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Effects of Dynamic Tubing Gait Training on Postural Alignment, Gait, and Quality of Life in Chronic Patients with Parkinson's Disease : Case Study

동적탄력튜빙 보행훈련 프로그램이 만성 파킨슨병 환자의 자세정렬과 보행능력과 삶의 질에 미치는 영향 : 사례연구

  • 이동률 (호남대학교 물리치료학과)
  • Received : 2021.11.23
  • Accepted : 2021.12.27
  • Published : 2021.12.31

Abstract

The present study investigated the effects of dynamic tubing gait training(I and II) on the postural alignment, gait, and quality of life in chronic patients with Parkinson's disease. This study is based on the case study that recruited a total of 3 patients with chronic Parkinson's disease (Hoehn and Yahr Stage of 1 to 3 each one person). Dynamic tubing gait training (I and II) applied to chronic patients with Parkinson's disease for 25 sessions, 30 minutes a day, 5 days a week, over 5 weeks period. To investigate the effects of this study, evaluating using the postural alignment test, muscle activity tests, gait analysis, and quality of life scale for patient with Parkinson's disease. After the intervention of Dynamic tubing gait training (I and II), Trunk flexion was decreased. Also, during walking from initial contact (IC) to mid stance (Mst), muscle activity of Quadriceps, Hamstring, and Tibialis Anterior (TA) was increased and muscle activity of Gastrocnemius was decreased. The muscle activation of Erector Spinae (ES T12, L3) was increased in the H&Y I and III stages and decreased in the H&Y II stage. Length of gait line, single support line, ant/post position and lateral symmetry of center of pressure (COP) parameters improved. The spatio-temporal gait parameters including of step length, stride length, and velocity was increased, and cadence decreased. Further the quality of life of patients with Parkinson's disease was improved. Based on these findings, Dynamic tubing gait training (I and II) could be applied as a new approach to improve posture, gait, quality of life in chronic patients with Parkinson's disease for more than 5 years, whose drug resistance is halved.

본 연구에서는 만성 파킨슨병 환자의 동적탄력튜빙 보행 훈련 (I, II)이 자세정렬, 보행, 삶의 질에 미치는 영향을 조사하였다. 총 3명의 만성 파킨슨병 환자를 모집하여 사례 연구를 시행하였다(Hoehn 및 Yahr 1-3단계 각 1명). 동적탄력튜빙 보행 훈련 (I 및 II)은 파킨슨병 환자에게 하루 30분, 주 5일, 5주 동안 25세션 적용되었다. 본 연구의 효과를 알아보기 위해, 자세정렬검사, 근 활성도검사, 보행분석 및 파킨슨병 환자의 삶의 질을 평가하였다. Dynamic tubing 보행 훈련(I, II) 중재 후 몸통 굽힘은 감소되었다. 또한 초기 접촉기(IC)에서 중간 디딤기(Mst)까지 보행 시 넙다리네갈래근, 뒤넙다리근, 앞정강근(TA)의 근 활성도가 증가하고 장딴지근의 근활성도가 감소하였다. 척추세움근(ES T12, L3)의 근활성도는 H&Y I, III 단계에서 증가하고 H&Y II 단계에서 감소하였다. 압력 중심(COP) 매개변수인 보행선의 길이, 한 발 지지선, 앞/뒤 위치, 좌우대칭 값이 개선되었다. 시공간 보행 매개변수인 보폭, 보폭, 의 속도는 증가하고 분당걸음수는 감소되었다. 나아가 파킨슨 병 환자의 삶의 질도 개선되었다. 이러한 연구 결과를 바탕으로 동적탄력튜빙 보행 훈련 (I 및 II)은 약물 내성이 절반으로 감소된 5년 이상된 만성 파킨슨병 환자의 자세, 보행, 삶의 질을 개선하기 위한 새로운 접근 방식으로 적용될 수 있을 것이다.

Keywords

Acknowledgement

This paper was studied with the support of Honam University's academic research funds in 2019.

