Background: Stroke patients have reduced trunk control compared to normal people. The ability to control the trunk of a stroke patient is important for gait and balance. However, there is still a lack of research methods for the characteristics of stroke control in stroke patients.
Objects: The aim of this research was to determine whether trunk position sense has any relation with balance and gait.
Methods: This study assessed trunk performance by measuring position sense. Trunk position sense was assessed using the David back concept to determine trunk repositioning error in 20 stroke patients and 20 healthy subjects. Four trunk movements (flexion, extension, lateral flexion, rotation) were tested for repositioning error and the measurement was carried out 6 times per move; these parameters were used to compare the mean values obtained. Subjects with stroke were also evaluated with clinical measures of balance and gait.
Results: There were significant differences in trunk repositioning error between the stroke group and the control group in flexion, lateral flexion to the affected side, lateral flexion to the unaffected side, rotation to the affected side, and rotation to the unaffected side. Mean flexion error: post-stroke: 7.95 ± 6.76 degrees, control: 3.32 ± 2.27; mean lateral flexion error to the affected side: 6.13 ± 3.79, to the unaffected side: 5.32 ± 3.15, control: 3.57 ± 1.92; mean rotation error to the affected side: 8.25 ± 3.09, to the unaffected side: 9.24 ± 3.94, control: 5.41 ± 1.82. There was an only significant negative correlation between the repositioning error of lateral flexion and the Berg balance scale score to the affected side (–0.483) and to the unaffected side (–0.497). A strong correlation between balance and gait was found.
Conclusion: The results of this study indicate that stroke patients exhibit greater trunk repositioning error than age-matched controls on all planes of movement except for extension. And lateral flexion has correlation with balance and gait.
본 연구의 목적은 평발을 가진 여성 노인의 계단 하강 보행 시 일반인솔 및 아치 지지형 인솔을 적용에 따른 족저압력 및 압력중심점 변인들의 차이를 조사하는데 목적이 있다. 족저압력 분석장비(Pedar-X, Novel, Germany)를 사용하여 14명의 평발 노인을 대상으로 3종류(일반인솔, A형 인솔, B형 인솔)의 인솔착용 후 최대족저압력, 평균족저압력, 접촉면적, 압력중심점의 이동거리, 변위 및 최대범위의 평균값을 산출하였으며, 일원변량분석(one-way ANOVA)를 이용하여 인솔 종류간 평균을 비교하였다. 족저압력 변인 중 최대족저압력은 중족부의 M3, 평균족저압력은 M2, M3, M4 영역에서, 접촉면적은 M2, M3, 그리고 M6 영역에서 통계적으로 유의한 차이를 보였으며, 압력중심점 변인 중 전후축과 좌우축에서 압력중심점의 이동거리에서 통계적으로 유의한 차이를 보였다. 족저압력 평가결과 아치 지지 기능을 가진 인솔을 삽입한 A와 B형 인솔에서 족궁지지 영역인 M3의 최대압력은 B형 인솔과 A형 인솔이 일반인솔과 비교했을 때 높게 나타났다. 좌우축, 전후축 압력중심점의 이동거리는 A형과 B형 인솔 모두 일반 인솔에 비해 짧게 나타났다.
The purpose of this study was to examine the effects of dual-task training (cognitive and exercise tasks) on the balance and gait performance of chronic stroke patients. Eighteen subjects with chronic stroke were divided equally into two groups, an experimental group and a control group. Subjects in both groups participated in an exercise program, performing the same tasks, for 45 minutes per day, three times per week for four weeks. The experimental group also performed additional cognitive task. The experimental group showed a more significant improvement than the control group on the Berg Balance Scale, the Timed Up and Go Test, the Korean Activities-Specific Balance Confidence Scale, and the Functional Gait Assessment (p<.05). The cognitive task error rates in the final week were significantly less than in the first week in the experimental group (p<.01). These results suggest that dual-task training for chronic stroke patients is effective in improving balance, gait, and cognitive abilities.
The purpose of this study was to investigate the effects of visual cue deprivation during sideways
treadmill training in individuals with stroke. Twenty-eight stroke patients were divided into two groups, and each group participated in a sideways treadmill training session for 20 minutes, three times per week for 4 weeks. The eyes close group (15 subjects) performed this treadmill training with visual cue deprivation, while the eyes open group (13 subjects) performed it without visual cue deprivation. Gait function was measured in both groups before and after the training sessions with the Biodex Gait Trainer 2, which determined walking speed, distance, step length, and time on each foot. Balance was measured before and after each training period in both groups using the Five-Times Sit-to-Stand Test (FTSST), the Timed Up and Go test (TUG), and the seven-item Berg Balance Scale-3P (7-item BBS-3P). The eyes close group showed significantly improved gait function, walking speed, distance, step length, and time on each foot after training (p<.05). The eyes close group showed improved balance ability, FTSST, TUG, and 7-item BBS-3P test after training (p<.05). The findings indicated that sideways treadmill training with visual cue deprivation positively affects gait ability of stroke patients. Therefore, sideways treadmill training with visual cue deprivation may be useful for the recovery of gait ability of stroke patients.
