DOI QR코드

DOI QR Code

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

  • Received : 2016.09.16
  • Accepted : 2016.10.13
  • Published : 2017.02.28

Abstract

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 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.

Keywords

References

  1. Bohannon RW. Lateral trunk flexion strength: impairment, measurement reliability and implications following unilateral brain lesion. International Journal of Rehabilitation research. 1992;15(3):249-51. https://doi.org/10.1097/00004356-199209000-00010
  2. Chern JS, Lo CY, Wu CY, et al. Dynamic postural control during trunk bending and reaching in healthy adults and stroke patients. Am J Phys Med Rehabil. 2010; 89(3):186-97. https://doi.org/10.1097/PHM.0b013e3181c56287
  3. Cohen J. "The earth is round (p<.05)" American Psychologist. 1994;49(12):997-1003. https://doi.org/10.1037/0003-066X.49.12.997
  4. Davis PM. Problems associated with the loss of selective trunk activity in hemiplegia. Right in the Middle. 2003: 31-66.
  5. Dickstein R, Heffes Y, Laufer Y, et al. Activation of selected trunk muscle during symmetric functional activities in post stroke hemiparetic and hemiplegic patients. Journal of Neurology, Nurosurgery, and Psychiatry. 1999;66(2):218-21. https://doi.org/10.1136/jnnp.66.2.218
  6. Dickstein R, Sheffi S, Ben Haim Z, et al. Activation of flexor and extensor trunk muscles in hemiparesis. Am J Phys Med Rehabil. 2000;79(3):228-34. https://doi.org/10.1097/00002060-200005000-00003
  7. Duarte E, Marco E, Muniesa JM, et al. Trunk control test as a functional predictor in stroke patients. J Rehabil Med. 2002;34(6):267-72. https://doi.org/10.1080/165019702760390356
  8. Flansbjer UB, Blom J, Brogardh C. The reproducibility of Berg Balance Scale and the Single-leg Stance in chronic stroke and the relationship between the two tests. PM R. 2012;4(3):165-70. https://doi.org/10.1016/j.pmrj.2011.11.004
  9. Flansbjer UB, Holmback AM, Downham D, et al. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med. 2005;37(2): 75-82. https://doi.org/10.1080/16501970410017215
  10. Fujiwara T, Sonoda S, Okajima Y, et al. The relationships between trunk function and the findings of transcranial magnetic stimulation among patients with stroke. J Rehabil Med. 2001;33(6):249-55. https://doi.org/10.1080/165019701753236428
  11. Han KB, Shin WS. Effects of Trunk Position Sense through Visual Cue Deprivation Balance Training in Subacute Stroke. J Korean Soc Phys Med. 2013;8(3):327-35. https://doi.org/10.13066/kspm.2013.8.3.327
  12. Hopkins WG. Measures of reliability in sports medicine and science. Sports Med. 2000;30(1):1-15. https://doi.org/10.2165/00007256-200030010-00001
  13. Jang JY, Kim SY. Effects of trunk control exercise performed on an unstable surface on dynamic balance in chronic stroke patients. J Korean Soc Phys Med. 2016;11(1): 1-9. https://doi.org/10.13066/kspm.2016.11.1.1
  14. Karatas M, Cetin N, Bayramoglu M, et al. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am J Phys Med Rehabil. 2004;83(2):81-7. https://doi.org/10.1097/01.PHM.0000107486.99756.C7
  15. Karthikbabu S, Nayak A, Vijayakumar, K, et al. Comparison of physio ball and plinth trunk exercises regimens on trunk control and functional balance in patients with acute stroke: a pilot randomized controlled trial. Clin Rehabil. 2011a;25(8):709-19. https://doi.org/10.1177/0269215510397393
  16. Karthikbabu S, Rao BK, Manikandan N, et al. Role of Trunk Rehabilitation on Trunk Control, Balance and Gait in Patients with Chronic Stroke: A Pre-Post Design. Neuroscience & Medicine. 2011b;2:61-7. https://doi.org/10.4236/nm.2011.22009
  17. Kong HN, Bang DH, Shin WS. Effects of Balance Training on Different Support Surface on Balance and Gait in Patients with Chronic Stroke. J Korean Soc Phys Med. 2015;10(3):275-83.
  18. Liaw LJ, Hsieh CL, Lo SK, et al. The relative and absolute reliability of two balance performance measures in chronic stroke patients. Disabil Rehabil. 2008;30(9): 656-61. https://doi.org/10.1080/09638280701400698
  19. Liston RA, Brouwer BJ. Reliability and validity of measures obtained from stroke patients using the Balance Master. Arch Phys Med Rehabil. 1996;77(5):425-30. https://doi.org/10.1016/S0003-9993(96)90028-3
  20. Lu WS, Wang CH, Lin JH, et al. The minimal detectable change of the simplified stroke rehabilitation assessment of movement measure. J Rehabil Med. 2008;40(8):615-9. https://doi.org/10.2340/16501977-0230
  21. Mao HF, Hsueh IP, Tang PF, et al. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke. 2002;33(4): 1022-7. https://doi.org/10.1161/01.STR.0000012516.63191.C5
  22. Messier S, Bourbonnais D, Desrosiers J, et al. Dynamic analysis of trunk flexion after stroke. Arch Phys Med Rehabil. 2004;85(10):1619-24. https://doi.org/10.1016/j.apmr.2003.12.043
  23. Mudie MH, Winzeler-Mercay U, Radwan S, et al. Training symmetry of weight distribution after stroke: a randomized controlled pilot study comparing task-related reach, Bobath and feedback training approaches. Clin Rehabil. 2002;16(6):582-92. https://doi.org/10.1191/0269215502cr527oa
  24. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  25. Ryerson S, Byl NN, Brown DA, et al. Altered trunk position sense and its relation to balance functions in people post-stroke. J Neurol Phys Ther. 2008;32(1):14-20. https://doi.org/10.1097/NPT.0b013e3181660f0c
  26. Ryerson S, Levit K. Functional movement: A practical model for treatment. Functional movement reeducation. Churchill Livingstone. 1997:1-14.
  27. Song JM, Kim SM. The effect of trunk stability exercise on balance and gait in stroke patients. J Korean Soc Phys Med. 2010;5(3):413-20.
  28. Tsuji T, Liu M, Hase K, et al. Trunk muscles in persons with hemiparetic stroke evaluated with computed tomography. J Rehabil Med. 2003;35(4):184-8. https://doi.org/10.1080/16501970306126
  29. Tyson SF. Trunk kinematics in hemiplegic gait and the effect of walking aids. Clin Rehabil. 1999;13(4):295-300. https://doi.org/10.1191/026921599666307333
  30. Van Nes IJ, Nienhuis B, Latour H, et al. Posturographic assessment of sitting balance recovery in the subacute phase of stroke. Gait Posture. 2008;28(3):507-12. https://doi.org/10.1016/j.gaitpost.2008.03.004
  31. Verheyden G, Nieuwboer A, Feys H, et al. Discriminant ability of the Trunk Impairment Scale: A comparison between stroke patients and healthy individuals. Disabil Rehabil. 2005;27(17):1023-8. https://doi.org/10.1080/09638280500052872
  32. Verheyden G, Nieuwboer A, Mertin J, et al. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004;18(3):326-34. https://doi.org/10.1191/0269215504cr733oa
  33. Verheyden G, Vereeck L, Truijen S, et al. Trunk performance after stroke and the relationship with balance, gait and functional ability. Clin Rehabil. 2006;20(5): 451-8. https://doi.org/10.1191/0269215505cr955oa
  34. Verheyden G, Vereeck L, Truijen S, et al. Additional exercises improve trunk performance after stroke: a pilot randomized controlled trial. Neurorehabil Neural Repair. 2009;23(3):281-6. https://doi.org/10.1177/1545968308321776

