Physical Therapy Rehabilitation Science

korean Academy of Physical Therapy Rehabilitation Science (물리치료재활과학회)
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Effect of backward walking training using an underwater treadmill on muscle strength, proprioception and gait ability in persons with stroke

  • Kum, Dong-Min (Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University) ;
  • Shin, Won-Seob (Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University)
  • Received : 2017.08.26
  • Accepted : 2017.09.13
  • Published : 2017.09.30
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Abstract

Objective: The purpose of this study was to investigate the effects of backward treadmill gait training between underwater and ground environments on strength, proprioception, and walking ability in persons with stroke. Design: Randomized control trial. Methods: Twenty eight subjects participated in the study in which they were randomly assigned to either the underwater backward treadmill training (UBTT) group (n=13) or the BTT group (n=15). In both groups, forward gait training was performed for 20 minutes on the ground treadmill. The UBTT group performed backward gait on an underwater treadmill for 20 minutes while the BTT group performed backward gait on a ground treadmill for 20 minutes. The gait training in each group was performed twice a week for a total of six weeks. Muscle strength, proprioception, and gait ability was assessed using a digital power meter, joint angle recurrence method using the smartphone protractor application, the Figure-of-Eight walk test (F8W) and the functional gait assessment (FGA) respectively. Results: Both groups showed significant improvement in strength, F8W and FGA scores after training (p<0.05). However, there was no statistically significant difference between the two groups. Both groups showed significant improvement in proprioception after training (p<0.05). In the comparison between the two groups, there was a greater significant change in the UBTT group for joint proprioception (p<0.05). Conclusions: In this study, it was found that both backward treadmill gait training programs were effective on strength, proprioception, and gait ability, and that underwater training was particularly effective on proprioception compared to ground training.

