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J Int Acad Phys Ther Res 2018; 9(2): 1494~1497 ISSN 2092-8475
www.iaptr.org https://doi.org/10.20540/JIAPTR.2018.9.2.1494
stroke patients had increased kyphosis, decreased cervical vertebral (CV) angle1), and decreased pelvic anterior tilt at the sitting posture 2). The slumped position reduces lumbar lordosis and pulmonary function 3). The lumbar support increases the lumbar lordosis more than the sacrum support and allows a pulmonary function increase rather than a slumped sitting posture 4).
Stroke patients have restrictive ventilatory disease due to decreased trunk mobility 5). There are studies that can improve body alignment by flattening seat backboards and backboards using wood in stroke patients 6). Since the study on the pulmonary function of the stroke patients through the wheelchair lumbar support option has not been conducted, it is neces- sary to develop an intervention plan.
The Mekenzie lumbar support, which is used in this study, is characterized by an increase in the lumbar lordosis and an increase in the CV angle of the head
7). The CV angle of the stroke patients is reduced and cervical mobilization, which can increase the CV angle, can improve pulmonary function 8). In this study, we investigated the effect of the Mekenzie lumbar support, which increases the lumbar lordosis in the wheelchair of stroke patients, on the pul- monary function, This study was conducted to pro- vide basic data for stroke patients and wheelchair rehabilitation.
This study was conducted on 20 stroke patients who were admitted to a rehabilitation hospital and were diagnosed with hemiparesis by CT and MRI. Twenty subjects were divided into two groups: 10 in the MLS group and 10 in the control group in the wheelchairs (Mekenzie lumbar support). The subjects were include
Effect of Mekenzie Lumbar Support on Pulmonary Function for Wheelchair Patients with Stroke
INTRODUCTION
This study aimed to determine the effect of McKenzie lumbar support on pul- monary function in Stroke patients.
Twenty subjects (n=20) were divided into two groups: a McKenzie lumbar support group (MLS group=10), a control group (n=10). Pulmonary function was performed to assess its effectiveness. A spirometer was used to measure the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF). The intervention was conducted for four weeks. In the MLS group, FEV1, FVC, and PEF were increased after McKenzie lumbar support. (p<0.05), while no significant differences in the variables were found in the control group (p>0.05). There were no significant differences in variables between the MLS group and the control group (p>0.05). Our findings suggest that applying Mckenzie lumbar support may be an alternative maneuver to improve pulmonary function in stroke patients.
Key words: McKenzie lumbar support pulmonary function, stroke, wheelchair
Shin Jun Parka, Soon Hee Kimb,
aGangdong College; bYoungin University, Yongin, Korea
Received : 25 April 2018 Revised : 17 May 2018 Accepted : 27 May 2018
Address for correspondence Soon Hee Kim, PT, Ph.D
Department of Physical Therapy, cYoungin University, 134, Yongin Daehakro, Chuhingu, Yonginshi, Kyunggido 449-714, Korea
Tel 82-10-6317-8310 E-mail: [email protected]
SUBJECTS AND METHODS
Subjects
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from among those who had no back pain or back surgery for more than 6 months, those without heart and respiratory disease other than stroke, those who were able to communicate and did not have cognitive dysfunction (K-MMSE 24 points or more). Subject with condition for abdominal spasticity were exclud- ed. The subjects were the subjects who understood the purpose and purpose of this study and signed the agreement. This study was approved by the Institutional Bioethics Committee of Yongin University and the research was conducted in accor- dance with the Helsinki Declaration.
Pulmonary function
In this study, we used a spirometer (MicroLab spirometer ML3500 MK6, UK) for the pulmonary function of the subject. The instrument consists of a disposable mouthpiece, a nose clip, a turbine and an analyzer. The forced vital capacity (FVC), forced expiratory volume in 1 second, FEV1 and peak expi- ratory flow (PEF) were measured after connecting the analyzer to the notebook. One trial and explanation were given, and the highest value was calculated as the result by measuring three times after one exer- cise.
The measurement method is to wear a nose clip and wrap the mouthpiece over the lips to prevent the air from being washed out by the mouth. After 3 times of stable breathing, maximal inspiration was com- pleted and maximal expiration was performed for 6 seconds according to the verbal signal of the researcher.
Intervention Methods
The McKenzie lumbar support(The Original McKenzie® Lumbar Roll ™, Orthopedic Physical Therapy Products, USA) worn on the wheelchair was applied only to the experimental group and was
placed at the level 3 of the lumbar vertebra of each subject (figure 1).The evaluation was carried out before wearing McKenzie lumbar support in a wheel- chair and 4 weeks after wearing it. The evaluation was carried out before wearing McKenzie lumbar support in a wheelchair and 4 weeks after wearing it.
If the pain is worn, it is taught to remove the wear and re-wear when there is no pain.
Statistical analysis
Descriptive statistics were used for the general characteristics of subjects, and the changes before and after wearing the McKenzie lumbar support were paired t test, Difference comparisons were made using an independent t test. All statistical analyzes were performed using SPSS 20.0 and α in this study was .05.
