Balance Function In Stroke Patients Research Articles

The effect of exercise on balance function in stroke patients: a systematic review and meta-analysis of randomized controlled trials.

A growing body of studies has examined the effect of exercise on balance function in stroke patients, with conflicting findings. This study aimed to investigate the effect of exercise on balance function in stroke patients and to determine the optimal exercise prescription for stroke patients. We conducted an extensive search across various databases, including PubMed, Web of Science, EBSCO, Cochrane, and Scopus. The search was conducted until March 11th, 2024. Data were pooled using the weighted mean difference (WMD) and 95% confidence interval. Twenty-nine studies fulfilled the inclusion criteria. Exercise significantly improved Berg balance scale (BBS, WMD, 5.24, P < 0.00001) and timed up and go test (TUG, WMD, - 2.91, P < 0.00001) in stroke patients. Subgroup analyses showed that aerobic exercise (WMD, 6.71, P = 0.003), exercise conducted ≥ 8weeks (WMD, 6.43, P < 0.00001), > 3 times per week (WMD, 6.18, P < 0.00001), ≥ 60min per session (WMD, 6.40, P < 0.0001), and ≥ 180min per week (WMD, 7.49, P < 0.00001) were more effective in improving BBS. Exercise improved balance function in stroke patients, and aerobic exercise might be the most effective intervention. To improve balance function, this meta-analysis provides clinicians with evidence to recommend that stroke patients participate in a minimum of 8weeks of exercise at least 3 times per week for more than 60min per session, with a goal of 180min per week being achieved by increasing the frequency of exercise.

Effects of trunk training using motor imagery on trunk control ability and balance function in patients with stroke

ObjectiveTo explore the effects of trunk training using motor imagery on trunk control and balance function in patients with stroke.MethodsOne hundred eligible stroke patients were randomly divided into a control group and trial group. The control group was given routine rehabilitation therapy, while the trial group was given routine rehabilitation therapy and trunk training using motor imagery.ResultsPrior to treatment, there was no significant difference between the two groups (P > 0.05) in Sheikh’s trunk control ability, Berg rating scale (BBS), Fugl-Meyer assessment (FMA), movement length, movement area, average front-rear movement speed, average left-right movement speed, and surface electromyography (sEMG) signal of the bilateral erector spinae and rectus abdominis. After treatment, Sheikh’s trunk control ability, FMA, and BBS in the two groups were significantly higher than those before treatment (P < 0.05). The movement length, movement area, the average front-rear movement speed, and the average left-right movement speed in the two groups decreased significantly (P < 0.05). The differences of these indicators between the two groups were statistically significant (P < 0.05). After treatment, the rectus abdominis and erector spinae on the affected side of the two groups improved when compared with those before treatment (P < 0.05). The rectus abdominis and erector spinae on the healthy side of the trial group descended after treatment (P < 0.05), while little changes were observed on the healthy side of the control group after treatment (P > 0.05). The rectus abdominis and erector spinae on the affected side of the trial group improved when compared with those in the control group (P < 0.05). There was no significant difference between the two groups in the decline of abdominalis rectus and erector spinal muscle on the healthy side.ConclusionTrunk training using motor imagery can significantly improve the trunk control ability and balance function of stroke patients and is conducive to promoting the recovery of motor function.

Effects of different rehabilitation training on balance function in stroke patients: a systematic review and network meta-analysis.

Stroke is a major noninfectious disease that endangers patients' health. About 83% of patients have some degree of balance dysfunction. Rehabilitation training is an effective means to improve the balance function of stroke patients. The aim of this meta-analysis was to assess which of the eight rehabilitation training methods was more effective in promoting balance recovery. Eight studies of rehabilitation training to improve balance function in stroke patients were searched in PubMed, Scopus, Web of Science, Embase, Cochrane, Chinese National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases. Data extraction was carried out by two independent researchers. The improvement in balance function included in the study was measured using the Berg Balance Scale (BBS). A random effects model was used to assess the mean difference in these values between patients who received different rehabilitation training and controls. A total of 46 randomized controlled trials (RCTs) were included, including 3741 patients. Meta-analysis results showed that the clinical effectiveness in promoting balance recovery in stroke patients was ranked as follows: core stability training (odds ratio (OR) = 14.98, 95% confidence interval (CI): 8.18-27.44) > whole-body vibration training (OR = 10.27, 95% CI: 4.36-24.18) > mirror therapy (OR = 5.15, 95% CI: 2.40-11.04). This results suggested that core stability was more beneficial for improving balance function in stroke patients.

