Effects of 3-Dimensional Lumbar Stabilization Training for Balance in Chronic Hemiplegic Stroke Patients: A Randomized Controlled Trial

Chun, Jin-Young; Seo, Jeong-Hwan; Park, Sung-Hee; Won, Yu Hui; Kim, Gi-Wook; Moon, Sung-Jun; Ko, Myoung-Hwan

Assessment method BBS (range, 0-56 scores) and TUG indicated the dynamic balance, Biodex Balance System's evaluation program indicated stability, Spine Balance 3D system's evaluation program indicated trunk muscle strength, and 10mWT indicated gait ability. The FRT indicated static balance, and the KFES-I measured the risk of falling. The patients performed TUG, a test that measures the time it takes a patient to rise from a chair, walk 3 m, turn around, walk back to the chair and sit down, and a stopwatch was used to measure timing. We measured the time it takes a patient to walk a distance of 10 m marked by tapelines when performing the 10mWT, and sufficient space was provided before and after the 10 m region to allow acceleration and deceleration. The forward FRT was performed by measuring the difference between the locations of the 3rd metacarpophalangeal joint of the unaffected side from a normal standing position and from a maximally forward-leaning position, and a 100 cm-long ruler was set horizontally at the acromion level to measure the difference. The patients placed both clavicles perpendicular to the long ruler lines on the wall to avoid error caused by the decrease in ipsilateral muscle strength. We separately measured the values for the affected and unaffected side in the lateral FRT. The lateral FRT measures the differences in the location of the metacarpophalangeal joints after abduction of the arm on the desired side from a natural upright position and from a laterally tilted trunk position. If the strength of the affected arm was not sufficiently strong, we measured the acromion locations instead. The Biodex Balance System and Spine Balance 3D system objectively evaluated the balance control. We used Biodex Balance System's evaluation program to conduct postural stability test with eyes open and closed, along with the limits of the stability test. We conducted the postural stability test by having the subjects maintain a relaxed standing position with eyes open and closed for 10 seconds each. We obtained three measurements from each condition to calculate the overall stability index, which reflected the stability as it approximates 0. We conducted the limits of the stability test on an easy level. We obtained three measurements to calculate the overall direction control score, which reflected a higher ability to control direction as the score decreased. Spine Balance 3D system's blind and open modes were used to evaluate the balance control. The difference between the blind mode and the open mode is defined as the ability to display the actual balance status on the screen by using the sensors attached to the back of the patient. The monitor displayed the actual balance status in the open mode whereas the screen turned black in the blind mode to restrict compensation. We increased the tilt in each of the eight directions to 15 o and 30 o by 2 o /s and stopped for 5 seconds at the maximum tilt (15 o and 30 o ). The subjects maintained a certain trunk position, depending on the tilt, and the results were reported as the Balance Position Ratio (BRP), expressed as the percentage of deviation from reference for the direction and tilt measured using the trunk sensor system. A score close to 100% reflects a good trunk muscle strength.