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Effects of Underwater Treadmill Gait Training on Gait, Balance, and Pulmonary Function in Stroke Patients

  • Yang, Ho-june (Dept. of Physical Therapy, The Graduate School, Daejeon University) ;
  • Choi, Jong-duk (Dept. of Physical Therapy, College of Health & Medical Science, Daejeon University)
  • Received : 2015.10.06
  • Accepted : 2015.11.09
  • Published : 2015.11.19

Abstract

The purpose of this study was to compare the effects of underwater treadmill gait training (UTGT) and overground treadmill gait training (OTGT) on the gait, balance ability and pulmonary function of stroke patients. Twenty subjects were recruited for this study. The subjects were randomly assigned to two groups: UTGT ($n_1$=10) and OTGT ($n_2$=10). The 10 m walk test (10 MWT), Berg Balance Scale, Timed Up and Go (TUG) test, center of pressure, pulmonary function of forced vital capacity (FVC), forced expiratory volume after 1 sec (FEV1) and FEV1/FVC were measured before and after 4 weeks of training. Both groups undertook the gait training for 30 min a day, 3 times a week, for 4 weeks, and rating of perceived exertion of the groups were measured and compared. All the studied variables were significantly improved in both groups (p<.05) at the end of the study, except in the FEV1 of OTGT (p>.05). There was significant between-group difference in all of the variables, except in the 10 MWT (p>.05). These findings suggest that UTGT is more effective than OTGT in improving the balance and pulmonary functions of stroke patients.