The purpose of this study was to determine the effects of weight shift training with joint mobilization on the ankle joint passive range of motion (PROM), balance capacity and gait velocity in hemiplegic patients. Fourteen subjects were randomly assigned to either the experimental group (EG) or the control group (CG), with seven subjects in each group. The EG received weight shift training with joint mobilization in the paretic leg's subtalar joint in order to increase ankle dorsiflexion. The CG received general physical therapy training. Both groups received training five times a week over a period of two consecutive weeks. The figures for PROM of ankle dorsiflexion on the paretic leg, the functional reach test (FRT), the timed up and go (TUG) test, and gait velocity were recorded both before and after the training sessions for both groups. The EG's results in gait velocity, the FRT and the TUG test improved after training (p<.05). The PROM of ankle dorsiflexion improved both in the EG and the CG (p<.05), the EG demonstrated a significantly higher increase (p<.05) than that of the CG. The results of this study suggest that increased joint mobilization positively affects balance and gait velocity of hemiplegic patients. Further studies with a greater sample size are necessary in order further prove the accuracy of the results of this study.
The aim of this study was to investigate correlations of the Trunk Control Test (TCT), Postural Assessment Scale for Stroke (PASS-TC), and Trunk Impairment Scale (TIS) and to compare the TCT, PASS-TC, TIS and its subscales in relation to balance, gait and functional performance ability after stroke. Sixty-two stroke patients attending a rehabilitation program participated in the study. Trunk control was measured with the use of TCT, PASS-TC, TIS balance (Berg Balance scale; BSS), gait ability (10 m walk test), functional performance ability (Tuned Up and Go Test TUG) and the mobility part of the Modified Barthel index (MBI), Fugl Meyer-Upper/Lower Extremity (FM-U․L/E). The scatter-plot (correlation coefficient) was composed for the total scores of the TCT, PASS-TC, and TIS. The multiple regression analysis was performed to evaluate the impact of trunk control on balance, gait, and functional performance ability. Twenty eight participants (45.2%) and twenty participants (32.3%) obtained the maximum score on the TCT and PASS-TC respectively; no subject reached the maximum score on the Trunk Impairment Scale. There were significant correlations between the TIS and TCT (r=.38, p<.01), PASS-TC (r=.30, p<.05), TCT and PASS-TC (r=.59, p<.01). Stepwise multiple regression analysis showed that the BBS score (β=.420~.862) had slightly more power in predicting trunk control than the . TIS-dynamic sitting balance, TUG and the MBI-mobility part. This study clearly indicates that trunk control is still impaired in stroke patients. Measures of trunk control were significantly related with values of balance, gait and functional performance ability. The results imply that management of trunk rehabilitation after stroke should be emphasized.
The purposes of this study were to determine correlations between the Berg Balance Test (BBS), Timed -UP & Go Test, Fugl Meyer-L/E, Balance, Sensory (FM-L/E, B, S), Motor Assessment Scale-Gait (MAS-G), Comfortable maximal Gait Speed (C MGS), and the Modified Barthel Index (MBI). The subjects were 40 stroke patients of the Korea National Rehabilitation Center in Seoul. Main outcome measures were Balance control (BBS, FM-B), Gait (TUG, C MGS, MAS-G), ADL (MBI) and Motor Function of Lower Extremities (FM-L/E, S). The data were analyzed using Pearson product correlation. FM scales between other clinical and instrumental indexes and multiple stepwise regression analyses were performed to identify prognostic factors for Balance, Gait and ADL Motor Function of Lower Extremity inclinations. The results of this study were as follows: The BBS, FM-L/E, balance, sensory and MBI showed positive correlation relations, but TUG and C MGS showed negative correlations. The sensory factor of the FM-scale showed the strongest variance in predicting BBS. However the FM-balance showed the strongest variance in predicting TUG, MAS-G and C MGS. The use of both quantitative and qualitative scales was shown to be a good measuring instrument for the classification of the general clinical performance of the patients.
본 연구는 중추신경계의 일부분으로서 신체의 자세 및 자발적 움직임의 조절과 평형을 유지하는 기능을 담당하는 소뇌에 이상이 있는 환자를 대상으로 댄스-기반 운동치료 프로그램이 환자의 균형과 보행능력의 재학습에 어떠한 영향을 주는지 조사하였다. 연구의 참가한 소뇌질환 환자는 유전적 원인으로 인해소뇌의 신경세포가 사멸하여 그 크기가 감소하는 소뇌위축증(cerebellar atrophy)으로 진단을 받고 그로인한 운동장애인 운동실조증(ataxia)을 보인 1명의 환자를 대상으로 하였다. 연구 대상자는 파트너 댄스인 탱고 스텝에 기반을 둔 운동치료 프로그램에 8주에 걸쳐 매주 3회씩 한번에 90분씩 진행하는 수업에 참가하였다(총 24회). 연구 결과, 댄스에 기반을 둔 운동 치료 프로그램에 참여한 소뇌성 운동실조증 환자의 평지 보행 능력 측정에서의 보폭 길이가 증가하였으며 보간 너비가 감소한 것으로 나타났다. 또한 보행 주기 중 한 다리 지지기 비율과 균형 능력의 향상과 같은 긍정적 상호작용도 나타났다. 보다 기능적인 보행 능력을 평가하는 장애물 넘기 보행에서는 장애물을 넘기 직전의 움직임 동결 시간이 감소하였으며, 장애물을 넘기 전 선행하는 발의 이륙거리와 장애물 통과 속도는 초기에 비해 사후 검사에서 증가하는 양상을 나타냈다. 이러한 결과는 댄스-기반 운동치료 프로그램 훈련이 소뇌성 운동실조증 환자에게 적용되었을 때 정상적인 보행주기 패턴의 재정립과 균형 능력의 회복에 긍정적인 영향을 줄 수있음을 보여준다.