Short-term and long-term predictors of balance function in stroke patients: a 6-month follow-up study.

We aimed to determine early predictors of balance function (Berg Balance Scale, BBS) at 3 and 6 months after stroke using clinical, neurophysiological, and neuroimaging variables. Seventy-nine patients with hemiparesis after a stroke were included. Demographics, stroke characteristics, and clinical variables [Mini-Mental State Examination, BBS, strength in the hemiparetic hip, knee, and ankle muscles, and Fugl-Meyer Assessment Lower Extremity (FMA-LE)] were evaluated 2 weeks post-stroke, on average. Somatosensory-evoked potentials (SEP) from both tibial nerves and diffusion tensor imaging data were collected respectively within 3 weeks and 4 weeks post-onset to calculate the SEP amplitude ratio and the laterality index of fractional anisotropy of the corticospinal tract. In multiple linear regression analysis, younger age, higher FMA-LE score, and stronger hemiparetic hip extensors were independent predictors of higher BBS at 3 months post-stroke (adjusted R2 = 0.563, P < 0.001). At 6 months post-stroke, significant predictors of higher BBS were younger age, higher FMA-LE, stronger hemiparetic hip extensors, and larger SEP amplitude ratio (adjusted R2 = 0.552, P < 0.001), although the incremental contribution of the latter was rather small ( R2 = 0.019). We conclude that age and the initial motor impairment of the affected lower limb can inform the state of balance function at 3 and 6 months after stroke.

Effects of Tai Chi Exercise on Balance Function in Stroke Patients: An Overview of Systematic Review.

Background Tai chi (TC) has received increased attention in stroke rehabilitation, yet services are greatly underutilized. An increasing number of systematic reviews and meta-analyses (SRs/MAs) have begun to investigate the effects of TC on balance function in stroke patients. The aim of this current study was to systematically collate, appraise, and synthesize the results of these SRs/MAs using a systematic overview. Methods Eight databases were searched: PubMed, Cochrane Library, Embase, Web of Science, CNKI, SinoMed, Chongqing VIP, and Wanfang Data. SRs/MAs of TC on balance function in stroke patients were included. Literature selection, data extraction, and assessment of the review quality were performed by two independent reviewers. Methodological quality was assessed by the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), reporting quality by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and evidence quality by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results Nine SRs/MAs were included in this study. For methodological quality, what resulted in unsatisfactory methodological quality was noncompliance with critical item 4 (using a comprehensive literature search strategy) and critical item 7 (providing the list of excluded research literature). For reporting quality, what resulted in unsatisfactory reporting quality was inadequate reporting of Q1 (protocol and registration), Q8 (search), Q15 (risk of bias across studies), Q16 (additional analyses), Q22 (risk of bias across studies), Q23 (additional analysis), and Q27 (funding). For GRADE, the evidence quality was high in 0, moderate in 3, low in 11, and very low in 6. Risk of bias was the most common factor leading to downgrading of evidence, followed by inconsistency, imprecision, publication bias, and indirectness. Conclusions TC may have beneficial effects on balance function in stroke survivors; however, this finding is limited by the generally low methodology, reporting quality, and evidence quality for published SRs/MAs.

Immediate effects of neuromuscular joint-facilitation bridging exercises on walking ability and balance function in stroke patients

[Purpose] This study aimed to examine the immediate effects of a pelvic neuromuscular joint-facilitation intervention on the walking and balance ability of patients with hemiplegia caused by cerebrovascular accidents. [Participants and Methods] A total of 15 patients with hemiplegia caused by cerebrovascular accidents underwent a neuromuscular joint-facilitation lumbar-pattern intervention (intervention group), a bridge exercise (bridge intervention group), or a neuromuscular joint-facilitation bridge intervention (neuromuscular joint-facilitation bridge group). Each intervention was randomly administered at 7-day intervals. Measurement items included the timed up-and-go test, functional reach test, 10-m maximum walking speed test, and load in the standing position. Measurements were taken before and after the intervention in each group. [Results] The timed up-and-go test result was significantly shorter in the neuromuscular joint-facilitation intervention group. Timed up-and-go test results, functional reach, 10-m walking time, and standing load (non-paralyzed side) significantly improved in the neuromuscular joint-facilitation bridge group. [Conclusion] The neuromuscular joint-facilitation bridge intervention was immediately effective in patients with hemiplegia caused by cerebrovascular accidents and improved their walking and balance ability.

