• Physical Therapy Rehabilitation Science
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• v.12 no.1
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• pp.62-71
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• 2023

Objective: Stroke patients need the training to adjust their posture and maintain balance is necessary to restore movement function, and unstable support training is one of the appropriate training. In this study, a systematic review and meta-analysis were conducted to find out the effects of unstable surface training on balance and gait in stroke patients. Design: Systematic review and meta-analysis Methods: After creating a search expression referring to MeSH and EMTREE, the literature from 1976 to February 2022 was searched in the databases of PubMed, EMBASE, and Cochrane Library CENTRAL. A total of 331 studies were searched from three databases, and 11 studies were finally selected according to the inclusion criteria. Unstable surface training included studies using balance trainer, Whole-body vibration, and sand surfaces. Results: The results were found to be d=2.28 (p=0.02) and the effect size was 0.36 (95% CI: 0.05, 0.67) on the Berg Balance Scale. In the Kinesthetic Ability Trainer static balance, d=2.59 (p=0.01) and the effect size was 1.01 (95% CI: 0.24, 1.78). Timed Up and Go test showed that d=2.18 (p=0.03) and the effect size was 0.38 (95% CI: 0.04, 0.72). At the gait speed, d=0.99 (p=0.32) and the effect size was 0.15 (95% CI: -0.15, 0.45). In the 6-minute walk test, d=0.14 (p=0.89) and the effect size was 0.04 (95% CI: -0.47, 0.55). Conclusions: In this study was found that training was effective in balance if it became unstable in standing posture. Therefore, unstable surface training can be used to improve the balance of stroke patients in clinical practice.

• PNF and Movement
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• v.16 no.2
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• pp.249-257
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• 2018

Purpose: This study aimed to explore the effects of additional trunk exercises on an unstable surface on the balance and walking ability of individuals with chronic stroke. Methods: Sixteen patients with chronic stroke participated in this study. The participants were randomly assigned to two groups: experimental group (n=8) and control group (n=8). All the participants underwent a typical physical therapy program for 30 min a day. Moreover, the experimental group participated in a 30 min trunk exercise program on an unstable surface, whereas the control group participated in a 30 min trunk exercise program on a stable surface. Both groups performed the exercises five times a week for three weeks. The Berg Balance Scale (BBS) was used to measure changes in balance. The gait variables were measured using the GAITRite system (CIR System Inc., Clifton, NJ, USA) to examine changes in walking ability. Results: Both groups showed a significant intragroup improvement in balance, gait speed, cadence, stride length, and double support period (p<0.05). In the intergroup comparisons after the intervention, the experimental group showed significant improvements over the control group in balance, gait speed, cadence, stride length, and double support period (p<0.05). Conclusion: This study applied additional trunk exercises on an unstable surface to chronic stroke patients, and the results showed a significant improvement in the patients' balance and walking abilities. Therefore, trunk exercise on an unstable surface may be applicable as an intervention method to improve the balance and walking ability of chronic stroke patients.

• The Journal of Korean Society for Neurotherapy
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• v.22 no.3
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• pp.19-23
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• 2018

Purpose The purpose of this study was to investigate the change of balance ability by performing closed chain exercise on stable support surface and unstable support surface in twenties. Methods This study randomly selected 15 students in the closed chain exercise group on the stable support side and 15 on the closed chain exercise group on the unstable support side. Balance ability was measured before and after the start of exercise and static balance was measured by OLT(One Leg Standing Test) and FRT (Functional Reach Test). Result The changes of the function reach test of the closed chain movement according to the ground type were significant in the unstable and stable support surfaces and the change of function reach test after the intervention in the two groups was significantly improved compared with the closed chain movement respectively. The one leg standing test changes of the closed chain movement according to the ground type showed significant results on the unstable and stable support surfaces, but there was no significant difference in the one leg standing test changes after intervention between the two groups. Conclusion The effect of closed chain training on ground type is unstable. The change of function reach test and one leg standing test of the closed chain exercise group on the stable support surface resulted in significant changes after exercise, but there was a significant difference in the balance ability of function reach test change after intervention between the groups.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.4
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• pp.211-223
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• 2021

