Boxing and Scapular Stabilization Training in Hemiparetics
NCT ID: NCT05568173
Last Updated: 2023-11-07
Study Results
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Basic Information
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COMPLETED
NA
60 participants
INTERVENTIONAL
2022-10-13
2023-09-10
Brief Summary
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When the investigators look at the literature, the investigators see that there is no study comparing the effects of both scapular stabilization and boxing training on upper extremity functions and trunk balance in stroke patients.
Therefore the aim of this study, compare the effects of boxing and scapular stabilization training on scapular mobility (primary outcome measure), upper extremity range of motion, shoulder proprioception, scapular balance angle, scapular muscle strength, trunk muscle strength, upper extremity motor functions, trunk balance and treatment satisfaction (secondary outcome measures) in hemiparetic individuals with stroke.
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Detailed Description
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A visible change in the movement pattern and position of the scapula relative to the thorax is defined as scapular dyskinesia. In the literature, there is no consensus on whether scapular dyskinesia occurs secondary to any pathology or influence, or whether it is the cause of these pathologies. In an EMG study performed during shoulder flexion in stroke patients, delayed muscle activation of the lower trapezius muscle was observed in stroke patients with shoulder pain compared to stroke patients without shoulder pain. In the electromyography study conducted by Betz et al. in 2014, they observed that the Serratus anterior muscle was inactive or late active in some of the stroke patients with shoulder pain, while the infraspinatus muscle was activated earlier and the activation lasted longer in stroke patients without shoulder pain. The researchers pointed out that these results show the role of the timing of activation of the infraspinatus muscle in shoulder stabilization and prevention of shoulder pain in stroke patients, and that infraspinatus muscle strengthening exercises should be added to rehabilitation to prevent shoulder impingement syndrome, and they drew attention to the importance of serratus anterior and lower trapezius muscle in scapular motor control to provide dynamic stabilization.
Postural stability is defined as the relationship of body parts to the center of gravity. It has been said that the basic prerequisite for movements requiring complex controlled ability is postural stability. Many studies have investigated the relationship between balance disorder and lower extremity dysfunction in stroke, however, it is thought that upper extremity dysfunction also affects balance significantly.Williams et al. showed in their study that scapulothoracic joint stabilization, mostly generated by the trapezius and serratus anterior muscles, contributes significantly to trunk core stability. During voluntary arm movements, force moments occur in the shoulder depending on the weight and dynamics of the arm. These forces and moments can affect the ability to sit, stand and also change positions. Body stabilization during walking is provided by ± 1.5 ° movement of the upper body. This movement can increase the stability of the head by reducing false signals from the otolith and vestibular systems. In the study conducted by Awad et al. in hemiparetic patients with stroke, stretching exercises for the pectorals, latissimus dorsi, rhomboids, and teres major muscles, scapular stabilization exercises in addition to trunk control exercises were applied 3 times a week for 6 weeks, and it was observed that scapular muscle strength increased and trunk alignment improved. In another study by Jo et al. in 2019, it was observed that strengthening exercises given to the scapular muscles 3 times a week for 8 weeks in addition to stretching exercises improved upper extremity and walking functions.
In a study published in 2020, in which the investigators compared the effects of virtual and real boxing training on upper extremity functions, balance, and cognitive functions in stroke patients, significant improvement was observed in each parameter in both groups .
When the investigators look at the literature, the investigators see that there is no study comparing the effects of both scapular stabilization and boxing training on upper extremity functions and trunk balance in stroke patients.
Therefore the aim of this study, compare the effects of boxing and scapular stabilization training on scapular mobility (primary outcome measure), upper extremity range of motion, shoulder proprioception, scapular balance angle, scapular muscle strength, trunk muscle strength, upper extremity motor functions, trunk balance and treatment satisfaction (secondary outcome measures) in hemiparetic individuals with stroke.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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Boxing Training
In the Boxing Training Group (BG) boxing training will be given. Additionally, stretching exercises and postural training will be applied.
Boxing Training
In addition to boxing training, stretching exercises and posture training will be given at BG. A physiotherapist with a boxing training certificate will perform modified boxing training that progresses according to the degree of difficulty. There will be four difficulty levels. The complexity of the exercises will increase at 2-week intervals as the patient progresses. As a result, 0-2 weeks 1st level, 2-4 weeks 2nd level, 4-6 weeks 3rd level and 6-8 weeks 4th level exercises will be done.
