Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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The Effects of Trunk Muscle Strengthening Exercises on Balance Performance of Sitting Posture and Muscle Tone of Children with Cerebral Palsy

체간근력 강화 운동이 뇌성마비 아동의 앉은 자세 균형 수행력과 근 긴장도 변화에 미치는 영향

  • Choi, Young-Chul (Department of Rehabilitation Science, The Graduate School, Daegu University) ;
  • Lee, Jung-Ho (Department of Rehabilitation Science, The Graduate School, Daegu University) ;
  • Kim, Jin-Sang (Department of Physical Therapy, College of Rehabilitation Science, Daegu University)
  • 최영철 (대구대학교 대학원 재활과학과) ;
  • 이중호 (대구대학교 대학원 재활과학과) ;
  • 김진상 (대구대학교 재활과학대학 물리치료학과)
  • Received : 2012.08.02
  • Accepted : 2012.09.06
  • Published : 2012.09.30
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Abstract

This study aims to investigate the effect of trunk muscle strengthening exercises on balance performance of sitting posture and muscle tone, targeting the children with spastic diplegic cerebral palsy. 16 children with spastic diplegic cerebral palsy in IV phase of GMFCS were sampled at random and the tests were conducted for 6 weeks, 3 times per week. For experimental groups, only trunk muscle strengthening exercises were conducted and for control groups, only basic physical therapy was conducted. The trunk muscle strengthening exercise consisted of 2 exercises to strengthen abdominal muscles and back muscles. BPM(Balance Performance Monitor) was used to measure balance performance and MMAS(Modified Modified Ashworth Scale) was used to measure muscle tone. As a result, the changes of sitting balance performance in experimental groups and control groups show significant difference in the changes of sway path and sway velocity(p<.05), the comparison of changes in sitting balance performance in between experimental groups and control groups show significant difference in the changes of sway path and sway velocity(p<.05). Knee flexor muscles and hip adductor muscles in both groups show no significant difference in changes of the muscle tone(p>.05). Therefore, the balance performance in both experimental groups and control groups was improved. However, the experimental group had more significant improvement in balance performance and no change in muscle tone was detected in both groups. Thus, these findings show trunk muscle strengthening exercises are effective in improving the balance performance of sitting posture for the children with spastic diplegic cerebral palsy without changing muscle tone.

본 연구는 경직성 양하지 뇌성마비 아동을 대상으로 하여 체간 근력 강화 운동이 앉은 자세 균형 수행력과 근 긴장도 변화에 어떠한 영향을 미치는지 알아보고자 하였다. 대상자는 대운동 분류 시스템 제 IV단계의 경직성 양하지 뇌성마비 아동 16명을 무작위로 배분하여 주 3회 6주 동안 실시하였고, 실험군은 체간 근력 강화 운동을 대조군은 기본 물리치료만 실시하였다. 체간 근력 강화 운동은 복부근과 배부근 강화를 위한 2가지 운동으로 구성하였다. 대상자들의 균형 수행력 측정은 BPM(Balance Performance Monitor)를 사용하였고 근 긴장도 측정은 MMAS(Modified Modified Ashworth Scale)를 사용하였다. 연구 결과, 앉은 자세 균형수행력 변화에서 실험군과 대조군의 동요거리, 동요속도에서 유의한 차이가 있었고(p<.05), 앉은 자세 균형 수행력 변화 비교에서 실험군과 대조군 사이에 동요속도, 동요거리에서 유의한 차이가 있었다(p<.05). 또한 근긴장도 측정 결과 실험군과 대조군의 무릎관절 굽힘근, 엉덩관절 모음근에서 유의한 차이가 나타나지 않았다(p>.05). 따라서 실험군과 대조군 모두에서 균형 수행력 향상이 나타났지만 실험군에서 조금 더 유의하게 향상되었고, 근 긴장도의 변화는 두 군에서 나타나지 않았다. 경직성 양하지 뇌성마비 아동에게 체간 근력 강화 운동은 근 긴장도의 변화 없이 앉은 자세 균형 수행력을 향상시키는데 효과적임을 알 수 있었다.