Two-Week Rehabilitation with Auditory Biofeedback Prosthesis Reduces Whole Body Angular Momentum Range during Walking in Stroke Patients with Hemiplegia: A Randomized Controlled Trial.

Walking rehabilitation is challenging in stroke patients with sensory impairments. In this study, we examined the two-week effect of an auditory biofeedback prosthesis, Auditory Foot (AF), on the change in the frontal whole body angular momentum (WBAM) range, before and after a two-week walking rehabilitation. We conducted a pilot randomized controlled trial (RCT). We employed statistical Bayesian modeling to understand the mechanism of the rehabilitation effect and predict the expected effect in new patients. The best-performing model indicated that the frontal WBAM range was reduced in the AF group by 12.9–28.7%. This suggests that the use of kinesthetic biofeedback in gait rehabilitation contributes to the suppression of frontal WBAM, resulting in an improved walking balance function in stroke patients.

Clinical Factors Associated With Balance Function in the Early Subacute Phase After Stroke.

The aim of the study was to investigate the key factors of balance function in the early subacute phase after stroke. Ninety-four stroke patients were included. Multiple variables were evaluated, including demographic factors, clinical variables (stroke type; lesion site; Mini-Mental State Examination; motor strength of the hip, knee, and ankle joints; Fugl-Meyer Assessment of lower extremity), neurophysiological variables (amplitude ratio of somatosensory evoked potential of the tibial nerves), and laterality index of fractional anisotropy of the corticospinal tract using diffusion tensor imaging. Balance function was measured using the Berg Balance Scale. The Berg Balance Scale score was significantly negatively correlated with age and laterality index of fractional anisotropy and positively correlated with Mini-Mental State Examination; Fugl-Meyer Assessment of lower extremity; motor strength of the affected hip, knee, and ankle joint; and somatosensory evoked potential amplitude ratio (P < 0.05). The abnormal somatosensory evoked potential group and poor integrity of the corticospinal tract group showed significantly decreased Berg Balance Scale scores. In multivariable logistic regression analysis, age, Fugl-Meyer Assessment of lower extremity score, and ankle plantar flexion strength were significantly associated with balance function (odds ratios = 0.919, 1.181, and 15.244, respectively, P < 0.05). Higher age, severe initial motor impairment, and strength of the affected lower limb muscles, especially the ankle plantar flexor, are strongly associated with poor balance function early after stroke. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: (1) Enhance ability to evaluate motor and balance function of stroke patients by learning common assessment tools including clinical tests, neurophysiological and neuroimaging studies; (2) Explain the important factors associated with balance function impairment in early subacute stroke patients; and (3) Enhance planning rehabilitation strategies for improvement of balance function according to recovery stage after stroke. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The minimal clinically important difference in Berg Balance Scale scores among patients with early subacute stroke: a multicenter, retrospective, observational study

ABSTRACT Background: Balance dysfunction is common in stroke patients. The Berg Balance Scale (BBS) is useful for evaluating the balance function of stroke patients, and it can estimate the minimal clinically important difference (MCID) in balance. BBS scores differ among stroke patients depending on whether they require walking assistance. The MCID should thus be estimated separately for patients who require assistance and those who do not. Objectives: To estimate the MCID of individuals who have had an early subacute stroke and require a walking aid and those who do not, to assist the clinical determination of the effectiveness of therapy. Methods: This was a retrospective clinical analysis of 80 early subacute stroke patients. We estimated the MCID by using the Functional Ambulation Categories (FAC) as anchors for changes in BBS scores during a 1-month period. The MCID was estimated based on a cutoff score for separating the patients who achieved a FAC change ≥1 point on receiver operator characteristic curves. The area under the curve (AUC) was used to measure the discrimination accuracy. The MCID was estimated for the patients who needed walking assistance and those who did not. Results: The estimated MCID of BBS scores in the assisted-walking group was 5 points and the AUC was 0.84 (p < .01); the corresponding values in the unassisted-walking group were 4 points and 0.62 (p = .26). Conclusions: For early subacute stroke patients who require assistance to walk, a 5-point improvement in the BBS score is a useful indicator for reducing the amount of assistance.

