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Effects of Ankle Joint Mobilization With Movement on Lower Extremity Muscle Strength and Spatiotemporal Gait Parameters in Chronic Hemiplegic Patients

만성 편마비 환자의 발목에 적용한 능동운동을 동반한 관절가동술이 하지근력과 보행의 시공간적 변수에 미치는 영향

  • An, Chang-Man (Dept. of Rehabilitation Science, The Graduate School, Jeonju University) ;
  • Won, Jong-Im (Dept. of Physical Therapy, College of Alternative Medicine, Jeonju University)
  • 안창만 (전주대학교 대학원 재활과학과) ;
  • 원종임 (전주대학교 대체의학대학 물리치료학과)
  • Received : 2012.05.21
  • Accepted : 2012.06.25
  • Published : 2012.09.17

Abstract

The purpose of this study was to determine the effect of ankle joint mobilization with movement (MWM) on the range of motion (ROM) in the ankle, on the muscle strength of lower extremities, and on spatiotemporal gait parameters in chronic hemiplegic patients. Fifteen subjects with chronic stroke were divided into two groups: an experimental group (8 subjects) and a control group (7 subjects). Both groups attended two or three sessions of physical therapy each week. The experimental group also attended additional MWM training sessions three times a week for five weeks. For both groups, the ROM of the ankle, the muscle strength of the lower extremities, and the spatiotemporal gait parameters in paretic limbs were evaluated before and after the training period. The results showed that the experimental group experienced more significant increases than did the control group in terms of passive (6.10%) and active (21.96%) ROM of the ankle, gait velocity (12.96%), and peak torque, of the knee flexor (81.39%), the knee extensor (24.88%), and the ankle plantar flexor (41.75%)(p<.05). These results suggest that MWM training in patients with chronic stroke may be beneficial in increasing ROM in the ankle, muscle strength in the lower extremities, and gait speed.

