Won-Seob Shin

The effects of action observational training on walking ability in chronic stroke patients: a double-blind randomized controlled trial

Objective: To investigate the effect of action observational training on walking ability with chronic stroke patients. Design: A double-blind randomized controlled trial. Setting: Inpatient rehabilitation hospital. Participants: Thirty chronic stroke patients. Interventions: Patients in both groups underwent treadmill training for 30 minutes. The action observational training group (n = 15) watched a video of treadmill walking actions taken at various speeds before treadmill training for 10 minutes. The control group (n = 15) watched a nature video unrelated to gait training for the same amount of time. All participants received training five times a week for a period of four weeks. Main measures: Timed up and go test, 10-metre walk test, 6-minute walk test and maximal flexed knee angle in the swing phase during walking. Results: There were significant improvements in timed up and go test (–4.47 vs. –2.47 seconds), 10-m walk test (0.35 vs. 0.16 m/s), 6-minute walk test (93.13 vs. 32.53 m) and maximal flexed knee angle in the swing phase during walking (7.11 vs. 4.58 degrees) in the action observational training group compared with the control group (P < 0.05). Small to huge effect sizes of 1.27, 0.57, 2.34 and 0.37 were observed for timed up and go test, 10-m walk test, 6-minute walk test, and maximal flexed knee angle in the swing phase during walking, respectively. Conclusion: These results suggest that action observational training is an effective method for improvement of the walking ability in chronic stroke patients.

Effect of Training with Whole Body Vibration on the Sitting Balance of Stroke Patients

[Purpose] The purpose of this study was to determine the effects of task-oriented training with whole body vibration (WBV) on the sitting balance of stroke patients. [Subjects] The subjects were 30 stroke patients who were randomly divided into experimental (n1=15) and control (n2=15) groups. [Methods] Subjects in both groups received general training five times per week. Subjects in the experimental group practiced an additional task-oriented training program with WBV, which was performed for 15 minutes, five times per week, for four weeks. The center of pressure (COP) path length and average velocity were used to assess subjects static sitting balance, and the Modified Functional Reach Test (MFRT) was used to assess their dynamic sitting balance. The paired t-test was performed to test the significance of differences between before and after the intervention. The independent t-test was conducted to test the significance of differences between the groups. [Results] Following the intervention, the experimental group showed a significant change in MFRT. [Conclusion] The results of this study suggest that task-oriented training with WBV is feasible and efficacious for stroke patients.

Effects of robot-assisted gait training on spatiotemporal gait parameters and balance in patients with chronic stroke: A randomized controlled pilot trial

BACKGROUND Body weight-supported treadmill training assisted by a robotic gait orthosis is a helpful tool for restoring a symmetrical gait pattern in people with gait discrepancies. OBJECTIVE This studys aim was to compare the effects of robot-assisted gait training (RAGT) versus treadmill gait training (TGT) on spatiotemporal gait parameters, balance, and activities-specific balance confidence with stroke patients. METHODS Eighteen participants with stroke were randomly assigned to RAGT or TGT. Each group underwent twenty sessions (1 h/d, 5 d/wk for 4 weeks). Patients were assessed with gait parameters (gait speed, cadence, step length, and double limb support period) using the GAITRite, the Berg Balance Scale (BBS) score, and the activities-specific balance confidence (ABC) score before and after the intervention. RESULTS Gait speed (P = 0.003), cadence (P = 0.002), step length (P = 0.004), the BBS score (P = 0.048), and the ABC score (P = 0.017) were significantly higher in the RAGT group than in the TGT group, while the double limb support period was significantly lower in the RAGT group (P = 0.043). CONCLUSION RAGT using Lokomat may be more effective than TGT in improving waking ability, balance, and balance confidence in patients with chronic stroke.

