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Phys. Ther. Korea 2017; 24(3): 10-20

Published online August 31, 2017

https://doi.org/10.12674/ptk.2017.24.3.010

© Korean Research Society of Physical Therapy

Four-Week Comparative Effects of Abdominal Drawing-In and Diaphragmatic Breathing Maneuvers on Abdominal Muscle Thickness, Trunk Control, and Balance in Patients With Chronic Stroke

Su-kyung Kim1, Tae-woo Kang1, Dong-hwan Park1, Ji-hyun Lee1, and Heon-seock Cynn2,3

1Dept. of Physical Therapy, The Graduate School, Yonsei University,
2Dept. of Physical Therapy, College of Health Science, Yonsei University,
3Dept. of Ergonomic Therapy, The Graduate School of Health Science, Yonsei University

Correspondence to: Corresponding author: Heon-seock Cynn cynn@yonsei.ac.kr

Received: April 28, 2017; Revised: April 28, 2017; Accepted: June 9, 2017

Abstract

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Background:

Patients with chronic stroke often shows decreased trunk muscle activity and trunk performance. To resolve these problems, many trunk stabilizing techniques including the abdominal drawing-in maneuver (ADIM) and the diaphragmatic breathing maneuver (DBM) are used to improve trunk muscle strength.

Objects:

To compare the effects of the ADIM and the DBM on abdominal muscle thickness, trunk control, and balance in patients with chronic stroke.

Methods:

This was a randomized controlled trial. Nineteen patients were randomly allocated to the ADIM (n1=10) and DBM (n2=9) groups. The ADIM and DBM techniques were performed three times per week for 4 weeks. The thicknesses of the transversus abdominis (TrA), internal oblique muscle, and external oblique muscles on the paretic and non-paretic sides, Trunk Impairment Scale (TIS) score, and Berg Balance Scale (BBS) score were used to assess changes in motor development after 4 weeks of training.

Results:

After the training periods, the TrA thickness on the paretic side, TIS score, and BBS score improved significantly in both groups compared to baseline (p<.05). TIS score was significantly greater in the DBM group than in the ADIM group (p<.05).

Conclusion:

This study demonstrated that ADIM and DBM are beneficial for improving TrA muscle thickness in the paretic side, trunk control, and balance ability. Intergroup comparison revealed that TIS score was significantly improved in the DBM group versus the ADIM group. Thus, DBM may be an effective treatment for low trunk muscle activity and performance in patients with chronic stroke.

Keywords: Abdominal drawing-in maneuver, Diaphragmatic breathing maneuver, Stroke

Article

ARTICLE

Phys. Ther. Korea 2017; 24(3): 10-20

Published online August 31, 2017 https://doi.org/10.12674/ptk.2017.24.3.010

Copyright © Korean Research Society of Physical Therapy.

Four-Week Comparative Effects of Abdominal Drawing-In and Diaphragmatic Breathing Maneuvers on Abdominal Muscle Thickness, Trunk Control, and Balance in Patients With Chronic Stroke

Su-kyung Kim1, Tae-woo Kang1, Dong-hwan Park1, Ji-hyun Lee1, and Heon-seock Cynn2,3

1Dept. of Physical Therapy, The Graduate School, Yonsei University,
2Dept. of Physical Therapy, College of Health Science, Yonsei University,
3Dept. of Ergonomic Therapy, The Graduate School of Health Science, Yonsei University

Correspondence to: Corresponding author: Heon-seock Cynn cynn@yonsei.ac.kr

Received: April 28, 2017; Revised: April 28, 2017; Accepted: June 9, 2017

Abstract

Background:

Patients with chronic stroke often shows decreased trunk muscle activity and trunk performance. To resolve these problems, many trunk stabilizing techniques including the abdominal drawing-in maneuver (ADIM) and the diaphragmatic breathing maneuver (DBM) are used to improve trunk muscle strength.

Objects:

To compare the effects of the ADIM and the DBM on abdominal muscle thickness, trunk control, and balance in patients with chronic stroke.

