DOI QR코드

DOI QR Code

The Effects of Backward Walking with Rhythmic Auditory Stimulation on Gait and Balance in Patients with Stroke

리듬청각자극을 이용한 후방 보행 훈련이 뇌졸중 환자의 보행과 균형에 미치는 영향

  • Hyun, Dong-Su (Dept. of Physical Therapy, Yuseong Hangajok Rehabilitation Hospital) ;
  • Choi, Jong-Duk (Dept. of Physical Therapy, College of Natural Science, Daejeon University)
  • 현동수 (유성한가족병원 재활치료센터) ;
  • 최종덕 (대전대학교 자연과학대학 물리치료과)
  • Received : 2013.08.12
  • Accepted : 2013.12.05
  • Published : 2013.12.31

Abstract

This study examined the effects of backward walking with rhythmic auditory stimulation on the gait and balance of stroke patients. Twenty-one people were divided randomly into three groups; group I(n=7, forward walking), group II(n=7, backward walking), group III(n=7, backward walking by rhythmic auditory stimulation). Each group was trained for 30 minutes 5 times per week for 3 weeks, and was evaluated using a 10m walking test, time up and go test, functional reach test, stride length and step length asymmetry ratio. As a result, the pre- to post-test measures revealed a significant effect in each group on the gait speed, gait symmetry and balance(p<.05). The walking speed, gait symmetry and balance were higher in group II (p<.05) than in group I and it was the highest in group III(p<.05). The stride length was higher in group II and group III(p<.05) than in group I. In conclusion, for stroke patients, backward walking training with rhythmic auditory stimulation is effective on the gait speed, gait symmetry and balance.

본 연구는 리듬청각자극을 이용한 후방 보행 훈련이 뇌졸중 환자의 보행과 균형에 미치는 영향을 알아보기 위한 것으로 21명의 뇌졸중 환자를 무작위로 세 집단으로 나누었고, 실험군I은 전방 보행 훈련 군, 실험군II은 후방 보행 훈련군, 실험군III은 리듬청각자극을 이용한 후방 보행 훈련 군으로 집단마다 7명씩 실험하였다. 실험은 3주간 주 5회 30분씩 실시하였으며 실험 전과 3주간의 실험 후에 각 실험군의 10m 보행 검사, 일어나 걸어가기 검사, 기능적 팔 뻗기 검사를 하였고, biodex gait trainer 2를 사용하여 활보장과 보장비대칭 비를 측정하였다. 연구의 결과 각 군내의 실험 전 후 비교에서 보행속도, 보행대칭성, 균형에 유의한 차이를 보였고(p<.05), 변화량을 비교했을 때 모두 유의한 차이를 보였으며(p<.05), 보행속도, 보행대칭성과 균형에서는 실험군III, 실험군II, 실험군I 순으로 효과적이였고, 활보장에서는 실험군II와 실험군III이 실험군I보다 효과적이였다. 이 결과를 통하여 뇌졸중 환자를 대상으로 보행 운동을 실시할 때 리듬청각자극을 이용한 후방 보행 훈련이 보행속도, 보행대칭성과 균형의 향상에 있어서 효과적인 방법임을 알 수 있다.