The general characteristics of the subjects are as fol- lows. The MLS(McKenzie lumbar support) group con- sisted of 8 males, 2 females, 4 right hemiplegia, mean
Gender Hemiplegic side
Age(yr) Height(cm) Weight(kg) K-MMSE(score) Onset time(month)
Male(8) Female(2) Left(6) Right(4)
64.70±7.63 168.80±6.08 72.40±5.10 24.90±1.10 13.90±4.20
Male(8) Female(2) Left(4) Right(6)
66.00±6.14 166.40±6.91 71.90±7.61 26.20±1.87 12.30±2.00
1.000 .371 .960 .085 .350 .480 .535 MLS Group(n=10)
Variable control group(n=10) p
Table 1. General characteristics of subject.
Measurement
Significant difference general characteristics in each group*
MLS: Mekenzie lumbar support
RESULTS
1. General characteristics of subjects.
Fig. 1. McKenzie lumbar support
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Effect of Mekenzie Lumbar Support on Pulmonary Function for Wheelchair Patients with Stroke
age 64.7 ± 7.63 years, mean weight 72.40 ± 5.10 kg, mean height 168.80 ± 6.08 cm, mean onset time 13.9
± 4.20 months, mean K-MMSE of 24.90 ± 1.10 points. The control group consisted of 8 males, 2 females, 4 left hemiplegia, 6 right hemiplegia, mean age 66.0 ± 6.14 years, mean weight 71.90 ± 7.61 kg, mean height 166.40 ± 6.91 cm, mean onset time The mean K-MMSE was 26.20 ± 1.87 points, and there was no significant difference between the two groups Table 1
After the intervention, there was a significant increase in FEV1, FVC and PEF in the MLS group.
There was no significant difference in all variables in the control group. However, there was no significant difference between the study and control groups.
Table 2
The purpose of this study was to investigate pul- monary function changes after wearing McKenzie lumbar support in a wheelchair of stroke patients for 4 weeks. There was a significant increase in FVC, FEV1, and PEF in the experimental group.
In the sitting position, a decrease in the CV angle of the stroke patient showed a strong correlation with thoracic kyphosis 1). The slumped position from wheelchair flattens the lumbar spine 9).
In a study of McKenzie lumbar support, the CV angle of the sitting position of the elderly over 60 years old was examined. One minute after wearing, CV angle of upper and lower neck spine was increased 7). Correct alignment of the cervical align- ment of stroke patients increased respiratory muscles
activation and pulmonary function 10).
Increased lumbar lordosis through the lumbar sup- port in the sitting position increases the effectiveness of breathing in a body upright position with improved cervical alignment 4). Enhanced lumbar support in wheelchair increased FVC, FEV1, PEF compared to slumped posture 3). In this study, FVC, FEV1, and PEF were increased after McKenzie lumbar support application, consistent with previous studies. When the lumbar extension is done, the rib cage movement becomes smooth, so that the inflow of air is increased
3,11). Therefore, it seems that the pulmonary function
has increased.
In a study similar to the lumbar support of this study, wheelchair manipulation increased the lumbar lordosis of the waist and corrected the sitting position, which was greater than the slumped sitting posture,
Before After Change
p Before
After Change
p Before
After Change
p FEV1(ℓ)
FVC(ℓ)
PEF(ℓ/min)
2.36 ± .33 2.77 ± .42*
.41 ± .41 .011 2.69 ± .39 3.12 ± .37*
.43 ± .0.46 .016 252.20 ± 51.89 303.00 ± 53.64*
50.80 ± 50.40 .011
2.50 ± .63 2.67 ± .58 .17 ± 0.31
.112 3.01 ± .86 3.13 ± .81 .12 ± 0.28
.209 247.60 ± 75.02 267.00 ± 69.24 19.40 ± 33.48
.100
.155
.88
.118 MLS Group(n=10)
Variable control group(n=10) p
Table 2. Comparison of pulmonary function
*Significant difference between before and after intervention in each group (p<0.05),
MLS: Mekenzie lumbar support, FEV1: Forced expiratory volume in the 1 second, FVC: Forced vital capacity, PEF: Peak expiratory flow
Change of pulmonary function after McKenzie lumbar support
DISCUSSION
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Increased lumbar angle, FVC, FEV1, and PEF increase were noted 3, 4). In addition, the increase in trunk angle, back support pressure, and buttock pressure were less than in the absence of support 12).
However, the previous study was directly on the wheelchair manipulation, and the subjects were healthy and elderly subjects. This study differs from previous studies because it was applied to stroke patients who have everyday life in a wheelchair in clinical practice. Because it is not a wheelchair manipulation, it is clinically meaningful because it increases pulmonary function through lumbar sup- port which can be easily applied by anyone.
However, this study has limitations in that it does not directly confirm the change in the angle of the lumbar angle by only identifying the pulmonary function of a stroke patient. However, it is important to verify the effect of the lumbar support on the wheelchair posture of patients with stroke. It is nec- essary to confirm the change of lumbar angle and sagittal spinal alignment through continuous research.
This study confirms that the Mckenzie lumbar sup- port increases pulmonary function in stroke patients who are routinely living in wheelchairs. However, the pulmonary function of stroke patients without pul- monary rehabilitation can’t be increased beyond the control group. Therefore, future studies may show a larger difference if applied with pulmonary rehabili- tation along with Mckenzie lumbar support
CONCLUSION
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