References

  1. Pandey, S., & Garg, H.(2016). Postural & Striatal deformities in Parkinson's Disease: Are these rare?. Indian Journal of Medical Research, 143: 11-17. https://doi.org/10.4103/0971-5916.178577
  2. Hwang, S., Song, S., Hong, Y.K., Choi, G., Suh, Y.S., Han, S.Y., Lee, M., Park, S.H., Lee, J.H., Lee, S., Bang, S.M., Jeong, Y., Chung, W.J., Lee, I.S., Jeong, G., Chung, J., & Cho, K.S.(2013). Drosophila DJ-1 Decreases Neural Sensitivity to Stress by Negatively Regulating Daxx-Like Protein through dFOXO. PLoS Genetics, 9(4): e1003412. https://doi.org/10.1371/journal.pgen.1003412
  3. Dolgacheva, L.P., Berezhnov, A.V., Fedotova, E.I., Zinchenko, V.P., & Abramov, A.Y.(2019). Role of DJ-1 in the mechanism of pathogenesis of Parkinson's disease. Journal of Bioenergetics and Biomembranes, 51(3): 175-188. https://doi.org/10.1007/s10863-019-09798-4
  4. Bjorklund, A., & Dunnett, S.B.(2007). Dopamine neuron systems in the brain an update. TRENDS in Neurosciences, 30(5): 194-202. https://doi.org/10.1016/j.tins.2007.03.006
  5. 천영주, 박용성, 김정태, 임성실(2015). 조기진단 파킨슨병 환자 최초 약물의 유효성 및 약물 내성기간에 대한 평가, 약학회지, 59(3): 127-134. https://doi.org/10.17480/psk.2015.59.3.127
  6. Nardone, A., & Schieppati, M.(2006). Balan-ce in Parkinson's Disease Under Static and Dynamic Conditions. Movement Disorders, 21(9): 1515-1520.. https://doi.org/10.1002/mds.21015
  7. Rizek, P., Kumar, N., & Jog, S.S.(2016). An update on the diagnosis and treatment of Parkinson disease. Canadian Medical Association journal, 188(16): 1157-1165. https://doi.org/10.1503/cmaj.151179
  8. Kuhlman, G.D., Flanigan, J.L., Sperling, S.A., & Barrett, M.J.(2019). Predictors of health-related quality of life in Parkinson's disease. Parkinsonisom & related Dirders, 65: 86-90. https://doi.org/10.1016/j.parkreldis.2019.05.009
  9. 김형섭, 고동진, 김용욱(2012). 파킨슨병에서 나타나는 자세이상 및 보행장애의 재활. Geriatric Rehabilitation, 2: 37-42.
  10. 이성용, 우영근, 신승섭, 정석(2008). 보행 시 파킨슨병 시.공간 지표의 특성. 한국전문물리치료학회지, 15(3): 35-43.
  11. Hausdorff, J.M.(2009). Gait dynamics in Parkinson's disease Common and distinct behavior among stride length, gait variability, and fractal-like scaling. Chaos, 19(2): 026113.
  12. Kuhlman, G.D., Flanigan, J.L., Sperling, S.A., & Barrett, M.J.(2019). Predictors of health-related quality of life in Parkinson's disease. Parkinsonisom & related Dirders, 65: 86-90. https://doi.org/10.1016/j.parkreldis.2019.05.009
  13. Straka, I., Minar, M., Gazova, A., Valkovic, P., & Kyselovic, J.(2018). Clinical aspects of adherence to pharmacotherapy in Parkinson disease A PRISMA-compliant systematic review. Medicine, 97(23): e10962. https://doi.org/10.1097/md.0000000000010962
  14. Connolly, B.S., & Lang A.E.(2014). Pharmacological treatment of parkinson disease: a review. Clinical Review & Education, 11(16): 1670-1683.
  15. Mehrholz, J., Kugler, J., Storch, A., Pohl, M., Elsner, B., & Hirsch, Kathleen(2015). Treadmill training for patients with Parkinson's disease. The Cochrane database of systemic reviews, 2015(8): CD007830.
  16. Corcos, D.M., Robichaud, J.A., David, F.J., Leurgans, S.A., Vaillancourt, D.E., Poon, C., Rafferty, M., Kohrt, W.M., & Comella, C.L.(2013). A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease. Movement Disorders, 28(9): 1230-1240. https://doi.org/10.1002/mds.25380
  17. Hass, C.J., Buckley, T.A., Pitsikoulis, C., & Barthelemy, E.J.(2012). Progressive resistance training improves gait initiation in individuals with Parkinson's disease. Gait & Posture, 35(4): 669-673. https://doi.org/10.1016/j.gaitpost.2011.12.022
  18. 방대혁, 조혁신(2017). 고유수용성신경근촉진법을 이용한 체간 운동과 트레드밀을 결합한 훈련이 파킨슨병 환자의 균형과 보행 능력에 미치는 영향. PNF and Movement, 15(3): 333-341.
  19. Frazzitta, G., Balbi, P., Maestri, R., Bertotti, G., Boveri, N., & Pezzoli, G.(2013). The beneficial role of intensive exercise on parkinson disease progression. American Journal of Physical Medicine & Rehabilitation, 92(6): 523-532. https://doi.org/10.1097/PHM.0b013e31828cd254
  20. Tuon, T., Valvassori, S.S., Dal Pont, G.C., Paganini, C.S., Pozzi, B.G., Luciano, T.F., Souza, P.S., Quevedo, J., Souza, C.T., & Pine, R.A.(2014). Physical training prevents depressive symptoms and a decrease in brain-derived neurotrophic factor in Parkinson's disease. Brain Research Bulletin, 108: 106-112. https://doi.org/10.1016/j.brainresbull.2014.09.006
