Wanhee Lee

The effects of body weight support treadmill training with power-assisted functional electrical stimulation on functional movement and gait in stroke patients.

ObjectiveThe aim of the current study was to examine the effect of body weight support treadmill training (BWSTT) with power-assisted functional electrical stimulation on functional movement and gait in stroke patients. DesignThirty stroke patients were randomly assigned to either the experimental group (n = 15) or the control group (n = 15). All subjects participated in the same standard rehabilitation program. In addition, the experimental group participated in BWSTT with power-assisted functional electrical stimulation for 30 mins per day, five times a week, for 4 wks, and those in the control group participated in BWSTT for 30 minutes per day, five times a week, for 4 wks. Functional movement was assessed using the Berg Balance Scale, the Timed Up and Go test, and the Stroke Rehabilitation Assessment of Movement. Gait ability was assessed using an electrical walkway system. ResultsSignificant differences in the time factor for functional movement and gait (P < 0.05) were observed in the experimental and control groups. For the group × time interaction, significant improvements were observed in the functional movement (Berg Balance Scale [10.93 vs. 6.00], Timed Up and Go test [−9.25 vs. −5.25 secs], and Stroke Rehabilitation Assessment of Movement scores [14.07 vs. 9.80]) and gait (velocity [40.07 vs. 18.64 cm/sec], cadence [30.57 vs. 17.75 steps per minute], paretic side step length [19.36 vs. 8.46 cm], and stride length [30.57 vs. 12.71 cm]) (P < 0.05). ConclusionsThe findings of the current study demonstrated the efficacy of BWSTT with power-assisted functional electrical stimulation on the functional movement and gait ability in stroke patients. Therefore, the authors suggest that power-assisted functional electrical stimulation may be an effective method for the improvement of functional movement and gait ability of stroke patients when added to BWSTT.

Modified constraint-induced movement therapy improves fine and gross motor performance of the upper limb in Parkinson disease.

Objective:The purpose of this study was to examine the effect of modified constraint-induced movement therapy on hand and arm functions in people with Parkinson disease. Design:Twenty individuals with Parkinson disease participated in the study. The experimental group (ten subjects) performed modified constraint-induced movement therapy for 4 wks (3 hrs/day, 5 days/wk), whereas the control group performed general upper limb exercises on the same schedule. The outcome measures both pretest and posttest were the box and block test, Fugl-Meyer assessment, and action research arm test. Results:The scores for the box and block test in the experimental group increased from 35.8 ± 2.6 to 44.8 ± 3.4 after training. Total scores for the Fugl-Meyer assessment in the experimental group significantly increased from 33.6 ± 1.5 to 53.7 ± 3.1 after training. Greater improvement in action research arm test scores were observed in the experimental group (from 35.1 ± 4.9 to 50.8 ± 3.6) than in the general exercise group (from 33.1 ± 2.2 to 34.8 ± 2.7). Conclusions:Modified constraint-induced movement therapy improves fine and gross motor performances of the upper limb in people with Parkinson disease. Therefore, the therapy would be recommended as an effective treatment for them.

The Effect of Trunk Stabilization Exercise Using an Unstable Surface on the Abdominal Muscle Structure and Balance of Stroke Patients

[Purpose] This study investigated the effect of unstable surface trunk stabilization exercise on the abdominal muscle structure and balance of stroke patients. [Subjects] The subjects were divided into two groups: an unstable surface trunk stabilization exercise group (n=13), and a stable surface trunk stabilization exercise group (n=11). [Methods] Both groups performed trunk stabilization exercise for 30 minutes, 3 days per week for 6 weeks. Abdominal muscle thickness and the Berg Balance Scale (BBS) were measured at the baseline and after 6 weeks. [Results] There was a significant improvement in the internal oblique muscle thickness, transversus abdominis thickness and balance ability of the unstable surface trunk stabilization exercise group. [Conclusion] The unstable surface trunk stabilization exercise improved the internal oblique and transversus abdominis muscles and balance ability. These results suggest that unstable surface trunk exercise is useful in the rehabilitation stroke patients.

Relationship between Postural Sway and Dynamic Balance in Stroke Patients.