In the first level, patients will be asked to punch the fixed boxing mat hanging on the wall with various instructions. Then, in levels 2-4, target gloves and heavy punching bags will be used to increase the difficulty level. As the sessions progress, the resistance and frequencies between the levels will be increased by the physiotherapist. There will be 3 sessions of 30-minute boxing training per week for 8 weeks at BG.
Scapular Stabilization
In the Scapular Stabilization Group (SSG) scapular stabilization training will be given. Additionally, stretching exercises and postural training will be applied.
Scapular Stabilization
In addition to scapular stabilization training, stretching exercises and posture training will be given in SSG. Progressive strengthening training for the scapular muscles will be used in the SSG. There will be four difficulty levels. The complexity of the exercises will increase at 2-week intervals as the patient progresses. As a result, 0-2 weeks 1st level, 2-4 weeks 2nd level, 4-6 weeks 3rd level and 6-8 weeks 4th level exercises will be done.
At the first level, scapular clock exercise, obstacle crossing exercise, wall gliding exercise with teraband, push up exercise, trunk rotation and maximum hip flexion will be performed. Then at levels 2-4, as the levels increase, the exercises at the first level will be more difficult (ball weight, surface, number of hurdles and hurdle crossing exercise position, by changing the teraband elasticity, push-up position). In SSG, 3 sessions of 30-minute scapular stabilization training will be applied per week for 8 weeks.
Control
Individuals in this group will not receive any treatment. Evaluations will be made before treatment and after 8 weeks of treatment.
No interventions assigned to this group
Interventions
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Boxing Training
In addition to boxing training, stretching exercises and posture training will be given at BG. A physiotherapist with a boxing training certificate will perform modified boxing training that progresses according to the degree of difficulty. There will be four difficulty levels. The complexity of the exercises will increase at 2-week intervals as the patient progresses. As a result, 0-2 weeks 1st level, 2-4 weeks 2nd level, 4-6 weeks 3rd level and 6-8 weeks 4th level exercises will be done.
In the first level, patients will be asked to punch the fixed boxing mat hanging on the wall with various instructions. Then, in levels 2-4, target gloves and heavy punching bags will be used to increase the difficulty level. As the sessions progress, the resistance and frequencies between the levels will be increased by the physiotherapist. There will be 3 sessions of 30-minute boxing training per week for 8 weeks at BG.
Scapular Stabilization
In addition to scapular stabilization training, stretching exercises and posture training will be given in SSG. Progressive strengthening training for the scapular muscles will be used in the SSG. There will be four difficulty levels. The complexity of the exercises will increase at 2-week intervals as the patient progresses. As a result, 0-2 weeks 1st level, 2-4 weeks 2nd level, 4-6 weeks 3rd level and 6-8 weeks 4th level exercises will be done.
At the first level, scapular clock exercise, obstacle crossing exercise, wall gliding exercise with teraband, push up exercise, trunk rotation and maximum hip flexion will be performed. Then at levels 2-4, as the levels increase, the exercises at the first level will be more difficult (ball weight, surface, number of hurdles and hurdle crossing exercise position, by changing the teraband elasticity, push-up position). In SSG, 3 sessions of 30-minute scapular stabilization training will be applied per week for 8 weeks.
Eligibility Criteria
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Inclusion Criteria
* Patients with hemiparesis
* Patients who are between the ages of 40-70
* Patients who has Mini Mental Test score above 23
* Patients whose functional level is less than 4 according to the Modified Rankin Scale
* Patients who has upper extremity spasticity lower than 2 on Modified Ashworth Scale
* Patients who can do 120 degrees of shoulder flexion
Exclusion Criteria
* Subluxation and fracture at the shoulder
* Risk of fracture and pain at the shoulder
* Visual and hearing impairment
* Unilateral neglect
* Botulinum toxin administration or surgical operation in the last 6 months patients
40 Years
70 Years
ALL
No
Sponsors
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Eastern Mediterranean University
OTHER
Responsible Party
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Ceren Ersoy
MSc physiotherapist
Principal Investigators
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Gözde İyigün, Assoc.Prof.
Role: STUDY_CHAIR
Eastern Mediterranean University
Locations
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Eastern Mediterranean University
Famagusta, , Cyprus
Countries
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References
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Other Identifiers
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ETK00-2022-0181
Identifier Type: -
Identifier Source: org_study_id
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