Keywords

References

  1. Kalache, A., & Aboderin, I., "Stroke: the global burden", Health policy and planning, Vol. 10, No. 1, pp. 1-21, 1995. DOI: http://dx.doi.org/10.1093/heapol/10.1.1
  2. de Vries, S., & Mulder, T., "Motor imagery and stroke rehabilitation: a critical discussion", Journal of Rehabilitation Medicine, Vol. 39, No. 1, pp. 5-13, 2007. DOI: http://dx.doi.org/10.2340/16501977-0020
  3. Sharp, S. A., & Brouwer, B. J., "Isokinetic strength training of the hemiparetic knee: effects on function and spasticity", Archives of physical medicine and rehabilitation, Vol. 78, No. 11, pp. 1231-1236, 1997. DOI: http://dx.doi.org/10.1016/S0003-9993(97)90337-3
  4. Friedman, P. J., "Gait recovery after hemiplegic stroke", Disability & Rehabilitation, Vol. 12, No. 3, pp. 119-122, 1990. DOI: http://dx.doi.org/10.3109/03790799009166265
  5. Jorgensen, H. S., Nakayama, H., Raaschou, H. O., & Olsen, T. S., "Recovery of walking function in stroke patients: the Copenhagen Stroke Study", Archives of physical medicine and rehabilitation, Vol. 76, No. 1, pp. 27-32, 1995. DOI: http://dx.doi.org/10.1016/S0003-9993(95)80038-7
  6. Bohannon, R. W., Morton, M. G., & Wikholm, J. B., "Importance of four variables of walking to patients with stroke", International Journal of Rehabilitation Research, Vol. 14, No. 3, pp. 246-250, 1991. DOI: http://dx.doi.org/10.1097/00004356-199109000-00010
  7. Hsu, A. L., Tang, P. F., & Jan, M. H., "Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke", Archives of physical medicine and rehabilitation, Vol. 84, No. 8, pp. 1185-1193, 2003. DOI: http://dx.doi.org/10.1016/S0003-9993(03)00030-3
  8. Jonsdottir, J., & Cattaneo, D., "Reliability and validity of the dynamic gait index in persons with chronic stroke", Archives of physical medicine and rehabilitation, Vol. 88, No. 11, pp. 1410-1415, 2007. DOI: http://dx.doi.org/10.1016/j.apmr.2007.08.109
  9. Michael, K. M., Allen, J. K., & Macko, R. F., "Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness", Archives of physical medicine and rehabilitation, Vol. 86, No. 8, pp. 1552-1556, 2005. DOI: http://dx.doi.org/10.1016/j.apmr.2004.12.026
  10. Bohannon, R. W., Andrews, A. W., & Smith, M. B., "Rehabilitation goals of patients with hemiplegia", International Journal of Rehabilitation Research, Vol. 11, No. 2, pp. 181-184, 1988. DOI: http://dx.doi.org/10.1097/00004356-198806000-00012
  11. Thomas, M. A., & Fast, A., "One step forward and two steps back: The dangers of walking backwards in therapy", American journal of physical medicine & rehabilitation, Vol. 79, No. 5, pp. 459-461, 2000. DOI: http://dx.doi.org/10.1097/00002060-200009000-00011
  12. Threlkeld, A. J., Horn, T. S., Wojtowicz, G., Rooney, J. G., & Shapiro, R., "Kinematics, ground reaction force, and muscle balance produced by backward running.", The Journal of orthopaedic and sports physical therapy, Vol. 11, No. 2, p. 56, 1989. https://doi.org/10.2519/jospt.1989.11.2.56
  13. Yang, Y. R., Yen, J. G., Wang, R. Y., Yen, L. L., & Lieu, F. K., "Gait outcomes after additional backward walking training in patients with stroke: a randomized controlled trial", Clinical Rehabilitation, Vol. 19, No. 3, pp. 264-273, 2005. DOI: http://dx.doi.org/10.1191/0269215505cr860oa
  14. Takami, A., & Wakayama, S., "Effects of partial body weight support while training acute stroke Patients to walk backwards on a treadmill-a controlled clinical trial using randomized allocation", Journal of physical therapy science, Vol. 22, No. 2, pp. 177-187, 2010. DOI: http://dx.doi.org/10.1589/jpts.22.177
