Effects of diaphragm and deep abdominal muscle exercise on walking and balance ability in patients with hemiplegia due to stroke

Abstract

The aim of this study was to investigate the effects of diaphragm and deep abdominal muscle exercise (DDAME) on walking ability (WA) and balance ability (BA) in subjects with hemiplegia due to stroke. Study subjects consisted of twenty patients diagnosed with hemiplegia due to stroke. They were randomized into a control group (CG) (n=10) that performed traditional exercise and an experimental group (EG) (n=10) that performed DDAME. The WA was measured using the 10-m walking test (10MWT) and 6-min walk test (6MWT). The BA was measured using the Timed Up and Go test (TUG) and Berg’s balance scale (BBS). Paired t-test was performed to compare differences within the groups before and after intervention. The analysis of covariance was performed to compare the differences between the EG and CG. The level of significance was set at α=0.05. Within-group changes in 10MWT and 6MWT were significantly different in both the EG (P<0.05) and CG (P<0.05). There was significantly more improvement in the 10MWT and 6MWT in the EG than in the CG (P<0.05). Within-group changes in TUG and BBS were significantly different in both the EG (P<0.05) and the CG (P<0.05). There was significantly more improvement in TUG and BBS in the EG than in the CG (P<0.05). DDAME program, with diaphragm and inspiratory muscle strengthening exercises, is needed for patients experiencing difficulty in WA, BA, trunk asymmetry, abnormal alignment, mobility of trunk muscles, power, or endurance decline.

The Effectiveness of Core Exercising for Postural Control in Patients with Stroke: A Systematic Review and Meta‐Analysis

“…Figure 1 shows the flow details of the trials selected in the different phases. A total of 14 studies were identified for inclusion in the review, totaling 490 participants analyzed 8,27–39 . The characteristics of the studies included are shown on Table 1.…”

“…Some trials compared the effects of core stabilization exercises with those of conventional physical therapies, which included stretching, range‐of‐motion, strengthening, breathing‐enhanced and upper and lower extremity exercises, and passive mobilizations 8,27,28,30,31,34,35 . Other studies include balance and/or gait training 30,33,38,39 . Functional training was used in two studies 28,32 .…”

“…Core stabilization exercises focused on improving trunk stability, postural control, and static and dynamic balance 14,28–31,37 . The most frequent exercises included selective movements 27,30,32,33,36,38 bridge exercises, 8,28,31,37,39 crunch, quadruped, 31,37 and bird dog exercises 28,31,39 . Progression usually included bed exercises, wedge exercises, and exercises using a Swiss ball 29,35 …”

“…Seven randomized controlled trials used the Berg Balance Scale and three showed significant improvements in its scores in patients with stroke 27,33,35 ; two studies showed no significant change 8,28 and in one study improved significantly in both experimental and control groups 39 . In the study conducted by Seung‐Heon and Dae‐Sung patients improved significantly in both groups but the improvement was more pronounced in patients receiving the core exercise training 36 .…”

“…Total overall effect of six studies using the Berg Balance Scale was not significant (mean difference 0.27; 95% confidence interval, −0.25 to 0.79; P = .317) (Figure 2). 27,28,33,35,36,39 …”