Keywords

References

  1. 박석우, 송창호. 수중트레드밀훈련이 만성뇌졸중 환자의 보행능력에 미치는 영향. 특수교육재활과학연구. 2011;50(2):149-165.
  2. 손효영, 최종덕. 체중이동 훈련을 통한 관절가동화기법이 편마비환자의 균형 및 보행속도에 미치는 영향. 한국전문물리치료학회지. 2012;19(1):10-18.
  3. Andriacchi TP, Andersson GB, Fermier RW, et al. A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am. 1980;62(5):749-757.
  4. Boudreau SN, Dwyer MK, Mattacola CG, et al. Hip-muscle activation during the lunge, single-leg squat, and step-up-and-over exercises. J Sport Rehabil. 2009;18(1):91-103.
  5. Chou SW, Wong AM, Leong CP, et al. Postural control during sit-to-stand and gait in stroke patients. Am J Phys Med Rehabil. 2003;82(1): 42-47. https://doi.org/10.1097/00002060-200301000-00007
  6. Collins N, Teys P, Vicenzino B. The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains. Man Ther. 2004;9(2):77-82. https://doi.org/10.1016/S1356-689X(03)00101-2
  7. Davidoff GN, Keren O, Ring H, et al. Acute stroke patients: Long-term effects of rehabilitation and maintenance of gains. Arch Phys Med Rehabil. 1991;72(11):869-873. https://doi.org/10.1016/0003-9993(91)90001-Y
  8. Dettmann MA, Linder MT, Sepic SB. Relationships among gait performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med. 1987;66(2):77-90.
  9. Dijs HM, Roofthooft JM, Driessens MF, et al. Effect of physical therapy on limited joint mobility in the diabetic foot. J Am Podiatr Med Assoc. 2000;90(3):126-132. https://doi.org/10.7547/87507315-90-3-126
  10. Eng JJ, Winter DA. Kinetic analysis of the lower limbs during walking: What information can be gained from a three-dimensional model? J Biomech. 1995;28(6):753-758. https://doi.org/10.1016/0021-9290(94)00124-M
  11. Ferrell WR, Tennant N, Sturrock RD, et al. Amelioration of symptoms by enhancement of proprioception in patients with joint hypermobility syndrome. Arthritis Rheum. 2004;50(10): 3323-3328. https://doi.org/10.1002/art.20582
  12. Goldie PA, Matyas TA, Evans OM. Gait after stroke: Initial deficit and changes in temporal patterns for each gait phase. Arch Phys Med Rehabil. 2001;82(8):1057-1065. https://doi.org/10.1053/apmr.2001.25085
  13. Green T, Refshauge K, Crosbie J, et al. A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains. Phys Ther. 2001;81(4):984-994.
  14. Hesse S, Jahnke MT, Luecke D, et al. Short-term electrical stimulation enhances the effectiveness of botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients. Neurosci Lett. 1995;201(1):37-40. https://doi.org/10.1016/0304-3940(94)12124-9
  15. Hill KD, Goldie PA, Baker PA, et al. Retest reliability of the temporal and distance characteristics of hemiplegic gait using a footswitch system. Arch Phys Med Rehabil. 1994;75(5): 577-883.
  16. Hsu AL, Tang PF, Jan MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil. 2003;84(8):1185-1193. https://doi.org/10.1016/S0003-9993(03)00030-3
  17. Jan MH, Lin CH, Lin YF, et al. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: A randomized controlled trial. Arch Phys Med Rehabil. 2009;90(6):897-904. https://doi.org/10.1016/j.apmr.2008.11.018
  18. Jonhagen S, Halvorsen K, Benoit DL. Muscle activation and length changes during two lunge exercises: Implications for rehabilitation. Scand J Med Sci Sports. 2009;19(4):561-568. https://doi.org/10.1111/j.1600-0838.2007.00692.x
  19. Kaltenborn FM. The kaltenborn method of joint examination and treatment. In: Kaltenborn FM, Evjenth O, Kaltenborn TB, eds. Manual Mobilization of the Joints. Oslo, Norlis Bokhandel. 1999:21-26.
  20. Kim CM, Eng JJ. The relationship of lower- extremity muscle torque to locomotor performance in people with stroke. Phys Ther. 2003;83(1):49-57.
  21. Kluding PM, Santos M. Effects of ankle joint mobilizations in adults poststroke: A pilot study. Arch Phys Med Rehabil. 2008;89(3):449-456. https://doi.org/10.1016/j.apmr.2007.12.005
  22. Lin PY, Yang YR, Cheng SJ, et al. The relation between ankle impairments and gait velocity and symmetry in people with stroke. Arch Phys Med Rehabil. 2006;87(4):562-568. https://doi.org/10.1016/j.apmr.2005.12.042
  23. MacIntyre NJ, Rombough R, Brouwer B. Relationships between calf muscle density and muscle strength, mobility and bone status in the stroke survivors with subacute and chronic lower limb hemiparesis. J Musculoskelet Neuronal Interact. 2010;10(4):249-255.
  24. Maitland GD. Peripheral Manipulation. 3rd ed. London, UK, Butterworths-Heinemann, 1991:171-190.
  25. Menz HB, Latt MD, Tiedmann A, et al. Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture 2004;20(1):20-25. https://doi.org/10.1016/S0966-6362(03)00068-7
  26. Moseley AM. The effect of casting combined with stretching on passive ankle dorsiflexion in adults with traumatic head injuries. Phys Ther. 1997;77(3):248-259.
  27. Mulligan BR. Mobilisation with movement. J Man Manip Ther. 1993;1(4):154-156. https://doi.org/10.1179/jmt.1993.1.4.154
  28. Nene A, Mayagoitia R, Veltink P. Assessment of rectus femoris function during initial swing phase. Gait Posture. 1999;9(1):1-9. https://doi.org/10.1016/S0966-6362(98)00042-3
  29. Olney SJ, Griffin MP, McBride ID. Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: A regression approach. Phys Ther. 1994;74(9):872-885.
  30. Selles RW, Li X, Lin F, et al. Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: Effects of a 4-week intervention program. Arch Phys Med Rehabil. 2005;86(12):2330-2336. https://doi.org/10.1016/j.apmr.2005.07.305
  31. Shields RK, Madhavan S, Gregg E, et al. Neuromuscular control of the knee during a resisted single-limb squat exercise. Am J Sports Med. 2005;33(10):1520-1526. https://doi.org/10.1177/0363546504274150
  32. Sole G, Hamren J, Milosavljevic S, et al. Test-retest reliability of isokinetic knee extension and flexion. Arch Phys Med Rehabil. 2007;88(5): 626-631. https://doi.org/10.1016/j.apmr.2007.02.006
  33. Sousa CO, Barela JA, Prado-Medeiros CL, et al. Gait training with partial body weight support during overground walking for individuals with chronic stroke: A pilot study. J Neuroeng Rehabil. 2011;8:48-54. https://doi.org/10.1186/1743-0003-8-48
  34. Sutherland DH, Cooper L, Daniel D. The role of the ankle plantar flexors in normal walking. J Bone Joint Surg Am. 1980;62(3):354-363.
  35. Teixeira-Salmela LF, Nadeau S, Mcbride I, et al. Effects of muscle strengthening and physical conditioning training on temporal, kinematic and kinetic variables during gait in chronic stroke survivors. J Rehabil Med. 2001;33(2):53-60. https://doi.org/10.1080/165019701750098867
  36. Tilson JK, Settle SM, Sullivan KJ. Application of evidence-based practice strategies: Current trends in walking recovery interventions poststroke. Top Stroke Rehabil. 2008;15(3): 227-246. https://doi.org/10.1310/tsr1503-227
  37. Vicenzino B, Branjerdporn M, Teys P, et al. Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain. J Orthop Sports Phys Ther. 2006;36(7):464-471. https://doi.org/10.2519/jospt.2006.2265
  38. Wu G. A review of body segmental displacement, velocity, and acceleration in human gait. In: Craik RL, Oatis CA, eds. Gait Analysis: Theory and application. St. Louis, Mosby, 1995:205-222.

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