Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
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The Effect of Weight Shift Training With Joint Mobilization on Balance and Gait Velocity of Hemiplegic Patients

체중이동 훈련을 통한 관절가동화기법이 편마비환자의 균형 및 보행속도에 미치는 영향

  • Son, Hyo-Young (Dept. of Rehabilitation Center, Youseong Wellness Hospital) ;
  • Choi, Jong-Duk (Dept. of Physical Therapy, College of Natural Science, Daejeon University)
  • 손효영 (유성웰니스병원 재활센터) ;
  • 최종덕 (대전대학교 자연과학대학 물리치료학과)
  • Received : 2011.08.08
  • Accepted : 2011.09.26
  • Published : 2012.02.19
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Abstract

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.

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References

  1. 공원태, 마상렬, 김태호. 회외발에 대한 족관절 관절가동술이 균형능력에 미치는 영향. 한국데이터정보과학회지. 2009;20(3);527-539.
  2. 김봉옥, 김태민, 채진목 등. 뇌졸중 환자의 보행 시작 중에 보이는 운동역학 특성. 대한재활의학회지. 2001;25(2):227-235.
  3. 김종만, 안덕현. 강직성 편마비 환자에서의 운동장애는 강직 때문인가? 근육약화 때문인가? 한국전문물리치료학회지. 2002;9(3):125-135.
  4. 박종한, 권용철. 노인용 한국판 Mini-Mental State Examination(MMSE-K)의 표준화 연구-제2편: 구분점 및 진단적 타당도. 신경정신의학. 1989;28(3):508-513.
  5. 박지웅, 안재기, 박용범 등. 보행 가능한 편마비 환자에서 편측 및 건측 하지 발목 관절의 인대와 힘줄의 초음파 비교. 한국전문물리치료학회지. 2010;17(2):60-66.
  6. 이성은. 발목관절 가동범위 증진 프로그램이 노인의 보행과 균형능력 향상에 미치는 효과. 한국전문물리치료학회지. 2005;12(2):28-36.
  7. 이한숙, 최홍식, 권오윤. 균형조절 요인에 관한 고찰. 한국전문물리치료학회지. 1996;3(3):82-91.
  8. 형인혁. 발의 안정성이 균형과 근활성도에 미치는 영향. 대구대학교 대학원, 박사학위 논문, 2008:92-103.
  9. Rosamond W, Fleqal K, Furie K, et al. Heart disease and stroke statistics 2008 update: A report from the american heart association statistics committee and stroke statistics subcommittee. Circulation. 2008;117:e25-e146. https://doi.org/10.1161/CIRCULATIONAHA.107.187998
  10. Andriacchi TP, Andersson GB, Fermier RW, et al. A study of lowerlimb mechanics during stair-climbing. J Bone Joint Surg Am. 1980;62(5):749-757. https://doi.org/10.2106/00004623-198062050-00008
  11. Berg KO, Maki BE, Williams JI, et al. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992;73(11):1073-1080.
  12. Chen CL, Chen HC, Tang SF, et al. Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil. 2003;82(12):925-935. https://doi.org/10.1097/01.PHM.0000098040.13355.B5
  13. 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
  14. Chung SG, Van Rey E, Bai Z, et al. Biomechanic changes in passive properties of hemiplegic ankles with spastic hypertonia. Arch Phys Med Rehabil. 2004;85(10):1638-1646. https://doi.org/10.1016/j.apmr.2003.11.041
  15. Cochrane CG. Joint mobilization principles: Considerations for use in the child with central nervous system dysfunction. Phys Ther. 1987;67(7):1105-1109. https://doi.org/10.1093/ptj/67.7.1105
  16. 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
  17. Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: A randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000;81(4):409-417. https://doi.org/10.1053/mr.2000.3839
  18. 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
  19. Duncan PW, Weiner DK, Chandler J, et al. Functional reach: A new clinical measure of balance. J Gerontol. 1990;45(6):192-197.
  20. Elveru RA, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: Subtalar and ankle joint measurements. Phys Ther. 1988;68(5):672-677. https://doi.org/10.1093/ptj/68.5.672
  21. Eng JJ, Chu KS. Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. Arch Phys Med Rehabil. 2002;83(8):1138-1144. https://doi.org/10.1053/apmr.2002.33644
  22. Friden J, Lieber RL. Spastic muscle cells are shorter and stiffer than normal cells. Muscle Nerve. 2003;27(2):157-164. https://doi.org/10.1002/mus.10247
  23. Gao F, Grant TH, Roth EJ, et al. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors. Arch Phys Med Rehabil. 2009;90(5):819-826. https://doi.org/10.1016/j.apmr.2008.11.004