Methods:

This was a randomized controlled trial. Nineteen patients were randomly allocated to the ADIM (n1=10) and DBM (n2=9) groups. The ADIM and DBM techniques were performed three times per week for 4 weeks. The thicknesses of the transversus abdominis (TrA), internal oblique muscle, and external oblique muscles on the paretic and non-paretic sides, Trunk Impairment Scale (TIS) score, and Berg Balance Scale (BBS) score were used to assess changes in motor development after 4 weeks of training.

Results:

After the training periods, the TrA thickness on the paretic side, TIS score, and BBS score improved significantly in both groups compared to baseline (p<.05). TIS score was significantly greater in the DBM group than in the ADIM group (p<.05).

Conclusion:

This study demonstrated that ADIM and DBM are beneficial for improving TrA muscle thickness in the paretic side, trunk control, and balance ability. Intergroup comparison revealed that TIS score was significantly improved in the DBM group versus the ADIM group. Thus, DBM may be an effective treatment for low trunk muscle activity and performance in patients with chronic stroke.

Keywords: Abdominal drawing-in maneuver, Diaphragmatic breathing maneuver, Stroke

Fig 1.

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Figure 1.

Measurements of abdominal muscles thickness (external oblique; EO, internal oblique; IO, transversus abdominis; TrA, reference line from the muscle–fascia junction of the TrA; D1, TrA muscle thickness; D2, IO thickness; D3, EO thickness; D4).

Physical Therapy Korea 2017; 24: 10-20https://doi.org/10.12674/ptk.2017.24.3.010

Fig 2.

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Figure 2.

Experimental procedures.

Physical Therapy Korea 2017; 24: 10-20https://doi.org/10.12674/ptk.2017.24.3.010

Fig 3.

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Figure 3.

Abdominal drawing-in (A) and diaphragmatic breathing maneuver (B) using real-time ultrasonography.

Physical Therapy Korea 2017; 24: 10-20https://doi.org/10.12674/ptk.2017.24.3.010

Table 1 . Patients’ baseline characteristics.

CharacteristicADIMa (n1=10)DBMb (n2=9)p
Age (year)59.3±10.5c59.1±13.70.973
Height (㎝)164.1±5.2165.0±6.00.728
Weight (㎏)61.5±9.365.2±10.50.423
Sex (Md/Fe)4-Jun2-Jul0.405
Hemiplegic side (Lf/Rg)5-May4-May0.809
Type of stroke (ischemia/hemorrhage)2-Aug3-Jun0.51
Disease duration (months)19.3±9.516.8±8.60.554
K-MMSEh26.3±1.626.7±2.50.703

aabdominal drawing-in maneuver

bdiaphragmatic breathing maneuver

cmean±standard deviation

dmale

efemale

fleft

gright

hKorean Mini-Mental State.

Table 2 . Intervention changes by group.

ParameterADIMa (n1=10)DBMb (n2=9)
Pre-testPost-testEScPre-testPost-testES
TrAd(㎜)paretic2.90±1.30e3.33±1.24*0.342.02±.482.61±.691
non-paretic3.08±.963.15±1.030.072.27±.582.38±.460.21
Iof (㎜)paretic5.79±1.665.93±1.520.095.36±1.505.82±1.840.28
non-paretic6.72±3.086.84±3.050.046.41±1.725.63±1.870.43
Eog (㎜)paretic3.55±1.173.42±.860.132.86±1.133.03±.950.16
non-paretic3.87±1.033.99±.870.133.53±1.023.18±.650.42
TISh (score)13.60±2.9114.20±2.940.212.11±2.3714.22±2.33 †1.21
BBS (score)i30.80±10.0332.80±10.550.1931.67±9.4235.44±9.190.41

aabdominal drawing-in maneuver

bdiaphragmatic breathing maneuver

ceffect size

dtransversus abdominis

emean±standard deviation

finternal oblique muscle

gexternal oblique muscle

htrunk impairment scale

iBerg balance scale

*p<.05

**p<.01

†p<.05 indicates a significant intergroup difference in post-test means.