DOI QR코드

DOI QR Code

Effect of Progressive Resistance Task-oriented Strengthening Exercise on Balance and Activities of Daily Living in Stroke Patients

점진적 과제지향적 다리근력강화 운동이 뇌졸중 환자의 균형능력과 일상생활수행능력에 미치는 영향

  • Kang, Tae-Woo (Department of Physical Therapy, College of Health and Welfare, Woosuk University) ;
  • Kim, Hye-Mi (Department of Physical Therapy, Ongoul Rehabilitation Hospital) ;
  • Kim, Beom-Ryong (Department of Physical Therapy, Design Hospital)
  • 강태우 (우석대학교 보건복지대학 물리치료학과) ;
  • 김혜미 (온고을 재활병원 물리치료실) ;
  • 김범룡 (대자인병원 재활센터)
  • Received : 2019.12.26
  • Accepted : 2020.02.08
  • Published : 2020.04.30

Abstract

Purpose: This study investigated the effects of progressive resistance task-oriented strengthening exercises (PRTSE) on the strength of the lower extremities, balance, and activities of daily living (ADL) of patients following a stroke. The purpose of the study was to provide fundamental data regarding the use of PRTSE with stroke patients. Methods: Twenty stroke patients were randomly divided into an experimental group (n = 10) who took part in PRTSE and a control group (n = 10) who performed general rehabilitation exercises. Both groups performed their respective exercises for 30 minutes five times a week for four weeks. The strength of their lower extremities was measured using a hand-held dynamometer. The balance of the participants was assessed using a Berg balance scale. The modified Barthel index was conducted to measure ADL. A paired t-test was performed to compare within-group changes before and after the PRTSE. Differences between the experimental and the control groups were analyzed using an independent t-test. For all tests, the level of statistical significance was α = 0.05. Results: After the exercises, there was a significant within-group change in the strength of lower extremities, balance, and ADL in the experimental group and the control group (p < 0.05). There was also a significant between-group difference in the strength of lower extremities after the intervention (p < 0.05). Conclusion: General rehabilitation is commonly applied as a treatment for stroke patients and is relatively effective. The application of PRTSE may be useful in such patients, considering its effects on the strength of lower extremities, balance, and ADL.

