Effects of Pelvic Tilt Training using Inclinometer on Joint Position Sense and Postural Alignment in Patients with Chronic Stroke

  • Gu, Ja-Shin (Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University) ;
  • Choi, Sung-Jin (Department of Physical Therapy, Graduate School of Daejeon University) ;
  • Choi, Ho-Suk (Department of Physical Therapy, Graduate School of Daejeon University) ;
  • Shin, Won-Seob (Department of Physical Therapy, College of Health and Medical Science, Daejeon University)
  • Received : 2016.01.13
  • Accepted : 2016.02.22
  • Published : 2016.02.25

Abstract

Purpose: The aim of this study was to determine the effectiveness of pelvic tilt training using an inclinometer on joint position sense and postural alignment in individuals with stroke. Methods: Thirty-one subjects with chronic stroke were divided into two groups: the experimental group (16 subjects) and the control group (15 subjects). Subjects in both groups received neuro-developmental therapy five times per week. In addition, the patients in the experimental group also received pelvic tilt training using an inclinometer for 30 minutes, 3 times a week for 4 weeks. Maximal range of anterior, posterior pelvic tilt and joint position sense were used to evaluate pelvic tilt motion. Image analysis was performed for evaluation of postural alignment on in standing position. Results: Significant difference in Iimprovement of pre- and post-intervention of joint position sense was observed showed significant difference (p<0.05) in all groups. Experimental groups showed sSignificant differences in maximal range of posterior pelvic tilt in on the paretic side were observed in the experimental groups compared to with the control group (p<0.05). Conclusion: These findings suggest that pelvic tilt training using an inclinometer may help to improve range of pelvic tilt and joint position sense of stroke patients.

