• Physical Therapy Rehabilitation Science
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• v.5 no.2
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• pp.63-69
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• 2016

Objective: To evaluate the effects of sit-to-stand (STS) imagery group training (IGT) on STS movement and balance performance for chronic hemiparetic stroke. Design: Randomized controlled trial. Methods: A total of 30 people with chronic hemiparetic stroke (15 for STS-IGT group and 15 for control) were recruited in this study. The STS-IGT group participated in a videotape-based STS-IGT for 30 minutes a day, five days a week for six weeks, while the control group watched a documentary on television for the same period. The STS-IGT focused on a five-stage protocol. Specifically, external imagery was used during the four phases of the STS movement from the seat of the chair to standing up. All of the participants also participated in a regular rehabilitation program. STS movement and balance performance were assessed using three clinical measures. Results: After training, time to perform the 5-repetition STS test significantly increased in the STS-IGT group (change value, $4.0{\pm}2.0$ sec) compared with the control group (change value, $0.9{\pm}0.7$ sec) (p<0.05). There was a greater improvement in Berg balance scale scores in the STS-IGT group (change value, $0.2{\pm}4.1$ points) compared with the control group (change value, $0.3{\pm}0.9$ points) (p<0.05). There was a greater improvement in Timed Up and Go scores in the STS-IGT group (change value, $2.6{\pm}1.5$ sec) compared with the control group (change value, $0.9{\pm}1.0$ sec) (p<0.05). Conclusions: STS-IGT can be considered as a useful option for restoration of STS movement and balance performance for individuals with chronic hemiparetic stroke who are unable to fully participate in physical activities.

• Physical Therapy Korea
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• v.24 no.3
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• pp.10-20
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• 2017

Background: Patients with chronic stroke often shows decreased trunk muscle activity and trunk performance. To resolve these problems, many trunk stabilizing techniques including the abdominal drawing-in maneuver (ADIM) and the diaphragmatic breathing maneuver (DBM) are used to improve trunk muscle strength. Objects: To compare the effects of the ADIM and the DBM on abdominal muscle thickness, trunk control, and balance in patients with chronic stroke. Methods: This was a randomized controlled trial. Nineteen patients were randomly allocated to the ADIM ($n_1=10$) and DBM ($n_2=9$) groups. The ADIM and DBM techniques were performed three times per week for 4 weeks. The thicknesses of the transversus abdominis (TrA), internal oblique muscle, and external oblique muscles on the paretic and non-paretic sides, Trunk Impairment Scale (TIS) score, and Berg Balance Scale (BBS) score were used to assess changes in motor development after 4 weeks of training. Results: After the training periods, the TrA thickness on the paretic side, TIS score, and BBS score improved significantly in both groups compared to baseline (p<.05). TIS score was significantly greater in the DBM group than in the ADIM group (p<.05). Conclusion: This study demonstrated that ADIM and DBM are beneficial for improving TrA muscle thickness in the paretic side, trunk control, and balance ability. Intergroup comparison revealed that TIS score was significantly improved in the DBM group versus the ADIM group. Thus, DBM may be an effective treatment for low trunk muscle activity and performance in patients with chronic stroke.

• Physical Therapy Rehabilitation Science
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• v.5 no.4
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• pp.170-176
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• 2016

Objective: The purpose of this study was to compare the effect of ball kicking dual task gait training with the addition of a cognitive task with general treadmill gait training (TGT) on gait speed, gait endurance, functional gait, balance and balance confidence in patients with chronic hemiparetic stroke. Design: Randomized controlled trial. Methods: Fourteen stroke patients who volunteered to participate in this study were randomly divided into two groups with seven patients in each group: ball kicking dual task training (DTT) group and TGT group. The DTT group received ball kicking DTT with cognitive tasks consisted of three stages and the TGT group received TGT using normal walking speed, respectively, for 30 minutes per day 3 days per week for 4 weeks. Outcome assessments were made with the 10-meter walking test (10MWT), 6-minute walking test (6MWT), functional gait assessment (FGA), Berg balance scale (BBS), timed up and go test (TUG), and the activities-specific balance confidence (ABC) scale. Results: The DTT group showed more significant improvement in the 10MWT, 6MWT, FGA, BBS, TUG, and ABC than the TGT group (p<0.05). In addition, within groups comparison showed significant improvement in all variables (p<0.05). Conclusions: The findings suggest that both ball kicking dual task gait training and TGT improve gait performance and balance in patients with chronic hemiparetic stroke. However, ball kicking dual task gait training results showed more favorable outcomes than TGT for chronic hemiparetic stoke patients.

