Objective: To investigate the effects of training using a trunk control robot (TCR) system combined with conventional therapy (CT) on balance and gait abilities in persons with chronic stroke. Design: Two-group pretest-posttest design. Methods: Thirty-five subjects with chronic stroke were randomly ...
Objective: To investigate the effects of training using a trunk control robot (TCR) system combined with conventional therapy (CT) on balance and gait abilities in persons with chronic stroke. Design: Two-group pretest-posttest design. Methods: Thirty-five subjects with chronic stroke were randomly assigned to either the TCR group (n=17) or the trunk extension-training (TET) group (n=18). Both groups performed CT for 30 minutes, after which the TCR group performed TCR training and the TET group performed trunk extension training for 20 minutes. Both groups performed the therapeutic interventions 3 days per week for 6 weeks. Balance ability was evaluated using the Berg Balance Scale (BBS), and the Timed Up-and-Go (TUG) test. Gait ability was measured using the 10 m Walk Test (10MWT) and the NeuroCom Smart Balance Master. Results: TCR group showed significant improvements in static balance (weight bearing) and dynamic balance (weight shifting speed, weight shifting direction, BBS, and TUG), 10MWT, gait speed, and step width (p<0.05); step length was not significant. The TET group showed a significant partial improvement of dynamic balance (weight shifting speed, weight shifting direction, BBS, and 10MWT (p<0.05), but the improvements in static balance, TUG, gait speed, and step width and step length was not significant. Additionally, significant differences in static balance, dynamic balance (weight shifting speed, weight shifting direction, BBS, and TUG), 10MWT, gait speed, and step width were detected between groups (p<0.05). Conclusions: TCR training combined with CT is effective in improving static and dynamic balance, as well as gait abilities in persons with chronic stroke.
Objective: To investigate the effects of training using a trunk control robot (TCR) system combined with conventional therapy (CT) on balance and gait abilities in persons with chronic stroke. Design: Two-group pretest-posttest design. Methods: Thirty-five subjects with chronic stroke were randomly assigned to either the TCR group (n=17) or the trunk extension-training (TET) group (n=18). Both groups performed CT for 30 minutes, after which the TCR group performed TCR training and the TET group performed trunk extension training for 20 minutes. Both groups performed the therapeutic interventions 3 days per week for 6 weeks. Balance ability was evaluated using the Berg Balance Scale (BBS), and the Timed Up-and-Go (TUG) test. Gait ability was measured using the 10 m Walk Test (10MWT) and the NeuroCom Smart Balance Master. Results: TCR group showed significant improvements in static balance (weight bearing) and dynamic balance (weight shifting speed, weight shifting direction, BBS, and TUG), 10MWT, gait speed, and step width (p<0.05); step length was not significant. The TET group showed a significant partial improvement of dynamic balance (weight shifting speed, weight shifting direction, BBS, and 10MWT (p<0.05), but the improvements in static balance, TUG, gait speed, and step width and step length was not significant. Additionally, significant differences in static balance, dynamic balance (weight shifting speed, weight shifting direction, BBS, and TUG), 10MWT, gait speed, and step width were detected between groups (p<0.05). Conclusions: TCR training combined with CT is effective in improving static and dynamic balance, as well as gait abilities in persons with chronic stroke.
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문제 정의
The goal of this study was to investigate the effectiveness of TCR-assisted therapy in improving balance and gait in individuals with chronic stroke. Our results indicated that TCR training combined with CT is effective in improving static and dynamic balance, as well as gait abilities in these individuals.
가설 설정
Recent reports in systemic reviews about trunk training on trunk control in patients suffering from stroke have shown that there is a strong amount of evidence showing that trunk training is able to improve trunk control, sitting and standing balance and mobility [23]. Therefore, we aimed to test the hypothesis that trunk control robot (TCR) system in training individuals with chronic stroke would improve their balance and gait ability.
제안 방법
The primary outcome was balance ability and the secondary outcome was gait ability. All assessments were performed at baseline and after the 6 weeks intervention. A NeuroCom Smart Balance Master (NeuroCom International, Clackamas, OR, USA) were used for the static and dynamic balance.
CT consisted of aerobic exercise for 10 minutes (Rehab Treadmill, JT4000M, JNBMED, Goyang, Korea), isokinetic exercise at 50 revolutions per minute for 10 minutes (SCIFIT Bi-Directional Recumbent Bikes, Tulsa, OK, USA), and strengthening exercise measured individually by a smartcard system for 10 minutes (10 per minute) (5540 Leg Press Rehab, HUR, Helsinki, Finland).
