[논문]Effects of Combined Functional Electrical Stimulation and Joint Mobilization on Muscle Activation and Mobility of Ankle Joints and Modified Functional Reach Test in Stroke Patient

Kim, Su-Jin; Son, Ho-Hee

doi:10.13066/kspm.2019.14.2.41

Effects of Combined Functional Electrical Stimulation and Joint Mobilization on Muscle Activation and Mobility of Ankle Joints and Modified Functional Reach Test in Stroke Patient 원문보기

대한물리의학회지 = Journal of the korean society of physical medicine, v.14 no.2, 2019년, pp.41 - 51

Kim, Su-Jin (Department of Physical Therapy, Graduate School of Health Sciences, Catholic University of Pusan) , Son, Ho-Hee (Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan)

Abstract ▼ AI-Helper

PURPOSE: This study was conducted to investigate the effects of combined Joint Mobilization and Functional Electrical Stimulation on Muscle Activation and Mobility of ankle joints in stroke patients and their Modified Functional Reach Test (MFRT) results. METHODS: A total of 26 patients with stroke were randomly selected for enrollment in this study. (1) Functional Electrical Stimulation (FES) (2) combined Joint Mobilization and FES. An EMG system was used to measure tibialis anterior and gastrocnemius activities. Range Of Motion (ROM) of Ankle Joint and MFRT for Dynamic Balance. Pre and post intervention results were compared by paired-t-tests and differences in changes after intervention between groups were identified by the independent t-test. RESULTS: The muscle activation, ROM, and MFRT differed significantly in the experimental group (p<.05). The ROM was significantly different for the active dorsiflexion pre and post intervention in the group that received FES alone (p<.05). CONCLUSION: The results of this study suggest use of a systematic program of proactive posture control to prevent dysfunction when planning interventions for ankle joints can help stroke patients walk efficiently.

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문제 정의

Muscle activation and ROM of ankle joints are especially important in intervention programs of stroke patients. Therefore, this study investigated the effects of combined joint mobilization and FES on muscle activation and mobility of ankle joints and MFRT in stroke patients.
However, there are insufficient studies on the application of FES and ankle joint mobilization in combination. Therefore, this study was conducted to investigate the effects of combined joint mobilization and FES on muscle activation and mobility of the ankle joint in stroke patients and their MFRT.

제안 방법

In this study, Microstim (Microstim, Medel Gmbk, Germany) was used as the FES therapy device. After receiving a full explanation of the purpose and method of the study, the subjects were divided into two groups, one that received FES only in the sitting position in a wheelchair and a another that received FES following joint mobilization. The functional electrical stimulation was set as Rectangular-Biphasic with 40 Hz frequency and 40 ㎲ amplitude [15].
Therefore, the modified reach test was used because it considered the muscles' functional activities associated with range of motion while reaching one’s arm and prevented falling. For the test, the patient sat on a chair in a relaxed position while flexing the hip joint and the knee joint at 90 degrees and keeping the distance from the popliteal region of the posterior legs at about 5 cm with the feet touching the ground [30]. For anterior measurement, the shoulder joint was flexed at 90 degrees and the elbow was maximally extended to align with the wrist.
The RVC values for the tibialis anterior and gastrocnemius muscles were calculated while the subjects performed sitto-stand activity. For the trial, the EMG signal was collected while the subjects performed plantarflexion and dorsiflexion of the ankle joint. Data for each trial were expressed as a percentage of the calculated mean RMS of the percentage of a reference voluntary contraction (%RVC), and the mean %RVC of three trials was used for analysis [23].
This study investigated the effects of combined FES on the dorsiflexor and plantar flexor of the ankle joint and joint mobilization on muscle activation, mobility, and MFRT. The results of this study showed that there were significant improvements in muscle activation, ROM, and MFRT (p<.

대상 데이터

This study investigated patients who were diagnosed with stroke and hospitalized at E - hospital located in Ulsan, South Korea for about two months from November 10, 2017 to January 11, 2018. Before the study, a cooperation letter was distributed to each ward and the primary care physicians.

데이터처리

0 (IBM, Korea) was used for the analyses performed in this study and the KolmogorovSmirnov test was employed to evaluate normality. The changes between pre and post intervention within the group were analyzed using the paired t-test, while those between groups were analyzed using the independent sample t-test. The statistical significance level (a) of all data was set to .
The raw data of the surface EMG signal were standardized by processing with the Root Mean Square (RMS). The reference voluntary contractions (RVC) value obtained for three seconds out of five seconds excluding the first and last seconds of the five seconds were used, and the average value of the three measurements was used.

이론/모형

SPSS version 24.0 (IBM, Korea) was used for the analyses performed in this study and the KolmogorovSmirnov test was employed to evaluate normality. The changes between pre and post intervention within the group were analyzed using the paired t-test, while those between groups were analyzed using the independent sample t-test.

