A review on assessment and treatment of the trunk in stroke A need or luxury

Trunk function has been identified as an important early predictor of functional outcome after stroke and the same deteriorates on both contralateral and ipsilateral sides of the body following stroke.The primary contribution of the trunk muscles is to allow the body to remain upright,adjust weight shifts,and control movements against constant pull of gravity and is considered central key point of the body.Proximal stability of the trunk is a pre-requisite for distal limb mobility,balance,gait and functional activities and its positive correlation in hemiplegia has been demonstrated in a cross-sectional study.Both isokinetic and handheld dynamometer muscle strength testing demonstrated the weakness of bilateral trunk flexors,extensors and rotator muscles in both acute and chronic hemiplegic patients.This was confirmed by electromyography analysis which identified poor bilateral trunk muscles activity in patients with stroke.Trunk impairment scale is sensitive to evaluate the selective muscle control of upper and lower trunk,and it has been reported that lateral flexion of the trunk is easier than rotation of the trunk and the clinical observation concurs to the difficulty in lower trunk rotation of stroke patients.However,trunk exercises given early after stroke could produce enhanced balance performance post-stroke.This review attempts to report the evidence supporting the involvement of the trunk and its influence on balance and functional performance in post-stroke hemiplegia.     

Factors in the acquisition of independent walking in patients with cerebral infarction using decision tree analysis

Objectives: Independent walking is considered a rehabilitation factor for patients with stroke. There are no reports examining the predictors of independent walking at approximately one month after stroke onset. We aimed to examine factors related to the degree of independent walking, using a decision tree analysis, in patients with stroke.Materials and Methods: This retrospective, observational study was conducted on patients with cerebral infarction. The study period was from May 2017 to October 2021. Patients were categorized into independent (≥ 6; N=88) and dependent (≤ 5; N=98) groups based on the Functional Independence Measure locomotion scale at discharge. A decision tree analysis was performed to identify factors related to independent walking.Results: Overall, 186 participants (mean age, 77.8 ± 9.6 years; 104 men and 82 women) were included. The independent group had higher scores in Functional Assessment for Control of Trunk (14.7 ± 4.6 vs. 7.8 ± 6.0, p <.001), Berg Balance Scale (35.5 ± 15.1 vs. 17.9 ± 15.4, p <.001) and Mini Mental State Examination-Japanese (22.6 ± 5.2 vs. 16.1 ± 7.3, p <.001) on admission than the dependent group. Decision tree analysis identified the Functional Assessment for Control of Trunk score on admission as the best discriminator for independent walking.Conclusions: The interrelationship between trunk function, cognitive function, and balance function may influence the acquisition of independent walking in patients with stroke.     

Validation of the Spanish version of the Trunk Impairment Scale Version 2.0 (TIS 2.0) to assess dynamic sitting balance and coordination in post-stroke adult patients

Background: In recent years the Trunk Impairment Scale version 2.0 (TIS 2.0) has been a frequently used scale to assess dynamic sitting balance and trunk control for stroke patients. Objective: To translate the TIS 2.0 into Spanish and validate it as an instrument to evaluate dynamic sitting balance and trunk control and coordination for post-stroke adult patients. Methods: The original version was translated into Spanish and was agreed by a team of experts. A back-translation into English was subsequently performed and sent to the original author, who approved this version. 58 post-stroke patients’ performance was recorded on a videotape. These videos were then used to carry out four measurements to assess the intra-rater and inter-rater reliability, two of these were performed by the same rater and the third and fourth by a second and third rater. Results: The reliability was calculated by the Kappa index, and was superior to 0.80 for intra-rater reliability, while inter-rater reliability varied from 0.487 to 1. Cronbach’s alpha for internal consistency was 0.896 and to subscales dynamic sitting balance and coordination were 0.899 and 0.613 respectively. Intra-class correlations (ICC) for the summed scores of the different subscales were above 0.90 for all of them. Conclusion: The Spanish version of the TIS 2.0 is valid and reliable, and can be recommended for use in the evaluation of dynamic sitting balance and trunk control and coordination in future research on post-stroke patients. Guidelines for treatment and level of quality of trunk activity can be derived from its use.     

