Effects of Isokinetic Strength Exercise of the Hemiparetic Knee Joint on Lower Extremity Sensorimotor and Gait Functions in Patients With Chronic Stroke: Open Kinetic Chain Versus Closed Kinetic Chain원문보기
Background: After stroke, in order to improve gait function, it is necessary to increase the muscle strength and to enhance the propriocetive function of the lower extremity. Objects: This study aimed to compare the effects of open kinetic chain (OKC) versus closed kinetic chain (CKC) isokinetic exe...
Background: After stroke, in order to improve gait function, it is necessary to increase the muscle strength and to enhance the propriocetive function of the lower extremity. Objects: This study aimed to compare the effects of open kinetic chain (OKC) versus closed kinetic chain (CKC) isokinetic exercise of the hemiparetic knee using the isokinetic equipment on lower extremity sensorimotor function and gait ability in patients with chronic stroke. Methods: Thirty participants with chronic hemiplegia (> 6 months post-stroke) were randomly divided into 2 equal groups: CKC group and OKC group. Patients from both groups attended conventional physiotherapy sessions 3 times a week for 6 weeks. Additionally, subjects from the CKC group performed isokinetic exercise using the CKC attachment, while those from the OKC group performed isokinetic exercise using the OKC attachment. The isokinetic knee and ankle muscles strength, position sense of the knee joint, and spatiotemporal gait parameters were measured before and after interventions. Results: The knee muscles peak torque/body weight (PT/BW) and hamstring/quadriceps (H/Q) ratio significantly increased in both groups (p<.01). In particular, ankle plantarflexors PT/BW, position sense of the knee, gait velocity, and spatial gait symmetry significantly improved in the CKC group (p<.01, p<.05, p<.01, and p<.01, respectively). Conclusion: CKC isokinetic exercise can be an effective therapeutic intervention for the improvement of sensorimotor function of the lower extremity and gait functions, such as gait velocity and symmetry. CKC position in isokinetic strength training is effective to improve functional ability in patients with chronic stroke.
Background: After stroke, in order to improve gait function, it is necessary to increase the muscle strength and to enhance the propriocetive function of the lower extremity. Objects: This study aimed to compare the effects of open kinetic chain (OKC) versus closed kinetic chain (CKC) isokinetic exercise of the hemiparetic knee using the isokinetic equipment on lower extremity sensorimotor function and gait ability in patients with chronic stroke. Methods: Thirty participants with chronic hemiplegia (> 6 months post-stroke) were randomly divided into 2 equal groups: CKC group and OKC group. Patients from both groups attended conventional physiotherapy sessions 3 times a week for 6 weeks. Additionally, subjects from the CKC group performed isokinetic exercise using the CKC attachment, while those from the OKC group performed isokinetic exercise using the OKC attachment. The isokinetic knee and ankle muscles strength, position sense of the knee joint, and spatiotemporal gait parameters were measured before and after interventions. Results: The knee muscles peak torque/body weight (PT/BW) and hamstring/quadriceps (H/Q) ratio significantly increased in both groups (p<.01). In particular, ankle plantarflexors PT/BW, position sense of the knee, gait velocity, and spatial gait symmetry significantly improved in the CKC group (p<.01, p<.05, p<.01, and p<.01, respectively). Conclusion: CKC isokinetic exercise can be an effective therapeutic intervention for the improvement of sensorimotor function of the lower extremity and gait functions, such as gait velocity and symmetry. CKC position in isokinetic strength training is effective to improve functional ability in patients with chronic stroke.
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문제 정의
It is necessary to study the effects of CKC exercise using the isokinetic equipment. Therefore, the purpose of this study was to compare the effects of OKC versus CKC exercise of the knee joint using the isokinetic equipment on the lower extremity sensorimotor function and gait ability in patients with chronic stroke.
This study was conducted to determine the effect of isokinetic exercise on the hemiparetic knee at the CKC and OKC position in patients with chronic stroke. As a result, both interventions were effective in improving the strength of the knee muscles.
제안 방법
Prior to the test, all participants performed a 5-minute warm-up using a stationary cycle and test procedures using sub-maximal practice trials to familiarize with the equipment. After a 10-minute rest time, to measure the knee isokinetic muscle strength, the subject was seated with the lateral femoral epicondyle of the knee joint axis aligned with the mechanical axis of the dynamometer. Then, the knee attachment was fixed 1 ㎝ above the medial malleolus.
Verbal encouragement and visual feedback on a monitor were provided during training sessions to motivate maximal effort (McNair et al, 1996). All participants received a total of 45 minutes of CKC or OKC isokinetic exercise per session, 3 times per week for 6 weeks. Each training session included a warm-up of 5 minutes using a stationary bicycle and 10 minutes of passive stretching to cool-down of the knee extensors and flexors after the isokinetic exercise.
Community dwelling stroke survivors were recruited on a volunteer basis through the rehabilitation center of a university hospital. All subjects were randomly divided equally into 2 groups: The CKC isokinetic exercise group and OKC isokinetic exercise group. A conventional rehabilitation program was applied to all subjects and maximal concentric isokinetic exercise was additionally applied to the hemiparetic knee in CKC or OKC position.
All participants received a total of 45 minutes of CKC or OKC isokinetic exercise per session, 3 times per week for 6 weeks. Each training session included a warm-up of 5 minutes using a stationary bicycle and 10 minutes of passive stretching to cool-down of the knee extensors and flexors after the isokinetic exercise.