Keywords

References

  1. M. Bax, M. Goldstein, P. Rosenbaum, et al., "Proposed definition and classification of cerebral palsy, April 2005" Dev Med Child Neurol, 47(8), pp. 571-6, 2005. https://doi.org/10.1017/S001216220500112X
  2. H. C. Kwon, C. H. Lee, "Advanced physical therapy I", pp.87-119, Hyunmoon Publisher, 1995.
  3. B. Bobath, "Adult hemiplegia: evaluation and treatment. 2nd. ed.", Oxford, England: William Heinemann Medical Books Ltd., 1991.
  4. M. H. Choi, D. H. Lee, H. L. Ro, "Effect of task-oriented training and neurodevelopmental treatment on the sitting posture in children with cerebral palsy", J Phys Ther Sci, 23(2)p. 323-325, 2011. https://doi.org/10.1589/jpts.23.323
  5. E. Brogren, M. Hadders-Algraa, H. Forssberg, "Postural control in sitting children with cerebral palsy." Neurosci Biobehav Rev, 22(4), pp. 591-6, 1998. https://doi.org/10.1016/S0149-7634(97)00049-3
  6. F. R. van der Weel, A. L. H. van der Meer, D. N. Lee, "Measuring dysfunction of basic movement control in cerebral palsy", Hum Mov Sci, 15(2), pp. 253-283, 1996. https://doi.org/10.1016/0167-9457(95)00046-1
  7. H. F. Liao, A. W.Hwang, "Relations of balance function and gross motor ability for children with cerebral palsy", Percept Mot Skills, 96(3), pp.1173-1184, 2003. https://doi.org/10.2466/pms.2003.96.3c.1173
  8. H. M. Kerr, J. J. Eng, "Multidirectional measures of seated postural stability.", Clinical Biomechanics, 17(7), pp. 555, 2002. https://doi.org/10.1016/S0268-0033(02)00068-2
  9. J. S. Kim, S. C. Gwak, J, G, Jung, "Posture guidance of children with cerebral palsy", Daegu University Press, 2000.
  10. J. L. Oh, "The effects of trunk muscle strength training on sitting balance of children with spastic cerebral palsy", Daegu University Dissertation of Master Degree, 2003.
  11. S. J. Jo, "The effects of the appropriateness of the postural control exercise program on trunk muscle control ability and gross motor function movement for the children with cerebral palsy.", Dankook University Dissertation of Doctor Degree, 2006.
  12. D. L. Damiano, M. F. Abel, "Functional outcomes of strength training in spastic cerebral palsy", Arch Phys Med Rehabil, 79(2), pp. 119-25, 1998. https://doi.org/10.1016/S0003-9993(98)90287-8
  13. E. G. Fowler, T. H. Kolobe, D. L. Damiano, et al., "Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings" Phys Ther, 87(11), pp. 1495-510, 2007. https://doi.org/10.2522/ptj.20060116
  14. B. H. Song, J. Y. Yoon, "The effects of trunk strengthening exercise using therapeutic ball on the gross functional movements for the cerebral palsy children with spastic type", Special Education Research, 2(2), pp. 125-146, 2003. https://doi.org/10.18541/ser.2003.10.2.2.125
  15. U. Givon, "Muscle weakness in cerebral palsy", Acta Orthop Traumatol Turc, 43(2), pp. 87-93, 2004.
  16. T. R. Han, M. S. Bang, "Rehabilitation Medicine", pp. 639-651, Koonja Publisher, 2008.
  17. D. L. Damiano, C. L. Vaughan, M. F. Abel, "Muscle response to heavy resistance exercise in children with spastic cerebral palsy.", Dev Med Child Neurol, 37(8), pp. 731-9, 1995.
  18. J. Rose, K. C. McGill, "Neuromuscular activation and motor-unit firing characteristics in cerebral palsy", Dev Med Child Neurol, 47(5), pp. 329-336, 2005. https://doi.org/10.1017/S0012162205000629
  19. K. J. Dodd, N. F. Taylor, H. K. Graham, "A randomized clinical trial of strength training in young people with cerebral palsy", Dev Med Child Neurol, 45(10), pp. 652-657, 2003.
  20. K. W. Nam, E. Y. Yang, G. D. Kim, "Effects of lower limb strengthening training on gross motor function and skeletal muscle architecture of children with spastic diplega", Journal of Rehabilitation Research, 16(1), pp. 315-330, 2012.
