Journal of Korean Physical Therapy Science (대한물리치료과학회지)

Korean Physical Therapy Science (대한물리치료과학회)
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The effect of obstacle gait training on balance, gait and ADL of the stroke patient - pilot study

장애물 보행훈련이 뇌졸중 환자의 균형, 보행 및 일상생활활동에 미치는 영향 - 예비연구

  • Kim, Soo Jin (Dept. of Physical Therapy, Graduate School, Korea National University of Transportation) ;
  • Oh, Gku Bin (Dept. of Physical Therapy, Graduate School, Korea National University of Transportation) ;
  • Lee, Hyo Jeong (Dept. of Physical Therapy, Korea National University of Transportation)
  • 김수진 (한국교통대학교 물리치료학과 대학원) ;
  • 오규빈 (한국교통대학교 물리치료학과 대학원) ;
  • 이효정 (한국교통대학교 물리치료학과)
  • Received : 2020.08.04
  • Accepted : 2020.09.09
  • Published : 2020.09.30
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Abstract

Background: The purpose of this study is intended to evaluate the effectiveness and analyse the change on balance, gait and ADL of the stroke patient by obstacle gait training. Design: Randomized controlled trial. Methods: Ten subjects with stroke patient are recruited from C rehablitation hospital located Chungbuck. The subjects which are divided to 2 group as experimental group (N=5) conducted the obstacle gait training and control group (N=5) conducted the general gait training. The gait (10mWT), balance (BBS) and ADL (FIM) were measured before and after intervention. Results: There were no significant differences (p>.05) in sex, age, height, weight and K-MMSE among subjects. There were significant differences (p<.05) in balance and gait between of the experimental group and control group. But there was no significant difference (p>.05) in the ADL between of the experimental group and control group. There were significant differences (p<.05) gait and balance in the experimental group. But there were no significant difference (p>.05) gait, balance and ADL in the control group. Conclusion: Obstacle gait training showed positive effects on the gait, balance of the stroke patient.

