[논문]Effects of Seated Exercise of Thoracic and Abdominal Muscles on Upper Extremity Function and Trunk Muscles Activity in Patients with Chronic Stroke

Park, Shinjun; Kim, Sangduk

doi:10.20540/jiaptr.2020.11.2.2065

Effects of Seated Exercise of Thoracic and Abdominal Muscles on Upper Extremity Function and Trunk Muscles Activity in Patients with Chronic Stroke 원문보기

Journal of international academy of physical therapy research, v.11 no.2, 2020년, pp.2065 - 2070

Park, Shinjun (Department of Physical Therapy, Gangdong University) , Kim, Sangduk (Department of Nursing, Gangdong University)

Abstract ▼ AI-Helper

Background: Weakness of the abdominal and mid thoracic muscles the lead to thoracic kyphosis of stroke patients. The trunk muscles activity of stroke patients is significantly related to upper extremity. Objectives: To investigate the effect of seated exercise of thoracic and abdominal muscles on upper extremity function and trunk muscles activity in stroke patients. Design: One-group pretest-posttest design. Methods: A total of 27 stroke patients were recruited. All stroke patient were given seated abdominal exercise (posterior pelvic tilt exercises) and thoracic exercise (postural-correction exercise). All exercises were conducted for 30 minutes, three times a week for four weeks. The manual function test (MFT) and electromyography (EMG) were measured, and EMG electrodes were attached to thoracic paraspinal muscles and lower rectus abdominal muscles. EMG signal is expressed as %RVC (reference voluntary contraction). Results: Experimental group showed significant increases in abdominal muscles, paraspinal muscles activity and MFT total score, items of arm motion (forward elevation of the upper extremity, lateral elevation of the upper extremity, touch the occiput with the palm) in MFT after four weeks. Conclusion: These results suggest that, in stroke patients, seated exercise of thoracic and abdominal muscles contribute to improve trunk muscles activity and upper extremity function in stroke patients.

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제안 방법

All subjects in this study were evaluated at baseline and after 4 weeks of intervention. All evaluations were evaluated by a physical therapist with at least 8 years of physical therapy experience.
Sampling was 2000 Hz, bandpass filtering was 10-200 Hz, and EMG signals were processed as Root Mean Square (RMS) and calculated as % Reference voluntary contraction (%RVC). First, RMS values of midthoracic paraspinal, and rectus abdominis EMG signals were extracted while in slumped sitting posture for 5 seconds. Second, RMS values of midthoracic paraspinal and rectus abdominis EMG signals were extracted while expiring for 5 seconds sitting upright.
The intervention was conducted by 5 neurological physiotherapists with at least 3 years of experience, and the researcher supervised the intervention. The exercises were conducted for 30 minutes, three times a week for four weeks. At the beginning of each session, subjects were seated at the treatment table with hip and knee joints in 90° flexion.
All participants in this study were either admitted to a rehabilitation hospital or undergoing outpatient treatment. The intervention was conducted by 5 neurological physiotherapists with at least 3 years of experience, and the researcher supervised the intervention. The exercises were conducted for 30 minutes, three times a week for four weeks.
80, and twenty-seven subjects were admitted to allow for dropouts. The intervention was seated exercise of thoracic and abdominal muscles, with outcomes evaluated by testing arm and trunk muscle function.

대상 데이터

Subjects were included if they had a score of 24 or higher on the mini-mental state examination (Korean version), ability to sit independently (static balance point on the trunk impairment scale 5 or more), a score of 1+ or less on the modified Ashworth Scale (MAS), and a first stroke that had occurred more than 6 months previously. Before the initial evaluation, the researcher explained to the purpose and method of the study to the study subjects.
This was a single group open intervention study with outcome assessments by a therapist who did not have detailed knowledge of the study. The required sample size (G* Power 3.1.9.2, Germany) was estimated using effect size .80, significance level .05 and power .80, and twenty-seven subjects were admitted to allow for dropouts. The intervention was seated exercise of thoracic and abdominal muscles, with outcomes evaluated by testing arm and trunk muscle function.
The study was conducted at the rehabilitation hospital in Gyeonggi-do. Twenty-seven stroke patients selected by screening were evaluated at baseline and after four weeks of intervention.
The study was conducted at the rehabilitation hospital in Gyeonggi-do. Twenty-seven stroke patients selected by screening were evaluated at baseline and after four weeks of intervention.

데이터처리

The muscle activity changes were analyzed using Student's t-test for paired values. The MFT changes were analyzed using the Wilcoxon signed rank test. A statistical significance level of .
The muscle activity changes were analyzed using Student's t-test for paired values.

성능/효과

After four weeks of seated exercise of thoracic and abdominal muscles, the experimental group experienced significant improvements in the midthoracic, paraspinal, and rectus abdominis %RVC and MFT total scores, forward elevation of the upper extremity (Task FE), lateral elevation of the upper extremity (Task LE), and "touch the occiput with the palm" (Task PO) (P<.05) (Tables 2 and 3).
The stroke patients participating in present study showed a significant increase in MFT total score after seated exercise of thoracic and abdominal muscles. MFT items showed a significant increase in Task FE, Task LE, and Task PO items.
The stroke patients participating in this study showed a significant increase in midthoracic paraspinal and rectus abdominis muscle activity after seated exercise of thoracic and abdominal muscles. The trunk exercise, which consisted of curl up, abdominal hollowing, bridge, and quadruped exercise, showed no significant difference in stroke abdominal muscles activity.
Second, since the scores for each MFT item evaluated in this study could not accurately confirm the change in the range of motion of the joint, it is necessary to check other evaluations for the arm function evaluation. Third, since the single group design has only the experimental group, the internal validity may be low. It is expected that the effects of seated exercise of thoracic and abdominal muscles will be clarified in larger test which include other trunk exercise³² or arm training³³.

후속연구

First, it is difficult to generalize because the subjects who participated in this study withal had mild to moderate stroke. Second, since the scores for each MFT item evaluated in this study could not accurately confirm the change in the range of motion of the joint, it is necessary to check other evaluations for the arm function evaluation. Third, since the single group design has only the experimental group, the internal validity may be low.

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