Effects of Trunk Exercise on Unstable Surfaces in Persons with Stroke: A Randomized Controlled Trial

Abstract

Background: Improving balance-related ability is an important goal in stroke rehabilitation. Evidence is needed to demonstrate how this goal could be better achieved. Aim: Determine if trunk exercises on unstable surfaces would improve trunk control and balance for persons in the subacute stage of stroke. Design: An assessor-blind randomized controlled trial. Setting: Inpatients in the department of rehabilitation in a general hospital. Population: Patients who suffered a first-time stroke with onset from one to six months. Methods: Inpatients with stroke were assigned to upper limb exercises (control group, n = 17) or trunk exercises on unstable surfaces (experimental group, n = 18) to receive training twice a week for six weeks, in addition to their daily conventional stroke rehabilitation. Sensorimotor function tests, including hand grip, plantar sensitivity, stroke rehabilitation assessment of movement and Fugl-Meyer lower extremity motor scale, and clinical outcome assessments, including Trunk Impairment Scale and 6 m walk test, were conducted before and after six weeks of training. The center of the pressure area while maintaining static posture and peak displacement while leaning forward, as well as the average speed of raising the unaffected arm, were measured in sitting without foot support, sitting with foot support and standing to reflect trunk control, sitting balance and standing balance, respectively. Results: The between-group differences in the sensorimotor functions were nonsignificant before and after training. Compared with the control group, the experimental group had significantly greater forward leaning and faster arm raising in sitting without foot support, higher Trunk Impairment Scale total score, and shorter 6 m walking time after training, but not before training. Conclusion: Trunk exercises on unstable surfaces could further improve trunk control, the ability to raise the unaffected arm rapidly in sitting, and walking for persons in the subacute stage of stroke. This intervention may be considered to be included in stroke rehabilitation.

Effect of Trunk Training on Dynamic Balance in Chronic Stroke Survivor

“…Trunk control and balance ability was significantly improved which is in compliance with the present study result as depicted by TIS score 10 . Lee et al study (2020) conducted various type of trunk exercise on unstable surface and the result showed improvement in dynamic balance in post stroke patients 8 . The improvement in BBS score showed trunk training exercise is highly effective to achieve balance in post stroke survivor which is correlated to the studies conducted in 2016 in Spain 2 .…”

“…Postural sway seen after stroke while preserving sitting/standing position as well as when shifting the body's center of mass in smaller range 8 . Neurologically, trunk is the key point of control for body movement so trunk stability is required for the distal movement.…”

The Use of Armeo®Spring Device to Assess the Effect of Trunk Stabilization Exercises on the Functional Capabilities of the Upper Limb—An Observational Study of Patients after Stroke

“…They found that trunk stabilization training had a beneficial effect on the trunk function and balance in standing positions and mobility in patients after a stroke [22]. The results of the stability studies indicate that in patients after strokes, trunk stabilization exercises should be introduced [23][24][25][26]. Lee et al assessed the influence of breathing exercises on trunk control, assuming that the trunk muscles play a large role in the work of the respiratory system [27].…”

Proprioceptive Neuromuscular Facilitation Neck Pattern and Trunk Specific Exercise on Trunk Control and Balance—an Experimental Study

“…( 23 ) There is evidence that trunk training exercises showed moderate evidence to improve trunk performance and dynamic sitting balance. ( 24 – 26 )…”

“…(23) There is evidence that trunk training exercises showed moderate evidence to improve trunk performance and dynamic sitting balance. (24)(25)(26) Though the existing studies proved that trunk exercises were mediated by improved trunk control, the gap still limits the understanding of lower limbs for balance. The current study hypothesized that PNF neck pattern and trunk-specific exercise would significantly improve trunk control and balance.…”