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References

  1. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1995;76:27-32. https://doi.org/10.1016/S0003-9993(95)80038-7
  2. Kim JO, Lee BH. Effect of upper extremity coordination exercise during standing on the paretic side on balance, gait ability and activities of daily living in persons with stroke. Phys Ther Rehabil Sci 2017;6:53-8. https://doi.org/10.14474/ptrs.2017.6.2.53
  3. Stibrant Sunnerhagen K. Circuit training in community-living "younger" men after stroke. J Stroke Cerebrovasc Dis 2007;16:122-9. https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.12.003
  4. An CS, Jung S. A study on gait analysis of normal adult and hemiplegia patients. J Korea Soc Phys Ther (JKPT) 2002;14:143-8.
  5. Park JH, Chung Y. The effects of providing visual feedback and auditory stimulation using a robotic device on balance and gait abilities in persons with stroke: a pilot study. Phys Ther Rehabil Sci 2016;5:125-31. https://doi.org/10.14474/ptrs.2016.5.3.125
  6. Park SE. Comparison of effect of underwater and land treadmill exercise on the stroke patient's gait and physical function [Master thesis]. Yongin: Yong In University; 2010.
  7. Hess RJ, Brach JS, Piva SR, VanSwearingen JM. Walking skill can be assessed in older adults: validity of the Figure-of-8 Walk Test. Phys Ther 2010;90:89-99. https://doi.org/10.2522/ptj.20080121
  8. Malouin F, Potvin M, Prevost J, Richards CL, Wood-Dauphinee S. Use of an intensive task-oriented gait training program in a series of patients with acute cerebrovascular accidents. Phys Ther 1992;72:781-9; discussion 789-93.
  9. Chen CL, Chen HC, Tang SF, Wu CY, Cheng PT, Hong WH. Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil 2003;82:925-35. https://doi.org/10.1097/01.PHM.0000098040.13355.B5
  10. Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil 2002;83:683-91. https://doi.org/10.1053/apmr.2002.32488
  11. Grasso R, Bianchi L, Lacquaniti F. Motor patterns for human gait: backward versus forward locomotion. J Neurophysiol 1998;80:1868-85. https://doi.org/10.1152/jn.1998.80.4.1868
  12. Ki KI, Kim SY, Oh DW, Kim KH. The effect of backward walking training in the walking speed and balance capability of patients with hemiplegia. Korean Acad Phys Ther Sci 2009;16:1-9.
  13. Bates A, Hanson N. Aquatic exercise therapy. Philadelphia: WB Saunders Company; 1996.
  14. An S, Jee Y, Lee D, Song S, Lee G. Predictive validity of the gait scale in the Performance Oriented Mobility Assessment for stroke survivors: a retrospective cohort study. Phys Ther Rehabil Sci 2016;5:1-8. https://doi.org/10.14474/ptrs.2016.5.1.1
  15. Matsumoto I, Araki H, Tsuda K, Odajima H, Nishima S, Higaki Y, et al. Effects of swimming training on aerobic capacity and exercise induced bronchoconstriction in children with bronchial asthma. Thorax 1999;54:196-201. https://doi.org/10.1136/thx.54.3.196
  16. Chu KS, Eng JJ, Dawson AS, Harris JE, Ozkaplan A, Gylfadottir S. Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil 2004;85:870-4. https://doi.org/10.1016/j.apmr.2003.11.001
  17. 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:M233-8.
  18. Kwon YC, Park JH. Korean version of mini-mental state examination (MMSE-K): part I: development of the test for the elderly. J Korean Neuropsychiatr Assoc 1989;28:125-35.
  19. Won JI, An CM. Knee strength and ankle range of motion influencing gait velocity and gait asymmetry in patients with chronic stroke. Phys Ther Korea 2015;22:1-10.
  20. Kim TW, Kim YW. Effects of visual cue deprivation during sideways treadmill training on balance and walking in stroke patients. Phys Ther Korea 2014;21:20-8.
  21. Dollings H, Sandford F, O'conaire E, Lewis JS. Shoulder strength testing: the intra-and inter-tester reliability of routine clinical tests, using the $PowerTrack^{TM}$ II Commander. Shoulder Elbow 2012;4:131-40. https://doi.org/10.1111/j.1758-5740.2011.00162.x
  22. Perlau R, Frank C, Fick G. The effect of elastic bandages on human knee proprioception in the uninjured population. Am J Sports Med 1995;23:251-5. https://doi.org/10.1177/036354659502300221
  23. Kim MC, Kim NJ, Lee MS, Moon SR. Validity and reliability of the knee joint proprioceptive sensory measurements using a smartphone. J Korean Soc Phys Med 2015;10:15-23.
  24. Park IW, Lim OB, Park KN, Yi Ch. Intra- and inter-rater reliability of measuring passive range of shoulder motion with smartphone and goniometer in patients with stroke. Phys Ther Korea 2014;21:1-12.
  25. Song HS, Kim JY. The effect of trampoline training on balance and position sense of knee joint in elderly women. J Korean Acad Orthop Man Ther 2012;18:11-7.
  26. Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL. Reliability, internal consistency, and validity of data obtained with the functional gait assessment. Phys Ther 2004;84:906-18.
  27. Won JI, Yu KH. Reliability of the functional gait assessment in patients with stroke. Phys Ther Korea 2011;18:64-73.
  28. Flynn TW, Soutas-Little RW. Mechanical power and muscle action during forward and backward running. J Orthop Sports Phys Ther 1993;17:108-12. https://doi.org/10.2519/jospt.1993.17.2.108
  29. Laufer Y. Effect of age on characteristics of forward and backward gait at preferred and accelerated walking speed. J Gerontol A Biol Sci Med Sci 2005;60:627-32. https://doi.org/10.1093/gerona/60.5.627
  30. Gusi N, Tomas-Carus P, Hakkinen A, Hakkinen K, Ortega-Alonso A. Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia. Arthritis Rheum 2006;55:66-73. https://doi.org/10.1002/art.21718
  31. Kim MC, Han SK. The effect of virtual reality-based exercise program using domestic console game machine on the balance abilities for the elderly. J Korean Soc Health Sci 2012;9:55-64.
  32. Yang YR, Yen JG, Wang RY, Yen LL, Lieu FK. Gait outcomes after additional backward walking training in patients with stroke: a randomized controlled trial. Clin Rehabil 2005;19:264-73. https://doi.org/10.1191/0269215505cr860oa
  33. Choi HS, Jeon SB. Effect of backward walking training on balance capability and gait performance in patients with stroke. J Digit Converg 2015;13:367-73.
  34. Suomi R, Koceja DM. Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention. Arch Phys Med Rehabil 2000;81:780-5. https://doi.org/10.1016/S0003-9993(00)90111-4

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