general characteristics of the 19 subjects (nine in the experimental groups and 10 in the control groups) who completed the study. In the weights of the two groups, the experimental group had an average of 9 kg more than the control group (p<.
Of the 81 patients with chronic stroke, who were undergoing rehabilitation at D rehabilitation hospital, 24 patients met the inclusion and exclusion criteria. The 24 subjects were informed of the purpose and method of the study and agreed to participate in the study. This study was conducted after gaining approval of the Institutional Bioethics Committee of Daejeon University (IRB: 1040647-201506-HR-011-03).
The subjects were chronic adult hemiplegic patients who were diagnosed with stroke and were hospitalized at the D rehabilitation hospital. The criteria for selection of the subjects were as follows: those six months or more after being diagnosed with a stroke, could walk more than 10m independently without assistive devices indoors, had an ankle joint manual movement range of five degrees or more with the knee joint extended, and had a score of 24 or higher on the Mini-Mental Status Examination-Korean version (MMSE-K).
Twenty-four subjects participated in this study, but five dropped out (three in the experimental group and two in the control group) due to discharge. Table 1 lists the general characteristics of the 19 subjects (nine in the experimental groups and 10 in the control groups) who completed the study.
데이터처리
A Mann-Whitney's U-test was used to compare the changes before and after the intervention between the two groups.
0 for Windows. A Shapiro-Wilk test was conducted to test the normality of all data, and the general characteristics of the subjects were tested using a chi-square test and independent sample t test. A Wilcoxon signed rank test was performed to verify the statistical significance of the tibialis anterior muscle activity, balance ability, and gait function before and after the intervention within each group.
A Shapiro-Wilk test was conducted to test the normality of all data, and the general characteristics of the subjects were tested using a chi-square test and independent sample t test. A Wilcoxon signed rank test was performed to verify the statistical significance of the tibialis anterior muscle activity, balance ability, and gait function before and after the intervention within each group. A Mann-Whitney's U-test was used to compare the changes before and after the intervention between the two groups.
이론/모형
A break of 30 seconds was provided between each measurement. The % RVC (reference voluntary contraction) method was used to standardize the calculated MVIC [24]. RVC EMG signal measured the muscle activity of the paralytic tibialis anterior while the subject remained static standing for five seconds.
성능/효과
As a result, significant improvements in the muscle activity, balance ability, and walking ability were observed after the intervention in both the experimental and control groups, but there was no significant difference between the groups. These results were different from the hypothesis in this study that bilateral dorsiflexion muscle strengthening exercise would be more effective, but the improvement of muscle activity of the paralytic tibialis anterior muscle before and after intervention in the experimental group proved the positive effect of cross-training. These results were attributed partly to the muscles of the lower extremity also being involved in muscle contraction to perform the training during non-paralytic flexion muscle strengthening exercise [12,15].
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