Keywords

References

  1. 박지원, 이병희, 이수현 등. 뇌졸중 환자의 운동기능, 균형 및 인지에 관한 상관관계분석. 대한물리치료과학회지 2020;27(1):56-65. https://doi.org/10.26862/jkpts.2020.06.27.1.56
  2. 선형석, 박경아, 손석준, 등. 뇌졸중 환자에서 연령에 따른 환측 상지 기능과 일상생활동작 수행과의 연관성. 노인병 2011;15(1):29-36. https://doi.org/10.4235/jkgs.2011.15.1.29
  3. 신나리, 우영근, 유영열. 다양한 지면 보행 훈련이 뇌졸중 환자의 보행 및 균형 능력에 미치는 영향. 대한치료과학회지 2015;7(2):56-64.
  4. 신윤아, 박소원, 권혁철. 만성 뇌졸중 환자의 신경정신행동학적 성격 변화와 삶의 질에 대한 연구. 특수교육재활과학연구 2015;54(1):435-451.
  5. 신정민. 독립보행이 가능한 뇌졸중 환자들의 수직 장애물 통과에 영향을 미치는 요인 분석[석사학위논문]. 청주대학교; 2019.
  6. 윤현식, 한규범, 오승인, 등. 오타고운동 기반 낙상예방교육활동이 아급성 뇌졸중 환자의 균형, 낙상 효능감 및 일상생활동작능력에 미치는 영향: 무작위 대조군 임상 연구. 대한물리치료과학회지 2020;27(1):1-8. https://doi.org/10.26862/jkpts.2020.06.27.1.1
  7. 이지은, 이호성. 장애물 넘기 트레드밀 보행 훈련이 편마비 환자의 정적 및 동적 균형 능력에 미치는 영향. 대한물리의학회지 2019;14(1):139-150. https://doi.org/10.13066/kspm.2019.14.1.139
  8. 정미정. 뇌졸중 환자의 일상생활동작 수행정도와 삶의 질[석사학위논문]. 경희대학교; 2000.
  9. 정연규, 정연재, 김현숙. 장애물 통과 트레드밀 보행훈련이 뇌졸중 환자의 보행기능에 미치는 효과. 한국전문물리치료학회지 2013;20(3):9-18. https://doi.org/10.12674/ptk.2013.20.3.009
  10. 정영일. 다양한 지면 장애물 보행 훈련을 동반한 트레드밀 훈련이 만성 뇌졸중 환자의 보행에 미치는 영향[석사학위논문]. 전주대학교; 2018.
  11. 조남주, 원영식. 뇌졸중 노인의 기능적 독립수준과 인지기능 및 우울증간의 상관관계. 고령자치매작업치료학회지 2011;5(1):1-12.
  12. 통계청 자료. 사망원인통계-사망원인/성/연령별 사망자수, 사망률. 2018.
  13. 홍성환, 현정근, 편성범, 등. 재활의학. 군자출판사; 2014.
  14. 황현철. 지상과 수중에서 장애물 보행훈련이 만성뇌졸중 환자의 하지 근활성도와 균형에 미치는 영향[석사학위논문]. 대구대학교; 2015.
  15. 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
  16. Asher IE. Occupational therapy assessment tools: An annotated index. Amer Occupational Therapy Assn; 1996.
  17. Belgen B, Beninato M, Sullivan PE, et al. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil. 2006;87(4):554-561. https://doi.org/10.1016/j.apmr.2005.12.027
  18. Bogle Thorbahn LD, Newton RA. Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther 1996;76(6):576-585. https://doi.org/10.1093/ptj/76.6.576
  19. Braun SM, Beurskens AJ, van Kroonenburgh SM, et al. Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial. BMC Neurol 2007;7:34. https://doi.org/10.1186/1471-2377-7-34
  20. Canning CG, Ada L, Woodhouse E. Multiple-task walking training in people with mild to moderate Parkinson's disease: a pilot study. Clin Rehabil 2008;22(3):226-233. https://doi.org/10.1177/0269215507082341
  21. Keller Chandra S, Bockisch CJ, Dietz V, et al. Gaze strategies for avoiding obstacles: Differences between young and elderly subjects. Gait Posture 2011;34(3):340-346. https://doi.org/10.1016/j.gaitpost.2011.05.022
  22. Combs-Miller SA, Kalpathi Parameswaran A, Colburn D, et al. Body weight-supported treadmill training vs. overground walking training for persons with chronic stroke: a pilot randomized controlled trial. Clin Rehabil 2014;28(9):873-884. https://doi.org/10.1177/0269215514520773
  23. Dean CM, Richards 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
  24. Dean CM, Rissel C, Sharkey M, et al. Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial. BMC Neurol. 2009;9:38. https://doi.org/10.1186/1471-2377-9-38
  25. Desrosiers J, Noreau L, Rochette A, et al. Predictors of handicap situations following post-stroke rehabilitation. Disabil Rehabil 2002;24(15):774-785. https://doi.org/10.1080/09638280210125814
  26. Donovan K, Lord SE, McNaughton HK, et al. Mobility beyond the clinic: the effect of environment on gait and its measurement in community-ambulant stroke survivors. Clin Rehabil 2008;22(6):556-563. https://doi.org/10.1177/0269215507085378
  27. Fletcher PC, Hirdes JP. Restriction in activity associated with fear of falling among community-based seniors using home care services. Age Ageing 2004;33(3):273-279. https://doi.org/10.1093/ageing/afh077
  28. Godi M, Nardone A, Schieppati M. Curved walking in hemiparetic patients. J Rehabil Med 2010;42(9):858-865. https://doi.org/10.2340/16501977-0594
  29. Hsu AL, Tang PF, Jan MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 2003;84(8):1185-1193. https://doi.org/10.1016/S0003-9993(03)00030-3
  30. Ijmker T, Houdijk H, Lamoth CJ, et al. Effect of balance support on the energy cost of walking after stroke. Arch Phys Med Rehabil 2013;94(11):2255-2261. https://doi.org/10.1016/j.apmr.2013.04.022
  31. Johannsen L, Broetz D, Karnath HO. Leg orientation as a clinical sign for pusher syndrome. BMC Neurol 2006;6:30. https://doi.org/10.1186/1471-2377-6-30
  32. Jung J, Lee J, Chung E, Kim K. The effect of obstacle training in water on static balance of chronic stroke patients. J Phys Ther Sci 2014;26(3):437-440. https://doi.org/10.1589/jpts.26.437
  33. Kim HS, Hwang YO, Yu JH, et al. The correlation between depression, motivation for rehabilitation, activities of daily living, and quality of life in stroke patients. J Korean Soc Occup Ther 2009;17(3),41-53.
