Effects of Ankle Joint Taping on Postural Balance Control in Stroke Patients

Transcription

1 J Int Acad Phys Ther Res 2012; 3(2): ISSN htt://dx.doi.org/ /jiaptr Effects of Ankle Joint Taing on Postural Balance Control in Stroke Patients This study aims to examine the effects of taing of the ankle joint on the static and dynamic balance and gait ability of stroke atients. Twenty-six stroke atients receiving hysical theray at a hosital located in Gyeonggi-do were divided equally into a grou that had taing in hysical theray and an ordinary hysical theray grou. They exercised for 30 minutes each, 3 times er week for from June to August Romberg s eye oen and eye closed tests, limits of stability(los), forward and back test, timed u and go test(tug) and 10-meter gait velocity test were erformed to evaluate static balance, dynamic balance, and gait ability, resectively, rior to and after the intervention. Differences within each grou in relation to the lase of time were comared by a aired t-test. Differences between the two grous were comared by an indeendent t-test. Regarding comarison of differences within each grou, all tests resulted in significant changes in both grous after the intervention (<.05). Comarison of differences between the two grous showed that taing in the hysical theray grou had significantly better test results than the ordinary hysical theray grou in all measured items(<.05). The after effects of ankle taing on stroke atients are more efficient and effective than ordinary hysical theray alone in imroving balance and gait ability. Key words: Static Balance; Dynamic Balance; Stroke; Gait Ability; Taing Yang Rae Kim a, Jae Ic Kim b, Yong Youn Kim c, Kwon Young Kang d, Bo Kyoung Kim e, Joo Hyun Park e, Ho Jung An f, Kyung Ok Min g a Karis Rehabilitation Hosital, Sungnam; b Bundang Jesaeng General Hosital, Sungnam; c Hyundai Skywalkers Volleyball Club, Cheonan; d Seonam University, Namwon; e International Universty of Korea, Jinju; f Daewon University College, Jecheon; g Yongin University, Yongin, Korea Received : 21 May 2012 Acceted : 3 August 2012 Address for corresondence Kyung Ok Min, PT, Ph.D Deartment of Physical Theray, Yongin University, 470 Samga-dong, Cheoingu, Yongin, Korea Tel: komin@yongin.ac.kr INTRODUCTION Clinically, the rimary urose of the rehabilitation of stroke-related hemilegic atients is the recovery of balance and gait ability(1). A general roblem in the gaits of stroke atients is in ankle dorsiflexion. That is, foot dro occurs in stroke atients because the dorsiflexor is not well controlled, and the muscle tone of the trices sura increases abnormally. These obstacles make standing and balancing difficult in the rehabilitation rocess of these atients, thereby reventing them from getting out of their beds and inhibiting normal gaits and activities of daily living (2). Comared to subjects with no damage to ankle joint roriocetion, those with damaged ankle joint roriocetion show increased body sway, lower balance scale scores(3), and larger changes in gait atter(4). Callaghan et al.(5) reorted that taing significantly imroved the accuracy of sees in those with relatively oor roriocetion although it had little effect on those with excellent roriocetion. Jerosch et al. (6) reorted that when roriocetion was examined using angle reroduction tests, errors in roriocetion decreased in a grou of atients with ankle damage to which taing was alied. Taing is generally known to imrove roriocetion and by coming into contact with the skin, rovide augmented skin roriocetor signals(7). Therefore, the resent study intends to rovide exerimental data on theraeutic intervention methods for imroving stroke atients indeendence by identifying the effects of taing on ostural balance control. Taing is alied to the ankle joints, the tibialis anterior, and the gastrocnemius, which lay imortant roles in the balance control of hemilegic atients for hysical stability when theraeutic exercises are erformed, in addition to assessing stroke atients static balance, dynamic balance, and gait ability. 446