The Influences of Tai Chi on Balance Function and Exercise Capacity among Stroke Patients: A Meta-Analysis.

Objective This study aims to explore the influences of Tai Chi on the balance function and exercise capacity among stroke patients. Methods Databases including PubMed, Embase, WOS (Web of Science), the Cochrane Library, CNKI (China National Knowledge Infrastructure), Wanfang Data, VIP (VIP database), and CBM (China Biology Medicine disc) were retrieved to gather the figures of randomized controlled trials on the balance function and exercise capacity among stroke patients. Then relevant data were input and analyzed in Review Manager 5.3. Results Nineteen papers were included and analyzed in this study. According to the combined effect size, the balance function of stroke patients improved significantly: the Berg Balance Function Scale score [MD = 7.67, 95% CI (3.44, 11.90)]; standing and walking test scores [MD = 3.42, 95% CI (4.22, −2.63)]; gravity swing area [MD = 0.79, 95% CI (1.48, 0.10)]; and gravity swing speed [MD = −5.43, 95% CI (−7.79, 3.08)]. In addition, the exercise capacity improved significantly as well: the FMA (Fugl-Meyer Assessment Scale) scale score [MD = 4.15, 95% CI (1.68, 6.63)]. There are no significant influences or changes of other related results. Conclusions Stroke patients are able to improve their balance functions and exercise capacities prominently when they do Tai Chi exercise once or twice a week and ≥5 times/week and >30 ≤ 60 min/time.

Therapeutic effect of acupoint catgut embedding on balance function and plantar pressure in hemiplegic patients

To investigate the therapeutic effect of acupoint catgut embedding on balance function and plantar pressure in hemiplegic patients. A total of 98 hemiplegic patients were equally randomly assigned to routine treatment group and acupoint catgut embedding group. The patients in the routine treatment group were given routine medical treatment, routine acupuncture and rehabilitation training. And those in the catgut embedding group were given catgut embedment at Shenshu (BL23), Xinshu (BL15), Ganshu (BL18), Pishu (BL20), Guanyuan (CV4) and Qihai (CV6) in addition to the treatment in the routine treatment group. The course of treatment was 3 weeks for both groups. The plantar pressure as well as the Berg balance scale (BBS) score were measured before and after treatment. (1) After 3 weeks treatment, the percentage of static plantar pressure of the affected foot was significantly increased in the two groups compared with their own pre-treatment (P<0.05, P<0.01), and it was significantly higher in the catgut embedding group than in the routine treatment group after one week treatment (P<0.01). (2) After 3 weeks treatment, the peak pressures of the following parts in the catgut embedding group increased significantly in comparison to its own pre-treatment (P<0.05, P<0.01), which were 1) the first toe (affected foot), 2) the first metatarsal bone (affected foot), 3) the third metatarsal bone (affected foot), 4) the middle of foot (affected foot), 5) the medial heel (affected foot). After 3 weeks treatment, the peak pressures of the first metatarsal bone and the medial heel of the affected foot in the routine treatment group were significantly higher than those before treatment (P<0.05). After 1 week treatment, the peak pressure of the first toe of the affected foot in the embedding group was significantly higher than that in the routine treatment group (P<0.05). The peak pressures of the first metatarsal bone and the middle of the affected foot in the catgut embedding group were significantly higher than those in the routine treatment group after one and two weeks treatment (P<0.01, P<0.05). After 1, 2 and 3 weeks treatment, the peak pressure in the middle of the healthy foot in the embedding group was significantly lower than that in the routine treatment group (P<0.01). (3) After 3 weeks treatment, the BBS scores of the two groups were significantly higher than those before treatment (P<0.05), and the BBS score of the embedding group was significantly higher than that of the routine treatment group (P<0.05). Acupoint catgut embedding can effectively improve the plantar pressure and balance function of stroke patients with hemiplegia.

Effects of visual feedback balance training with the Pro-kin system on walking and self-care abilities in stroke patients.

