Kim, Heejoong
(Department of Physical Therapy, The Graduate School, Sahmyook University)
,
Chung, Yijung
(Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University)
Purpose: This study aimed to investigate the effect of progressive speed increase during underwater gait training on stroke patients' balance, gait, and endurance, as well as to compare the effects of underwater gait training and land gait training. Methods: Subjects were randomly allocated into thr...
Purpose: This study aimed to investigate the effect of progressive speed increase during underwater gait training on stroke patients' balance, gait, and endurance, as well as to compare the effects of underwater gait training and land gait training. Methods: Subjects were randomly allocated into three groups. Underwater gait training group (n=10), land gait training group (n=9) and control group (n=9). The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks. The patients were assessed before and after the experiment in terms of the Berg balance scale, characteristics of gait, and 6-minute walking test. Results: The beneficial effect perceived in the speed increase underwater gait training (UGT) group was significantly greater than in the groups who were trained with speed increase land gait training (LGT) group, and the control group regarding the following aspects: the Berg balance scale, the affected step length, the affected stride length, and the 6-minute walking test (p<0.05). The LGT group showed a more significant effect on the Berg balance scale, the affected step length, the affected stride length, and the 6-minute walking test (p<0.05), compared to the control group. Furthermore, the UGT group showed a significantly greater effect on the gait speed when compared to the control groupb (p<0.05). Conclusion: This study shows that progressive UGT is effective in improving balance, gait, and endurance in stroke patients. Therefore, we believe that progressive UGT may be used as a method for general physical therapy in patients with stroke.
Purpose: This study aimed to investigate the effect of progressive speed increase during underwater gait training on stroke patients' balance, gait, and endurance, as well as to compare the effects of underwater gait training and land gait training. Methods: Subjects were randomly allocated into three groups. Underwater gait training group (n=10), land gait training group (n=9) and control group (n=9). The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks. The patients were assessed before and after the experiment in terms of the Berg balance scale, characteristics of gait, and 6-minute walking test. Results: The beneficial effect perceived in the speed increase underwater gait training (UGT) group was significantly greater than in the groups who were trained with speed increase land gait training (LGT) group, and the control group regarding the following aspects: the Berg balance scale, the affected step length, the affected stride length, and the 6-minute walking test (p<0.05). The LGT group showed a more significant effect on the Berg balance scale, the affected step length, the affected stride length, and the 6-minute walking test (p<0.05), compared to the control group. Furthermore, the UGT group showed a significantly greater effect on the gait speed when compared to the control groupb (p<0.05). Conclusion: This study shows that progressive UGT is effective in improving balance, gait, and endurance in stroke patients. Therefore, we believe that progressive UGT may be used as a method for general physical therapy in patients with stroke.
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문제 정의
The purpose of this study was to assess the improvement in balance, gait, and endurance by using progressive UGT. Among the underwater exercises, underwater gait has been suggested as a method to improve the function of the lower limbs.
Second, it is thought that gait speed was influenced by the inability to control the flotation phenomenon in the lower limb of the affected side. This study shows that UGT is effective in improving the balance, gait, and endurance of stroke patients. As mentioned above, UGT was confirmed that training in the water was effective as resistance exercise of the lower limb.
가설 설정
This was reported to be due to the fact that the lower limbs require higher force by water resistance. In this study, the authors considered that UGT strengthens the flexor and extensor muscles of the hip joints of the existing side, increasing the stability in posture and the stability in gait stance phase, resulting in an augmented step length and stride length.
제안 방법
The 30 subjects selected were divided into three groups: speed increase underwater gait training (UGT) group, speed increase land gait training (LGT) group, and control group according to the intervention method. All subjects underwent general physical therapy five times a week for 30 minutes per section. Additionally, the UGT group trained three times a week for 30 minutes per section.
There were three research assistants for the main research and four research assistants to perform the study measurements. Before conducting the experiments and the measurements, instruction and exercises on how to use the equipment, measurement methods, and on the training progress were given in order to minimize errors that could have occurred during the experiment. During gait training, patients were followed from behind to ensure their safety
In order to measure the stride length frequency at a comfortable speed in the water, the patient’s comfortable speed was measured three times, and the mean value was calculated.
The LGT group underwent the intervention three times a week for 30 minutes per section. In the control group, land gait training was conducted three times a week for 30 minutes per section. The training was set to 5 minutes of warm up, 20 minutes of gait training, and 5 minutes of cool down.