성능/효과

In conclusion, the intervention method combining FES with joint mobilization was found to be more effective at improving muscle activation, mobility, and MFRT than the application of FES alone during ankle joint rehabilitation of stroke patients.
It should be noted that this study was limited in that pre and post intervention effects were measured after four weeks, the follow-up effects were not examined, and the sample size was small. Therefore, in the future, systematic research should be conducted to monitor the long-term effects in a large number of stroke patients.
In a study conducted by Cho [20], FES and exercise therapy were applied together in 60 stroke patients, with FES applied to the tibialis anterior, and isometric contraction of gastrocnemius and contraction of the tibialis anterior manually applied as an exercise therapy. The results of this study showed that ROM increased gradually with decreased spasticity of the plantar flexor in the group that received both FES and exercise therapy. The changes in ROM over time were found to be statistically significant (p<.
The results of this study showed that there were significant improvements in muscle activation, ROM, and MFRT (p<.05) in the group that received combined FES and joint mobilization compared to the group that received FES alone (p<.05).
In the control group, ankle joint stretching was performed with the application of FES. The results revealed significant increases in the FRT score 3 and 6 weeks after the start of training in both groups compared to before training. In the control group, the FRT improved from 18.
05). Therefore, the results of this study suggest that a systematic program of proactive posture control can be used to prevent dysfunction when planning interventions for ankle joints as a way to help stroke patients walk efficiently.

참고문헌 (42)

Burridge JH, Wood DE, Taylor PN, et al. Indices to describe different muscle activation patterns, identified during treadmill walking, in people with spastic drop-foot. Med Eng Phys. 2001;23(6):427-34.

상세보기
Harlaar J, Becher JG, Snijders CJ, et al. Passive stiffness characteristics of ankle plantar flexors in hemiplegia. Clin Biomech. 2000;15(4):261-70.

상세보기
Baker LL, Yeh C, Wilson D et al. Electrical stimulation of wrist and fingers for hemiplegic patients. Phys Ther. 1979;59(12):1495-9.

상세보기
Morone G, Fusco A, Capua PD, et al. Walking Training with Foot Drop Stimulator Controlled by a Tilt Sensor to Improve Walking Outcomes: A Randomized Controlled Pilot Study in Patients with Stroke in Subacute Phase. Stroke Res Treat. 2012;(2012):523-64.
Tiebin Yan, CWY Hui-Chan, LSW Li. Functional Electrical Stimulation Improves Motor Recovery of the Lower Extremity and Walking Ability of Subjects With First Acute Stroke. Stroke. 2005;36:80-5.

상세보기
Sabut SK, Sikdar C, Kumar R, et al. Functional electrical stimulation of dorsiflexor muscle: Effects on dorsiflexor strength, plantarflexor spasticity, and motor recovery in stroke patients. NeuroRehabilitation. 2011;29(4):393-400.

상세보기
Sabut SK, Bhattacharya SD, Manjunatha M. Functional electrical stimulation on improving foot drop gait in poststroke rehabilitation: a review of its technology and clinical efficacy. Crit Rev Biomed Eng. 2013;41(2):149-60.

상세보기
An CM, Won JI. Effects of Ankle Joint Mobilization with Movement on Lower Extremity Muscle Strength and Spatiotemporal Gait Parameters in Chronic Hemiplegic Patients. Phys Ther Korea. 2012;19(3):20-9.
An CM, Won JI. Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study. J Phys Ther Sci. 2016;28(2):689-94.

상세보기
Lee J, Kim JO, Lee BH .The effects of posterior talar glide with dorsiflexion of the ankle on mobility, muscle strength and balance in stroke patients: a randomised controlled trial. J Phys Ther Sci. 2017;29(3):452-56.

상세보기
Kim K, Lee S, Kim D, et al. The effects of ankle joint muscle strengthening and proprioceptive exercise programs accompanied by functional electrical stimulation on stroke patients' balance. J Phys Ther Sci. 2015;27(9):2971-5.

상세보기
Runge CF, Shupert CL, Horak FB, et al. Ankle and hip postural strategies defined by joint torques. Gait & Posture. 1999;10(2):161-70.

상세보기
Park KH. The Effect of Ankle Strategy Exercises on Balance of Patients with Hemiplegia. Master's Degree Daegu University. 2013.
Jeon SN. Impact of Ankle Strategy Exercise on Balancing Ability of Patients with Stroke According to the Existence of Visual Feedback. Master's Degree Namseoul University. 2015.
Mun BM. Effect of Strengthening Exercise with Lower Extremity and Functional Electrical Stimulation on Gait, Balance and Spasticity in Chronic Stroke Patients. Doctor's Degree Daegu University. 2014.
Kang YH, Toon SE, Seo SK, et al. The Effect on Change of Spinal Neuron Excitability during Gait Training of Hemiplegia Patients by the Functional Electrical Stimulation. J Phys Ther Sci. 2007;19(1):11-22.
Jung TW. The Effects of Functional Electrical Stimulation with Progressive Resistance Exercise on Dorsiflexors of Hemiparesis Side for The Patients with Stroke. Master's Degree DanKook University. 2013.
Stewart C, Postans N, Schwartz MH, et al. An exploration of the function of the triceps surae during normal gait using functional electrical stimulation. Gait & Posture. 2007;26(4):482-8.