Some scholars’ studies have demonstrated that Pro-kin balance system training is able to promote the recovery of the balance function in stroke patients. The present study has expanded on those studies, and was not merely limited to studying balance, but also encompassed walking and self-care abilities of the patients; furthermore, the association among balance and walking and self-care abilities was also explored.A total of 40 stroke patients were randomly and equally divided into 2 groups: the control group (n = 20) and the treatment group (n = 20). Both groups underwent conventional balance training, although the treatment group also underwent visual feedback balance training with the Pro-kin system. The balance function was assessed using the Berg Balance Scale (BBS), the Timed “Up & Go” (TUG) test, and Pro-kin system parameters. The Pro-kin system parameters included the perimeter and ellipse area, which were both tested once with eyes open (EO) and eyes closed (EC). Walking ability was assessed using the Holden Walking Ability Scale, according to the Functional Ambulation Classification (FAC). The self-care abilities were assessed with the Barthel Index (BI). The tests were conducted prior to training, and 3 weeks after the end of the training programme.No significant differences were noted among the groups before the training. After 3 weeks of training, for both the groups, significant improvements in balance and the walking and self-care abilities were noted: The BBS value was significantly increased (P < .05), whereas the TUG, perimeter, and ellipse area with EO and EC measurements were significantly decreased after treatment (P < .05). The FAC and BI readings were significantly increased after treatment (P < 0.05), and the treatment group outperformed the control group (P < .05). Furthermore, the balance function was shown to be strongly correlated with the walking and self-care abilities (P < .01).The present study has demonstrated that the use of the Pro-kin visual feedback balance training system in combination with conventional training is a viable method for improving walking and self-care abilities of stroke patients.

The Effects of Whole Body Vibration Stimulation Training Combined with Respiratory resistance on Respiratory and Balance Function in Stroke Patients

The Effects of Whole Body Vibration Stimulation Training Combined with Respiratory resistance on Respiratory and Balance Function in Stroke Patients

Immediate effects of lumbar spine patterns after neuromuscular joint facilitation on balance in stroke patients.

[Purpose] The present study investigated changes in the balance function of stroke patients after neuromuscular joint facilitation treatment. [Participants and Methods] Fourteen stroke patients were randomly subjected to neuromuscular joint facilitation intervention (neuromuscular joint facilitation intervention group) and no intervention (control group), with a 1-day interval between treatments. The interventions were performed consecutively. The order of interventions was completely randomized. Before and after one neuromuscular joint facilitation and control intervention, the functional reach test, and body sway were measured. [Results] Functional reach test values were significantly increased and peripheral area was significantly reduced in the neuromuscular joint facilitation intervention group than in the control group. [Conclusion] These results suggest that neuromuscular joint facilitation of the trunk has an immediate effect on balance and function in stroke patients.

Effect of Tai Chi Exercise on Balance Function of Stroke Patients: A Meta-Analysis.

BackgroundTai Chi is an ancient form of physical activity that has been shown to improve cardiovascular function, but to date there had been no comprehensive systematic review on the effect of Tai Chi exercise on balance function of patients with stroke. This study evaluated the effect of Tai Chi exercise on balance function in stroke patients.Material/MethodsPubMed, Cochrane library, and China National Knowledge Information databases and the Wan Fang medical network were searched to collect the articles. The random-effects model was used to assess the effect of Tai Chi exercise on balance function of stroke patients.ResultsSix studies were chosen to perform the meta-analysis according to the inclusion and exclusion criteria. There were significant improvements of balance on Berg Balance Scale score (MD=4.823, 95% CI: 2.138–7.508), the standing balance with fall rates (RR=0.300, 95%CI: 0.120–0.770), functional reach test and dynamic gait index in Tai Chi intervention group compared to the control intervention group. However, the short physical performance battery for balance (SPBB) showed Tai Chi did not significantly improve the ability of balance for stroke patients (MD=0.293, 95%CI: −0.099~0.685).ConclusionsTai Chi exercise might have a significant impact in improving balance efficiency by increasing BBS score and reducing fall rate.

