Role of Trunk Rehabilitation on Trunk Control, Balance and Gait in Patients with Chronic Stroke: A Pre-Post Design

Abstract

Purpose: Although proximal stability of the trunk is a prerequisite for balance and gait, to determine the role of trunk rehabilitation on trunk control, balance and gait in patients with chronic stroke is yet unknown. Method: Fifteen sub-jects (post-stroke duration (3.53 ± 2.98) years) who had the ability to walk 10 meters independently with or without a walking aid; scoring ≤ 21 on Trunk Impairment Scale (TIS), participated in a selective trunk muscle exercise regime, consisting of 45 minutes training per day, four days a week, and for four weeks duration in an outpatient stroke reha-bilitation centre. Results: The overall effect size index for trunk rehabilitation was 1.07. This study showed large effect size index for Trunk Impairment Scale (1.75), Berg Balance Scale (1.65) than for gait variables (0.65). After trunk rehabilitation, there was a significant improvement for gait speed (p= 0.015), cadence (p= 0.001) and gait symmetry (p=0.019) in patients with chronic stroke. In addition, all the spatial gait parameters had a significant change post-intervention. There was no significant change in temporal gait parameters with the exception of affected single limb support time. The level of significance was set at p < 0.05. Conclusion: The exercises consisted of selective trunk movement of the upper and the lower part of trunk had shown larger effect size index for trunk control and balance than for gait in patients with chronic stroke. Future randomized controlled studies incorporating large sample size would provide insight into the effectiveness and clinical relevance of this intervention

Weight-Shift Training Improves Trunk Control, Proprioception, and Balance in Patients with Chronic Hemiparetic Stroke

“…This may indicate that improved trunk control affects dynamic balance in patients with stroke. According to a study on trunk movement during gait in stroke patients, the patients had unstable and asymmetric trunk movements (Tyson 1999), and an improvement in trunk control affected walking speed and symmetry (Karthikbabu et al 2011b). The significantly improved TUG scores after training in this study may have been affected by improved trunk control that influenced balance during gait.…”

“…In addition, the carry-over effect of trunk control training on mobility is insufficient. Also, most studies on trunk control training in stroke patients are based on acute stroke patients, and studies on chronic stroke lack in quantity (Karthikbabu et al 2011b). Therefore, this study is designed to investigate the effects of weight-shift training on an unstable surface in sitting position on trunk control, proprioception, and dynamic balance during gait in patients with chronic stroke.…”

Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Technique on Facilitation of Trunk Movement in Hemiparetic Stroke Patients

“…The exercises in sitting were as follows: flexion and extension of the trunk (the participant were asked to flexed and extends the trunk without moving the trunk forward or backward);trunk lateral flexion initiated from the shoulder and pelvic girdle (from the shoulder girdle means -participant touches the plinth with one elbow and returns to the starting position, from the pelvic girdle means-participant lifts one side of the pelvis and returns to the starting position); rotation from the upper part of trunk (from the upper part of the trunk means-participant moves each shoulder forward and backward); rotation from the lower part of the trunk (from the lower part of the trunk means-participant moves each knee forward and backward); and shuffling the pelvis forward, backward and one side to other on a plinth.The truncal exercises were performed with the assistance initially if required and progressed to a state of no assistance. The therapist based on the participant"s performance determined the numbers of repetitions of the exercise [25][26][27].…”

Efeitos da facilitação neuromuscular proprioceptiva na estabilidade postural e risco de quedas em pacientes com sequela de acidente vascular encefálico: estudo piloto

“…Quando ocorre uma lesão em qualquer área cerebral percepção sensitiva, orientação espacial e mecanismos do controle motor ficam prejudicados, causando hipertonicidade da musculatura antigravitária, que leva a fraqueza muscular e proporciona posturas assimétricas com maior descarga de peso na perna não afetada, aumentando o risco de queda para o sujeito com hemiparesia [4][5][6] . A facilitação neuromuscular proprioceptiva (PNF) é uma filosofia de tratamento criada na década de 1950 que parte do princípio de que cada indivíduo possui um potencial não explorado e de um enfoque positivista, apresentando técnicas específicas que visam o ganho de flexibilidade, a coordenação motora, o fortalecimento muscular e a estabilidade, quer seja axial ou apendicular, tendo efeitos positivos no programa de reabilitação neurológica, inclusive em sujeitos com hemipareia [7][8][9][10] . O objetivo do estudo foi avaliar o efeito do método PNF na estabilidade postural e no risco de quedas em pacientes com sequela de AVE.…”