  34. Kirker SG, Jenner JR, Simpson DS, et al. Changing patterns of postural hip muscle activity during recovery from stroke. Clin Rehabil 2000;14(6):618-626. https://doi.org/10.1191/0269215500cr370oa
  35. Kloter E, Dietz V. Obstacle avoidance locomotor tasks: adaptation, memory and skill transfer. Eur J Neurosci 2012;35(10):1613-1621. https://doi.org/10.1111/j.1460-9568.2012.08066.x
  36. Kwak KH, Lee DW, Bae SS. Effect of pelvic tilting exercise and gait training on gait characteristics of the patients with hemiplegia. Journal of Korean Physical Therapy 2003;15(3),45-64.
  37. Lay AN, Hass CJ, Richard Nichols T, et al. The effects of sloped surfaces on locomotion: an electromyographic analysis. J Biomech 2007;40(6):1276-1285. https://doi.org/10.1016/j.jbiomech.2006.05.023
  38. 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
  39. Lu TW, Yen HC, Chen HL. Comparisons of the inter-joint coordination between leading and trailing limbs when crossing obstacles of different heights. Gait Posture 2008;27(2):309-315. https://doi.org/10.1016/j.gaitpost.2007.04.007
  40. Lu TW, Yen HC, Chen HL, et al. Symmetrical kinematic changes in highly functioning older patients post-stroke during obstacle-crossing. Gait Posture 2010;31(4):511-516. https://doi.org/10.1016/j.gaitpost.2010.02.012
  41. Mak MK, Levin O, Mizrahi J, et al. Joint torques during sit-to-stand in healthy subjects and people with Parkinson's disease. Clin Biomech (Bristol, Avon) 2003;18(3):197-206. https://doi.org/10.1016/S0268-0033(02)00191-2
  42. Mansfield A, Inness EL, Komar J, et al. Training rapid stepping responses in an individual with stroke. Phys Ther 2011;91(6):958-969. https://doi.org/10.2522/ptj.20100212
  43. Mercier L, Audet T, Hebert R, et al. Impact of motor, cognitive, and perceptual disorders on ability to perform activities of daily living after stroke. Stroke 2001;32(11):2602-2608. https://doi.org/10.1161/hs1101.098154
  44. Michel J, Benninger D, Dietz V, et al. Obstacle stepping in patients with Parkinson's disease. Complexity does influence performance. J Neurol 2009;256(3):457-463. https://doi.org/10.1007/s00415-009-0114-0
  45. Patla AE, Prentice SD. The role of active forces and intersegmental dynamics in the control of limb trajectory over obstacles during locomotion in humans. Exp Brain Res 1995;106(3):499-504.
  46. Said CM, Goldie PA, Patla AE, et al. Effect of stroke on step characteristics of obstacle crossing. Arch Phys Med Rehabil 2001;82(12):1712-1719. https://doi.org/10.1053/apmr.2001.26247
  47. Said CM, Goldie PA, Patla AE, et al. Balance during obstacle crossing following stroke. Gait Posture 2008;27(1):23-30. https://doi.org/10.1016/j.gaitpost.2006.12.009
  48. Saleh MSM, Rehab NI, Aly SMA. Effect of aquatic versus land motor dual task training on balance and gait of patients with chronic stroke: A randomized controlled trial. NeuroRehabilitation 2019;44(4):485-492. https://doi.org/10.3233/NRE-182636
  49. Shumway-Cook A, Patla AE, Stewart A, et al. Environmental demands associated with community mobility in older adults with and without mobility disabilities. Phys Ther 2002;82(7):670-681. https://doi.org/10.1093/ptj/82.7.670
  50. Silsupadol P, Lugade V, Shumway-Cook A, et al. Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial. Gait Posture 2009;29(4):634-639. https://doi.org/10.1016/j.gaitpost.2009.01.006
  51. Takakusaki K. Neurophysiology of gait: from the spinal cord to the frontal lobe. Mov Disord 2013;28(11):1483-1491. https://doi.org/10.1002/mds.25669
  52. Taylor D, Stretton CM, Mudge S, et al. Does clinic-measured gait speed differ from gait speed measured in the community in people with stroke?. Clin Rehabil 2006;20(5):438-444. https://doi.org/10.1191/0269215506cr945oa
  53. Tilson JK, Sullivan KJ, Cen SY, et al. Meaningful gait speed improvement during the first 60 days poststroke: minimal clinically important difference. Phys Ther 2010;90(2):196-208. https://doi.org/10.2522/ptj.20090079
  54. van Ooijen MW, Heeren A, Smulders K, et al. Improved gait adjustments after gait adaptability training are associated with reduced attentional demands in persons with stroke. Exp Brain Res 2015;233(3):1007-1018. https://doi.org/10.1007/s00221-014-4175-7
  55. Verhoeff LL, Horlings CG, Janssen LJ, et al. Effects of biofeedback on trunk sway during dual tasking in the healthy young and elderly. Gait Posture 2009;30(1):76-81. https://doi.org/10.1016/j.gaitpost.2009.03.002
  56. Wolfson L, Judge J, Whipple R, et al. Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol A Biol Sci Med Sci 1995;50 Spec No:64-67.