2 Effects of ankle joint taing on ostural balance control in stroke atients Subjects METHODS The subjects of the resent study were 26 stroke atients hositalized in A hosital located in Gyeonggi-do. These subjects were randomly assigned to either a taing-alied theraeutic exercise grou of 13 atients or a general theraeutic exercise grou of 13 atients. Training was administered to both grous. Theraeutic Exercise Program In the resent study, a theraeutic exercise rogram was devised by revising and sulementing the roriocetion motor control rogram roosed by Lynch and Grisogono(8) and Peath Rohlfs(9). The theraeutic exercise rogram is shown in Table 1. The rogram was imlemented in 26 atients that met the selection criteria for 30 minutes er session, three times er week for eight weeks. The same theraeutic exercise rogram was imlemented in both the taing-alied theraeutic exercise grou and the general theraeutic exercise grou. Table 1. Theraeutic exercise rogram Theraeutic exercise rogram Stage 1: ankle joint mobility imroving and muscle strengthening exercise Promote the range of motion of the ankle joint in a sitting osition Reeat ankle joint flexion and exteion Reeat ankle joint dorsiflexion and lantar flexion Stage 2: weight bearing exercise in a static standing osition Reeat the motion of moving the affected side weight in a sitting osition and standing u Move the weight in diverse directio in a standing osition Stage 3: weight movement and task training in a standing osition on one foot Raise the non-affected side foot in a standing osition on both feet Diverse affected side weight movements in a standing osition on one foot Uer extremity task training in a standing osition on one foot Number of times and time 20 times/10 minutes 5 times/3 minutes 5 times/2 minutes 20 times/10 minutes 20 times/10 minutes 5 times/2 minutes 5 times/3 minutes Research Tools The theraeutic exercise rogram was imlemented after alying Kinesio Taing(elastic taing) to the ankle joint, the tibialis anterior, and the gastrocnemius(10, 11, 12). a b c ig. 1. Ankle joint taing a. Tibialis anterior taing b. Gastrocnemius taing c. Ankle fig 8 taing 447

3 Y.R. Kim, J.I. Kim, Y.Y. Kim, et al. In the resent study, a balance ability measuring and training system analysis systems by biofeedback(ap1153 Biorescue, rance) was used to measure the study subjects balance ability. Before measuring balance ability, the measuring methods were exlained in detail to the subjects. In the basic measuring osition, atients stood on a force late, lacing the midline of the feet on the indicated line marked at 30, which was drawn on the force late. In a standing osition, the weight distribution areas of the left and right feet were measured after five seconds while the subject was standing on the force late in the basic osition with eyes looking straight ahead. As tests of static balance, Romberg's eyes oen, eyes closed tests were conducted by measuring the movements of the center of gravity(cog) in a standing osition. As tests of dynamic balance, tests of the limit of stability(los) and forward and back tests were conducted. The TUG test and 10m gait velocity test were used to measure gait ability. The TUG test was develoed by Podsiadlo and Richardson in 1991(13), which quickly measures basic mobility and balance(14). The measurement was conducted three times in all the study subjects and average values were used as resultant values. Research Procedure The resent study was conducted from June through August 2011, and the subjects general characteristics were surveyed before alying theraeutic interventio to the study subjects. The theraeutic exercise rogram was administered to the taingalied theraeutic exercise grou with taing alied to the ankle joint, the tibialis anterior, and the gastrocnemius three times er week, 30 minutes er session. The theraeutic exercise rogram was administered to the theraeutic exercise grou three times er week, 30 minutes er session. All assessments were conducted before the treatment and eight weeks after the treatment using the same method. Data Analysis All statistical analyses in the resent study were conducted using PASW Statistics 18.0 for Windows. The normality of all subjects was tested using the Kolmogorov-Smironov test. The homogeneity of the subjects general characteristics was tested by Chisquared tests. Paired samle t-tests were conducted for intra-grou comarison of each atient in the taing-alied theraeutic exercise grou and in the general theraeutic exercise grou at different time oints during the exerimental eriod. or intergrou comariso, the average values of variances were calculated by deducting values obtained in reassessment from values obtained in assessment conducted eight weeks after the beginning of the exeriment. Indeendent samle t-tests were conducted to comare the variances. The statistical significance level of all data was set to α=.05. RESULTS General Characteristics of the Study Subjects The results of tests of the study subjects general characteristics and homogeneity are shown in Table 2. Table 2. General characteristics of the study subjects Grou Study grou (n=13) Control grou (n=13) X 2 Gender Male emale 5(38%) 8(62%) 4(31%) 9(69%).170 Diagnosis Cerebral infarction Cerebral hemorrhage 9(69%) 4(31%) 7(54%) 6(46%).650 Affected side Right hemilegia Left hemilegia 6(46%) 7(54%) 5(38%) 8(62%)