  21. E. J. Lee, R. J. Park, H. L. Ro, "The effects of thera-band for the gross motor function and balance of children with cerebral palsy", Journal of Adapted Physical Activity, 17(4), pp. 249-267, 2009. https://doi.org/10.17006/kjapa.2009.17.4.249
  22. Y. S. Kim, "The effects of trunk muscles strength training program on gross function of children with spastic cerebral palsy. Dankook University Dissertation of Master Degree, 2000.
  23. C. M. Sackley, B. I. Baguley, "Visual feedback after stroke with the balance performance monitor: two single-case studies.", Clin Rehabil 7(3), pp. 189-195, 1993. https://doi.org/10.1177/026921559300700302
  24. C. S. Kim, J. S. Lee, "The comparison between blind and normal children in standing position", J Kor Soc Phys Ther, 15(1), pp. 1-36, 2003. https://doi.org/10.1589/jpts.15.1
  25. H. M. Kerr, J. J. Eng, "Multidirectional measures of seated postural stability.", Clinical Biomechanics, 17(7), pp. 555, 2002. https://doi.org/10.1016/S0268-0033(02)00068-2
  26. T. H. Kim, Y. W. Kim, "Reliability of the modified modified ashworth scale for the muscle tone of poststroke patients", J Kor Soc Phys Ther Med, 5(3), pp. 477-485, 2010.
  27. N. N. Ansari, S. Naghdi, H. Moammeri, S. Jalaie, "Ashworth scales are unreliable for the assessment of muscle spasticity", Physiother Theory Pract, 22(3), pp. 119-125, 2006. https://doi.org/10.1080/09593980600724188
  28. R. J. Palisano, P. L. Rosenbaum, D. J. Russell, S. D. Walter, E. P. Wood, B. E. Galuppi, "Development and reliability of a system to classify gross motor function in children with cerebral palsy", Dev Med child Neurl, 39(4), pp. 214-223, 1997.
  29. S. Ostensjo, E. B. Carberg, N. K. Vollestad, "Motor impairments in young children with cerebral palsy: Relationship to gross motor function and everyday activities", Dev Med Child Neurol, 46(9), pp. 580-589, 2004.
  30. K. Bobath, "A neurological basis for the treatment of cerebral palsy. 2nd ed.", London, England: William Heinemann Medical Books Ltd., 1980.
  31. J. C. van der Heide, B. Otten, L. A. van Eykern, M. Hadders-Algra, "Development of postural adjustments during reaching in sitting children", Exp Brain Res, 151, pp. 32-45, 2003. https://doi.org/10.1007/s00221-003-1451-3
  32. F. J. Vera-Garcia, S. G. Grenier, S. M. McGill, "Abdominal muscle response during curl-ups on both stable and labile surfaces." Phys Ther, 80(6), pp. 564-9, 2000.
  33. M. Unger, M Faure, A Frieg, "Strength training in adolescent learners with cerebral palsy: a randomized controlled trial", Clin Rehabil, 20(6), pp. 469-477, 2006. https://doi.org/10.1191/0269215506cr961oa
  34. H. McBurney, N. F. Taylor, K. J. Dodd, H. K. Graham, "A qualitative analysis of the benefits of strength training for young people with cerebral palsy", Dev Med Child Neurol, 45(10), pp. 658-668, 2003.
  35. J. H. Lee, "The effects of strengthening trunk muscles using water exercises on sitting postures and muscle tone in lower extremities for the children with cerebral palsy", Dankook University Dissertation of Master Degree, 2006.
  36. B. H. Song, "The effect of an exercise using elastic thera-band strengthening trunk muscle on the static sitting posture for children with CP", Journal of Special Education, 10(1), pp. 301-317, 2003.
  37. D. L. Damiano, L. E. Kelly, C. L. Vaughn, "Effects of quadriceps femoris muscle strengthening on crouch gait in children with spastic diplegia", Phys Ther, 75(8), pp. 658-667, 1995. https://doi.org/10.1093/ptj/75.8.658
  38. E. G. Fowler, T. W. Ho, A. I. Nwigwe, F. J. Dorey, "The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy." Phys Ther, 81(6), pp. 1215-1223, 2001.

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