Purpose : The purpose of this study was to examine the effect of task-oriented circuit training using unstable support surface on balance, gait ability, and balance confidence in subacute stroke patients. Methods : Forty-five patients with subacute stroke were randomly divided into the three following groups of 15: 1) TOCT-US group; task-oriented circuit training using unstable surface (experimental group 1), 2) TOCT-SS group; task-oriented circuit training using stable surface (experimental group 2), and 3) CON group; conventional physical therapy (control group). All patients participated in one of the three training programs for 6 weeks, 30 minutes per session, 3 times per week. Patients' balance ability was assessed using the BT-4, BBS (berg balance scale), TUG (time up and go test), and LOS (limit of stability). Gait speed was measured to examine gait ability. K-ABC (activities-specific balance confidence scale) was also used to assess the level of patients' confidence in daily activities. Results : After the intervention, the sway area in experimental groups 1 and 2 decreased, but that in the control group increased. Experimental group 1 showed significant improvement compared with experimental group 2 and the control group. BBS, TUG, and LOS scores of experimental group 1 were significantly improved compared with those of experimental group 2 and the control group. Also, gait speed significantly improved in experimental group 1 compared with experimental group 2 and the control group. Experimental groups 1 and 2 showed significant improvement in K-ABC scores after training. Conclusion : Patients with subacute stroke had significantly improved balance, gait, and level of confidence in performing activities of daily living following task-oriented circuit training using the unstable surface. This indicates that task-oriented circuit training using unstable surfaces can be an effective treatment method for the recovery of balance and gait in subacute stroke patients.

• Journal of Korean Physical Therapy Science
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• v.15 no.1
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• pp.67-74
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• 2008

A decrease in the ability to maintain static and dynamic balance after stroke could be related to the inability to select reliable sensory information in producing relative motor action needed to maintain postural stability. The purpose of this study was to compare the effects of two different types of surface conditions on the balancing ability of subjects with stroke. Eighteen hemiparetic subjects were assigned to an experimental and control group participating in a six－week rehabilitative therapeutic exercise program focusing on balance and mobility. Exercises were performed 3 to 5 times per week in a stable surface condition by the control group, and in an unstable surface condition by the experimental group. Pre－ and post test assessments involved the measurement of the static balance and dynamic balance, respectively by 7－item Berg Balance Scale－3P and by Pro－3 Balance System. Results showed that under the unstable surface condition, static balance in the experimental group showed more improvement than that of the control group.(Statistically, not very significant.) All the aspects of dynamic balance and mediolateral sway(balance) improved significantly than those of the control group. However, there were no significant differences between two groups. Overall, it can be concluded that under the unstable surface condition, the rehabilitative therapeutic exercise programs are effective in improving the dynamic balance of stroke subjects. The results suggest that the adaptation of the unstable surface in the rehabilitative therapeutic exercises could be effective for the patients with hemiplegia in balance. Further studies are needed to confirm the effectiveness of the unstable surface on improving balance and postural stability of hemiplegics.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.20 no.2
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• pp.1-7
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• 2014

Purpose: The purpose of this study was to compare the effects of the balance training on the stable and unstable supporting surfaces for the subjects with functional ankle instability. Methods: Twenty-nine subjects with functional ankle instability were randomly assigned to the stable group (n=14) and the unstable group (n=15). Balance training was conducted twenty minutes a day on the stable surface for the stable group and on the airostep for the unstable group three times a week for four weeks. Balance training program was consisted of ten steps by eye opened or closed and two or one leg standing. X-speed for transverse balance and Y-speed for longitudinal balance were measured with eye opened and closed in affected leg standing position. Results: There were significant improvements of balance ability in eye opened (p<.01) and eye closed standing (p<.01) in stable group. Unstable group also showed significant improvements of balance ability in eye opened (p<.01) and eye closed standing (p<.01). There were no statistical differences in the magnitude of improvement between the groups (p<.05). Conclusions: Based on such results, it can be said that balance training on the stable surface is effective as much as training on the unstable surface for the subjects with functional ankle instability.

• Journal of International Academy of Physical Therapy Research
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• v.11 no.2
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• pp.2028-2035
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• 2020

Background: Weakness of the trunk muscles decreases the trunk control ability of stroke patients, which is significantly related to balance and gait. Objectives: To compare the impact of diagonal pattern self-exercise on an unstable surface and a stable surface for trunk rehabilitation on trunk control, balance, and gait ability in stroke patients. Design: Nonequivalent control group design. Methods: Twenty four participants were randomized into the experimental group (diagonal pattern self-exercise while sitting on an unstable surface, n=12) and the control group (diagonal pattern self-exercise while sitting on a stable surface, n=12). All interventions were conducted for 30 minutes, three times a week for four weeks, and the trunk impairment scale (TIS), berg balance scale (BBS), functional gait assessment (FGA), and G-walk were measured. Results: All groups indicated significant increases in all variables (TIS, BBS, FGA, cadence, speed, stride length) after four weeks. The TIS, BBS, FGA, cadence, gait speed, and stride length group-by-time were significantly different between the two groups. Conclusion: We found that, in stroke patients, diagonal pattern self-exercise on an unstable surface is a more effective method for improving trunk control, balance, and gait ability than diagonal pattern self-exercise on a stable surface.