Relationship between trunk muscle strength,reaching ability and balance in children with Down syndrome – A cross-sectional study

BackgroundChildren with Down Syndrome (DS) present with neuromuscular disturbances leading to delayed developmental milestones, poor quality of movement and poor balance. The aim of this study is to discuss the role of trunk muscle strength in the functional performance of children with DS.Methodology28 children were recruited in the study, 14 with DS and 14 age and gender-matched controls. Trunk muscle strength, reaching ability and balance were assessed using a Handheld Dynamometer, Modified Functional Reach test and Pediatric Balance Scale, respectively.ResultsChildren with DS present with poorer trunk muscle strength, reaching ability and balance as compared to typically developing (TD) children. There was a positive correlation between trunk muscle strength and lateral reaching in children with DS. A strong to moderate correlation was observed between the trunk muscle strength and balance in children with DS.DiscussionChildren with DS demonstrated a significantly weak trunk muscle groups. Lateral reaching distance is reduced due to the poor proximal control and they present with near-normal forward reach distance attributed to compensation using the lower trunk muscles. They exhibit poor balance in the components that require a small base of support.ConclusionChildren with DS exhibit weak trunk muscles along with lesser reaching distance and poor balance. Also, trunk muscle strength influences lateral reaching ability. Trunk muscle strength, mainly trunk extensors impacted functional balance in sitting, standing and while performing transfers.     

The effects of treadmill walking combined with obstacle-crossing on walking ability in ambulatory patients after stroke: a pilot randomized controlled trial

Background and objective: Treadmill walking training (TWT) provides greater amount and intensity of stepping practice than conventional walking training in patients with chronic stroke. However, there is not any conclusive evidence regarding the effects of TWT for ambulatory post-stroke patients. This study investigated the effects of treadmill walking combined with obstacle-crossing on the walking ability of ambulatory post-stroke patients.

Methods: Twenty-nine subjects from a university hospital-based rehabilitation center were randomly assigned to one of the following: experimental group (15 subjects) or control group (14 subjects). All subjects underwent 30 min of active/passive exercises and 30 min of gait training in the form of treadmill walking. The subjects in the experimental group underwent simultaneous training in obstacle-crossing while walking on the treadmill for 30 min/day, 5 times/week, for 4 weeks. Main measures were the 10-m walk test (10MWT), 6-min walk test (6MWT), Berg Balance Scale (BBS), timed “Up & Go” (TUG) test, and Activities-specific Balance Confidence (ABC) scale used before and after the intervention.

Results: The changed values of the 6MWT and BBS were significantly higher in the experimental group than in the control group after adjusting for each baseline value, with large effects of 1.12 and 0.78, respectively, but not in the 10MWT, TUG, and ABC scale scores. Both groups showed a significant difference in all variables before and after the intervention.

Conclusion: Treadmill walking combined with obstacle-crossing training may help improve the walking ability of patients with hemiplegic stroke and can possibly be used as an adjunct to routine rehabilitation therapy as a task-oriented practice based on community ambulation.     

Trunk control and functionality in children with spastic cerebral palsy

ABSTRACT

Purpose: To investigate the relationship between trunk control in sitting and functionality in children with spastic cerebral palsy (CP).

Methods: Fifty-eight children with spastic CP were included in the study. Functional abilities were evaluated with the Gross Motor Function Measurement-88 (GMFM-88) and the Pediatric Evaluation of Disability Inventory Functional Skills domain (PEDI-FSD). Trunk control in sitting was tested with the Trunk Control Measurement Scale (TCMS) and the Trunk Impairment Scale (TIS). The scores of the TCMS and TIS were compared with GMFM-88 and PEDI-FSD with Spearman correlation analysis.

Results: The total score of GMFM-88 was signi?cantly correlated with the total score of TCMS (r_ho = 0.90, p < 0.01) and TIS (r_ho = 0.78, p < 0.01). The total score of PEDI-FSD was also signi?cantly correlated with the total score of TCMS (r_ho = 0.76, p < 0.01) and TIS (r_ho = 0.72, p < 0.01).

Conclusions: The evaluation of trunk control can provide valuable information for functional abilities of children with spastic CP.     

Does Trunk,Arm, or Leg Control Correlate Best With Overall Function in Stroke Subjects?