상세보기
Kaltenborn. Manual Mobilization of the Joints (7th ed). Yeongmun Publisher. Orthopedic Physical Therapy Products. 2011.
Cho MS. The Effect on Ankle Joint Movement by FES Application on Tibialis Anterior Muscle in Chronic Stroke Patients. J Kor Soc Med. 2011;6(3):277-86.
Nam SM. The Effects on Muscle Activation and Reaction Time of The Balance Trainer Controlled Knee-joint Mobility in Functional Ankle Instability Adult Males. Master's Degree Daegu University. 2015.
Moon GS. The kinematic analysis of the ankle joint and EMG analysis of the Lower Limbs muscle for the different walking speed. Sports Biomech. 2005;15(1):177-95.
Park MC, Lee SY. Deltoid Middle Fiber of the Isometric Contraction According to Elastic Band and Dumbbell on Various Shoulder Abduction Angle. J Korean Soc Phys Med 2016;11(2):71-6.
Dean CM, Shepherd R. Task-related training improves performance of seated reaching tasks after stroke: a randomized controlled trial. Stroke. 1997;28(4):722-8.

상세보기
Bock C, Gentile AM, Kaminski TR. The coordination between trunk and arm motion during pointing movements. Exp Brain Res. 1995;106(3):457-66.

상세보기
Mastalerz A, Palczewska IW. The influence of trunk inclination on muscle activity during sitting on forward inclined seats. Acta Bioeng Biomech. 2010;12(4):19-24.

상세보기
Rapport, LJ, Websster JS, Flemming KL, et al. Predictors of fall among right-hemisphere stroke patients in the rehabilitation setting. Arch Phys Med Rehabil. 1993;74(6):621-6.

상세보기
Mackintosh SF, Hill KD, Dodd KJ, et al. Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Arch Phys Med Rehabil. 2006;87(12):1583-9.

상세보기
Lee HS, Choi JH. Correlation between BBS, FRT, STI, TUG, MBI, and falling in stroke patients. The Journal of Korean Society of Physical Therapy. 2008;20(4):1-6.
Lynch SM, Leahy P, Barker SP. Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury. Phys Ther. 1998;78(2):128-33.

상세보기
Katz-Leurer M, Rotem H, Keren O, et al. Balance abilities and gait characteristics in post-traumatic brain injury, cerebral palsy and typically developed children. Dev Neurorehabil. 2009;12(2):100-5.

상세보기
Duncan PW, Weiner DK, Chandler J, et al. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45(6):192-7.

상세보기
Carr JH, Shepherd RB, Nordholm L, et al. Investigation of a new motor assessment scale for stroke patient. Phys Ther. 1985;65(2):175-80.
Welmer AK, Holmqvist LW, Disa K, et al. Hemiplegic limb synergies in stroke patients. Am J Phys Med Rehabil. 2006;85(2):112-9.

상세보기
Hur YG. The Effects on Spasticity, Range of Motion, Balance on Combining Active-Stretching Exercise of Plantarflexor on Ankle with FES in The Patients with Stroke. Master's Degree Yongin University. 2013.
Jin HK, Cho SH. The Effect of Electrical Stimulation Level on Autonomic Nerve System in Normal Adults. Journal of the Korea Academia-Industrial cooperation Society. 2015;16(3):2029-37.

원문보기 상세보기
Sheffler LR, Chae J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve. 2007;35(5):562-90.

상세보기
Kim SL. The Effects of Weight Bearing based Mobilization with Movement on Balance and Gait in Stroke Patients. Master's Degree SahmYook University. 2015.
Bower KJ, McGinley JL, Miller KJ, et al. Instrumented Static and Dynamic Balance Assessment after Stroke Using Wii Balance Boards: Reliability and Association with Clinical Tests. PLoS One. 2014;9(12):115-282.
Jeong SB. The Effects of Lower Extremity Muscle Strength Exercise of 8 Weeks on the Balance and Gait in Stroke Patients. Master's Degree Yongin University. 2013.
Winter DA, Paltla AE, Prince F. Stiffness control of balance in quiet standing. J Neurophysiol. 1998;80(3):1121-211.
Almeida GL, Carvalho RL, Talis VL. Postural strategy to keep balance on the seesaw. Gait & posture. 2006;23(1):17-21.

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