• The Journal of Korean Physical Therapy
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• v.29 no.2
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• pp.55-61
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• 2017

Purpose: The purpose of this study was to investigate the effects of a task-oriented upper arm exercise performed in a sitting position on either an unstable support surface or a stable support surface for children with cerebral palsy. Methods: We prospectively evaluated 18 children with cerebral palsy. Eight subjects were randomly assigned to each of the stable and unstable support surface groups. We performed the upper arm exercise three times a week for 6 weeks. To confirm the effects of the intervention, the berg balance scale test, modified functional reaching test (MFRT), timed up and go test (TUG), and Jebsen-Taylor hand function test were conducted before and after the study. Results: Significant differences were observed in MFRT and TUG between the experimental and control groups (p<0.05). In the Jebsen-Taylor hand function test, there were significant differences between the groups for the items picking up small objects, stacking checkers, lifting large light objects, and lifting large heavy objects (p<0.05), but not for writing and stimulation of feeding. Significant differences were observed between the groups in items of card turning, lifting large light objects, and lifting heavy objects. Conclusion: The purpose of this study was to evaluate the effectiveness of a task-oriented upper extremity exercise program for dynamic balance and hand function performed in a sitting position with either stable or unstable support by cerebral palsy patients. There were improvements in the two groups, but performing the exercise while sitting on an unstable support surface had a greater effect on dynamic balance and hand function than exercise while sitting on a stable supporting surface. The results of this study can be used to improve the daily lives of cerebral palsy patients.

• Journal of the Korean Society of Physical Medicine
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• v.9 no.2
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• pp.181-191
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• 2014

PURPOSE: The purpose of this study was to investigate the effect of sensorimotor training in unstable surface on balance ability of elderly women. METHODS: Total of 40 subject were recruited from two separated institution for elderly women in Changwon and conveniently allocated into experimental and control groups. Twenty women were included into experimental group and another twenty women were into control group. Experimental group performed sensorimotor training in unstable surface and control group were only activities of daily living during eight weeks. To assess static balance ability used One leg stance test (OLST) and to assess dynamic balance ability used timed up and go test (TUGT) and Functional reach test (FRT). RESULTS: Control group did not show any difference in balance ability. However static balance ability in experimental group improved on hard or soft surface only eye open condition. Also dynamic balance ability in experimental group improved TUGT or FRT. CONCLUSION: Sensorimotor training in unstable surface improved balance ability of elderly women.

• Journal of the Korean Society of Physical Medicine
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• v.17 no.2
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• pp.75-82
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• 2022

PURPOSE: This study examined the correlation between the pulmonary function and respiratory muscle strengthening training on an unstable support surface and a stable support surface in stroke patients. METHODS: The study subjects were 22 stroke patients undergoing central nervous system developmental rehabilitation treatment. After excluding six dropouts, eight people in the experimental group and eight people in the control groups were classified by random sampling. Both groups performed central nervous system developmental rehabilitation therapy and were provided a 10-minute break. The experimental group was provided with an unstable support surface using Togu, and the control group was trained to strengthen the respiratory muscle in a stable support surface. Respiratory muscle strengthening training was conducted three times per week for 20 minutes. Before and after each group of experiments, a nonparametric test Wilcoxon signed rank test, and a Mann Whitney U-test analysis were used to analyze the variations between the two groups. All statistical significance levels (α) were set at 0.05. RESULTS: Both groups showed increases in the pulmonary function but showed significant differences only in the experimental group. There was a significant difference in the peak expiratory flow between the two groups. CONCLUSION: Central nervous system development rehabilitation treatment for patients with an impaired nervous system and respiratory muscle strengthening training on unstable support surfaces are effective in improving the pulmonary function of stroke patients. Therefore, they are expected to be applied to physical therapy programs to help various functional activities.