• Physical Therapy Korea
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• v.18 no.2
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• pp.67-75
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• 2011

The purpose of this study was to investigate the effects of virtual reality (VR) therapy with compensation inhibition and feedback (CIF) on upper extremity function in chronic stroke patients. Seven chronic stroke patients participated in this study, which was a randomized controlled trial with a crossover design. Self upper extremity exercise, conservative VR therapy, and VR therapy with CIF were performed for one hour per session, 5 times per week, over a 3 week period. The main outcome measures involved range of motion (ROM) including shoulder, elbow, and wrist joints, a Manual Function Test (MFT), and a Motor Activity Log (MAL). Data were calculated as posttest and pretest changes in every session and were analyzed using Friedman and Wilcoxon signed-rank tests at p<.05. The results were as follows: 1) Statistically significant increase in ROM measurements of shoulder and elbow joints were seen with VR therapy with CIF compared to VR therapy and self upper extremity exercise (p<.05), whereas no significant increasing was noted for the wrist joint (p>.05). 2) Statistically significant increase in the MFT was seen with VR therapy with CIF compared with VR therapy and self upper extremity exercise (p<.05). 3) VR therapy with CIF also resulted in statistically significant increase in both activity of use (AOU) (p<.05) and quality of movement (QOM) (p<.05) on the MAL test when compared with VR therapy and self upper extremity exercise, respectively. In conclusion, VR therapy with CIF was more effective than conservative VR therapy and self upper extremity exercise in improving the upper extremity function in hemiplegic patients with chronic stroke.

• The Journal of Korean Physical Therapy
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• v.28 no.2
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• pp.71-76
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• 2016

Purpose: This study was conducted to assess the effects of robot-assisted gait training with visual feedback on gait, balance, and balance confidence in patients with chronic stroke. Methods: Thirty subjects with chronic stroke were randomly assigned to two groups: the experimental group (n=15) and the control group (n=15). The experimental group performed robot-assisted gait training for 30 minutes and the control group performed gait training with assisted devices training for 30 minutes after both groups performed conventional physical therapy for 30 minutes. Both groups performed the therapeutic interventions for 5 days per week, for a period of 4 weeks. For assessment of the 10 m walking test (10 MWT), Figure of 8 on the walk test (F8WT), Timed-Up and Go test (TUG), and Berg Balance Scale (BBS) were used to test the gait and balance, and the Korean version of the Activities-specific Balance Confidence Scale was used to test the balance confidence. Results: The experimental group showed significant improvement in the 10 MWT and the K-ABC (p<0.05), and the control group showed significant improvement in the BBS and the TUG (p<0.05). In four measurements, there were significant differences between the two groups (p<0.05), and the control group showed significant improvement in the F8WT at pre and post intervention (p<0.05). Conclusion: This study demonstrated that Robot-assisted gait training with visual feedback is an effective intervention for improving straight gait abilities and balance confidence, while the control group showed some improvement in curve gait and balance. Thus, we suggest both Robot-assisted gait training with visual feedback and gait training with assisted devices training exercise as a therapeutic intervention in chronic stroke rehabilitation.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.2
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• pp.83-91
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• 2016

PURPOSE: The purpose of this study was to determine the efficacy of dual-task action observation training (AOT) and single-task AOT related with daily living task on walking ability and ADL performance in chronic stroke patients. METHODS: Twenty-seven chronic stroke subjects were included in the study. They were randomly assigned to three task categorieds as follows: whole dual-task AOT or partial dual-task AOT or single-task AOT rehabilitation. Whole dual-task AOT observed the movement at once and partial dual-task AOT observed the movement divided into 4 parts related functional gait and activities of daily living task for 2 minutes 30 seconds. Single-task AOT observed the movement related functional gait for 2 minutes 30 seconds. Both groups had physical training session for 12 minutes 30 seconds. The study was conducted for four weeks, with three training sessions a week, for twelve weeks. All subjects were evaluated for their walking ability and activities of daily living through devices, 10m walking test (10MWT), dynamic gait index (DGI), and Korea-Modified Barthel Index (K-MBI). RESULTS: A significant improvement of walking ability and ADL performance happened among dual-task AOT subjects, compared with a single-task AOT subjects, during the 4-weeks course treatment. The results of the study showed statistically significant differences in 10MWT (p<0.05) and DGI (p<0.05), and K-MBI (p<0.05). CONCLUSION: Our results indicated that dual-task AOT has a positive additional impact on recovery of walking ability and ADL performance in chronic stroke patients.