Abstract

Background: Attainment of functional independence is the ultimate goal of a sound stroke rehabilitation program. Good trunk stability is essential for balance and extremity use. Stroke patients may have upper extremity impairments that may affect functional activity and lower extremity impairments that may hinder mobility. Hence, quantifying the specific levels of impairment in the trunk, upper extremity, and lower extremity is helpful to determine the extent to which each might influence the ability to perform activities of daily living. Objective: To assess the impairment of the trunk and the upper and lower extremity of stroke patients and correlate it with overall function. Methods: A cross-sectional repeated correlation study. Twenty-three subjects with a first-time stroke, between 50 and 75 years of age, of both genders, admitted in hospital within 5 weeks of stroke onset were included using purposive sampling technique. On the eighth day of the stroke, trunk impairment was assessed using the Trunk Impairment Scale, upper and lower limb impairment was assessed using the Simplified Stroke Rehabilitation Assessment of Movement (upper and lower limb subscale, respectively), and overall function was measured by FIM. Results: Trunk activity showed highly significant correlation (r = 0.598, P = .003) with overall function compared with upper limb activity (r = 0.501, P = .015). Lower limb impairment showed no correlation with overall function (r = 0.208, P = .342). Conclusions: The overall functional independence in acute stroke patients is most closely correlated with the levels of impairments of trunk function, followed by upper limb impairments.     

Pelvic Belt Wearing during Exercise Improves Balance of Patients with Stroke: A Randomized,Controlled, Preliminary Trial

ObjectivesTo investigate whether wearing a pelvic belt during a trunk stability exercise program positively affects balance in patients with stroke.Materials and MethodsTwenty-four patients with stroke were randomly allocated to the experimental or control group and performed a 60-min general physical therapy and an additional 30-min trunk stability exercise (five times/week for 6 weeks). Those in the experimental and control groups performed the trunk stability exercises with and without wearing the pelvic belt, respectively.ResultsThe experimental group showed a significantly greater magnitude of improvements in balance than the control group (Postural Assessment Scale for Stroke: +18.3%, F (1, 22)=14.350, p=.001, η²=.395; Berg Balance Scale: +11%, F (1, 22)=19.062, p=.000, η²=.464; Timed Up and Go Test: ?10.5%, F (1, 22)=8.562, p=.008, η²=.280; center of pressure path length with eyes open: ?15.1%, F (1, 22)=6.770, p=.016, η²=.235; center of pressure path length with eyes closed: -19.5%, F (1, 22)=9.256, p=.006, η²=.296; center of pressure path velocity with eyes open: -22.6%, F (1, 22)=37.747, p=.000, η²=.632; center of pressure path velocity with eyes closed: ?13.9%, F (1, 22)=6.511, p=.018, η²=.228, respectively).ConclusionsWearing a pelvic belt while performing trunk stability exercise programs could be a more effective approach for improving balance in patients with stroke.     

Effects of trunk rehabilitation with kinesio and placebo taping on static and dynamic sitting postural control in individuals with chronic stroke: A randomized controlled trial

ABSTRACT

Background: Impaired trunk postural control is common after stroke. Combining kinesio taping with trunk rehabilitation has been shown to enhance the recovery of postural control ability in patients with stroke.

Objective: We investigated whether the combination of kinesio taping with trunk rehabilitation would improve dynamic and static sitting stability after stroke.

Methods: Twenty-eight patients with stroke were recruited and randomly assigned to one of the two 8-week trunk rehabilitation programs with kinesio (experimental group) or placebo taping (control group). Outcome measures were dynamic forward, dynamic backward, affected-side, and unaffected-side sway areas, static sway area and length, and the total limit of stability (LOS) area. The variables were measured using the BioRescue analysis system. All outcome measures were assessed at baseline and after 8 weeks of trunk rehabilitation.

Results: Significant increases were observed in the dynamic forward, dynamic backward, affected-side, and unaffected-side sway areas, and the total LOS area, in the experimental and control groups, whereas decreases were observed in the static sway area and length. The dynamic forward sway area was significantly higher in the experimental group than in the control group, but there were no significant differences between the groups in the other variables.

Conclusions: Trunk rehabilitation is effective for improving dynamic and static sitting stability after stroke. The addition of kinesio taping to the back muscles further increases forward mobility.     