The Effect of Low-Frequency (1 Hz) rTMS on the Cerebellar Cortex in Patients with Ataxia After a Posterior Circulation Stroke : Randomized Control Trial

To assess the Safety, feasibility, and efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the cerebellum in patients with acute posterior circulation stroke. Thirty ataxic patients with acute posterior circulation stroke were randomized to experimental (EG = 15) and control groups (CG = 15). All subjects received a 30-minute mirror therapy in common, which consisted of lower limb strengthening exercises and balance enhancement program related to functional tasks. During this intervention, mirrors were placed on the front and side walls to provide visual feedback about their movement. EG applied 1HZ real rTMS for 15 minutes to the cerebellum before mirror treatment and sham rTMS for CG. Intervention was performed once a day, five times a week for four weeks. Static balance test, Wisconsin gait scale, 6 minute walk test (6MWT) and time up go test (TUG) were performed before and after the intervention. At post-test, Static balance test (98.53.68 ± 6.94 versus 110.53 ± 16.83), Wisconsin gait scale (25.61 ± 4.86 versus 29.54 ± 5.82), 6 minute walk test (181.47 ± 34.52 versus 165.72 ± 35.63), time up go test (24.47 ± 4.55 versus 28.93 ± 3.13) was a significant difference in the experimental group than in the control group (p < 0.05). There was a significant difference between the pre-test and post-test scores for all variables in both groups (p < 0.01). The results of this study show that 1 Hz rTMS application to the cerebellum is safe and feasible and may have beneficial effects on the balance function of stroke patients with posterior circulation dysfunction.

Effects of Repetitive Transcranial Magnetic Stimulation Over Trunk Motor Spot on Balance Function in Stroke Patients.

ObjectiveTo assess the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) on balance function in patients with chronic stroke.MethodsThirty participants with chronic stroke were enrolled in this study. High frequency (10 Hz) rTMS was delivered with butterfly-coil on trunk motor spot. Each patient received both real and sham rTMS in a random sequence. The rTMS cycles (real or sham) were composed of 10 sessions each, administered over two weeks, and separated by a 4-week washout period. Balance function was measured by Berg Balance Scale and computerized dynamic posturography to determine the effect of rTMS before and one day after the end of each treatment period, as well as at a 1-month follow-up.ResultsThe balance function was significantly improved after high frequency rTMS as compared with that after sham rTMS (p<0.05). There was no serious adverse effect in patients during the treatment period.ConclusionIn the chronic stroke patients, high frequency rTMS to the trunk motor area seems to be a helpful way to improve balance function without any specific adverse effects. Further studies are needed to identify the underlying mechanism and generate a detailed protocol.

Influence of Resistance Exercise Training to Strengthen Muscles across Multiple Joints of the Lower Limbs on Dynamic Balance Functions of Stroke Patients.

[Purpose] The objective of this study was to evaluate the effects of resistance exercise training for strengthening muscles across multiple joints on the dynamic balance function of stroke patients. [Subjects and Methods] Subjects in the training group (n=14) and the control group (n=14) received conservative physical therapy for 30 minutes per day, five days per week, for a period of six weeks. The training group additionally performed three sets (eight to 10 repetitions per set) of resistance exercise at 70% of the 1-repetition maximum (1RM) to strengthen muscles across multiple joints. The control group did the same exercises for the same duration but without resistance. To assess dynamic balance function, before and after the intervention, we measured antero-posterior (A-P) and medio-lateral (M-L) sway distances, the Berg balance scale (BBS), and the timed up and go (TUG) times. [Results] Compared to pre-intervention values, the BBS score showed significant increases in both groups, and A-P and M-L sway distances and TUG times showed significant decreases in both groups. Changes in A-P and M-L sway distances, BBS scores, and TUG times were significantly different between the muscle training group and the control group. [Conclusion] Training involving muscle strength across multiple joints is an effective intervention for improvement of dynamic balance function of stroke patients.

