The Effects of Reaching Task Following Selective Trunk Stability Exercise

The Effects of Reaching Task Following Selective Trunk Stability Exercise in Chronic Stroke Survivors

This study is performed in a controlled randomized, two-period crossover design to test the efficacy of Abdominal drawing-in maneuver (ADIM) exercise compared to conventional physiotherapy in chronic stroke survivors.

All participants provided written informed consent and are assigned to Group A or Group B. The inclusion criteria are Exclusion criteria are Abdominal drawing-in maneuver exercise is following as: It's for strengthening the Transversus Abdominis muscle(TrA). The simple device, that observes the pressure changes by the gauge. Subjects receive intervention 2 times a week for 4 weeks. Each session is 40 minutes. From the supine position to the hook-lying position (hip joint at 40 degrees and the knee joint at 80 degrees) and pull the navel deeply to the lumbar region through the Stabilizer™ Pressure Biofeedback that stabilizes transversus abdominis muscle. At this time, subjects are controlled to maintain contraction while keep breathing lightly, to contract slowly, also to not move the pelvis and chest while exercising The device assists in body control movements of the spine and abdominal muscle. Conventional physiotherapy is following as: Release pain, limb stretching, mobilization of joint and pelvic movement. Subjects receive 2 times a week for 4 weeks. Each session is 40 minutes. Group A received Abdominal drawing-in maneuver exercise for 4 weeks on period 1. Afterward washout period in a month, follow period 2 of conventional physiotherapy. On the other side, Group B receives first conventional physiotherapy on period 1. Afterward washout period in a month, follow period 2 of Abdominal drawing-in maneuver exercise.

One group is the abdominal drawing-in maneuver exercise, afterward conventional physiotherapy in Participants With stroke survivors. On the contrary, Another group is conventional physiotherapy afterward the abdominal drawing-in maneuver exercise.

Participants first received Abdominal drawing-in maneuver exercise 2 times a week for 4 weeks. Each session is 40 minutes for additional 10 min with conventional therapy. Afterward a washout period of one month, they then received sham therapy (conventional therapy_release pain or upper limb mobilization) 2 times a week for 4 weeks. Each session is 40 minutes.

Participants first received sham therapy(release pain or upper limb mobilization)2 times a week for 4 weeks. Each session is 40 minutes. Afterward a washout period of one month, they then received Abdominal drawing-in maneuver exercise 2 times a week for 4 weeks. Each session is 40 minutes for additional 10 min with conventional therapy

From the supine position to the hook-lying position (hip joint at 40 degrees and the knee joint at 80 degrees) and pull the navel deeply to the lumbar region through the Stabilizer™ Pressure Biofeedback that stabilize transversus abdominis muscle. At this time, subjects are controlled to maintain contraction while keep breathing lightly, to contract slowly, also to not move the pelvis and chest while exercising

Elbow angle in degree for reaching phase -elbow angle: joining vector of acromion to lateral epicondyle and vector of lateral epicondyle and medial styloid process.

Scoring for Biceps and Triceps MAS 0: No increase in tone MAS 1: slight increase in tone giving a catch when slight increase in muscle t-tone, manifested by the limb was moved in flexion or extension. MAS 1+: slight increase in muscle tone, manifested by a catch followed by minimal resistance throughout (ROM ) MAS 2: more marked increase in tone but more marked increased in muscle tone through most limb easily flexed MAS 3: considerable increase in tone, passive movement difficult MAS 4: limb rigid in flexion or extension

Shoulder and elbow joint range of motion Shoulder: flexion, adduction, abduction, external rotation, internal rotation Elbow: flexion, extension

The total score ranges from minimum 0 to maximum 23 points, a higher score indicating a better performance. Static sitting balance Dynamic sitting balance Coordination Total score is 23 points

-Maintaining posture Sitting without support Standing with support Standing without support Standing on non paretic leg Standing on paretic leg -Changing a posture Supine to paretic side lateral Supine to non-paretic side lateral Supine to sitting up on the edge mat Sitting on the edge of mat to supine Sitting to standing up Standing up to sitting down Standing, picking up a pencil from the floor Total scoring ranges from 0 to 36

Upper extremity(UE) Commonly used FMA-UE cutoff scores defined each category: 0 to 20 severe, 21 to 50 moderate, and 51 to 66 mild. Shoulder, Elbow and Forearm Reflex activity Volitional movement within synergies Volitional movement mixing synergies Volitional movement with little or no synergy Normal reflex activity Wrist Hand Coordination/Speed Total score is 66 points

Inclusion Criteria: The subject consisted of the physician's confirmation of chronic hemiplegia onset ≥ 6 months Mini-mental state examination≥25 Biceps ≤2, Triceps≤2 Ability to Sit on a chair alone FMA UE score ≥ 21points, FMA UE≤ 60 points Exclusion Criteria: Biceps>2, Triceps>2 Flaccid Neglect syndrome Have neurological disease and orthopedic disease Lack of coordination

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