What is the effect of additional physiotherapy on sitting balance following stroke compared to standard physiotherapy treatment: a systematic review

Background: Sitting balance dysfunction is commonly experienced following stroke. Physiotherapists utilize interventions to address this problem but it is unclear whether treatment type, target or practice intensity may affect outcomes.

Objective: To compare the effects of standard physiotherapy to standard physiotherapy plus an additional physiotherapy treatment after stroke.

Data Sources: The databases of Cochrane Library, CINAHL, Embase, Ovid Medline, AMED, and the Physiotherapy Evidence Database (PEDro) up to December 2014 were searched.

Study Selection: Randomized controlled trials in English reported in peer-reviewed journals regarding the effect of additional physiotherapy on sitting balance were retrieved.

Data Extraction: The PEDro scale was used to assess study quality.

Results: Eleven studies met inclusion criteria. Nine targeted the ICF (International Classification of Function, Disability and Health) domain of Activity. The Trunk control test (TCT) was used as a primary outcome measure in five studies, and the Trunk Impairment Scale (TIS) was used in four. There was a significant effect (mean difference?=?1.67, 95% CI?=?0.54–2.80) favoring intervention, as measured by the TIS. There was no evidence to support the effect of additional treatment on sitting balance as measured by the TCT (mean difference?=???1.53, 95% CI?=???9.37 to 6.32).

Conclusion:The current evidence supports strategies that target deficits at the activity level and increase total treatment time. The TIS is most responsive as a measure of treatment efficacy. Further research is required using recommended outcome measures to facilitate generation of a minimum data set and data pooling.     

Three-Dimensional Balance Training Using Visual Feedback on Balance and Walking Ability in Subacute Stroke Patients: A Single-Blinded Randomized Controlled Pilot Trial

Background: Trunk-activating exercises for balance are important because trunk weakness is relevant to the functional performance of individuals with stroke. This study aimed to explore the effects of three-dimensional balance training using visual feedback on balance and walking ability in subacute stroke patients. Methods: Twenty-four participants with subacute stroke were randomly assigned to the experimental or control group. Each group underwent twenty sessions (30 min/day, 5 days/week for 4 weeks). Patients were assessed using the Berg balance scale, gait parameters (gait speed, cadence, step length, and double-limb support period) using GAITRite, and activity-specific balance confidence score, before and after the intervention. Results: The three-dimensional balance training using visual feedback exhibited greater changes in the Berg balance scale, gait speed, cadence, step length, double-limb support period, and activity-specific balance confidence compared with the control group. Statistical analyses showed significant differences in Berg balance scale (P?=?.012; 95% CI, 2.585-6.415), gait speed (P?=?.001; 95% CI, .079-.155), cadence (P?=?.001; 95% CI, 1.622-4.392), step length (P?=?.003; 95% CI, 1.864-3.908), double-limb support period (P?=?.003; 95% CI, ?3.259 to ?0.761) and activity-specific confidence (P?=?.008; 95% CI, 6.964-14.036) between groups. Conclusion: Three-dimensional balance training using visual feedback may be more effective than conventional training in improving balance, walking ability, and activity-specific balance confidence in patients with subacute stroke.     

A Preliminary Study of Dual-Task Training Using Virtual Reality: Influence on Walking and Balance in Chronic Poststroke Survivors

BackgroundStroke is a leading cause of death and disability in the Western world, and leads to impaired balance and mobility. Objective: To investigate the feasibility of using a Virtual Reality-based dual task of an upper extremity while treadmill walking, to improve gait and functional balance performance of chronic poststroke survivors.MethodsTwenty-two individuals chronic poststroke participated in the study, and were divided into 2 groups (each group performing an 8-session exercise program): 11 participated in dual-task walking (DTW), and the other 11 participated in single-task treadmill walking (TMW). The study was a randomized controlled trial, with assessors blinded to the participants’ allocated group. Measurements were conducted at pretest, post-test, and follow-up. Outcome measures included: the 10-m walking test (10 mW), Timed Up and Go (TUG), the Functional Reach Test (FRT), the Lateral Reach Test Left/Right (LRT-L/R); the Activities-specific Balance Confidence (ABC) scale, and the Berg Balance Scale(BBS).ResultsImprovements were observed in balance variables: BBS, FRT, LRT-L/R, (P < .01) favoring the DTW group; in gait variables: 10 mW time, also favoring the DTW group (P < .05); and the ABC scale (P < .01). No changes for interaction were observed in the TUG.ConclusionsThe results of this study demonstrate the potential of VR-based DTW to improve walking and balance in people after stroke; thus, it is suggested to combine training sessions that require the performance of multiple tasks at the same time.     