This study had several limitations. First, the TCR system was applied to all subjects, regardless of the general characteristics of the subject, such as gender, age, height, and weight. Although tools of various difficulties were provided according to the general characteristics of the subjects and various parameters of the tool were changed according to individual balance and the gait ability, there was a limit in providing diversity.
TET was performed by using a pneumatic trunk strength training system (Abdomen/Back Extension Rehab 5310; HUR, Helsinki, Finland). This equipment was specifically designed to assist older adults to comfortably exercise the back and abdominal muscles for targeted core strengthening. The degree of resistance was measured by 10 repetition maximum tests, and the individual exercise form and resistance level were memorized by a smart card system.
The degree of resistance was measured by 10 repetition maximum tests, and the individual exercise form and resistance level were memorized by a smart card system. This training was performed while sitting, and the resistance bars were placed on the 5th and 6th thoracic vertebrae of the subject by adjusting the height of the chair and the angle and resistance position of the resistance bar. To prevent the compensation action of the upper extremity, both limbs were folded and placed in front of the chest (Figure 2).
대상 데이터
Flow diagram of this study. Thirty-five individuals were enrolled in the study and were randomly assigned to the Trunk control robot group (n=17) or the Trunk extension group (n=18).
데이터처리
An independent t-test and the χ2 test were used to compare the baseline characteristics of the two groups. For the change of primary and secondary outcomes within each group, pre and post intervention data were compared separately using the paired t-test and an independent t-test was used for between-group comparisons. A p-value of less than 0.
이론/모형
, Armonk, NY, USA). The Shapiro-Wilk test was used to determine the normality of the parameter. The continuous data and the categorical data were expressed as the mean±SD and as a percentage respectively.
성능/효과
In this study, there were clinically significant effect sizes and large power for detecting statistically significant changes in the weight shifting speed (effect size=0.79), weight shifting direction (effect size=0.51), and BBS (effect size=0.60). In addition, there were clinically significant effect sizes for weight bearing rates on hemiparetic lower limb (effect size= 0.
Regarding gait ability, 10MWT (p=0.014; effect size= 0.54), gait speed (p≤0.001; effect size=0.56), and step width (p=0.033; effect size=0.39) of the TCR group increased more significantly than the corresponding parameters of the TET group.
Therefore, further studies will need to take this point into account. Second, the number of subjects was small, and the condition of subjects was limited to chronic stroke, which limited the generalization of the results of the TCR training. Future studies should assess obtained results on a larger cohort of subjects with various durations from the stroke onset.
However, the current study focused on the activation of the trunk muscles through anti-gravity training, consisting of standing up from the sitting position with the aid of the TCR system in order to match the degree, time, and condition of the intervention, while TET was applied to subjects from TET group. The BBS and the 10MWT were performed as a basic test, but dynamic balance and gait abilities were assessed by the TUG, and the influence of subjective judgment was minimized by using a highly reliable balance master. We measured the degree of weight support to determine the change in static balance and measured the speed and direction of the weight shift to detect even minimal changes in dynamic balance.
They reported that the 10MWT improved significantly in the experimental group (using the Spine Balance 3D system), but not in the control group, and that the core muscle strength, which was estimated by the Spine Balance 3D system evaluation program, improved more significantly in the experimental group as well. This study confirms that balance training using the Spine Balance 3D system effectively improves dynamic balance, static balance, and gait by improving trunk muscle strength [35]. Our study also showed a significant difference in the 10MWT through trunk training, which is similar to our results in that improvement of trunk function improved balance and gait ability.
후속연구
Moreover, it will be necessary to compare the effects of applying the TCR training by classifying patients into acute and sub-acute stroke groups. Finally, further studies are needed to confirm the suitability of training method of the trunk by long-term follow-up of TCR training by setting longer experimental study periods. In consideration of the above problems, a more detailed training method should be provided to identify various effects of this method.
Second, the number of subjects was small, and the condition of subjects was limited to chronic stroke, which limited the generalization of the results of the TCR training. Future studies should assess obtained results on a larger cohort of subjects with various durations from the stroke onset. Moreover, it will be necessary to compare the effects of applying the TCR training by classifying patients into acute and sub-acute stroke groups.
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