The Effects of Trunk Exercise on Mobility, Balance and Trunk Control of Stroke Patients

Abstract

| Abstract |1 )PURPOSE: The initiation of the trunk muscles in stroke patients is delayed because the muscles involved in reach arm are activated earlier than the trunk muscles. The objective of this study was to examine the effects of mobility, balance, and trunk control ability through selective trunk exercise (STE) in patients with chronic stroke. METHODS:A randomized pre-test and post-test control group design was initially used, with subjects randomly assigned to the STE group (n=15) and a control group (n=14).All groups underwent physical therapy based on the neuro-developmental therapy (NDT) for 30 minutes a day, five times per week for four weeks. Additionally, the STE group did the trunk exercise for 30 minutes a day, three times per week for four weeks. The timed up and go test (TUG), Berg balance scale (BBS), and trunk impairment scale (TIS) were used for assessment. RESULTS:The scores of the TUG, BBS, dynamic sitting balance subscale, and coordination subscale of TIS improved significantly in both groups but the improvement was more †Corresponding Author : daeric@konyang.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. pronounced in the STE group (p<.05). This study showed a large effect on the scores of the TIS coordination subscale (d=.93) (p<.05), TIS dynamic balance subscale (d=.81) (p<.05), TUG (d=.75) (p<.05), and BBS (d=.73) (p<.05). CONCLUSION:The combined STE and NDT program showed improvements in measures of mobility, balance, and trunk control in chronic stroke patients. These results suggest that STE should be considered to be included in the treatment program for patients with chronic stroke.

The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis

“…The mean PEDro score was 6 out of 10, which corresponds with a low risk of bias (Supplemental Table 1). A total of 14 studies reached a high-quality score, 15–28 while 8 studies reached a fair-quality score. 29–36 Most studies did not meet the criteria of blinding the subjects and therapist as this does not seem possible with respect to treatment.…”

“…Time post stroke varied from 15 days to 47 months after stroke diagnosis; 10 studies examined the effect of additional trunk training compared to only conventional training or no therapy. 15–36 The remaining 12 studies examined the effect of trunk training compared to a control training programme such as upper limb training, 20,27 conventional training, 21,22,24,26,33 cognitive training, 18,19 general exercises 30 and stretching exercises 23 and neuromuscular electrical stimulation. 25 The majority of exercises consisted of core stability exercises such as bridging, dead bug position, upper and lower trunk flexion, extension and rotation, for the trunk training groups on both stable and unstable surfaces.…”

“…25 The majority of exercises consisted of core stability exercises such as bridging, dead bug position, upper and lower trunk flexion, extension and rotation, for the trunk training groups on both stable and unstable surfaces. 15–17,20,21,26–29,33–36 Other studies implemented a sitting training protocol consisting of weight-shift 22,23 or reaching exercises. 18,19,31,32 A final study used proprioceptive neuromuscular facilitation techniques to enhance trunk function.…”

“…First, 20 studies assessed trunk control and sitting balance, 15–28,30–32,34–36 of which the majority found significant effects on the total Trunk Impairment Scale SMD 1.34 (95% CI: 0.96–1.71), the dynamic subscale SMD 1.33 (95% CI: 0.95–1.71), the coordination subscale SMD 1.08 (95% CI: 0.57–1.59) and reaching ability SMD 1.54 (95% CI: 1.06–2.02; Figures 2 and 3). However, the static subscale of the Trunk Impairment Scale did not result in a significant treatment effect SMD 0.18 (95% CI: −0.09 to 0.45).…”

“…Second, six studies investigated the effectiveness of trunk training on standing balance, 15,16,24,27,33,35 of which the majority of studies found significant effects on the Berg Balance Scale SMD 0.78 (95% CI: 0.49–1.06), Tinetti Balance Subscale SMD 1.13 (95% CI: 0.78–1.49) and Forward Reach SMD 0.51 (95% CI: 0.04–0.98; Figure 4). The remaining outcome measures assessing standing balance which resulted in significant between-group differences were the Four Test Balance Scale 27 and the Brunel Balance Assessment standing subscale.…”