  15. Thaut, M. H., Leins, A. K., Rice, R. R., Argstatter, H., Kenyon, G. P., McIntosh, G. C., Bolay, H. V., & Fetter, M., "Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: A single-blind, randomized trial", Neurorehabilitation & Neural Repair, Vol. 21, No. 5, pp. 455-459, 2007. DOI: http://dx.doi.org/10.1177/1545968307300523
  16. Thaut, M. H., McIntosh, G. C., & Rice, R. R., "Rhythmic facilitation of gait training in hemiparetic stroke rehabilitation", Journal of the Neurological Sciences, Vol. 151, No. 2, pp. 207-212, 1997. DOI: http://dx.doi.org/10.1016/S0022-510X(97)00146-9
  17. Conklyn, D., Stough, D., Novak, E., Paczak, S., Chemali, K., & Bethoux, F., "A home-based walking program using rhythmic auditory stimulation improves gait performance in patients with multiple sclerosis: a pilot study", Neurorehabilitation & Neural Repair, Vol. 24, No. 9, pp. 835-842, 2010. DOI: http://dx.doi.org/10.1177/1545968310372139
  18. Hurt, C. P., Rice, R. R., McIntosh, G. C., & Thaut, M. H., "Rhythmic auditory stimulation in gait training for patients with traumatic brain injury.", Journal of music therapy, Vol. 35, No. 4, p. 228, 1998. https://doi.org/10.1093/jmt/35.4.228
  19. Suteerawattananon, M., Morris, G. S., Etnyre, B. R., Jankovic, J., & Protas, E. J., "Effects of visual and auditory cues on gait in individuals with Parkinson's disease", Journal of the Neurological Sciences, Vol. 219, No. 1, pp. 63-69, 2004. DOI: http://dx.doi.org/10.1016/j.jns.2003.12.007
  20. Kurz, M. J., Wilson, T. W., & Arpin, D. J., "Stride-time variability and sensorimotor cortical activation during walking", NeuroImage, Vol. 59, No. 2, pp. 1602-1607, 2012. DOI: http://dx.doi.org/10.1016/j.neuroimage.2011.08.084
  21. C. Y., Kim, I. M., Park, & D. W., Oh, "Comparison of the effect of treadmill gait training and overground gait training on gait function in stroke patients", Korea Journal of Neural Rehabilitation, Vol. 1, No. 1, pp. 13-20, 2011.
  22. Davies, P. M., Right in the middle: selective trunk activity in the treatment of adult hemiplegia, pp. 224-238, Springer Verlag., 1990.
  23. Eifert-Mangine, M., Minning, S., Desai, H., Papania, N., Mangine, R. E., & Holloway, J., "Test-retest reliability of the biodex gait trainer", The Journal of Orthopaedic & Sports Physical Therapy, Vol. 35, No. 1, PO186, 2005
  24. Dean, C. M., Richards, C. L., & Malouin, F., "Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial", Archives of physical medicine and rehabilitation, Vol. 81, No. 4, pp. 409-417, 2000. DOI: http://dx.doi.org/10.1053/mr.2000.3839
  25. Podsiadlo, D., & Richardson, S., "The timed" Up & Go": a test of basic functional mobility for frail elderly persons", Journal of the American geriatrics Society, Vol. 39, No. 2, p. 142, 1991. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  26. Behrman, A. L., Light, K. E., Flynn, S. M., & Thigpen, M. T., "Is the functional reach test useful for identifying falls risk among individuals with Parkinson's disease?", Archives of physical medicine and rehabilitation, Vol. 83, No. 4, pp. 538-542, 2002. DOI: http://dx.doi.org/10.1053/apmr.2002.30934
  27. S. H., Cho, & S. G., Kim, "The effect of depending on variations of speed in backward walking on lower extremities muscle", Journal of the Korea Academia-Industrial cooperation Society, Vol. 13, No. 5 pp. 2199-2205, 2012. DOI: http://dx.doi.org/10.5762/KAIS.2012.13.5.2199
  28. S. H., Lee, K. J., Lee, G. H., Ha, T. S., In, & C. H., Song, "The effects of thythmic auditory stimulation on the gait symmetry in the chronic stroke patients", Journal of the Korea Academia-Industrial cooperation Society, Vol. 12, No. 5 pp. 2187-2196, 2011. DOI: http://dx.doi.org/10.5762/KAIS.2011.12.5.2187