Does training sitting balance on a platform tilted 10° to the weak side improve trunk control in the acute phase after stroke? A randomized,controlled trial

Background: Trunk performance and sitting balance, especially lateral sitting control, are important predictors of functional outcome after stroke. However, no studies have focused only on trunk function in the frontal plane for persons with acute-phase stroke.

Objective: To investigate the effects of lateral sitting training on a tilting platform in persons with stroke.

Methods: An assessor-blinded, randomized, controlled trial was carried out involving inpatients at a stroke rehabilitation center. Patients were allocated to either an experimental group (n?=?15) or a control group (n?=?15). The experimental group sat without leg support on a platform tilted 10° to the paretic side in the frontal plane, while the controls sat on a horizontal platform. Both groups were asked to move their trunk laterally from the paretic side to the nonparetic side. In addition to conventional therapy, this training was performed 60 times/session, with 6 sessions/week. Trunk function was assessed using the Trunk Control Test (TCT), and the ability to move the trunk laterally was evaluated kinematically. Measurements were performed at baseline and after training. Two-way repeated measures analysis of variance was used to test the significance between and within treatments for each dependent variable.

Results: None of the demographic data differed between the groups. After training, a significant improvement was noted in the experimental group compared to the controls in the TCT and the ability for lateral trunk transference (P?<?0.05, 1???β?=?0.98, effect size?=?0.4).

Conclusion: Lateral sitting training on the tilting platform improved the impaired trunk function of persons with stroke.     

早期躯干控制训练对脑卒中急性期患者平衡功能的康复作用

研究背景躯干作为人体核心部分,在维持身体平衡方面发挥重要作用。躯干控制训练可以改善脑卒中患者平衡功能和移动能力,提高运动功能和日常生活活动能力。本研究旨在探讨早期躯干控制训练对脑卒中急性期患者平衡功能的康复作用。方法共120例缺血性卒中急性期(病程≤14 d)患者随机接受脑卒中常规药物治疗及康复宣教和指导(对照组,60例)以及在此基础上联合躯体控制训练(观察组,60例),分别于训练前和训练2周时采用Fugl-Meyer平衡功能评价量表(FMA-Balance)和改良Rivermead移动指数(MRMI)评价平衡功能。结果 120例患者均顺利完成康复训练,无一例发生不良反应。与训练前相比,训练后两组患者FMA-Balance评分(P=0.000)和MRMI评分(P=0.000)均增加;与对照组相比,训练后观察组患者FMA-Balance评分(P=0.002)和MRMI评分(P=0.002)亦增加。结论脑卒中患者进行早期躯干控制训练可以显著改善平衡功能和移动能力。     

The trunk control: Which scale is the best in very acute stroke patients?

Background: It is important to evaluate trunk control, given that it is one of the indicators of adequate functional and motor recovery in patients following a stroke. The assessment should be feasible and adequate in clinical conditions in the acute phase.

Objectives: The aim of this study was to detect the most appropriate scale used for trunk control assessment in very acute stroke patients in terms of time and ease of implementation.

Methods: Sixty-five patients with very acute stroke were included in the study. The patients were assessed with the Trunk Impairment Scale-1 (VTIS), the Trunk Impairment Scale-2 (FTIS), the Motor Assessment Scale trunk subscale (T-MAS) and the Trunk Control Test (TCT), and Functional Impairment Measure (FIM). Floor/ceiling effects, reliability, validity responsiveness of all trunk control scales analyzed. The correlation between all scales and FIM were calculated.

Results: All scales had similar reliability, responsiveness and construct validity level. T-MAS and TCT were more advantageous than other scales according to time. TCT and VTIS showed floor effect. The best predictive validity values were observed for the T-MAS and TCT.