4 Effects of ankle joint taing on ostural balance control in stroke atients Age(year) 58.85± ± Height( cm ) ± ± Weight( kg ) 60.52± ± Romberg's eye oen test( cm ) 32.92± ± Romberg's eye close test( cm ) 43.57± ± Limit of stability( cm2 ) ± ± owards and back test( cm ) 51.89± ± Timed U and Go test(s) 24.03± ± m gait velocity test( m s ) 0.68± ± Values are N (%) or Mean ± standard deviation, =not significant Study grou: Alied taing and hysical theray, Control grou: Physical theray. Comarison of Static Balance Ability before and after the Exeriment in the Taing Alied Theraeutic Exercise Grou and the General Theraeutic Exercise Grou The results of the comariso of static balance ability between the two grous both before and after the exeriment are shown in Table 3. In the Romberg's eye oen tests, both the taing-alied theraeutic exercise grou and the general theraeutic exercise grou showed degreases in COG movement distances with significant differences. (<.05). Comariso of variances in the Romberg's eye oen tests showed significant differences between the two grous. The taing-alied theraeutic exercise grou showed decreases by 4.18±3.03 cm on average, and the general theraeutic exercise grou showed decreases by 1.90±1.45 cm on average(<.05). In the comarison of variances in Romberg's eyes closed tests, both the taing-alied theraeutic exercise grou and the theraeutic exercise grou showed degreases in COG movement distances with significant differences(<.05). Comariso of variances in the Romberg's eyes closed tests showed significant differences between the two grous(<.05). Comarison of Dynamic Balance Ability before and after the Exeriment in the Taing Alied Theraeutic Exercise Grou and the General Theraeutic Exercise Grou The results of the comariso of dynamic balance ability before and after the eight-week exeriment in the taing-alied theraeutic exercise grou and the general theraeutic exercise grou are shown in Table 4. In tests of the limit of stability, both the taing-alied theraeutic exercise grou and the theraeutic exercise grou showed increased COG movement areas with significant differences(<.05). Comariso of variances in the limit of stability (LOS) showed significant differences between the two grous(<.05). In the forward and back test, both the taingalied theraeutic exercise grou and the general theraeutic exercise grou showed decreases in COG movement distances with significant differences (<.05). Comariso of variances in the forward and back tests showed significant differences between the two grous(<.05). Comarison of Gait Ability before and after the Exeriment in the Taing Alied Theraeutic Exercise Grou and the General Theraeutic Exercise Ggrou The results of the comariso of gait assessment before and after the eight-week exeriment in the taing-alied theraeutic exercise grou and the general theraeutic exercise grou are shown in Table 5. In the TUG tests, both the taing-alied theraeutic exercise grou and the theraeutic exercise grou showed decreases in time before and after the exeriment with significant differences(<.05). Comariso of variances in the TUG tests showed significant differences between the two grous (<.05). In the 10m gait velocity tests, both the taing-alied theraeutic exercise grou and the theraeutic exercise grou showed increases in velocity with significant differences(<.05). Comariso of variances in the 10m gait velocity tests showed significant differences between the two grous(<.05). 449

5 Y.R. Kim, J.I. Kim, Y.Y. Kim, et al. Table 3. Comarison of static balance between the two grous Grou Study grou Control grou t 32.92± ± ± ±11.67 Romberg's eye oen test( cm ) 4.18± ± *.001* 43.57± ± ± ±13.87 Romberg's eye close test( cm ) 8.29± ± ` *<.05 Table 4. Comarison of dynamic balance between the two grous Grou Study grou Control grou t 4,131.20±1, ,209.68±1, ,402.70±1, ,315.02±1, Test of the limit of stability( cm2 ) 2,270.50± ± ± ± ± ±11.50 orward and back test( cm ) 8.57± ± *<.05 Table 5. Comarison of gait ability between the two grous Grou Study grou Control grou t 24.04± ± ± ±7.07 Timed U and Go test(sec) 4.36± ± * 0.68± ± ± ± m gait velocity test( m s ) 0.16± ± *.024*.015* *<

