The Comparison of Effect of Treadmill and Ergometer Training on Gait and Balance in Stroke

뇌졸중 환자의 보행과 균형에 대한 트레드밀과 에르고미터 자전거 훈련의 효과

  • Kim, Chang-Sook (Physical Therapy, Department of Rehabilitation Science, Graduate School of Daegu University) ;
  • Bae, Sung-Soo (Department of Physical Therapy, College of Rehabilitation Science, Daegu University)
  • 김창숙 (대구대학교 대학원 재활과학과) ;
  • 배성수 (대구대학교 재활과학대학 물리치료학과)
  • Received : 2010.06.30
  • Accepted : 2010.08.30
  • Published : 2010.08.31

Abstract

Purpose : The goal of this study was to identify the effects of treadmill walking training (TW) and ergometer bicycle training (EB) on gait and balance in stroke patients. Methods : The subjects consisted of 42 stroke patients. They were randomly divided to two groups: TW(n=20) and EB(n=22). Each group trained along with the conventional physical therapy, three times a week for six weeks. The ability of gait was assessed by the 10m walk test and Timed Up and Go test(TUG). The ability of balance was assessed by Berg Balance Scale(BBS) and Balance Performance Monitor(BPM). Results : There was no significant difference between the 10m walking test and TUG groups, but there was a statistical difference between before and after the training for all groups. The result of BBS that assessed balance showed a significant reduction between before and after the training for all groups, but there was no difference between the two groups. While the two groups showed no difference in the BPM assessment, only the EB showed a significant improvement of before and after the training in each group. Conclusion : The outcomes suggest that stroke patients can improve their gait and balance performance through the TW and EB trainings. Although dynamic mean balance showed significance from EB, no significant difference was found between two groups. Even though it cannot be determined through this study which training group is more effective among the above mentioned two, it could be suggested that each training is effective to gait ability and the ability of balance of stroke patients.

