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The Effect of an Abdominal Drawing-In Maneuver Combined with Low·High Frequency Neuromuscular Electrical Stimulation on Trunk Muscle Activity, Muscle Fatigue, and Balance in Stroke Patients

  • Received : 2022.09.23
  • Accepted : 2022.10.30
  • Published : 2022.10.31

Abstract

Purpose: This study investigated the effects of an intervention that combined the abdominal drawing-in maneuver and frequency-specific neuromuscular electrical stimulation on changes in trunk muscle activity, muscle fatigue, and balance in stroke patients. Methods: Thirty stroke patients were randomly assigned to two groups. Fifteen subjects were assigned to group I which performed the abdominal drawing-in maneuver combined with low-frequency neuromuscular electrical stimulation and the other 15 subjects to group II where the abdominal drawing-in maneuver was combined with high-frequency neuromuscular electrical stimulation. Muscle activity and fatigue were measured using surface electromyography before the intervention. Balance was measured using the Trunk Impairment Scale and re-measured after six weeks of intervention for comparative analysis. Results: Both groups showed a significant increase in muscle activity and balance (p<0.05), and there was no significant difference between the groups (p>0.05). In the changes in muscle fatigue, only the experimental group II showed a significant increase in muscle fatigue (p<0.05). The difference between the groups was statistically significant (p<0.05). Conclusion: It was confirmed that among stroke patients, the combination of the abdominal drawing-in maneuver and low-frequency neuromuscular electrical stimulation was more effective in changing the muscle activity and balance of the trunk by minimizing the occurrence of muscle fatigue compared to the combination of the abdominal drawing-in maneuver and high-frequency stimulation. These results can be used as basic data for clinical trunk stabilization training.

Keywords

Acknowledgement

본 연구는 세한대학교의 연구비 지원을 받았음.