Keywords

References

  1. Ryerson S, Levit K. Functional movement reeducation: A contemporary model for stroke rehabilitation. Secaucus, Churchill Livingstone, 1997:15-48.
  2. Wadell I, Kusoffsky A, Nilsson BY. A follow-up study of stroke patients 5-6 years after their brain infarct. Int J Rehabil Res. 1987;10:103-10. https://doi.org/10.1097/00004356-198712005-00021
  3. Carey LM, Matyas TA, Oke LE. Sensory loss in stroke patients: Effective training of tactile and proprioceptive discrimination. Arch Phys Med Rehabil. 1993;74(6):602-11. https://doi.org/10.1016/0003-9993(93)90158-7
  4. Newcomer KL, Laskowski ER, Yu B et al. Differences in repositioning error among patients with low back pain compared with control subjects. Spine. 2000;25(19):2488-93. https://doi.org/10.1097/00007632-200010010-00011
  5. Wolpert DM, Ghahramani Z, Jordan MI. An internal model for sensorimotor integration. Science. 1995;269(5232):1880-2. https://doi.org/10.1126/science.7569931
  6. Miura K, Ishibashi Y, Tsuda E et al. The effect of local and general fatigue on knee proprioception. Arthroscopy. 2004;20(4):414-8. https://doi.org/10.1016/j.arthro.2004.01.007
  7. Maurer C, Mergner T, Bolha B et al. Vestibular, visual, and somatosensory contributions to human control of upright stance. Neurosci Lett. 2000;281(2):99-102. https://doi.org/10.1016/S0304-3940(00)00814-4
  8. Friemert B, Bach C, Schwarz W et al. Benefits of active motion for joint position sense. Knee Surg Sports Traumatol Arthrosc. 2006;14(6):564-70. https://doi.org/10.1007/s00167-005-0004-7
  9. Uchio Y, Ochi M, Fujihara A et al. Cryotherapy influences joint laxity and position sense of the healthy knee joint. Arch Phys Med Rehabil. 2003;84(1):131-5. https://doi.org/10.1053/apmr.2003.50074
  10. Kirker S, Simpson D, Jenner J et al. Stepping before standing: Hip muscle function in stepping and standing balance after stroke. J Neurol Neurosurg Psychiatry. 2000;68(4):458-64. https://doi.org/10.1136/jnnp.68.4.458
  11. Yavuzer G, Eser F, Karakus D et al. The effects of balance training on gait late after stroke: A randomized controlled trial. Clin Rehabil. 2006; 20(11):960-9. https://doi.org/10.1177/0269215506070315
  12. Vleeming A, Mooney V, Stoeckart R. Movement, stability & lumbopelvic pain: Integration of Research and Therapy. 2nd ed. Edinburgh, Churchill Livingstone Elsevier, 2007:113-37.
  13. Bae SS, Kim TY, Chung HA et al. A comprehensive kinematic approach to pelvis. J Kor Phys Ther. 1999;11(2):93-102.
  14. Aruin AS. The effect of asymmetry of posture on anticipatory postural adjustments. Neurosci lett. 2006;401(1):150-3. https://doi.org/10.1016/j.neulet.2006.03.007
  15. Carr JH, Shepherd RB, Nordholm L et al. Investigation of a new motor assessment scale for stroke patients. Phys Ther. 1985;65(2):175-80. https://doi.org/10.1093/ptj/65.2.175
  16. Kim JH, Chang SK. The effects of robo-horseback riding with changes of pelvic tilting and speeds on muscle activities of trunk and lower limb. J Kor Phys Ther. 2014;26(5):290-5.
  17. Kong SW, Jeong YW, Kim JY. Correlation between balance and gait according to pelvic displacement in stroke patients. J Phys Ther Sci. 2015; 27(7):2171-4. https://doi.org/10.1589/jpts.27.2171
  18. Wada O, Tateuchi H, Ichihashi N. The correlation between movement of the center of mass and the kinematics of the spine, pelvis, and hip joints during body rotation. Gait Posture. 2014;39(1):60-4. https://doi.org/10.1016/j.gaitpost.2013.05.030
  19. Lennon S. Gait re-education based on the bobath concept in two patients with hemiplegia following stroke. Phys Ther. 2001;81(3):924-35.
  20. Tyson SF, Selley A. The development of the stroke physiotherapy intervention recording tool (SPIRIT). Disabil Rehabil. 2004;26(20):1184-8. https://doi.org/10.1080/09638280410001714781
  21. Jang SH, Park SJ, Kim MH et al. The effect of pelvic tilt exercise with changing the body position on foot contact pattern in hemiplegic patients. J Korean soc phys med. 2010;5(3):445-53.
  22. Trueblood PR, Walker JM, Perry J et al. Pelvic exercise and gait in hemiplegia. Phys Ther. 1989;69(1):18-26. https://doi.org/10.1093/ptj/69.1.18
  23. Davies PM. Right in the middle: Selective trunk activity in the treatment of adult hemiplegia. Berlin, Springer-Verlag, 1990:31-65.
  24. Lee J. A study on the effect of pelvic tilting exercise in hemiplegic patients. Phys Ther Korea. 1998;5(2):23-38.
  25. Kim JH, Hwang BY, Oh TY. Influence of trunk control using pelvic movements upon the foot pressure in patients with hemiplegia. J Kor Phys Ther. 2007;19(5):11-9.
  26. Hlavacka F, Horak FB. Somatosensory influence on postural response to galvanic vestibular stimulation. Physiol Res. 2006;55(1):121-7.
  27. Thikey H, Grealy M, van Wijck F et al. Augmented visual feedback of movement performance to enhance walking recovery after stroke: Study protocol for a pilot randomised controlled trial. Trials. 2012;13(1):163. https://doi.org/10.1186/1745-6215-13-163
  28. Comerford M, Mottram S. Kinetic control: The management of uncontrolled movement. Amsterdam, Elsevier Churchill Livingstone, 2012:63-81.
  29. Molier BI, Van Asseldonk EH, Hermens HJ et al. Nature, timing, frequency and type of augmented feedback; does it influence motor relearning of the hemiparetic arm after stroke? A systematic review. Disabil and rehabil. 2010;32(22):1799-809. https://doi.org/10.3109/09638281003734359
  30. Heino JG, Godges JJ, Carter CL. Relationship between hip extension range of motion and postural alignment. J Orthop Sports Phys Ther. 1990;12(6):243-7. https://doi.org/10.2519/jospt.1990.12.6.243
  31. Nemmers TM, Miller JW, Hartman MD. Variability of the forward head posture in healthy community-dwelling older women. J Geriatr Phys Ther. 2009;32(1):10-4. https://doi.org/10.1519/00139143-200932010-00003
  32. Raine S, Twomey LT. Head and shoulder posture variations in 160 asymptomatic women and men. Arch Phys Med Rehabil. 1997;78(11): 1215-23. https://doi.org/10.1016/S0003-9993(97)90335-X
  33. Fonseca S, Ocarino J, Silva P et al. Integration of stresses and their relationship to the kinetic chain. Scientific foundations and principles of practice in musculoskeletal rehabilitation. St Louis, Saunders Elsevier. 2007:476-86.
  34. Park SJ. The effects of trunk and pelvic stabilization exercise using a sling on functional improvement in chronic stroke patient. Dankook University. Dissertation of Master's Degree. 2010.
  35. Kim JH. An influence of trunk control using pelvic movement upon the foot pressure of patient with hemiplegia. Yong-in University. Dissertation of Master's Degree. 2007.
  36. Bae EH, Oh DW. Comparison of the effects of active and passive exercises on shoulder position sense in chronic stroke patient. Journal of Special Education & Rehabilitation Science. 2011;50(2):167-80.
  37. Kim BN, Lee WH. The influence of pelvic tilt exercise using visual feedback upon the gait charicteristics of patients with hemiplegia. J Kor Phys Ther. 2002;14(1):75-88.
  38. Bonan IV, Colle FM, Guichard JP et al. Reliance on visual information after stroke. Part 1: Balance on dynamic posturography. Arch Phys Med Rehabil. 2004;85(2):268-73. https://doi.org/10.1016/j.apmr.2003.06.017