[Purpose] The purpose of the current study was to investigate the relationship between postural sway and dynamic balance in post stroke patients. [Subjects] Thirty-one stroke patients (20 men and 11 women; age 64.25 years; stroke duration 12.70 months; MMSE-K score 26.35) participated in this study. [Methods] This study applied a cross-sectional design. A Good Balance system was used for measurement of the postural sway velocity (anteroposterior and mediolateral) and velocity moment of subjects under the eyes open and eyes closed conditions in a standing posture. The postural sway of subjects was measured under two surface conditions (stable and unstable surfaces). [Results] On the unstable surface (foam), no significant correlation was observed between postural sway and dynamic balance except for the berg balance scale (BBS) score and anteroposterior postural sway velocity under the eyes open condition, anteroposterior postural sway velocity under the eyes closed condition, and postural sway velocity moment. In addition, in the stable condition, no significant correlation was observed between postural sway and dynamic balance. [Conclusion] Our results indicate that a decrease in postural sway does not necessarily reflect improvement of dynamic balance ability. We believe that this finding may be useful in balance rehabilitation for prevention of falls after a stroke.

Reliability of the good balance system(®) for postural sway measurement in poststroke patients.

[Purpose] The purpose of this study was to examine test-retest reliability of the Good Balance system® for measurement of postural sway in poststroke patients. [Subjects] Sixty chronic stroke patients (40 men and 20 women; age 63.08 years; stroke duration 16.45 months) participated in this study. [Methods] Postural sway was evaluated using a force platform system (Good Balance system, Metitur Oy, Jyvaskyla, Finland). Two examiners measured postural sway for all participants during two separate testing sessions. The second measurement was performed one week after the first measurement. Intraclass correlation coefficients [ICC(2,1)] were used for estimation of reliability. [Results] The ICC (95% CI) for intra-examiner reliability was good to very good, ranging from 0.69 to 0.93 (0.53–0.96), and the ICC for inter-examiner reliability was good to very good, ranging from 0.85 to 0.98 (0.77–0.99). [Conclusion] The results of the current study indicated that the intra- and inter-examiner reliability of the Good Balance system® for measurement of postural sway was good to very good. Therefore, we suggest that measurement of postural sway using the Good Balance system® would be useful for clinical assessment in poststroke patients.

Effect of a local vibration stimulus training programme on postural sway and gait in chronic stroke patients: a randomized controlled trial

Objective: To investigate the effect of a local vibration stimulus training programme on postural sway and gait in stroke patients. Design: A randomized controlled trial with two groups: a local vibration stimulus training programme group and a sham group. Setting: Inpatient rehabilitation centre. Subjects: Thirty-one chronic stroke patients. Interventions: Both groups underwent a standard rehabilitation programme. The local vibration stimulus training programme group (n = 16) participated in the local vibration stimulus training programme for 30 minutes a day, five times a week, for six weeks. The sham group (n = 15) participated in a sham local vibration stimulus training programme for 30 minutes a day, five times a week, for six weeks. Main measures: A forceplate was used to measure postural sway under two conditions: standing with eyes open and eyes closed. Gait ability was measured using the GAITRite system. Results: In postural sway, greater improvements in the postural sway distance with eyes-open (–11.91 vs. 0.80) and eyes-closed (–20.67 vs. –0.34) conditions and postural sway velocity with eyes-open (–0.40 vs. 0.03) and eyes-closed (–0.69 vs. –0.01) conditions were observed in the local vibration stimulus training programme group, compared with the sham group (P < 0.05). In gait ability, greater improvement in gait speed (15.06 vs. 2.85), cadence (8.46 vs. 1.55), step length (7.90 vs. 3.64), and single limb support time (0.12 vs. 0.01) were observed in the local vibration stimulus training programme group, compared with the sham group (P < 0.05). Conclusions: These findings suggest that local vibration stimulus training programme is an effective method for improvement of the postural sway and gait ability of chronic stroke patients.