Keywords

References

  1. 김범수. 12주간의 에르고미터 운동이 여성노인의 대퇴사두근 등속성 신전근력에 미치는 영향. 한국스포츠리서치. 2007;18(2):709-18.
  2. 김상엽. 트레드밀 보행훈련이 만성편마비 환자의 보행 속도와 보행 지구력에 미치는 영향. 대한물리치료학회지. 2004;16(2):221-8.
  3. 배성수, 이진희. 우리나라 중소도시 뇌졸중 환자의 임상적 특성괴 재활서비스 수혜 실태에 관한 연구. 대한물리치료학회지. 2001;13(3):799-814.
  4. 전계호, 조강희, 김봉옥. 체중 탈부하가 편마비 보행에 미치는 영향. 대한 재활의학회지. 1999;23(2): 371-6.
  5. Anne M, Angela S, Alex P, et al. Treadmill training and body weight support for walking after stroke . Stroke. 2003;34(12):3006 https://doi.org/10.1161/01.STR.0000102415.43108.66
  6. Badke, M, Dunaca, P. Patterns of rapid motor responsed during postural adjustments when standing when standing in healthy subjects and hemiplegic patients. Phys Ther. 1983;63(1);13-20.
  7. Berg K, Wood-Dauphinee S, Williams JI, et al. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy(Canada). 1989;41(1): 304-11.
  8. Bogle Thorbahn L.D, Newton RA. Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther. 1996;76(6): 576-583.
  9. Burke ER. Proper fit of the bicycle. Clinics Sports Med. 1994;13(1):1-14.
  10. Cole B, Finch E, Gowland C, et al. Physical rehabilitation outcome measure. Wiliams & Wilkins. Baltimore. 1994.
  11. Cristensen LOD, Johannsen P, Sinkjaer T, et al. Cerebral activation during bicycle movements in man. Exp Brain Res. 2000;135(1):66-72 https://doi.org/10.1007/s002210000493
  12. Crutchfied CA, Barnes MR. Motor control and motor learning in Rehabwilitation. Atlanta: Stokesville. 1993.
  13. Cwikel J, Fried A, Galinski D, et al. Gait and activity in the elderly: implications for community falls prevention and treatment programs. Disability. 1995;17(1):277-80.
  14. David AB, Sabina Nagpal, Sam Chi. Limb loaded cycling program for locomotor intervention following stroke. Phys Ther. 2005;85(2):159-68.
  15. Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke. Arch Phys Med Rehabil. 2001;81(4):409-17.
  16. Dobkin BH, Sullivan KJ, Knowlton BJ. Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil. 2002;83(5):683-91. https://doi.org/10.1053/apmr.2002.32488
  17. Engle V. The relationship of movement and time to older adults' functional health. Research Nursing Health. 1986;9(2):123-9. https://doi.org/10.1002/nur.4770090207
  18. Ericson MO, Nisell R, Arborelius UP, et al. Muscular activity during ergometer cycling. Scand J Rehabil Med. 1985;17(3):53-61
  19. Forssberg H. Ontogeny of human locomotor control. 1. Infant stepping, supported locomotion and transition to independent locomotion and transition to independent locomotion. Exp Brain Res. 1985; 57(3):480-93.
  20. Frontera W, Silver JK. Essentials of physical medicine and rehabilitation. Hanley & Belfus Inc. 2002.
  21. Fujiwara T, Liu M. Chino N. Effect of pedaling Exercise on the hemiplegic lower limb. Am J Phys Med Rehabil. 2003;82(5):357-63
  22. Grillner S. The locomotion of the acute spinal cat injected with clonidine i.v. Brain Res. 1973;50 (1):184-6. https://doi.org/10.1016/0006-8993(73)90606-9
  23. Hassid E, Rose D, Commisarow J, et al. Improved gait symmetry in hemiparetic stroke patients induced during body weight-supported treadmill stepping. Journal Neuro Rehabil. 1997;11(1):21-6.
  24. Hesse S, Konrad M. Uhlenbrock D. Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. Arch Phys Med Rehabil. 1999;80(4):421-7. https://doi.org/10.1016/S0003-9993(99)90279-4
  25. Laufer Y, Dickstein R, Chefez Y, et al. The effect of treadmill training on the ambulation of stroke survivors in the early stages of rehabilitation: a randomized study. JRRD. 2001;38(1):69-78.
  26. Luukinen H, Koski K, Laippala, P, et al. Risk factors for recurrent falls in the elderly in longterm institutional care. Public Health. 1995;109 (1):57-65. https://doi.org/10.1016/S0033-3506(95)80076-X
  27. Mackay-Lyons M Central pattern generation of locomotion; A review of the evidence. Phys Thera. 2002;82(1 ):69-83.
  28. Mauritz KH. Gait training in hemiplegia. European Journal of Neurology. 2002;9(S1):23-9. https://doi.org/10.1046/j.1468-1331.2002.0090s1023.x
  29. Michal Katz-Leurer, Iris Sender, Ofer Keren, et al. The influence of early cycling training on balance in stroke patients at the subacute stage. Clin Rehabi. 2006;20(5):398-405. https://doi.org/10.1191/0269215505cr960oa
  30. Michal Katz-Leurer, Mara S. Early cycling test as a predictor of walking performarl'ce in stroke patients. Physiotherapy Research International. 2006;10(1): 1-9.
  31. Podsialo D, Richardson S. The timde "up and go":a test of basic functional mobility for frail elderly person. JAGS. 1991;39(2):142-8
  32. Potter J, Evans A & Duncan G. Gait speed and activities in the elderly: Implications for community falls prevention and treatment programs. Disability and Rehabilitation. 1995;17(6):277-80. https://doi.org/10.3109/09638289509166647
  33. Raasch CC, Zajac FE. Locomotor strategy for pedaling: muscle groups and biomechanicaI function. J Neruophysiol. 1999;82(2):515-25.
  34. Rossignol S. Locomotion and its recovery after spinal injury. Curr Opin Neurobiol. 2000;10(6): 708-16. https://doi.org/10.1016/S0959-4388(00)00151-3
  35. Sakley CM, Bagyley BI. Visual feedback after stroke with the balancc performance monitor: Two single-case studies. Clin Rehabil. 1993;7(3): 189-95. https://doi.org/10.1177/026921559300700302
  36. Shumway-Cook A, Baldwin M, Polossar NL, et al. Predicting the probability for falls in communitydwelling older adults. Phys Ther. 1997;77(8): 812-19.
  37. Silver KH, Macko RF, Forrester LW, et aI. Effects of aerobic treadmill training on gait velocity, cadence, and gait symmetry in chronic hemiparetic stroke: a preliminary report. Neurorehabilitation and Neural Repair. 2000;14(1):65-71. https://doi.org/10.1177/154596830001400108
  38. Tanaka H, Bassett DR, Swensen TC, et aI. Aerobic and anaerobic power characteristics of compentitivc cyclist in the United States Cycling Federation. International Journal of Sports Medicine. 1993; 14 (2):334-8.
  39. Thomas WJ, Marijke B, Peter E, et al. Effects of electric stimulation-Assisted cycling training in people with chronic stroke. Arch Phys Med Rehabil. 2008; 89(3 ):463-69 https://doi.org/10.1016/j.apmr.2007.09.028
  40. Trueblood PR. Partial body weight treadmill training in persons with chronic stroke. NeuroRehabilitation. 2001; 16(3): 141-53.
  41. Tumbull G, Charteris J, Wall JC. A comparsion of the range of walking speeds between normal and hemiplegic subjects. Scandinabian Journal of Rehabilitation Medicine. 1995;27(3): 175-82.
  42. Visinfin M, Barbeau H, Dobkin HB. A new approach to retrain gait in stroke patients through body wcight support and treadmill stimulation. Stroke. 1998;29(6):1122-8. https://doi.org/10.1161/01.STR.29.6.1122
  43. Waagfjord J, Levangie PK, Certo CM. Effect of treadmill training on gait in a hemiparetic patients. Phys Ther. 1990;70(9):549-60.