Effect of Unstable Surface Training on Walking Ability in Stroke Patients

[Purpose] The purpose of this study was to determine the effects of unstable surface training (UST) on walking ability in chronic stroke patients. [Subjects] The subjects were 12 stroke patients who were randomly divided into experimental (n1=6) and control (n2=6) groups. [Methods] The Subjects in both groups performed treadmill training for 30 minutes. The Subjects in the experimental group also performed UST after treadmill training, with the UST being performed for 10 minutes, five times per week, for four weeks. All subjects were evaluated with a 10-meter walk test, Timed Up and Go test and 6-minute walk test. The pared t-test was performed to test the significant differences between before and after the intervention. The independent t-test was conducted to test the significant differences between groups. [Results] Following the intervention, the experimental group showed significant differences in the Timed Up and Go test and 6-minute walk test. [Conclusion] The results of the study suggest that UST is an effective method for improvement of walking ability in chronic stroke patients.

Validity of the lower extremity functional movement screen in patients with chronic ankle instability

[Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen included the deep squat, the hurdle step (HS) and the in-line lunge (ILL). The symmetry ratios (RS) were accurately measured during the deep squat trial. [Results] Between the two groups, there were significant differences in scores on the LE-FMS, HS, ILL, RS, FADI, and FADI-sport. The FADI was strongly correlated with both LE-FMS score (r=0.807) and ILL score (r=0.896). There was a strong relationship (r=0.818) between LE-FMS score and FADI-sport. [Conclusion] These results suggest that the LE-FMS may be used to detect deficits related to CAI. Additionally, this instrument is reliable in detecting functional limitations in patients with CAI.

The effects of modified constraint-induced movement therapy combined with trunk restraint in subacute stroke: a double-blinded randomized controlled trial

Objective: To investigate the effects of a modified constraint-induced movement therapy (mCIMT) with trunk restraint in subacute stroke patients. Design: Double-blind, randomized controlled trial. Setting: Rehabilitation clinic. Participants: Eighteen subacute stroke patients with moderate motor impairment. Interventions: The patients were treated with either mCIMT combined with trunk restraint or mCIMT for 5 days per week for 4 weeks. The mCIMT combined with trunk restraint group participated in structured intervention sessions for use of the more affected upper-extremity in task-oriented activities with trunk restraint for 1 hour per day, and with the less affected upper-extremity restrained for 5 hours per day weeks. The mCIMT group followed the same protocol without trunk restraint. Main outcome measures: The outcome measures included the action research arm test (ARAT), the Fugl-Meyer assessment (FMA), the modified Barthel index (MBI), the motor activity log (MAL) and the maximal elbow extension angle during reaching (MEEAR) were completed at baseline and post intervention. Results: The mCIMT combined with trunk restraint group exhibited more improved in the ARAT, FMA, MBI, MAL and MEEAR compared with the mCIMT group. Statistical analyses showed significantly different in ARAT (P = 0.046), FMA (P = 0.008), MBI (P = 0.001), MAL-AOU (P = 0.024), MAL-QOM (P = 0.010) and MEEAR (P = 0.001) between groups. Conclusions: These results suggest that mCIMT combined with trunk restraint is more helpful to improve upper-extremity function than mCIMT only in subacute stroke patients with moderate motor impairment.

The Effects of a Warm Whirlpool Bath on Pain and Stiffness of Patients with Chronic Stroke Induced Knee Osteoarthritis

[Purpose] This study set out to investigate the effects of leg immersion in warm water on pain, and stiffness of patients with stroke-induced chronic osteoarthritis. [Subjects] Forty-four patients with chronic stroke were randomly assigned to either the whirlpool group (n=24) or the control group (n=20). [Methods] Subjects in the whirlpool group immersed their legs in a whirlpool bath at 40 °C for 40 minutes 5 times a week for 8 weeks. The control group of patients was instructed to perform activities as usual without using a whirlpool bath. Pre-immersion and post-immersion measurements of the Western Ontario and McMaster University arthritis index (WOMAC)-pain and stiffness indexes were compared to determine the effects of the intervention. The paired t-test was performed to test the significance of differences before and after the experiment. The independent t-test was conducted in order to test the significance of differences between the whirlpool and control groups. Statistical significance was accepted for values of p<0.05. [Results] The WOMAC-pain score, and stiffness index were significantly lower after the intervention. [Conclusion] Immersion of the lower extremities in a whirlpool bath was beneficial for patients with chronic stroke-induced knee osteoarthritis.