  21. Vallabhajosula, S., McMillion, A.K., & friend, J.E.(2017). The effects of exergaming and treadmill training on gait, balance, and cognition in a person with Parkinson's disease: A case study. Physiotherapy theory and practice, 33(12): 920-931. https://doi.org/10.1080/09593985.2017.1359867
  22. Cakit, B.D., Saracoglu, M., Genc, H., Rana, H.E., & Inan, L.(2007). The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease. Clinical Rehabilitation, 21(8): 698-705. https://doi.org/10.1177/0269215507077269
  23. Shulman, L.M., Katzel, L.I., Ivey, F.M., Sorkin, J.D., Favors, K., Anderson, K.E., Smith, B.A., Reich, S.G., Weiner, W.J., & Macko, R.F. (2013). Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. Jama Neurology, 70(2): 183-190. https://doi.org/10.1001/jamaneurol.2013.646
  24. Lee, D.R.(2013). Effects of Dynamic Tubing Gait Training on Knee Joint Neuromuscular Control and Kinematics During Locomotion in Children With Cerebral Palsy. The Gaduate School, Yonsei University, A Dissertation for the degree of Doctor of Philosophy.
  25. 설동윤(2017). 동적탄력튜빙 보행훈련이 편마비 환자 보행 시 발목관절의 근 활성도와 균형 및 보행에 미치는 영향. 호남대학교 대학원 석사학위 논문.
  26. 이선영(2018). 동적탄력튜빙 II 보행훈련이 뇌졸중 환자의 균형 및 보행에 미치는 영향. 호남대학교 대학원 석사학위 논문.
  27. Lee, S.Y., & Lee, D.R.(2021). Effect of Dynamic Tubing Gait Training for Life-Care on Balance of Stroke Patients. Journal of the Korea Entertainment Industry Association, 15(1): 171-180.
  28. Mikami, K., Shiraishi, M., Kawasaki, T., & Kamo, T.(2017). Forward flexion of trunk in Parkinson's disease patients is affected by subjective vertical position. PLoS ONE, 12(7): e0181210. https://doi.org/10.1371/journal.pone.0181210
  29. Lee, D.R.(2020). Effects of Visual Feedback Treadmill Gait Training Program Combined with Virtual Reality Technology and a Force Plate Measurement System on Gait Ability and Quality of Life in Stroke Patients. Journal of the Korea Entertainment Industry Association, 14(3): 363-373. https://doi.org/10.21184/jkeia.2020.4.14.3.363
  30. Norkin, C.C., & White, D.J.(2003). Measurement of joint motion. FA Davis Company.
  31. Criwell Eleanor.(2011). Cram's Introduction To Surface Electromyography. 2nd edition, Jones & Bartlett publishers.
  32. 정재목(2016). 파킨슨병 삶의 질(PDQ-39)의 결정 요인으로서의 의사소통 삶의 질과 임상적 특성. 연세대학교 대학원 석사학위논문.
  33. Jenkinson, C., Fitzpatrick, R., Sarah, V.P., Laura, D., David, K., & Morley(2018). The Parkinson's disease questionnaires: user manual (PDQ-39, ePDQ, PDQ-8, PDQ Summary Index, PDQ-Carer & PDQ-Carer Summary Index). Health Services Research Unit, University of Oxford.
  34. Jenkinson, C., Fitzpatrick, R., Peto, V., Greenhall, R., & Hyman, N.(1997). The Parkinson's Disease Questionnaire (PDQ-39): development and validation of a Parkinson's disease summary index score. Age Ageing, 26(5): 353-357. https://doi.org/10.1093/ageing/26.5.353
  35. Gaertner, C., Bucci, M.P., Obeid, R. & Wiener-Vacher, S.(2013). Subjective visual vertical and postural performance in healthy children. PLoS ONE, 8(11): e79623. https://doi.org/10.1371/journal.pone.0079623
  36. Sutherland, D.H.(2001). The evolution of clinical gait analysis part l: kinesiological EMG. Gait & Posture, 14(1): 61-70. https://doi.org/10.1016/S0966-6362(01)00100-X
  37. Petzinger, G.M., Fisher, B.E., McEwen, S., Beeler, J.A., Walsh, J.P., & Jakowec, M.W.(2013). Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease. The Lancet Neurology, 12(7): 716-726. https://doi.org/10.1016/S1474-4422(13)70123-6
  38. Nudo, R.J.(2013). Recovery after brain injury: mechanisms and principles. frontiers in Human Neuroscience, 7: 887. https://doi.org/10.3389/fnhum.2013.00887
  39. Hsue, B.J., Miller, F., & Su, F.C.(2009). The dynamic balance of the children with cerebral palsy and typical developing during gait. Part I: Spatial relationship between COM and COP trajectories. Gait & Posture,29: 465-470. https://doi.org/10.1016/j.gaitpost.2008.11.007
  40. 양창수, 임비오.(2012). 파킨슨 환자의 멈춤 보행 시 하지 근전도 분석. 한국운동역학회지, 22(3): 333-339. https://doi.org/10.5103/KJSB.2012.22.3.333
  41. Hollman, J.H., McDade, E.M., & Petersen, R.C.(2011). Normative spatiotemporal gait parameters in older adults. Gait & Posture, 34(1): 111-118. https://doi.org/10.1016/j.gaitpost.2011.03.024
  42. Nonnekes, J., Giladi, N., Guha, A., Fietzek, U.M., Bloem, B.R., & Ruzicka, E.(2019). Gait festination in parkinsonism: introduction of two phenotypes. Journal of Neurology, 266(2): 426-430. https://doi.org/10.1007/s00415-018-9146-7