Keywords

References

  1. Ada L, Dean CM, Hall JM, et al. A treadmill and overground walking program improves walking in persons residing in the community after stroke: A placebo-controlled, randomized trial. Arch Phys Med Rehabil. 2003;84(10):1486-1491. https://doi.org/10.1016/S0003-9993(03)00349-6
  2. Altenburger PA, Dierks TA, Miller KK, et al. Examination of sustained gait speed during extended walking in individuals with chronic stroke. Arch Phys Med Rehabil. 2013;94(12):2471-2477. http://dx.doi.org/10.1016/j.apmr.2013.06.015
  3. Becker BE. Aquatic therapy: Scientific foundations and clinical rehabilitation applications. PM R. 2009;1(9):859-872. http://dx.doi.org/10.1016/j.pmrj.2009.05.017
  4. 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.
  5. Brach JS, Lowry K, Perera S, et al, Improving motor control in walking: A randomized clinical trial in older adults with subclinical walking difficulty. Arch Phys Med Rehabil. 2015;96(3):388-394. http://dx.doi.org/10.1016/j.apmr.2014.10.018
  6. Bressel E, Wing JE, Miller AI, et al. High-intensity interval training on an aquatic treadmill in adults with osteoarthritis: Effect on pain, balance, function, and mobility. J Strength Cond Res. 2014;28(8):2088-2096. http://dx.doi.org/10.1519/JSC.0000000000000258
  7. Chu KS, Eng JJ, Dawson AS, et al. A randomized controlled trial of water-based exercise for cardiovascular fitness in individuals with chronic stroke. Arch Phys Med Rehabil. 2004;85(6):870-874. https://doi.org/10.1016/j.apmr.2003.11.001
  8. Dean CM, Rechards 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
  9. Flansbjer UB, Holmbäck AM, Downham D, et al. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med. 2005;37(2):75-82. https://doi.org/10.1080/16501970410017215
  10. Gillen G. Stroke Rehabilitation: A function-based approach. 3rd ed. St Louis, Mosby, 2010:389-415.
  11. Harris-Love ML, Forrester LW, Macko RF, et al. Hemiparetic gait parameters in overground versus treadmill walking. Neurorehabil Neural Repair. 2001;15(2):105-112. https://doi.org/10.1177/154596830101500204
  12. 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
  13. Hyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community: Circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil. 2002;83(2):165-170. https://doi.org/10.1053/apmr.2002.28030
  14. Jung T, Lee D, Charalambous C, et al. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke. Arch Phys Med Rehabil. 2010;91(1):129-136. http://dx.doi.org/10.1016/j.apmr.2009.09.012
  15. Kang SW. Breathing retraining. Pediatr Allergy Respir Dis. 2003;13(1):1-7.
  16. Kim CM, Eng JJ. Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. Gait Posture. 2003;18(1):23-28. https://doi.org/10.1016/S0966-6362(02)00122-4
  17. Kim JS, Son YH, Hwang YB, et al. Effect of submerged treadmill gait training on gait and balance function in people with hemiparesis. Kor J Neural Rehabil. 2011;1(2):63-70.
  18. Kim NH, Cha YJ. Effect of gait training with constrained- induced movement therapy (CIMT) on the balance of stroke patients. J Phys Ther Sci. 2015;27(3):611-613. http://dx.doi.org/10.1589/jpts.27.611
  19. Kim SH, Lee DK, Kim EK. Effect of aquatic exercise on balance and depression of stroke patients. J Korean Soc Phys Ther. 2014;26(2):104-109.
  20. Kisner C, Colby LA. Therapeutic Exercise: Foundations and techniques. 5th ed. Philadelphia, PA, F.A. Davis Co., 2007:851-862.
  21. Lanini B, Bianchi R, Romagnoli I, et al. Chest wall kinematics in patients with hemiplegia. Am J Respir Crit Care Med. 2003;168(1):109-113. https://doi.org/10.1164/rccm.200207-745OC
  22. Lee DG, Jeong SK, Kim YD. Effects of underwater treadmill walking training on the peak torque of the knee in hemiplegic patients. J Phys Ther Sci. 2015;27(9):2871-2873. http://dx.doi.org/10.1589/jpts.27.2871
  23. Lee SM, Kang JH, Ko TS, et al. Cardiovascular and Pulmonary Physical Therapy. 1st ed. Seoul, Hyunmoon, 2011:210-214.
  24. Lord SE, McPherson K, McNaughton HK, et al. Community ambulation after stroke: How important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil. 2004;85(2):234-239. https://doi.org/10.1016/j.apmr.2003.05.002
  25. Macko RF, Smith GV, Dobrovolny CL, et al. Treadmill training improves fitness reserve in chronic stroke patients. Arch Phys Med Rehabil. 2001;82(7):879-884. https://doi.org/10.1053/apmr.2001.23853
  26. Masumoto K, Applequist BC, Mercer JA. Muscle activity during different styles of deep water running and comparison to treadmill running at matched stride frequency. Gait Posture. 2013;37(4):558-563. http://dx.doi.org/10.1016/j.gaitpost.2012.09.019
  27. Masumoto K, Shono T, Hotta N, et al. Muscle activation, cardiorespiratory response, and rating of perceived exertion in older subjects while walking in water and on dry land. J Electromyogr Kinesiol. 2008;18(4):581-590. https://doi.org/10.1016/j.jelekin.2006.12.009
  28. Moore JL, Roth EJ, Killian C, et al. Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a "plateau" in recovery. Stroke. 2010;41(1):129-135. http://dx.doi.org/10.1161/STROKEAHA.109.563247
  29. Ng SS, Hui-Chan CW. The timed up & go test: Its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. Arch Phys Med Rehabil. 2005;86(8):1641-1647. https://doi.org/10.1016/j.apmr.2005.01.011
  30. Patterson SL, Forrester LW, Rodgers MM, et al. Determinants of walking function after stroke: Differences by deficit severity. Arch Phys Med Rehabil. 2007;88(1):115-119. https://doi.org/10.1016/j.apmr.2006.10.025
  31. Park SE, Kim SH, Lee SB, et al. Comparison of underwater and overground treadmill walking to improve gait pattern and muscle strength after stroke. J Phys Ther Sci. 2012;24(11):1087-1090. https://doi.org/10.1589/jpts.24.1087
  32. Park SE, Lee MJ, Yoon BC, et al. Comparison of underwater and overground treadmill walking exercise to improve gait and physical function in people after stroke. J Int Acad Phys Ther Res. 2010;1(2):120-125.
  33. Park SW, Lee KJ, Shin DC, et al. The effect of underwater gait training on balance ability of stroke patients. J Phys Ther Sci. 2014;26(6):899-903. http://dx.doi.org/10.1589/jpts.26.899
  34. Pollock AS, Durward BR, Rowe PJ, et al. What is balance? Clin Rehabil. 2000;14(4):402-406. https://doi.org/10.1191/0269215500cr342oa
  35. Roth EJ, Merbitz C, Mroczek K, et al. Hemiplegic gait. Relationships between walking speed and other temporal parameters. Am J Phys Med Rehabil. 1997;76(2):128-133. https://doi.org/10.1097/00002060-199703000-00008
  36. Shumway-Cook A, Anson D, Haller S. Postural sway biofeedback: Its effect on reestablishing stance stability in hemiplegic patient. Arch Phys Med Rehabil. 1988;69(6):395-400.
  37. Simmons V, Hansen PD. Effectiveness of water exercise on postural mobility in the well elderly: An experimental study on balance enhancement. J Gerontol A Biol Sci Med Sci. 1996;51(5):233-238.
  38. Sin J. The effects of treadmill gait on physical responses, gait, and trunk muscle activation of stroke. Seoul, Sahmyook University, Master Thesis. 2012.
  39. Silver KH, Macko RF, Forrester LW, et al. Effects of aerobic treadmill training on gait velocity, cadence, and gait symmetry in chronic hemiparetic stroke: A preliminary report. Neurorehabil Neural Repair. 2000;14(1):65-71. https://doi.org/10.1177/154596830001400108
  40. Shono T, Masumoto K, Fujishima K, et al. Gait patterns and muscle activity in the lower extremities of elderly women during underwater treadmill walking against water flow. J Physiol Anthropol. 2007;26(6):579-586. https://doi.org/10.2114/jpa2.26.579
  41. Tyson SF, Hanley M, Chillala J, et al. Balance disability after stroke. Phys Ther. 2006;86(1):30-38. https://doi.org/10.1093/ptj/86.1.30
  42. Williams GR, Jiang JG, Matchar DB, et al. Incidence and occurrence of total (first-ever and recurrent) stroke. Stroke. 1999;30(12):2523-2528. https://doi.org/10.1161/01.STR.30.12.2523
  43. Yoo JH, Lim KB, Lee HJ, et al. Cardiovascular response during submaximal underwater treadmill exercise in stroke patients. Ann Rehabil Med. 2014;38(5):628-636. https://doi.org/10.5535/arm.2014.38.5.628

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