DOI QR코드

DOI QR Code

Combined Effect of Joint Mobilization and Active Stretching on Gait Speed and Ability after Stroke

  • Go, Junhyeok (Department of Physical Therapy, Kyungbok University) ;
  • An, Hojung (Department of Physical Therapy, Dongnam University)
  • Received : 2021.04.05
  • Accepted : 2021.05.20
  • Published : 2021.06.30

Abstract

Background: Patients with stroke have limited ankle range of motion (ROM) due to soft tissue abnormalities around the ankle and thus experience functional impairment. Increased muscle tension and reduced ankle ROM impair gait and hinder the activities of daily living. Joint mobilization and stretching are effective interventions that improve gait performance by enhancing the ankle ROM. Objectives: To investigate the effects of ankle joint mobilization and calf muscle stretching on gait speed and gait performance in patients with stroke. Design: This was a randomized controlled trial. Methods: Twenty patients with stroke patients were randomized into two groups. The joint mobilization group (JMG) underwent anteroposterior mobilization of the talocrural joint and the joint mobilization stretching group (JMSG) underwent calf muscle stretching in addition to joint mobilization. Gait speed and gait parameters were measured using the 10-meter walk test and the GAITRite. Results: Both the JMG and JMSG groups showed significant improvements in gait speed, affected-side step length, and cadence after the intervention (P<.05). Conclusion: Joint mobilization and stretching were effective interventions for improving gait performance by enhancing ankle function in patients with stroke.

Keywords

References

  1. O'Sullivan SB, Schmitz TJ. Physical Rehabilitation: Assessment and Treatment. 5th ed. Philadelphia, PA: F.A. Davis Company; 2007.
  2. Kwah LK, Herbert RD, Harvey LA, et al. Passive mechanical properties of gastrocnemius muscles of people with ankle contracture after stroke. Arch Phys Med Rehabil. 2012;93(7):1185-1190. https://doi.org/10.1016/j.apmr.2012.02.009
  3. Lin PY, Yang YR, Cheng SJ, Wang RY. The relation between ankle impairments and gait velocity and symmetry in people with stroke. Arch Phys Med Rehabil. 2006;87(4):562-568. https://doi.org/10.1016/j.apmr.2005.12.042
  4. Faisal A, Mirza OB. Effects of ankle stability exercises on balance in stroke patients. Pak J Med Res. 2020;59(1):28-31.
  5. Gao F, Ren Y, Roth EJ, Harvey R, Zhang LQ. Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors. Clinical Biomech. 2011;26(5):516-538. https://doi.org/10.1016/j.clinbiomech.2010.12.003
  6. Cho KH, Park SJ. Effects of joint mobilization and stretching on the range of motion for ankle joint and spatiotemporal gait variables in stroke patients. J Stroke Cerebrovasc Dis. 2020;29(8):104933. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104933
  7. Park DH, Lee JH, Kang TW, Cynn HS. Four-week training involving ankle mobilization with movement versus static muscle stretching in patients with chronic stroke: a randomized controlled trial. Top Stroke Rehabil. 2018;26(2):81-86. https://doi.org/10.1080/10749357.2018.1550614
  8. Elly H, Kevin B. Maitland's Peripheral Manipulation: Management of Neuromusculoskeletal Disorders. 5th ed. UK: Churchill Livingstone; 2013.
  9. Matthew CH, Richard DA, David RM, et al. Two-week joint mobilization intervention improves self-reported function, range of motion, and dynamic balance in those with chronic ankle instability. J Orthop Res. 2012;30(11):1798-1804. https://doi.org/10.1002/jor.22150
  10. An CM, Won JI. Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study. J Phys Ther Sci. 2016;28(2):689-694. https://doi.org/10.1589/jpts.28.689
  11. Slatyer MA, Hensley MJ, Lopert R. A randomized controlled trial of piroxicam in the management of ankle sprain in Australian Regular Army recruits. Am J Sport Med. 1997;25(4):544-553. https://doi.org/10.1177/036354659702500419
  12. Evjenth O, Hamberg J. Muscle Stretching in Manual Therapy: A Clinical Manual. 5th ed. Sweden: Alfta Rehab Forlag; 1994.
  13. Lee JH, Lee JH, Kwon WA, Kim JS. The effect of ankle joint muscle strengthening training and static muscle stretching training on stroke patients' plantar pressure and gait. J Korea Acad Ind Coop Soc. 2012;13(3):1153-1160. https://doi.org/10.5762/KAIS.2012.13.3.1153
  14. Ehsan G, Khosro KK, Minoo KZ, et al. The effect of functional stretching exercises on neural and mechanical properties of the spastic medial gastrocnemius muscle in patients with chronic stroke: a randomized controlled trial. J Stroke Cerebrovasc Dis. 2018;27(7):1733-1742. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.01.024
  15. Kang TW, Lee JH, Cynn HS. Six-week Nordic treadmill training compared with treadmill training on balance, gait, and activities of daily living for stroke patients: a randomized controlled trial. J Stroke Cerebrovasc Dis. 2016;25(4):848-904. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.037
  16. Wong SST, Yam MS, Ng SSM. The figure-of-eight walk test: reliability and associations with stroke-specific impairments. Disabil Rehabil. 2013;35(22):1896-2798. https://doi.org/10.3109/09638288.2013.766274
  17. Lin PY, Yang YR, Cheng SJ, et al. The relation between ankle impairments and gait velocity and symmetry in people with stroke. Arch Phys Med Rehabil. 2006;87(4):562-568. https://doi.org/10.1016/j.apmr.2005.12.042
  18. Gao F, Grant TH, Roth EJ, Zhang LQ. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors. Arch Phys Med Rehabil. 2009;90(5):819-826. https://doi.org/10.1016/j.apmr.2008.11.004
  19. Sunee B, Vimonwan H, Roongtiwa V, Mantana V. Gait symmetrical indexes and their relationships to muscle tone, lower extremity function, and postural balance in mild to moderate stroke. J Med Assoc Thai. 2011;94(4):476-484.
  20. Kim S. Effects of joint mobilization techniques on the joint receptors. Phys Ther Korea. 1996;2(1):9-19.
  21. Capaday C, Cody FW, Stein RB. Reciprocal inhibition of soleus motor output in humans during walking and voluntary tonic activity. J Neurophysiol. 1990;64(2):607-623. https://doi.org/10.1152/jn.1990.64.2.607
  22. Roy A, Forrester LW, Macko RF, Krebs HI. Changes in passive ankle stiffness and its effects on gait function in people with chronic stroke. J Rehabil Res Dev. 2013;50(4):555-572. https://doi.org/10.1682/JRRD.2011.10.0206
  23. Kim JS. Effects of gastrocnemius stretching on α-motor neuron excitability and ankle joint active dorsiflexion range of motion. Int J Con. 2009;9(9):278-286.