Yoon Hyun S, You Joshua Sung H
Chungnam National University Hospital, Daejeon, Korea.
Sports ⋅ Movement Institue & Technology, Department of Physical Therapy Program, Yonsei University, Wonju, Kangwon-do, Korea.
Technol Health Care. 2017 Jul 20;25(S1):99-106. doi: 10.3233/THC-171311.
Postural core instability is associated with poor dynamic balance and a high risk of serious falls. Both neurodevelopmental treatment (NDT) and dynamic neuromuscular stabilization (DNS) core stabilization exercises have been used to improve core stability, but the outcomes of these treatments remain unclear.
This study was undertaken to examine the therapeutic effects of NDT and DNS core stabilization exercises on muscular activity, core stability, and core muscle thickness.
Ten participants (5 healthy adults; 5 hemiparetic stroke patients) were recruited. Surface electromyography (EMG) was used to determine core muscle activity of the transversus abdominis/internal oblique (TrA/IO), external oblique (EO), and rectus abdominis (RA) muscles. Ultrasound imaging was used to measure transversus abdominals/internal oblique (TrA/IO) thickness, and a pressure biofeedback unit (PBU) was used to measure core stability during the DNS and NDT core exercise conditions. Data are reported as median and range and were compared using nonparametric Mann - Whitney U test and Wilcoxon signed rank test at p< 0.05.
Both healthy and hemiparetic stroke groups showed greater median EMG amplitude in the TrA/IO muscles, core stability, and muscle thickness values during the DNS exercise condition than during the NDT core exercise condition, respectively (p< 0.05). However, the relative changes in the EMG amplitude, core stability, and muscle thickness values were greater during the DNS exercise condition than during the NDT core exercise condition in the hemiparetic stroke patient group (p< 0.05).
Our novel results provide the first clinical evidence that DNS is more effective than NDT in both healthy and hemiparetic stroke subjects to provide superior deep core muscle activation, core stabilization, and muscle thickness. Moreover, such advantageous therapeutic benefits of the DNS core stabilization exercise over the NDT exercise were more apparent in the hemiparetis stroke patients than normal controls.
姿势性核心不稳定与动态平衡差及严重跌倒的高风险相关。神经发育疗法（NDT）和动态神经肌肉稳定化（DNS）核心稳定训练均已用于改善核心稳定性，但这些治疗的效果仍不明确。
本研究旨在探讨NDT和DNS核心稳定训练对肌肉活动、核心稳定性及核心肌厚度的治疗效果。
招募了10名参与者（5名健康成年人；5名偏瘫性脑卒中患者）。使用表面肌电图（EMG）来确定腹横肌/腹内斜肌（TrA/IO）、腹外斜肌（EO）和腹直肌（RA）的核心肌肉活动。使用超声成像测量腹横肌/腹内斜肌（TrA/IO）厚度，并使用压力生物反馈装置（PBU）在DNS和NDT核心训练条件下测量核心稳定性。数据以中位数和范围表示，并使用非参数Mann - Whitney U检验和Wilcoxon符号秩检验进行比较，p<0.05。
健康组和偏瘫性脑卒中组在DNS训练条件下TrA/IO肌肉的肌电图振幅中位数、核心稳定性和肌肉厚度值均分别高于NDT核心训练条件下（p<0.05）。然而，偏瘫性脑卒中患者组在DNS训练条件下肌电图振幅、核心稳定性和肌肉厚度值的相对变化大于NDT核心训练条件下（p<0.05）。
我们的新结果提供了首个临床证据，表明在健康和偏瘫性脑卒中受试者中，DNS在提供更好的深层核心肌肉激活、核心稳定和肌肉厚度方面比NDT更有效。此外，DNS核心稳定训练相对于NDT训练的这种有利治疗效果在偏瘫性脑卒中患者中比正常对照组更明显。
