AZUSA PACIFIC UNIVERSITY

THE EFFECT OF THE SAHRMANN LOWER

ABDOMINAL MUSCLE EXERCISE PROGRESSION ON
IMPROVING BALANCE IN THE FRAIL ELDERLY POPULATION

by

Soliven Lansangan

W
IE A capstone project submitted to the

School of Behavioral and Applied Sciences

EV
in partial fulfillment of the requirements

for the degree Doctor of Physical Therapy

PR

Azusa, California

December, 2019
 ProQuest Number: 22592001

All rights reserved

INFORMATION TO ALL USERS

The quality of this reproduction is dependent on the quality of the copy submitted.

In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.

W
IE
EV
ProQuest 22592001

Published by ProQuest LLC ( 2019 ). Copyright of the Dissertation is held by the Author.

All Rights Reserved.

PR

This work is protected against unauthorized copying under Title 17, United States Code
Microform Edition © ProQuest LLC.

ProQuest LLC
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, MI 48106 - 1346
 AZUSA PACIFIC UNIVERSITY

THE EFFECT OF THE SAHRMANN LOWER

ABDOMINAL MUSCLE EXERCISE PROGRESSION ON
IMPROVING BALANCE IN THE FRAIL ELDERLY POPULATION

by

Soliven Lansangan

W
IE has been approved by the

School of Behavioral and Applied Sciences

EV
in partial fulfillment of the requirements

for the degree Doctor of Physical Therapy

PR

Tamara Eichelberger, Ph.D., Committee Chair

Annette Karim, DPT, Ph.D., Committee Member

Susan Shore, PT, Ph.D., Chair, Doctor of Physical Therapy Department

Robert K. Welsh, Ph.D., ABPP, Dean, School of Behavioral and Applied Sciences
 W
IE
EV
PR

© Copyright by Soliven Lansangan 2019

All Rights Reserved

ii
 DEDICATION

I wish to dedicate this dissertation to my family for their unconditional love and to

Kimberly Cayco, who has supported me every step of the way. I could not have done this

without you.

W
IE
EV
PR

iii
 ACKNOWLEDGMENTS

I would like to thank my advisor, Dr. Tamara Eichelberger, and my professor, Dr.

Annette Karim, for their guidance and encouragement throughout this entire process. I

would also like to thank my close friends and classmates for their overwhelming support.

W
IE
EV
PR

iv
 ABSTRACT

THE EFFECT OF THE SAHRMANN LOWER

ABDOMINAL MUSCLE EXERCISE PROGRESSION ON
IMPROVING BALANCE IN THE FRAIL ELDERLY POPULATION

Soliven Lansangan

W
Doctor of Physical Therapy, 2019
Azusa Pacific University
Advisor: Tamara Eichelberger, Ph.D.
IE
Background. Falls commonly lead to fatal and non-fatal injuries in older adults. Research
EV
has shown that core strength training can improve balance and decrease the risk for falls

in the elderly. Purpose. The purpose of this study was to evaluate the effectiveness of the
PR

Sahrmann Lower Abdominal Muscle Exercise Progression (SLAMEP) in improving

static and dynamic balance in the geriatric population who reside in long-term nursing

care. This intervention was compared to the traditionally used exercise for balance,

perturbation-based balance training (PBBT). Literature Review. A comprehensive

literature review was conducted, with 27 articles appraised in full text. Current literature

supports the use of core training to improve balance; however, these studies utilized

healthy community-dwelling older adults. Evidence shows that PBBT can significantly

improve balance in the elderly through enhanced postural righting reactions. Case

Description. The patient was a 72-year-old female long-term resident of a skilled nursing

v
facility, recovering from pneumonia. She presented with balance deficits and had an

increased fear of falling. Her plan of care included a 4-week SLAMEP intervention to

improve balance through increase in core strength. Balance and fall risk outcome

measures were utilized at the time of initial evaluation and after completion of the

intervention. These outcome measures included Timed Up and Go (TUG), Tinetti Test,

Rhomberg Test, and Functional Balance Assessment. The re-assessment showed

clinically important differences in improvement of balance and decrease in fall risk.

