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Effects of Aquatic and Ground Obstacle Training on Balance and Muscle Activity in Patients With Chronic Stroke

  • Received : 2019.10.02
  • Accepted : 2019.11.08
  • Published : 2019.11.19

Abstract

Background: Obstacle training affects lower limb muscle activity, balance, reducing the risk of falls, and making gait more stable. Objects: This study aimed to investigate the effects of aquatic and ground obstacle training on balance and muscle activity in patients with chronic stroke. Methods: The study subjects included 30 patients with stroke, who were divided into aquatic ($n_1=15$) and ground ($n_2=15$) groups. Groups underwent obstacle training three times per week, 30 min per session, for six weeks that went as follows: walking over sites with the paralyzed leg, stepping onto and down from a box step, and walking over obstacles with the non-paralyzed leg. Results: The experimental results were obtained by comparing muscle activity. Activity of the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius were significantly increased in the aquatic group (p<.05). Activity of the biceps femoris and tibialis anterior were significantly increased in the ground group (p<.05); however, the rectus femoris and gastrocnemius were not significantly different. In the comparison of maximal distance regarding the limits of stability, it was significantly increased on the non-affected side, affected side, and anterior and posterior distance in the aquatic group (p<.05). It was significantly increased in the non-affected side and anterior and posterior distance the ground group (p<.05); however, maximal distance on the affected side distance was not significantly different. Conclusion: Gait training with aquatic and ground obstacles is effective for improving balance and gait ability of patients with stroke. However, it was more effective for the aquatic group than for the ground group.

Keywords

References

  1. Ashburn A, Hyndman D, Pickering R, et al. Predicting people with stroke at risk of falls. Age Ageing. 2008;37(3):270-276. http://doi.org/10.1093/ageing/afn066
  2. Austin GP, Garrett GE, Bohannon RW. Kinematic analysis of obstacle clearance during locomotion. Gait Posture. 1999;10(2):109-120. http://doi.org/10.1016/s0966-6362(99)00022-3
  3. Chen HC, Ashton-Miller JA, Alexander NB, et al. Stepping over obstacles: gait patterns of healthy young and old adults. J Gerontol. 1991;46(6):196-203. http://doi.org/10.1093/geronj/46.6.m196
  4. Chu KS, Eng JJ, Dawson AS, et al. Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2004;85(6):870-874. http://doi.org/10.1016/j.apmr.2003.11.001
  5. Duncan PW, Horner RD, Reker DM, et al. Adherence to postacute rehabilitaion guidelines is associated with functional recovery in stroke. Stroke. 2002;33(1):167-177. http://doi.org/10.1161/hs0102.101014
  6. Eich HJ, Mach H, Werner C, et al. Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: A randomized controlled trial. Clin Rehabil. 2004;18(6):640-651. http://doi.org/10.1191/0269215504cr779oa
  7. Eyvaz N, Dundar U, Yesil H. Effects of water-based and land-based exercises on walking and balance functions of patients with hemiplegia. Neuro-Rehabilitation. 2018;43(2):237-246. http://doi.org/10.3233/NRE-182422
  8. Hakim RM, Ross MD, Runco W,et al. A community-based aquatic exercise program to improve endurance and mobility in adults with mild to moderate intellectual disability. J Exerc Rehabil. 2017;13(1):89-94. http://doi.org/10.12965/jer.1732838.419
  9. Hauer K, Specht N, Schuler M, et al. Intensive physical training in geriatric patients after severe falls and hip surgery. Age Ageing. 2002:31(1):49-57. http://doi.org/10.1093/ageing/31.1.49
  10. Ikai T, Kamikubo T, Takehara I, et al. Dynamic postural control in patients with hemiparesis. Am J Phys Med Rehabil. 2003;82(6):463-469. https://doi.org/10.1097/01.PHM.0000069192.32183.A7
  11. Matsumoto S, Uema T, Ikeda K, et al. Effect of underwater exercise on lower-extremity function and quality of life in post-stroke patients: a pilot controlled clinical trial. J Altern Complement Med. 2016;22(8):635-641. http://doi.org/10.1089/acm.2015.0387
  12. Means KM, O'Sullivan PS. Modifying a functional obstacle course to test balance and mobility in the community. J Rehabil Res Dev. 2000;37(5):621-632.
  13. Melzer I, Elbar O, Tsedek I, et al. A water-based training program that include perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross-overtrial. BMC Geriatr. 2008;8:19. http://doi.org/10.1186/1471-2318-8-19
  14. Miller EW, Combs SA, Fish C, et al. Running training after stroke: a single-subject report. Phys Ther. 2008;88(4):511-522. http://doi.org/10.2522/ptj.20050240
  15. Noh DK, Lim JY, Shin HI, et al. The effect of aquatic therapy on postural balance and muscle strength in stroke survivors: A randomized controlled pilot trial. Clin Rehabil. 2008;22(10-11):966-976. http://doi.org/10.1177/0269215508091434
  16. Orlin MN, Mcpoil TG. Plantar pressure assessment. Phys Ther. 2000;80(4):399-409. http://doi.org/10.1093/ptj/80.4.399
  17. Stegeman DF, Blok JH, Hermens HJ, et al. Surface EMG models: Properties and applications. J Electromyogr Kinesiol. 2000;10(5):313-326. http://doi.org/10.1016/s1050-6411(00)00023-7
  18. Teasell R, McRae M, Foley NB, et al. The incidence and consequences of falls in stroke patients during inpatient rehabilitation: Factors associated with high risk. Arch Phys Med Rehabil. 2002;83(3):329-333. http://doi.org/10.1053/apmr.2002.29623
  19. Watelain E, Barbier F, Allard P, et al. Gait pattern classification of healthy elderly men based on biomechanical data. Arch Phys Med Rehabil. 2000;81(5):579-586. http://doi.org/10.1016/s0003-9993(00)90038-8