Conclusions: Four scales investigated in this study can also be used to evaluate the patients with very acute stroke. On the other hand, the advantages and disadvantages of the scales should be thoroughly assessed and researchers can use one of four scales considering their aim, patient populations and clinical characteristics of patients     

Trunk performance after stroke: an eye catching predictor of functional outcome

Background and aim

Trunk performance is an important predictor of functional outcome after stroke. However, the percentage of explained variance varies considerably between studies. This may be explained by the stroke population examined, the different scales used to assess trunk performance and the time points used to measure outcome. The aim of this multicentre study was to examine the predictive validity of the Trunk Impairment Scale (TIS) and its subscales when predicting the Barthel Index score at 6 months after stroke.

Methods

A total of 102 subjects were recruited in three European rehabilitation centres. Participants were assessed on admission (median time since stroke onset 20 days) and 6 months after stroke. Correlation analysis and forward stepwise multiple regression analysis were used to model outcome.

Results

The best predictors of the Barthel Index scores at 6 months after stroke were total TIS score (partial R² = 0.52, p<.0001) and static sitting balance subscale score (partial R² = 0.50, p<.0001) on admission. The TIS score on admission and its static sitting balance subscale were stronger predictors of the Barthel Index score at 6 months than the Barthel Index score itself on admission.

Conclusions

This study emphasises the importance of trunk performance, especially static sitting balance, when predicting functional outcome after stroke. The TIS is recommended as a prediction instrument in the rehabilitation setting when considering the prognosis of stroke patients. Future studies should address the evolution of trunk performance over time and the evaluation of treatment interventions to improve trunk performance.Although the age specific incidence of major stroke has fallen over the past few years,¹ it is still the main cause of long term disability in adults, with a growing number of survivors being dependent for activities of daily living (ADL).^2,3 Frequently identified variables predicting ADL after stroke are age and initial severity of motor and functional deficits.⁴ Trunk performance has also been identified as an important independent predictor of ADL after stroke.^5,6,7,8,9 However, based on multiple regression analyses, the reported variance of functional outcome after stroke explained by trunk performance ranges from 9% to 71%.^5,6,7,8,9 Differences in reported variance could be explained by the stroke population included, the various scales used to measure trunk performance and the time points used to measure outcome.Previous studies evaluating the predictive validity of trunk performance after stroke were performed in a single rehabilitation setting, warranting caution when generalising results.^5,6,7,8,9,10 Clinical tools used to assess trunk performance are the Trunk Control Test,^5,6,10 trunk control items of the Postural Assessment Scale for Stroke patients^7,8 and trunk assessment of Fujiwara et al.⁹ A limitation of the first two tests is that they both have a ceiling effect, which makes their use less suitable in long term outcome studies.^5,11,12,13 Furthermore, the trunk control items of the Trunk Control Test and Postural Assessment Scale for Stroke patients are largely comparable with the items of the trunk measure of Fujiwara et al.⁹ All previously mentioned clinical tools include items in the supine position which involve rolling as well as only basic balance movements in sitting. Finally, with the exception of the trunk control items of the Postural Assessment Scale for Stroke patients,⁸ no study has evaluated the prognostic value of trunk performance when predicting functional outcome at 6 months after stroke.The Trunk Impairment Scale (TIS) for patients after stroke was designed to measure ADL related selective trunk movements rather than participation of the trunk in gross transfer movements.¹⁴ The TIS assesses static and dynamic sitting balance and trunk coordination. Reliability, validity, measurement error, internal consistency and discriminant ability of the TIS have been reported elsewhere.^14,15 The TIS has no ceiling effect in subacute and chronic stroke patients and already appeared to be strongly related to measures of gait, balance and functional ability in a cross sectional study.¹² To the best of our knowledge, the predictive value of the TIS and its subscales has not been evaluated. Including age and other measures of motor and functional performance could provide a useful combination of variables predicting outcome after stroke. The Barthel Index score is a widely accepted measure in stroke rehabilitation research and assesses functional milestones in stroke recovery. Predicting Barthel Index scores at 6 months after stroke based on measurements taken on admission to a rehabilitation centre would further establish the importance of trunk performance when predicting long term outcome after stroke. Experts in the field of neurological rehabilitation have addressed the trunk as the central key point of the body.¹⁶ Proximal stability of the trunk is a prerequisite for distal head and limb movement and therefore expected to be related to functional ADL.In summary, there is still a lack of clarity regarding the importance of trunk performance in functional outcome after stroke. Scales which have been used in previous studies have important statistical limitations and are likely to be a comprehensive measure of motor performance of the trunk. Therefore, the aim of this multicentre study was to examine the predictive validity of the TIS and its subcomponents, together with other known predictors, in predicting functional outcome measured as a Barthel Index score at 6 months after stroke.     