• Journal of the Korean Society of Physical Medicine
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• v.12 no.1
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• pp.35-42
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• 2017

PURPOSE: The purpose of this study was to examine the effects of treadmill gait training in an adjusted position from the functional training system on the gait and balance of chronic stroke patients. METHODS: Thirty chronic stroke patients were randomly assigned to either the experimental group, who received treadmill gait training in an adjusted position, or the control group, who received regular treadmill gait training. Both groups underwent a 30-minute comprehensive rehabilitation treatment before receiving an additional 20-minute treadmill gait training. This routine was repeated five times a week for four weeks. To measure the difference before and after training in walking and balance, patients were scored on the following: 10 m walking test (10 MWT), 6 minute walking distance (6 MWD), timed up and go test (TUG), and static standing balance test (stability index). RESULTS: While post-training scores of 10 MWT, 6 MWD, TUG, and stability index for both groups increased significantly compared with pre-training (p<.05), the experimental group showed greater improvement than the control group (p<.05). The scores of the experimental group increased significantly by 9% in the 10 MWT, 11% in 6 MWD, 13% in the TUG, 8% in the stability Index (eye opened), and 10% in the stability index (eye closed). CONCLUSION: Treadmill gait training in an adjusted position from the functional training system would be a useful gait training method to improve walking and balance of chronic stroke patients.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.4
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• pp.63-70
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• 2019

PURPOSE: This study examined the effects of bilateral ankle dorsiflexors-strengthening exercise on the paralytic tibialis anterior activity, balance ability, and gait function of patients with chronic stroke. METHODS: Nineteen patients with chronic stroke were assigned randomly to the experimental and control groups. All participants received general physical therapy for 60-minutes per session, five times a week, for 6 weeks. In addition, the experimental group (n = 9) performed bilateral ankle dorsiflexion muscle-strengthening training three times a week, 30 minutes per session, for six weeks. The control group (n=10) performed the paraplegic ankle dorsiflexion muscle- strengthening training in the same manner. Before and after the intervention, the paralytic tibialis anterior muscle activity, timed up and go test (TUG), and 10m walking test (10 MWT) were performed. RESULTS: Both groups showed significant improvement in the post-intervention muscle activity of the paralytic tibialis anterior, TUG, and 10MWT compared to that before the intervention (p<.05), but the differences between the two groups were not significant (p >.05). CONCLUSION: Bilateral ankle dorsiflexors strengthening exercise is an effective cross-training method to improve the muscle activity of the paraplegic tibialis anterior, balance ability, and walking function in chronic stroke patients.

• The Journal of Internal Korean Medicine
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• v.35 no.1
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• pp.1-11
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• 2014

Objectives : To investigate the effects of Sa-am acupuncture on muscle architecture and elastic properties of the spastic elbow flexor and to evaluate the correlation between clinical findings and parameters of real-time sonoelastography (RTS) in patients with chronic post-stroke hemiparesis. Materials and Methods : Seven patients (five males, two females) with chronic post-stroke hemiparesis were included. Sa-am acupuncture of Ganseunggyeok (肝勝格: LU8 LR4 補, HT8 LR2 瀉) was applied to the unaffected side 3 times a week for 4 weeks. During each acupuncture treatment period, patients were requested to exercise their affected arm, and spasticity and functional recovery outcomes of the affected arm were evaluated before and after Sa-am acupuncture treatment. Clinical outcomes were assessed using motricity index (MI), modified Ashworth scale (MAS), Fugl-Meyer assessment scale (FMA) and modified Barthel index (MBI) for elbow flexor spasticity. RTS images indicate the relative hardness of the examined muscles ranged from red (hard) to purple (soft) for color-scale, and from black (hard) to white (soft) for hue scale. Color and hue histograms of the biceps brachii and brachialis were analyzed using Image J software, and median red, blue, and hue pixel intensity were obtained. Results : MI and FMA score significantly increased and MAS score significantly decreased (p<0.05). F-wave maximal amplitude of affected abductor pollicis brevis significantly decreased (p<0.05). Muscle thickness of affected brachialis significantly increased (p<0.05). Red and green pixel intensity of affected brachialis significantly decreased (p<0.05). Conclusions : Our study revealed that Sa-am acupuncture is effective as a useful and safe treatment for spasticity in chronic post-stroke hemiparesis.

• The Journal of the Korea Contents Association
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• v.16 no.10
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• pp.711-718
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• 2016

The aim of this study was to investigate the effects of dual-task training on balance and upper extremity function with chronic stroke. For seventeen persons with chronic stroke, we executed dual-task training for 4 weeks, five times per week, and 30 minutes each time. Before and after the dual-task training, the patients were tested with Berg Balance Scale(BBS) and BTS FreeEMG 300(BTS FreeEMG 300, BTS, Italy). After the dual-task training, the subjects showed significant changes in the score of BBS(p<.05). And, the subjects' shoulder and elbow movement had negative values of change after the intervention, indicating that there was a positive change. The results of this study show that dual-task training for persons with chronic stroke is a useful therapeutic approach by enhancing the their quality of life through improving balance and upper extremity function.