In the current study, we aimed to analyze the effect of isokinetic PRT performed in CKC or OKC positions on the lower extremity sensorimotor function and gait performance in patients with chronic stroke. For this purpose, isokinetic equipment was used to perform PRT of the hemiparetic knee joint in CKC or OKC positions for 6 weeks. As a result, the OKC isokinetic exercise showed a significant improvement in the gait velocity, as well as in the muscle strengthening and H/Q ratio of the knee compared with pre-intervention.
Measurements of the knee and ankle isokinetic strength, knee joint position sense, and gait performance were assessed 2 to 3 days before and 2 to 3 days after the intervention.
This equipment has shown good-to-excellent test-retest reliability of the muscle strength measurements (Flansbjer et al, 2005). Prior to the test, all participants performed a 5-minute warm-up using a stationary cycle and test procedures using sub-maximal practice trials to familiarize with the equipment. After a 10-minute rest time, to measure the knee isokinetic muscle strength, the subject was seated with the lateral femoral epicondyle of the knee joint axis aligned with the mechanical axis of the dynamometer.
The footplate could be used in a fixed position of 5-10˚ plantarflexion. The CKC isokinetic exercise consisted of 15 sets of maximal knee extension and flexion performed at 3 angular velocities, including low speed (at 90˚/sec, 5 repetitions, 5 sets), moderate speed (at 120˚/sec, 8 repetitions, 5 sets), and high speed (at 150˚/sec, 10 repetitions, 5 sets) separated by 10 seconds of rest after every set and 2 minutes of rest before each angular velocity change (Figure 1).
The OKC isokinetic exercise was conducted using the OKC knee attachment. Each subject was seated in a comfortable upright position with a 110˚ hip flexion and 90˚ knee flexion.
Thirty community-dwelling individuals who had experienced a stroke and had residual unilateral weakness were included. The inclusion criteria were as follows: (1) a history of a single stroke at least 6 months before participating in the study, (2) ability to walk independently for a minimum of 10 meters without assistive device, (3) an activity tolerance of 45 minutes with resting time, and (4) nonparticipation in any formal training program or similar interventions. Participants were excluded if they had (1) visual impairment and comprehensive aphasia, (2) an unstable medical condition (i.
To measure the position sense of the knee joint, the participant was placed on the equipment and the starting angle of the test was set at 90˚ knee flexion. The target joint angles were 30˚ and 60˚ knee flexion; participants were instructed in advance to hold for 10 seconds and perceive the target joint angle position. During passive extension of the knee joint at an angular velocity of 2˚/sec, each participant was instructed to press a stop button when he or she recognized the target angle (Rombaut et al, 2010).
This study was carried out prospectively and the convenient sampling method was used to select the samples. Community dwelling stroke survivors were recruited on a volunteer basis through the rehabilitation center of a university hospital.
After 10 minutes of rest, the participants wore an eye patch and earplugs to prevent the input of visual and auditory information (Peixoto et al, 2011). To measure the position sense of the knee joint, the participant was placed on the equipment and the starting angle of the test was set at 90˚ knee flexion. The target joint angles were 30˚ and 60˚ knee flexion; participants were instructed in advance to hold for 10 seconds and perceive the target joint angle position.
대상 데이터
, Clifton, NJ, USA). The GAITRite mat contains 6 sensor pads with 13,824 sensors encapsulated in a roll-up carpet with an active area of 3.66 m length and .61 m width. Data were sampled at 30 ㎐.
데이터처리
The χ2 test was used to compare the categorical variables, such as gender, hemiplegic side, and type of stroke, between two groups. A paired t-test was used to analyze the training effects within group differences (pre and post intervention), and the independent t-test for differences between the groups. Statistical significance for α was set at .
Continuous variables, such as age, disease duration, height, body weight, Korean version of the Modified Barthel Index, isokinetic PT/BW, H/Q ratio, reposition error, and gait spatiotemporal parameters were presented as mean±standard deviation. Demographic and clinical characteristics of subjects were compared between two groups by the independent t-test (for continuous variables). The χ2 test was used to compare the categorical variables, such as gender, hemiplegic side, and type of stroke, between two groups.
성능/효과
After 6 weeks of isokinetic exercise, the PT/BW of the knee muscles significantly increased in both groups compared to pre-intervention PT/BW (p<.01).
Continuous variables, such as age, disease duration, height, body weight, Korean version of the Modified Barthel Index, isokinetic PT/BW, H/Q ratio, reposition error, and gait spatiotemporal parameters were presented as mean±standard deviation.
Perhaps the instability of the paretic lower limb was the main reason during the stance phase (Hendrickson et al, 2014). In this study, an improvement of spatial gait symmetry was noted in the CKC group compared to the OKC group. Although the CKC isokinetic exercise has not progressed at the weight bearing position, the knee extension and flexion with the distal extremity firmly fixed was similar to the actual gait pattern.
후속연구
First, the follow-up measurements were not performed; accordingly, the carryover effect of the 2 types of isokinetic exercise could not be determined. Second, the intervention applied in this study was expected to have a sufficient influence on the hip muscles. Nonetheless, the lack of measuring the isokinetic strength of the hip muscles also limits the interpretation of the results.
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