The Berg Balance Scale was used to assess balance ability, the spatiotemporal gait ability test was used to assess gait ability, and the 6-minute walking test was used to assess endurance. In this study, a single-blind method was used and the assessment, analysis and training were conducted by a therapist with 3 years of clinical experience who was unaware of the group to which each patient belonged.
This result was reported to arise from the greater resistance and turbulent flow in the underwater environment in comparison to what happens on the land.40In this study, underwater gait training with fast speed is applied, which is thought to induce increased metabolic consumption by generating large water resistance. Therefore, in line with the purpose of this study, progressive UGT had a positive impact on the improvement of gait endurance in stroke patients.
We assessed balance ability, gait ability, and endurance. The 30 subjects selected were divided into three groups: speed increase underwater gait training (UGT) group, speed increase land gait training (LGT) group, and control group according to the intervention method. All subjects underwent general physical therapy five times a week for 30 minutes per section.
94) as a measure of the maximum walkable distance for 6 minutes.31The assessment method required the patients to go back and forth along a gait passage of 25 m, which had markers every 1 m, in its total length without assistance for 6 minutes. The gait speed and break time were adjusted according to the patient’s ability
The control group was placed in the treatment room with the markings measuring 4×6 m and the land gait training was conducted for 30 minutes.
97, which shows that this is a very valid assessment tool.30 The gait ability test was performed with the subject walking at a comfortable speed, the measurement was taken 3 times and the mean value was used. The shoes and walking aids were used according to the characteristics of the patient and the measurements were made under the same conditions in the preand post-tests.
In order to exclude the gait acceleration period and deceleration period, the subjects were allowed to walk at a comfortable gait speed for 2 m before and including the gait plate. The gait speed and cadence for temporal gait ability, and step length and stride length for spatial gait ability were collected and analyzed.
30 The gait ability test was performed with the subject walking at a comfortable speed, the measurement was taken 3 times and the mean value was used. The shoes and walking aids were used according to the characteristics of the patient and the measurements were made under the same conditions in the preand post-tests. In order to exclude the gait acceleration period and deceleration period, the subjects were allowed to walk at a comfortable gait speed for 2 m before and including the gait plate.
In the control group, land gait training was conducted three times a week for 30 minutes per section. The training was set to 5 minutes of warm up, 20 minutes of gait training, and 5 minutes of cool down. We performed general physical therapy, which is an exercise-based therapy conducted during the hospitalization and neurodevelopmental treatment.
UGT was conducted in a 4×6-meter pool at a water temperature of 34°C18 and a water depth of 1.2 m for 30 minutes.
대상 데이터
The subjects of all the three groups participated in the program according to the designated schedule. There were three research assistants for the main research and four research assistants to perform the study measurements. Before conducting the experiments and the measurements, instruction and exercises on how to use the equipment, measurement methods, and on the training progress were given in order to minimize errors that could have occurred during the experiment.
We selected 30 adult stroke patients who were admitted to the Hospital B in Gyeonggi-do, and participated in the rehabilitation program. We randomized hemiplegia patients who were diagnosed with stroke into three groups (Table 1).
데이터처리
We used the paired t-test to respectively verify the difference between preand post-test mean values within the group. One-way ANOVA was performed to compare the differences in variation between the groups. The least squares difference (LSD) method was used for post-hoc analysis to explain differences between the groups after the test
The pre-experiment homogeneity test was con ducted for subjects’ general characteristics, and dependent variables were analyzed by chi-square test and one-way ANOVA.
이론/모형
We measured the results using four clinical tests with high reliability, validity, and sensitivity. The Berg Balance Scale was used to assess balance ability, the spatiotemporal gait ability test was used to assess gait ability, and the 6-minute walking test was used to assess endurance. In this study, a single-blind method was used and the assessment, analysis and training were conducted by a therapist with 3 years of clinical experience who was unaware of the group to which each patient belonged.
The general characteristics of patients were analyzed using descriptive statistics, and normality tests were performed using the Shapiro–Wilk test.
성능/효과
The Berg Balance Scale score of the UGT group patients increased from 45.44 points, before the experiment, to 52.70 points, after the experiment, yielding a difference of 6.50 points, which was statistically significant when compared to other two groups (p < 0.05).
The UGT group showed a significant improvement (pre- and postintervention difference, hereinafter difference, 4.05) in gait speed before and after the experiment compared to land gait training (difference, 0.62) (p < 0.05).
37 investigated heart rate, maximal oxygen uptake, gait, and lower limb muscle activity while walking on a treadmill on the land and underwater in elderly women. The results showed significantly increased heart rate, decreased cadence, and significantly increased lower extremity muscle activity in the underwater gait during gait at the same speed. Additionally, Chu et al.
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