뇌졸중 환자의 체간조절, 균형능력에 기계적 승마치료가 미치는 영향

본 연구는 기계적 승마치료가 뇌졸중 환자의 체간조절, 균형능력에 미치는 영향을 평가하기 위해 실시되었다. 본 연구에 15명의 뇌졸중 환자가 참여하였다. 연구 대상은 뇌줄중 환자를 실험군과 대조군으로 각각 7명, 8명씩 무작위로 배정하였다. 모든 환자들은 보존적 물리치료를 받았으며, 실험군에게 추가적으로 기계적 승마치료를 30분동안 시행하였다. 연구는 2013년 3월 4일부터 5월 3일 까지 약 8주간 진행되었다. 본 연구의 평가 도구는 체간조절 검사, 뇌졸중 자세조절 검사, 버그 균형 척도, 일어나서 걷기 검사였다. 측정은 중재 전, 후로 실시하였다. 중재 후 군내에서 실험군과 대조군의 체간조절 검사, 뇌졸중 자세조절 검사, 버그 균형 척도, 일어나서 걷기 검사의 중재 전, 후 값에서 유의한 차이를 보였다(p<.05). 실험군은 중재 전, 후 차이값이 체간조절 검사, 뇌졸중 자세조절 검사, 버그 균형 척도, 일어나서 걷기 검사에서 각각 <TEX>$27.85{\pm}19.03$</TEX>, <TEX>$6{\pm}4.04$</TEX>, <TEX>$19.28{\pm}4.27$</TEX>, <TEX>$16.68{\pm}4.61$</TEX> 향상되었고, 대조군에서는 각각 <TEX>$17.87{\pm}18.3$</TEX>, <TEX>$2{\pm}2.07$</TEX>, <TEX>$7.62{\pm}6.75$</TEX>, <TEX>$3.21{\pm}1.75$</TEX> 향상되었다. 두 군간의 중재 후의 평가 비교에서 중재 후 체간조절 감사, 뇌졸중 자세조절 검사, 버그 균형 척도, 일어나서 걷기 검사에서 유의한 차이가 있었다(p<.05). 이는 기계적 승마치료가 뇌졸중 환자의 체간조절 능력, 균형 능력에 긍정적인 영향을 미치는 것을 의미하여 앞으로 이러한 연구결과를 일반화시키는 것이 필요할 것이라고 사료된다. The purpose of this study was to determine the effect of mechanical horseback riding training on trunk control, balance function in stroke patients. 15 stroke patients were recruited for this study. The subjects were randomly assigned to two groups: experimental(n=7) and control(n=8). All subjects received a routine physical therapy. The mechanical horseback riding training was for 30 min in the case of the EG subjects. This study was carried out approximately 8 weeks from March 4 to May 3. The assessment tools of this study involved the trunk control test, postural assessment scale for stroke, Berg balance scale and timed up and go test. The measurements were recorded before the intervention and after the intervention. In the cases of the EG subjects and CG subjects, the variables measured after the intervention significantly differed from trunk control test, postural assessment scale for stroke, Berg balance scale and timed up and go test before the intervention (p<.05). Also, there were significant differences in trunk control test, postural assessment scale for stroke, Berg balance scale and timed up and go test at post test between the 2 groups (p<.05). The findings indicate that mechanical horseback riding training exerts a positive effect on trunk control, balance function in stroke patients. Further studies are required to generalize the result of this study.

Relationship between the changes of surface electromyographic signal of thigh muscle and balance function in stroke patients

To explore the relationship between the changes of surface electromyography (sEMG) signal of thigh muscles and balance function in stroke patients during maximum isometric voluntary contraction (MIVC) of knee extension and flexion so as to provide rationales for rehabilitation. Twenty-one stroke patients and 18 age- and sex-matched normal controls were recruited for this study. The surface electromyographic signals of of vastus medialis (VM), rectus femoris (RF), vastus lateralis (RL) and biceps femoris (BF) were recorded during MIVC of knee extension and flexion. Root mean square (RMS) and co-contraction ratio (CR) of both groups were compared and analyzed. The balance function was assessed by Berg balance scale (BBS). There were significant differences in RMS of VM, RF, VL and BF of ipsilateral [(136 +/- 63) microV, (107 +/- 24) microV, (154 +/- 19) microV, (91 +/- 63) microV], thigh during knee extension and flexion (P < 0.05). There were significant differences in CR on ipsilateral thigh muscles than the unaffected (43% +/- 13% vs 37% +/- 20%) and controls (43% +/- 13% vs 32% +/- 10%) during knee flexion (P < 0.05). The RMS of RF and BF on ipsilateral thigh was significantly positively correlated with the score of BBS (rRF = 0.53, P = 0.01 vs rBF = 0.51, P = 0.02); The CR of knee extension and flexion on ipsilateral thigh had a significantly negative correlation (CRE = -0.59, P = 0.005 vs. CRF = -0.41, P = 0.046). The strength of bilateral thigh muscles decreases in stroke patients. The spasticity of thigh extensor still exists. Besides reducing the spasticity of hemiplegic limb extensor, rehabilitation should also focus upon bilateral thigh muscles, particularly ipsilateral RF and BF strength training to improve the knee joint stability and improve the balance function.