Keywords

References

  1. Ada L, Dean CM, Hall JM, et al. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Archives of Physical Medicine and Rehabilitation. 2003;84(10):1486-1491. https://doi.org/10.1016/S0003-9993(03)00349-6
  2. Arnold CM, Warkentin KD, Chilibeck PD, et al. The reliability and validity of handheld dynamometry for the measurement of lower-extremity muscle strength in older adults. The Journal of Strength and Conditioning Research. 2010;24(3):815-824. https://doi.org/10.1519/JSC.0b013e3181aa36b8
  3. Bale M, Strand LI. Does functional strength training of the leg in subacute stroke improve physical performance? a pilot randomized controlled trial. Clinical Rehabilitation. 2008;22(10-11):911-921. https://doi.org/10.1177/0269215508090092
  4. Berg K, Wood-Dauphinee S, Williams JI. The balance scale: reliability assessment with elderly residents and patients with an acute stroke. Scandinavian Journal of Rehabilitation Medicine. 1995;27(1):27-36.
  5. Bogle Thorbahn LD, Newton RA. Use of the Berg balance test to predict falls in elderly persons. Physical Therapy. 1996;76(6):576-583. https://doi.org/10.1093/ptj/76.6.576
  6. Bohannon RW. Muscle strength and muscle training after stroke. Journal of Rehabilitation Medicine. 2007;39(1):14-20. https://doi.org/10.2340/16501977-0018
  7. Botner EM, Miller WC, Eng JJ. Measurement properties of the activities-specific balance confidence scale among individuals with stroke. Disability and Rehabilitation. 2005;27(4):156-163. https://doi.org/10.1080/09638280400008982
  8. Carr JH, Shepherd RB. Stroke rehabilitation: guidelines for exercise and training to optimize motor skill, 3rd ed. London. Bitterworth Heinemann. 2003.
  9. Chakravarty K, Chatterjee D, Das RK, et al. Analysis of muscle activation in lower extremity for static balance. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2017; 2017(1):4118-4122.
  10. Cheng PT, Wu SH, Liaw MY, et al. Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Archives of Physical Medicine and Rehabilitation. 2001;82(12):1650-1654. https://doi.org/10.1053/apmr.2001.26256
  11. Choi IY. Effects of elastic band exercise using the PNF lower extremity pattern on balance and weight bearing in the adult hemiplegic patients. Pochon CHA University. Dissertation of Master's Degree. 2008.
  12. Davies PM. Steps to follow: the comprehensive treatment of patients with hemiplegia, 2nd ed. New York. Springer Science and Business Media. 2000.
  13. De Nunzio A, Zucchella C, Spicciato F, et al. Biofeedback rehabilitation of posture and weight-bearing distribution in stroke: a center of foot pressure analysis. Functional Neurology. 2014;29(2):127-134.
  14. Duncan PW. Stroke disability. Physical Therapy. 1994;74(5):399-407. https://doi.org/10.1093/ptj/74.5.399
  15. Edwards S. Neurological physiotherapy, 2nd ed. Edinburgh. Churchill Livingstone. 2002.
  16. Flansbjer UB, Downham D, Lexell J. Knee muscle strength, gait performance, and perceived participation after stroke. Archives of Physical Medicine and Rehabilitation. 2006;87(7):974-980. https://doi.org/10.1016/j.apmr.2006.03.008
  17. Ford MP, Wagenaar RC, Newell KM. The effects of auditory rhythms and instruction on walking patterns in individuals post stroke. Gait and Posture. 2007;26(1):150-155. https://doi.org/10.1016/j.gaitpost.2006.08.007
  18. Gregson JM, Leathley M, Moore AP, et al. Reliability of the tone assessment scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. Archives of Physical Medicine and Rehabilitation. 1999;80(9):1013-1016. https://doi.org/10.1016/S0003-9993(99)90053-9
  19. Hendrey G, Clark RA, Holland AE, et al. Feasibility of ballistic strength training in subacute stroke: a randomized, controlled, assessor-blinded pilot study. Archives of Physical Medicine and Rehabilitation. 2018;99(12):2430-2446. https://doi.org/10.1016/j.apmr.2018.04.032
  20. Hobart J, Thompson A. The five item Barthel index. Journal of Neurology, Neurosurgery and Psychiatry. 2001;71(2):225-230. https://doi.org/10.1136/jnnp.71.2.225
  21. Ivey FM, Prior SJ, Hafer-Macko CE, et al. Strength training for skeletal muscle endurance after stroke. Journal of Stroke and Cerebrovascular Diseases. 2017;26(4):787-794. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.10.018
  22. Jo H. The effects of neuromuscular electrical stimulation on quadriceps muscle strengthening and balance in patients with total knee arthroplasty. Daegu University. Dissertation of Master's Degree. 2016.