Effects of a multifactorial fall prevention program on balance, gait, and fear of falling in post-stroke inpatients

[Purpose] This study investigated the effects of a multifactorial fall prevention program on balance, gait, and fear of falling in stroke patients. [Subjects] Twenty-five stroke patients were divided randomly into multifactorial fall prevention program group (n=15) and control treadmill group (n=10). [Methods] All interventions were applied for 30 min, five times per week, for five weeks. The fall prevention program included interventions based on the “Step Up to Stop Falls” initiative and educational interventions based on the Department of Health guidelines. For those in the treadmill group, the speed was increased gradually. The Korean falls efficacy scale and Korean activities-specific balance confidence scale were used to assess fear of falling. To assess balance and walking ability, the Korean performance-oriented mobility assessment scale and the 10-m and 6-minute walk tests were used. [Results] The fall prevention program interventions were found to be very effective at improving gait, balance, and fear of falling compared with the treadmill intervention and therefore seem appropriate for stroke patients. [Conclusion] A multifactorial fall prevention program is effective at improving balance, gait ability, and fear of falling. It is a more specific and broad intervention for reducing falls among inpatients in facilities and hospitals.

Effect of Weight-bearing Therapeutic Exercise on the Q-angle and Muscle Activity Onset Times of Elite Athletes with Patellofemoral Pain Syndrome: A Randomized Controlled Trial.

[Purpose] The purpose of this study was to determine the effect of a weight-bearing therapeutic exercise program for elite athletes diagnosed as having patellofemoral pain syndrome (PFPS). [Subjects] The subjects were 34 elite athletes from the Seoul T Center. They were randomly allocated to three groups: an elastic band exercise group (EBG), a sling exercise group (SEG), or a control group (CG). [Methods] Therapeutic exercises were performed 3 times a week for 8 weeks. The visual analogue scale (VAS) hamstring length, and static and dynamic Q angles were used to test the exercise effect of the exercises, as well as the onset time of electromyographic activity of vastus medialis oblique (VMO) and vastus lateralis (VL). [Results] Decrease of the dynamic Q-angle in EBG was significant and significantly greater than that in CG. The decrease in VAS in SEG was significant and significantly greater than that in CG. There were significant differences in the VL and VMO activity onset times in SEG between pre- and post-test, and their differences between pre- and post-test were also significantly different. [Conclusion] Weight-bearing therapeutic exercise is hoped that clinicians will use this information for better implementation of effective exercise methods for elite athletes with PFPS.

Effect of space balance 3D training using visual feedback on balance and mobility in acute stroke patients.

[Purpose] The purpose of the study was to determine the effects of balance training with Space Balance 3D, which is a computerized measurement and visual feedback balance assessment system, on balance and mobility in acute stroke patients. [Subjects and Methods] This was a randomized controlled trial in which 52 subjects were assigned randomly into either an experimental group or a control group. The experimental group, which contained 26 subjects, received balance training with a Space Balance 3D exercise program and conventional physical therapy interventions 5 times per week during 3 weeks. Outcome measures were examined before and after the 3-week interventions using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Postural Assessment Scale for Stroke Patients (PASS). The data were analyzed by a two-way repeated measures ANOVA using SPSS 19.0. [Results] The results revealed a nonsignificant interaction effect between group and time period for both groups before and after the interventions in the BBS score, TUG score, and PASS score. In addition, the experimental group showed more improvement than the control group in the BBS, TUG and PASS scores, but the differences were not significant. In the comparisons within the groups by time, both groups showed significant improvement in BBS, TUG, and PASS scores. [Conclusion] The Space Balance 3D training with conventional physical therapy intervention is recommended for improvement of balance and mobility in acute stroke patients.

An efficacy study on improving balance and gait in subacute stroke patients by balance training with additional motor imagery: a pilot study.

[Purpose] The few studies conducted on subacute stroke patients have focused only on gait function improvement. This study therefore aimed to confirm the effect of balance training with additional motor imagery on balance and gait improvement in subacute stroke patients. [Subjects and Methods] Participants were divided into an experimental or control group. The experimental group received balance training for 20 minutes/day with mental imagery for 10 minutes/day, three days/week, for four weeks. The control group received only balance training for 30 minutes. Before and after the 12 sessions, balance and gait ability were assessed by the researcher and a physical therapist. [Results] After completion of the 4-week intervention, Berg Balance Scale, Timed Up and Go test, Functional Reach Test, and Four Square Step test scores significantly increased in the experimental group. In the control group, Berg Balance Scale and Functional Reach Test scores significantly improved. Changes in the Timed Up and Go test, Functional Reach Test, and Four Square Step Test scores after intervention were significantly higher in the experimental than in the control group. [Conclusion] Specific balance training with additional motor imagery may result in better rehabilitation outcomes of gait and balance ability than balance training alone.