An exploration of trunk reposition error in subjects with acute stroke: An observational design

Background & Objective: Trunk reposition error (TRE) is a component of trunk control, yet has not been reported in acute stroke. The purpose of this study was to quantify TRE in acute stroke and report this with related rehabilitation outcomes.

Methods: Sixty subjects, 30 with acute stroke and 30 healthy controls, completed this study. Subjects with acute stroke were measured before and after an in-patient acute rehabilitation stay.

Measures: TRE using an electromagnetic tracking device, Berg Balance Scale, Postural Assessment Scale for Stroke, and Functional Independence Measures. Pre-post measures were analyzed with paired t-tests. Between-group measures were analyzed with independent w-tests.

Results: There were significant between group differences (acute stroke vs. controls) for all functional outcome measures (P < 0.001) and for three-dimensional TRE (P = 0.001). There were significant improvements in all functional outcome measures following an in-patient rehabilitation stay (P < 0.001). All measures of TRE reduced but did not achieve significance.

Conclusion: TRE was not as severely impaired as anticipated and was variable based on plane of measure. Time in a rehabilitation setting produced significant improvements in functional outcomes but TRE improvements were not as robust. These results indicate a need for further investigation of the strength of the interrelationship between TRE and function.     

Effect of virtual reality-based balance training in multiple sclerosis

Abstract

Objectives:

Balance and mobility impairments are common life-altering complications in patients with multiple sclerosis (MS). In this study, we aimed to investigate the efficacy of a short-term virtual reality (VR)-based balance training program on the balance ability of patients with MS.

Methods:

In this randomized controlled trial, 30 patients with relapsing–remitting or secondary-progressive MS were randomly assigned to an intervention or a control group. The intervention group performed a balance training program [postural stability training program (PST)] using the Biodex Balance System SD. Subjects in both groups were assessed using the manual muscle test (MMT), timed ‘up and go’ (TUG) test, the modified Ashworth scale, the Romberg test, the Berg balance scale (BBS), and the fall risk and postural stability tests, at baseline and after 12?weeks.

Results:

The TUG, fall risk index (FRi), and overall stability index (OSI) were significantly improved in the intervention group after 24 sessions of balance training. The changes in TUG, Fri, and OSi indices in the intervention group were significantly higher than the control group.

Discussion:

According to the fall risk and postural stability tests results, the VR-based balance training program could improve the balance ability of the patients with MS.     

Immediate effects of talus-stabilizing taping on balance and gait parameters in patients with chronic stroke: a cross-sectional study

Background: Talus-stabilizing taping (TST) may improve ankle range of motion and gait performance by providing a posterior–inferior talar glide in a closed-chain dorsiflexion position.

Objectives: This study aimed to investigate the immediate effects of TST on balance and gait parameters in patients with chronic stroke.

Methods: Twenty post-stroke patients participated in this study. Each participant performed tests under three conditions (TST, barefoot, and conventional ankle-foot orthosis [AFO]), in random order. Before testing, the patients walked for 10 min under the three conditions, followed by a 5 min rest period. The outcome measures were static balance ability (SBA), timed up-and-go (TUG) test results, and gait parameters evaluated using a 6-m-long gait mat. One-way repeated measures analysis of variance was used to determine the difference in balance and gait parameters under the three conditions.

Results: SBA more significantly improved in the TST condition than in the barefoot condition. SBA more significantly improved in the conventional AFO condition than in the barefoot condition. The TUG test results more significantly improved in the TST condition than in the conventional AFO and barefoot conditions. Walking speed, cadence, and affected side and unaffected side step and stride lengths more significantly improved in the TST condition than in the conventional AFO and barefoot conditions.

Conclusions: This study used a cross-sectional method and demonstrated that TST improves SBA, TUG, gait speed, cadence, step length, and stride length in patients with chronic stroke.