References

  1. Kang SH. A study of correlation among MMSE-K, CDR and Neurocognitive test (LICA) in patients with stroke. Gachon University. Dissertation of Master's Degree. 2020.
  2. Van Criekinge T, Saeys W, Hallemans A et al. Effectiveness of additional trunk exercises on gait performance: study protocol for a randomized controlled trial. Trials. 2017;18(1):1-12. https://doi.org/10.1186/s13063-016-1752-z
  3. Franceschini M, Rampello A, Agosti M et al. Walking performance: correlation between energy cost of walking and walking participation. New statistical approach concerning outcome measurement. PloS one. 2013;8(2):e56669. https://doi.org/10.1371/journal.pone.0056669
  4. Kwakkel G, Kollen BJ. Predicting activities after stroke: what is clinically relevant? Int J Stroke. 2013;8(1):25-32. https://doi.org/10.1111/j.1747-4949.2012.00967.x
  5. Ryerson S, Byl NN, Brown DA et al. Altered trunk position sense and its relation to balance functions in people post-stroke. J Neurol Phys Ther. 2008;32(1):14-20. https://doi.org/10.1097/NPT.0b013e3181660f0c
  6. Richardson CA, Snijders CJ, Hides JA et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002;27(4):399-405. https://doi.org/10.1097/00007632-200202150-00015
  7. Beazell JR, Grindstaff TL, Hart JM et al. Changes in lateral abdominal muscle thickness during an abdominal drawing-inmaneuver in individuals with and without low back pain. Res Sports Med. 2011;19(4):271-82. https://doi.org/10.1080/15438627.2011.608053
  8. Teyhen DS, Miltenberger CE, Deiters HM et al. The use of ultrasound imaging of the abdominal drawing-in maneuver in subjects with low back pain. J Orthop Sports Phys Ther. 2005;35(6):346-55. https://doi.org/10.2519/jospt.2005.35.6.346
  9. Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. 7th ed. Philadelphia, Fa Davis, 2017:491-545.
  10. Haruyama K, Kawakami M, Otsuka T. Effect of core stability training on trunk function, standing balance, and mobility in stroke patients: a randomized controlled trial. Neurorehabil Neural Repair. 2017;31(3):240-9. https://doi.org/10.1177/1545968316675431
  11. Kang TW. The effects of the upper extremity and lower extremity patterns of PNF on abdominal muscle activity in healthy subjects and abdominal muscle strength and respiratory functions in stroke patients. Silla University. Dissertation of Doctorate Degree. 2019.
  12. Robson N, Faller II KJ, Ahir V et al. Creating a virtual perception for upper limb rehabilitation. International Journal of Biomedical and Biological Engineering. 2017;11(4):152-7.
  13. Fujiwara T, Kawakami M, Honaga K et al. Hybrid assistive neuromuscular dynamic stimulation therapy: a new strategy for improving upper extremity function in patients with hemiparesis following stroke. Neural Plast. 2017.
  14. Park D, Ryu JS. Neuromuscular electrical stimulation for swallowing. J Korean Dysphagia Soc. 2016;6(1):1-6. https://doi.org/10.34160/jkds.2016.6.1.001
  15. Ogino M, Shiba N, Maeda T et al. MRI quantification of muscle activity after volitional exercise and neuromuscular electrical stimulation. Am J Phys Med Rehabil. 2002;81(6):446-51. https://doi.org/10.1097/00002060-200206000-00009
  16. Baek SO, Cho HK, Jung GS et al. Verification of an optimized stimulation point on the abdominal wall for transcutaneous neuromuscular electrical stimulation for activation of deep lumbar stabilizing muscles. Spine J. 2014;14(9):2178-83. https://doi.org/10.1016/j.spinee.2014.02.016
  17. Gorgey AS, Black CD, Elder CP et al. Effects of electrical stimulation parameters on fatigue in skeletal muscle. J Orthop Sports Phys Ther. 2009;39(9):684-92. https://doi.org/10.2519/jospt.2009.3045
  18. Chanthapetch P, Kanlayanaphotporn R, Gaogasigam C et al. Abdominal muscle activity during abdominal hollowing in four starting positions. Man Ther. 2009;14(6):642-6. https://doi.org/10.1016/j.math.2008.12.009
  19. Marshall P, Murphy B. The validity and reliability of surface EMG to assess the neuromuscular response of the abdominal muscles to rapid limb movement. J Electromyogr Kinesiol. 2003;13(5):477-89. https://doi.org/10.1016/S1050-6411(03)00027-0
  20. O'Sullivan PB, Twomey L, Allison GT. Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention. J Orthop Sports Phys Ther. 1998;27(2):114-24. https://doi.org/10.2519/jospt.1998.27.2.114
  21. Yun JH, Kim TS, Lee BK. The effects of combined complex exercise with abdominal drawing-in maneuver on expiratory abdominal muscles activation and forced pulmonary function for post stroke patients. J Korean Soc Phys Med. 2013;8(4):513-23. https://doi.org/10.13066/kspm.2013.8.4.513
  22. Kwon K. The effect of applying different bridge exercise after abdominal drawing-in maneuver on trunk muscles activation and balance for chronic stroke patients. Yongin University. Dissertation of Master's Degree. 2016.
  23. Lee SC, Kim TH, Cynn HS et al. The influence of unstability of supporting surface on trunk and lower extremity muscle activities during bridging exercise combined with core-stabilization exercise. Physical Therapy Korea. 2010;17(1):17-25.
  24. Waongenngarm P, Rajaratnam BS, Janwantanakul P. Internal oblique and transversus abdominis muscle fatigue induced by slumped sitting posture after 1 hour of sitting in office workers. Saf Health Work. 2016;7(1):49-54. https://doi.org/10.1016/j.shaw.2015.08.001
  25. Ko JY, You YY. Reliability and responsiveness of the Korean version of the trunk impairment scale for stroke patients. J Kor Phys Ther. 2015;27(4):175-82. https://doi.org/10.18857/jkpt.2015.27.4.175
  26. Cho HS. The Effect of Coordinative Pattern Exercise of Upper and Lower Extremities for Balance and Gait in Chronic Stroke Patients. Daejeon University. Dissertation of Doctorate Degree. 2014.
  27. Lim JS, Lee SY, Lee DH et al. The effect of a bridge exercise using the abdominal drawing-in maneuver on the balance of chronic stroke patients. J Phys Ther Sci. 2012;24(8):651-3. https://doi.org/10.1589/jpts.24.651
  28. Doucet BM, Griffin L. High-versus low-frequency stimulation effects on fine motor control in chronic hemiplegia: a pilot study. Top Stroke Rehabil. 2013;20(4):299-307. https://doi.org/10.1310/tsr2004-299
  29. Stevens-Lapsley JE, Balter JE, Wolfe P et al. Relationship between intensity of quadriceps muscle neuromuscular electrical stimulation and strength recovery after total knee arthroplasty. Phys Ther. 2012;92(9):1187-96. https://doi.org/10.2522/ptj.20110479
  30. Macedo LG, Maher CG, Latimer J et al. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Phys Ther. 2009;89(1):9-25. https://doi.org/10.2522/ptj.20080103
  31. Seo DK, Kwon OS, Kim JH et al. The effect of trunk stabilization exercise on the thickness of the deep abdominal muscles and balance in patients with chronic stroke. J Phys Ther Sci. 2012;24(2):181-5. https://doi.org/10.1589/jpts.24.181
  32. Shi J, Zheng YP, Chen X et al. Assessment of muscle fatigue using sonomyography: muscle thickness change detected from ultrasound images. Med Eng Phys. 2007;29(4):472-9. https://doi.org/10.1016/j.medengphy.2006.07.004
  33. Sillen MJ, Franssen FM, Gosker HR et al. Metabolic and structural changes in lower-limb skeletal muscle following neuromuscular electrical stimulation: a systematic review. PLoS One. 2013;8(9):e69391. https://doi.org/10.1371/journal.pone.0069391
  34. Gondin J, Brocca L, Bellinzona E et al. Neuromuscular electrical stimulation training induces atypical adaptations of the human skeletal muscle phenotype: a functional and proteomic analysis. J Appl Physiol. 2011;110(2):433-50. https://doi.org/10.1152/japplphysiol.00914.2010
  35. Horstman AM, Gerrits KH, Beltman MJ et al. Intrinsic properties of the knee extensor muscles after subacute stroke. Arch Phys Med Rehabil. 2010;91(1):123-8. https://doi.org/10.1016/j.apmr.2009.09.008
  36. Malesevic NM, Popovic LZ, Schwirtlich L et al. Distributed low-frequency functional electrical stimulation delays muscle fatigue compared to conventional stimulation. Muscle Nerve. 2010;42(4):556-62. https://doi.org/10.1002/mus.21736
  37. Vanderthommen M, Duchateau J. Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sport Sci Rev. 2007;35(4):180-5. https://doi.org/10.1097/jes.0b013e318156e785
  38. Shinde K, Ganvir S. Effectiveness of trunk proprioceptive neuromuscular facilitation techniques after stroke: a meta-analysis. Natl J Med Allied Sci. 2014;3:29-34.
  39. Chan BK, Ng SS, Ng GY. A home-based program of transcutaneous electrical nerve stimulation and task-related trunk training improves trunk control in patients with stroke: a randomized controlled clinical trial. Neurorehabil Neural Repair. 2015;29(1):70-9. https://doi.org/10.1177/1545968314533612
  40. Tsutaki A, Ogasawara R, Kobayashi K et al. Effect of intermittent lowfrequency electrical stimulation on the rat gastrocnemius muscle. Biomed Res Int. 2013;2013.