Effects of the Abdominal Drawing-in Maneuver and the Abdominal Expansion Maneuver on Grip Strength, Balance and Pulmonary Function in Stroke Patients

Abstract

Purpose:The purpose was to determine whether the application of the abdominal drawing-in maneuver (ADIM) and abdominal expansion maneuver (AEM) to stroke patients would affects their trunk stability, balance, pulmonary function, and grip strength. Methods: The subjects were 36 stroke patients who were randomly and equally assigned to an ADIM group (n = 12), an AEM group (n= 12), and a control group (n= 12). The intervention was applied to each group three times per week, 30 minutes each time, for four weeks. Outcome measures were grip strength, modified functional reach test (mFRT) and pulmonary function. Pulmonary function were measured force expiratory volume at one second (FEV1), forced vital capacity (FVC), FEV1/FVC and peak expiratory flow (PEF) values. Results: The results of the three groups showed statistically significant improvements in grip strength. The AEM group showed significantly greater differences in grip strength than either the ADIM group or the control group. In the anterior mFRT, the ADIM group showed significantly improvements than the control group. The ADIM and AEM groups were showed statistically significant greater improvements in PEF between the baseline and post-intervention and the post-analysis revealed that the AEM group showed significantly greater improvements than the control group. Conclusion: The results of this study indicate that the ADIM and AEM were effective in improving the PEF of pulmonary function. The ADIM was more effective than AEM in trunk stabilization. This is an Open Access article distribute under the terms of the Creative Commons Attribution Non-commercial License (Http:// creativecommons.org/license/by-nc/3.0.) which permits unrestricted non-commercial use, distribution,and reproduction in any medium, provided the original work is properly cited. Korean Physical Therapy significantly affects the maintenance of life, and it is an essential element to be maintained for improving the physical function and the quality of life in stroke patients. 2 In addition, the cardio-pulmonary function affects the trunk control which does an important role in the maintenance of standing position, body movements, balance and stability required for activities of daily living (ADL). A symptom of the stroke is the reduction of the motor control for which the co-contraction of the muscles involved in the respiratory circulation is essential. The damage in respiratory function induces the dysfunction of the trunk posture and the weakness of the respiration muscle. 7 In addition, the damage causes the decrease in updown movement of the diaphragm over voluntary breathing and hyperpnea, which results in a continuous increase in the affected side diaphragm. 8 Normally, the deep abdominal muscles, in coordination with the deep multifidus muscle, play a central role in lumbar spinal stiffness, contributing to core stability. The TrA muscle is preferentially activated to maintain postural stability in the motor control of the trunk muscles during limb movement. 9 To improve the breathing ...

Comparison on postural control between abdominal draw-in maneuver and abdominal expansion maneuver in persons with stroke

“…If the navel extends in the caudal anterior direction, it may have the advantage of being able to increase the IAP, the simultaneous contraction of the diaphragm, and deep spinal stabilizer muscles. ADIM training was performed in the prone position using a pressure bio-feedback system, which has been commonly used to give stability to the pelvis and lower back area during movement of the upper and lower limbs [14]. We performed the ADIM training in the prone position with adults with instability that was reported of the thickened core muscle, the transverse abdominis, and obliqus abdominus interni.…”

“…Subjects were instructed to keep breathing in this state and to keep the posture for 10 seconds. After repeating the AEM 10 times, a 3-minute break was given and an application of 3 sets of AEM for 15 minutes was administered in total [14].…”

“…It could increase the simultaneous contraction of the diaphragm and deep spinal stabilizer muscles and intra-abdominal pressure (IAP). This is required to provide forward stability of the lumbopelvis position [13,14]. Abdominal draw-in maneuver (ADIM) is commonly used in a clinical setting and is a technique that stabilizes the trunk with faster selective contraction of the transverse abdominis, rectus abdominis muscle, obliqus abdominus externi, and obliqus abdominus interni than other superficial muscles.…”

“…In a prior studies of stroke patients, clinical balance ability, upper extremity function, pulmonary function by applying the trunk stabilization exercises such as ADIM, AEM and comparative studies of the normal person have been studied [14]. However, studies with ADIM and AEM training interventions being implemented in trunk stabilization training with a quantitative evaluation of the impact on postural stability in unsupported sitting is not enough.…”

Effect of Static Abdominals Training and Incentive Spirometer in Improvement of Pulmonary Function and Abdominal Strength in Spinal Cord Injury Patients- A Comparative Study

“…And found that the change of PEF (peak expiratory flow) in the ADIM (abdominal drawing-in maneuver) and AEM groups is larger compared with control group [12].…”