  24. Given JD, Dewald JP, Rymer WZ. Joint dependent passive stiffness in paretic and contralateral limbs of spastic patients with hemiparetic stroke. J Neurol Neurosurg Psychiatry. 1995;59(3):271-279. https://doi.org/10.1136/jnnp.59.3.271
  25. 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.
  26. Harlaar J, Becher JG, Snijders CJ, et al. Passive stiffness characteristics of ankle plantar flexors in hemiplegia. Clin Biomech(Bristol, Avon). 2000;15(4):261-270. https://doi.org/10.1016/S0268-0033(99)00069-8
  27. Hunt SM, Mckenna SP, Williams J. Reliability of a population survey tool for measuring perceived health problems: A study of patients with osteoarthrosis. J Epidemiol Community Health. 1981;35(4):297-300. https://doi.org/10.1136/jech.35.4.297
  28. Jeng SF, Schenkman M, Riley PO, et al. Reliability of a clinical kinemetic assessment of the sit to stand movement. Phys Ther. 1990;70(8):511-520. https://doi.org/10.1093/ptj/70.8.511
  29. Kaltenborn FM. Manual Mobilization of the Joints: The Kaltenborn method of joint examination and treatment. Oslo, Olaf Norlis Bokhandel, 1999:21-26.
  30. 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
  31. Mahabir D, Bickran L, Gullifort MC. Stroke in trinidad and tobago: Burden of illness and risk factors. Rev Panam Salud Publica. 1998;4(4):233-237.
  32. Mecagni C, Smith JP, Roberts KE, et al. Balance and ankle range of motion in community-dwelling women aged 64 to 87 years: A correlational study. Phys Ther. 2000;80(10):1004-1011.
  33. Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the timed up and go test in people with Parkinson disease. Phys Ther. 2001;81(2):810-818. https://doi.org/10.1093/ptj/81.2.810
  34. Mulligan BR. Manual Therapy: NAGS, SNAGS, MWM'S, etc, 4th ed. Wellington, Plane View Services Ltd., 1999:121-125.
  35. Perry J. Kinegiology of lower extremity bracing. Clin Orthop Relat Res. 1974;102:18-31. https://doi.org/10.1097/00003086-197407000-00004
  36. Podsiadlo D, Richardson S. The timed "up & go": A test of basic functional mobility for frail elderly person. J Am Geriatr Soc. 1991;39(2):142-148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  37. Richards JD, Pramanik A, Sykes L, et al. A comparison of knee kinematic characteristics of stroke patients and agematched healthy volunteers. Clin Rehabil. 2003;17(5):565-571. https://doi.org/10.1191/0269215503cr651oa
  38. Runge CF, Shupert CL, Horak FB, et al. Ankle and hip postural strategies defined by joint torques. Gait Posture. 1999;10(2):161-170. https://doi.org/10.1016/S0966-6362(99)00032-6
  39. Salsich GB, Mueller MJ, Hastings MK, et al. Effect of achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic plantar ulcer. Phys Ther. 2005;85(1):34-43.
  40. Schenkman M, Bulter RB. A model for multisystem evaluation treatment of individual with Pakinson's disease. Phys Ther. 1989;69(11):932-943. https://doi.org/10.1093/ptj/69.11.932
  41. Sharp SA, Brouwer BJ. Isokinetic strength training of the hemiparetic knee: Effect on function and spasticity. Arch Phys Med Rehabil. 1997;78(11):1231-1236. https://doi.org/10.1016/S0003-9993(97)90337-3
  42. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community dwelling older adults using the timed up & go test. Phys Ther. 2000;80(9):896-903.
  43. Svantesson U, Takahashi H, Carlsson U, et al. Muscle and tendon stiffness in patients with upper motor neuron lesion following a stroke. Eur J Appl Physiol. 2000;82(4):275-279. https://doi.org/10.1007/s004210000216
  44. Thilmann AF, Fellows SJ, Ross HF. Biomechanical changes at the ankle joint after stroke. J Neurol Neurosurg Psychiatry. 1991;54(2):134-139. https://doi.org/10.1136/jnnp.54.2.134
  45. 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
  46. Wolfson L, Whipple R, Judge J, et al. Training balance and strength in the elderly to improve function. J Am Geriatr Soc. 1993;41(3):341-343. https://doi.org/10.1111/j.1532-5415.1993.tb06716.x

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