Discussion. In this case study, increased core strength was found to improve balance in

static positions and dynamic movements. Evidence from this case study and supporting

W
literature suggest that core strength training is a viable alternative to PBBT for improving
IE
balance in the elderly population who require long-term nursing care.

Keywords: case report, core strength training, elderly, balance, fall prevention,
EV
fall risk
PR

vi
 TABLE OF CONTENTS

Dedication .......................................................................................................................... iii

Acknowledgments.............................................................................................................. iv

Abstract ................................................................................................................................v

List of Tables .......................................................................................................................x

W
List of Figures .................................................................................................................... xi

Chapter IE Page

1. Introduction ......................................................................................................................1
EV
2. Literature Review.............................................................................................................3

Purpose.....................................................................................................................4

Methods: Evidence Acquisition ...............................................................................4

PR

Data Sources and Search Strategies .............................................................4

Study Selection ............................................................................................4

Assessment of Methodologic Quality ..........................................................5

Methods: Evidence Synthesis ..................................................................................5

Systematic Reviews .....................................................................................5

Randomized Controlled Trials .....................................................................6

Non-Randomized Controlled Trials .............................................................7

Summary of Results .................................................................................................7

Discussion ................................................................................................................7

vii
Chapter Page

Conclusion ...............................................................................................................8

3. Case Report ......................................................................................................................9

Background and Purpose .........................................................................................9

Case Description: Patient History and Systems Review........................................10

Clinical Impression #1 ...........................................................................................11

Examination ...........................................................................................................11

Range of Motion (ROM) ...........................................................................11

Manual Muscle Test (MMT) .....................................................................12

W
Balance .......................................................................................................12
IE
Functional Mobility Assessment................................................................14

Gait .............................................................................................................15
EV
Cardiopulmonary Assessment ...................................................................15

Clinical Impression #2 ...........................................................................................16

Diagnosis....................................................................................................16
PR

Prognosis ....................................................................................................16

Plan of Care................................................................................................16

Intervention ............................................................................................................17

Outcomes ...............................................................................................................19

Discussion ..............................................................................................................20

4. Discussion ......................................................................................................................23

References ..........................................................................................................................26

viii
Appendix Page

A: Tables and Figures from Literature Review .....................................................30

B: Tables and Figures from Chapter 3 ...................................................................38

W
IE
EV
PR

ix
 LIST OF TABLES

Table A1: CEBM and Quality Ratings of Individual Articles ...........................................31

Table A2: Systematic Reviews of Randomized Controlled Trials ...................................32

Table A3: Randomized Control Trial Comparisons ..........................................................34

Table A4: Single Subject Experimental Design ................................................................36

W
Table B1: Intervention Timeline ........................................................................................44

Table B2: Description of Sahrmann Lower Abdominal Muscle Exercise Progression.....45

IE
Table B3: Results of Outcome Measures Addressing Fall Risk and Balance ...................47
EV
PR

x
 LIST OF FIGURES

Figure A1: Search Strategy ................................................................................................37

Figure B1: Timeline to Day 1 ............................................................................................39

Figure B2: International Classification of Function, Disability, and Health

(ICF) Model ...........................................................................................................40

W
Figure B3: Level 0.3 of Sahrmann Lower Abdominal Muscle Exercise Progression .......41

Figure B4: Level 1A of Sahrmann Lower Abdominal Muscle Exercise Progression .......42
IE
Figure B5: Level 1B of Sahrmann Lower Abdominal Muscle Exercise Progression .......43
EV
Figure B6: Level 2 of Sahrmann Lower Abdominal Muscle Exercise Progression ..........43
PR

xi

Reproduced with permission of copyright owner. Further reproduction prohibited without permission.