Effects of modified constraint-induced movement therapy combined with trunk restraint in chronic stroke: A double-blinded randomized controlled pilot trial.

BACKGROUND Reducing the compensatory mechanism by restraining the unnecessary movement may be helpful in relearning the upper-limb movement. OBJECTIVE To investigate the effects of a modified constraint-induced movement therapy (mCIMT) with trunk restraint (TR) in chronic stroke patients with moderate impairment. METHODS Eighteen participants with hemiparesis were randomly assigned to mCIMT + TR or mCIMT. Each group underwent 20 (1 h/d) intervention session (5 d/wk for 4 weeks). Patients were assessed with the action research arm test (ARAT), the Fugl-Meyer assessment upper extremity (FMA-UE), the modified Barthel index (MBI), and the motor activity log (MAL-AOU and MAL-QOM). RESULTS The mCIMT combined with trunk restraint group exhibited greater changes in the ARAT, FMA, MBI, and MAL (MAL-AOU and MAL-QOM) compared with the mCIMT group. Statistical analyses showed significantly different in ARAT (Z = -2.17, P = 0.03), FMA-UE (Z = -2.49, P = 0.01), MBI (Z = -2.44, P = 0.02), MAL-AOU (Z = -2.17, P = 0.03), and MAL-QOM (Z = -2.17, P = 0.03) between groups. CONCLUSION These finding suggest that mCIMT combined with trunk restraint is more helpful to improve upper-extremity function than mCIMT only in patient with chronic stroke.

Postural control systems in two different functional movements: a comparison of subjects with and without chronic ankle instability.

[Purpose] The aim of this study was to evaluate postural control during two different movements of the Functional Movement Screen in patients with chronic ankle instability compared with healthy subjects. [Subjects] This study was a cross-sectional survey of 50 participants comprised of 25 chronic ankle instability patients and 25 healthy subjects. [Methods] All subjects were subjected to measurement of the Foot and Ankle Disability Index and center of pressure and Functional Movement Screen testing. The deep squat and hurdle step were performed for the lower extremities in Functional Movement Screen testing. Then, the center of pressure was measured with balance assessment software using a Nintendo Wii Balance Board. The center of pressure path length, velocity, and area of the 95% confidence ellipse and Functional Movement Screen scores were evaluated for all subjects. [Results] The results showed significant differences in center of pressure path length, velocity, and area of the 95% confidence ellipse between the groups for the hurdle step with the non-affected limb. However, there were no significant differences between groups for the deep squat and hurdle step with the affected limb. [Conclusion] The results of this study showed that there was a difference in the hurdle step with the non-affected limb in chronic ankle instability patients compared with normal subjects.

Comparison of the effect of weight-bearing and non-weight-bearing positions on knee position sense in patients with chronic stroke

[Purpose] The purpose of this study was to investigate the knee joint proprioception in weight-bearing (WB) and non-weight-bearing (NWB) positions and to study the difference between the methods in chronic stroke patients. [Subjects and Methods] The subjects were 15 stroke patients who were randomly scheduled to perform both positions by a physical therapist not involved in the study. The subjects performed the positions (WB and NWB) based on a randomized controlled cross-sectional design. WB subjects were positioned in one-leg standing to assess the knee joint position sense. NWB subjects were instructed to sit comfortably in a chair and maintain the knees at 90° of flexion with the leg out of the plinth. [Results] The results revealed that the WB position showed a significant difference in knee position sense. The proprioception sense in the WB position was a higher than that in the NWB position. [Conclusion] The knee proprioception of chronic stroke patients differs between the weight-bearing and non-weight-bearing positions.