Effect of Inspiratory Muscle Training Combined With Abdominal Drawing-In Maneuver on Balance, Gait, and Pulmonary Function in Subacute Stroke Patients: A Randomized Controlled Trial
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Sahmyook University
- Enrollment
- 20
- Locations
- 1
- Primary Endpoint
- Change in Trunk Control as Measured by the Trunk Impairment Scale (TIS)
Study Overview
Brief Summary
This study examines how Inspiratory Muscle Training (IMT) combined with the Abdominal Drawing-In Maneuver (ADIM) affects balance, gait, and breathing in stroke patients. It aims to determine whether this combined intervention improves mobility and respiratory function more effectively than standard rehabilitation.
Detailed Description
This study investigates the effects of Inspiratory Muscle Training (IMT) and Abdominal Drawing-In Maneuver (ADIM) on stroke rehabilitation. IMT involves resistance-based breathing exercises to strengthen the inspiratory muscles and improve pulmonary function, while ADIM focuses on activating the deep abdominal muscles, particularly the transversus abdominis, to enhance trunk stability and postural control. Participants in the intervention group perform IMT using a threshold resistance device, starting at 30% of MIP and progressively increasing to 60% MIP over four weeks. ADIM exercises are conducted with verbal and manual guidance to ensure proper engagement of core muscles. Sessions are held five times per week for four weeks, with each session lasting 40 minutes (20 minutes for each intervention). The control group receives conventional rehabilitation without resistance-based inspiratory training.
The study utilizes TIS, BBS and TUG to assess balance, FGA to evaluate gait performance, and MIP and MEP to measure respiratory function. Assessments are conducted before and after the intervention to evaluate changes resulting from the treatment.
Eligible participants are individuals with subacute stroke (onset within 1-6 months), an MMSE-K score of 24 or higher, and the ability to walk at least 6 meters with or without an assistive device. Exclusion criteria include conditions prohibiting the Valsalva maneuver (e.g., glaucoma, aneurysm, pulmonary hypertension), acute respiratory infections, severe cognitive or language impairments, prior inspiratory muscle training within the past six months, unstable medical conditions, and neurological or musculoskeletal disorders affecting gait and balance.
This study aims to determine whether the combined application of IMT and ADIM enhances functional recovery, improves postural control, and promotes better respiratory health in stroke patients. The findings may contribute to the development of more effective rehabilitation strategies for improving quality of life in individuals recovering from stroke.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Participants diagnosed with subacute stroke (1-6 months post-onset)
- •Mini-Mental State Examination-Korean (MMSE-K) score of 24 or higher
- •Ability to walk at least 6 meters, with or without an assistive device
Exclusion Criteria
- •Conditions prohibiting the Valsalva maneuver (e.g., glaucoma, aneurysm, pulmonary hypertension)
- •Acute respiratory infections
- •Severe language or cognitive impairments preventing communication
- •Previous inspiratory muscle training within the last 6 months
- •Unstable medical conditions (e.g., uncontrolled hypertension, diabetes)
- •Neurological disorders affecting function and balance (e.g., Parkinson's disease, multiple sclerosis)
- •Severe musculoskeletal impairments limiting functional mobility.
Arms & Interventions
Inspiratory Muscle Training (IMT) with Abdominal Drawing-In Maneuver (ADIM) Group
participants recieve in IMT using a threshold resistance device, starting at 30% of maximal inspiratory pressure and progressively increasing to 60% over four weeks. The ADIM is performed with verbal and manual guidance to ensure correct deep abdominal muscle engagement. Sessions are conducted five times per week for four weeks, with each session lasting 40 minutes (20 minutes for each intervention).
Intervention: Inspiratory Muscle Training (IMT) with Abdominal Drawing-In Maneuver (ADIM) training (Behavioral)
Sham Inspiratory Muscle Training(IMT) with Abdominal Drawing-In Maneuver(ADIM) Group
participants recieve simulated IMT with minimal resistance while performing the same ADIM as the experimental group. This design ensures that any effects observed can be attributed to inspiratory muscle training rather than ADIM. Sessions are conducted five times per week for four weeks, with each session lasting 40 minutes (20 minutes for each intervention).
Intervention: Sham Inspiratory Muscle Training (IMT) with Abdominal Drawing-In Maneuver (ADIM) training (Behavioral)
Outcomes
Primary Outcomes
Change in Trunk Control as Measured by the Trunk Impairment Scale (TIS)
Time Frame: change from Baseline to 4 weeks post intervention
The TIS assesses trunk stability, coordination, and dynamic sitting balance in participants. It consists of three subscales: static sitting balance (score range: 0-7), dynamic sitting balance (score range: 0-10), and trunk coordination (score range: 0-6). The total score ranges from 0 to 23, with higher scores indicating better trunk control. The test is conducted with the participant seated on a firm, stable surface without back or arm support.
Change in Functional Mobility as Measured by the Timed Up and Go (TUG) Test
Time Frame: change from Baseline to 4 weeks post intervention
TUG Test assesses functional mobility and fall risk. Participants start seated, stand up at a signal, walk 3 meters, turn around, walk back, and sit down. The test is timed in seconds, with lower times indicating better mobility. A time exceeding 14 seconds suggests an increased fall risk.
Change in Balance Ability as Measured by the Berg Balance Scale (BBS)
Time Frame: change from Baseline to 4 weeks post intervention
BBS evaluates balance and fall risk through 14 items, covering sitting, standing, and positional changes. Each item is scored from 0 (unable) to 4 (normal performance), with a total possible score of 0 to 56. Scores below 44 indicate a high fall risk.
Secondary Outcomes
- Change in Gait Performance as Measured by the Functional Gait Assessment (FGA)(change from Baseline to 4 weeks post intervention)
- Change in Respiratory Muscle Strength as Measured by Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP)(change from Baseline to 4 weeks post intervention)
Investigators
DOHYOUNG KIM
Physical Therapist
Sahmyook University