  23. Joo MJ. Effects of task-oriented training on depression and motor function in stroke. Dongshin University. Dissertation of Master's Degree. 2011.
  24. Kim JH. Effects of virtual reality program on balance, gait and brain activation patterns in stroke patients. Daegu University. Dissertation of Doctorate Degree. 2005.
  25. Kim JW, Lee KM. Evaluation of isometric shoulder strength in Korean adults using a hang-held dynamometer. Annals of Rehabilitation Medicine. 1996;20(1):186-93.
  26. Kim WH. Effect of task-oriented approach on weight-bearing distribution and muscular activities of the paretic leg during sit-to-stand movement in chronic stroke patients. Physical Therapy Korea. 2011;18(2):18-26.
  27. Lacour M, Bernard-Demanze L, Dumitrescu M. Posture control, aging, and attention resources: models and posture-analysis methods. Neurophysiologie Clinique/Clinical Neurophysiology. 2008;38(6):411-421. https://doi.org/10.1016/j.neucli.2008.09.005
  28. Laufer Y, Dickstein R, Resnik S, et al. Weight-bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights. Clinical Rehabilitation. 2000;14(2):125-129. https://doi.org/10.1191/026921500674231381
  29. Lennon S. Gait re-education based on the Bobath concept in two patients with hemiplegia following stroke. Physical Therapy. 2001;81(3):924-935. https://doi.org/10.1093/ptj/81.3.924
  30. Mahabir D, Bickram L, Gulliford MC. Stroke in Trinidad and Tobago: burden of illness and risk factors. Revista Panamericana de Salud Publica. 1998;4(4):233-237.
  31. Makizako H, Kabe N, Takano A, et al. Use of the Berg balance scale to predict independent gait after stroke: a study of an inpatient population in Japan. PM&R. 2015;7(4):392-399. https://doi.org/10.1016/j.pmrj.2015.01.009
  32. Mauritz KH. Gait training in hemiplegia. European Journal of Neurology. 2002;9(1):23-29. https://doi.org/10.1046/j.1468-1331.2002.0090s1023.x
  33. Ouellette MM, LeBrasseur NK, Bean JF, et al. High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors. Stroke. 2004;35(6):1404-1409. https://doi.org/10.1161/01.str.0000127785.73065.34
  34. Park CH, Chung BI. Effects of treadmill training on hyperextension of the knee and cadence in patients with hemiplegia. Physical Therapy Korea. 2001;8(1):89-96.
  35. Park H. Effects of the group task-related program training on functional independence and quality of life for the CVA patients. Dankuk University. Dissertation of Master's Degree. 2005.
  36. Park JH, Kwon YC. Modification of the mini-mental state examination for use in the elderly in a non-western society. Part 1. Development of Korean version of mini-mental state examination. International Journal of Geriatric Psychiatry. 1990;5(6):381-387. https://doi.org/10.1002/gps.930050606
  37. Salbach NM, Mayo NE, Wood-Dauphinee S, et al. A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial. Clinical Rehabilitation. 2004;18(5):509-519. https://doi.org/10.1191/0269215504cr763oa
  38. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology. 1989;42(8):703-709. https://doi.org/10.1016/0895-4356(89)90065-6
  39. Song CH, Choi KW, In TS. Effects of progressive task-oriented resistive training on lower extremity strength, balance and gait in stroke. Journal of Special Education and Rehabilitation Science. 2010;49(2):157-179.
  40. Thielman GT, Dean CM, Gentile AM. Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. Archives of Physical Medicine and Rehabilitation. 2004;85(10):1613-1618. https://doi.org/10.1016/j.apmr.2004.01.028
  41. Tyson SF, Hanley M, Chillala J, et al. Balance disability after stroke. Physical Therapy. 2006;86(1):30-38. https://doi.org/10.1093/ptj/86.1.30
  42. Walker C, Brouwer BJ, Culham EG. Use of visual feedback in retraining balance following acute stroke. Physical Therapy. 2000;80(9):886-895. https://doi.org/10.1093/ptj/80.9.886
  43. Wandel A, Jorgensen HS, Nakayama H, et al. Prediction of walking function in stroke patients with initial lower extremity paralysis: the copenhagen stroke study. Archives of Physical Medicine and Rehabilitation. 2000;81(6):736-738. https://doi.org/10.1016/S0003-9993(00)90102-3
  44. Wee JY, Wong H, Palepu A. Validation of the Berg balance scale as a predictor of length of stay and discharge destination in stroke rehabilitation. Archives of Physical Medicine and Rehabilitation. 2003;84(5):731-735. https://doi.org/10.1016/S0003-9993(02)04940-7
  45. Yang YR, Wang RY, Lin KH, et al. Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke. Clinical Rehabilitation. 2006;20(10):860-870. https://doi.org/10.1177/0269215506070701