6 Effects of ankle joint taing on ostural balance control in stroke atients DISCUSSION s in the center of mass(com) within the limit of stability, which is defined as the maximum distance the center of gravity(cog) can move while balance is maintained on a normal base of suort, are controlled through muscles around the ankle joint. This is called ankle strategies(15). The loss of equilibriocetion has been related to reduced ankle joint muscle strength(16). Seory inuts are imortant for maintaining balance and integrated roles of somato seory, visual seory, and vestibular seory systems. Of these, somato seory inuts are the most imortant in adults for roviding information about balance. Somato seory recetors are located in joints, ligaments, muscles, and the skin. They deliver roriocetive seory information related to muscle length, muscle tone, and joint location(17). Previous research studied the effects of changes in the sees of the feet on lantar ressure and lower limb muscle activity. When the hind foot sees decreased, the center of ressure significantly moved toward the fore foot. The activity of the tibialis anterior decreased and the activity of the medial gastrocnemius increased. When the fore foot sees decreased, the center of ressure significantly moved toward the hind foot, the activity of the medial gastrocnemius decreased, and the activity of the hamstring increased(18). It can be inferred from the aforementioned studies that the activity of the tibialis anterior and the medial gastrocnemius serve imortant roles in recovering the COM to a stable osition by concentrating body movements on regio around the ankle joint in ankle strategies. To measure body sway, the movements of the center of ressure and the COM are generally measured(19). Silsuadol et al.(20) reorted that the measurement of the center of ressure could be a measurement tool seitive to balance. In the resent study, static balance ability was measured. The results of comariso between the grous were as follows: the taing-alied theraeutic exercise grou showed decreased average movement distances comared to the general theraeutic exercise grou with significant differences. In the case of dynamic balance ability, the taing alied-theraeutic exercise grou showed increased average movement areas comared to the general theraeutic exercise grou with significant differences. These results are coistent with the results of revious studies(21, 22), indicating that taing ositively affected osture control ability by limiting excessive movements of joints and roviding somato seory feedback(21, 22). The increased static osture sway in hemilegic atients is coidered the result of decline in balance ability, which is caused by decline in the roriocetion of the ankle joint or in the function to distribute weight aroriately while motio are erformed. Therefore, the results of the resent study showed that theraeutic exercise with the alication of ankle-joint taing imroved roriocetion and weight distribution functio to enhance balance ability. In the resent study, in order to measure gait ability, gait velocity was measured using the TUG tests and 10m gait velocity tests. Comariso between the grous showed that the taing-alied theraeutic exercise grou had decreased average time and increased average velocity with significant differences. In relation to see of balance, ankle joint taing reduced the time it took to recruit the dynamic ankle joint stabilizer muscles by limiting excessive joint movements and imroving roriocetic feedback mechanisms(23). The alication of ankle joint taing increases roriocetion sees when no weight is alied so that joint locatio in lantar flexion can be more clearly recognized and balance ability can be imroved(24). In alignment with revious studies, the resent study showed that the alication of taing imroved gait ability by imroving roriocetic feedback mechanisms, thereby reducing the time needed to recruit the dynamic ankle joint stabilizer muscles. The results showed that ankle joint taing increased stroke atients roriocetion and thus was effective in imroving balance ability and gait ability. Therefore, ankle-joint taing is coidered helful in the clinical recovery of stroke atients functio. However, further studies are necessary to determine whether the alication of taing has lasting effects through long-term follow-us. These studies should be conducted with larger numbers of atients in order to generalize the results. CONCLUSION The resent study examined the effects of anklejoint taing on theraeutic exercise regarding stroke atients static balance ability, dynamic balance ability and gait ability. A taing-alied theraeutic exercise grou and a general theraeutic exercise grou were administered theraeutic exercise rograms for 30 minutes er session, three times er 451

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