Cited by

  1. The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis pp.1477-0873, 2019, https://doi.org/10.1177/0269215519830159
  2. Analysis of Research Trends Using G-power in Physiotherapy Research in Korea: Systematic Review vol.32, pp.2, 2017, https://doi.org/10.18857/jkpt.2020.32.2.114
  3. Effects of dynamic core-postural chain stabilization on diaphragm movement, abdominal muscle thickness, and postural control in patients with subacute stroke: A randomized control trial vol.46, pp.3, 2017, https://doi.org/10.3233/nre-192983
  4. The Effectiveness of Core Exercising for Postural Control in Patients with Stroke: A Systematic Review and Meta‐Analysis vol.12, pp.11, 2020, https://doi.org/10.1002/pmrj.12330
  5. Caso clínico de enfermería: Implementación del modelo del logro de las metas a sujeto con diagnóstico de Sarcoma de Ewing vol.23, pp.3, 2017, https://doi.org/10.29375/01237047.3739
  6. Do Initial Trunk Impairment, Age, Intervention Onset, and Training Volume Modulate the Effectiveness of Additional Trunk Exercise Programs after Stroke? A Systematic Review with Meta-Analyses vol.17, pp.23, 2020, https://doi.org/10.3390/ijerph17238714
  7. Technology-supported sitting balance therapy versus usual care in the chronic stage after stroke: a pilot randomized controlled trial vol.18, pp.1, 2021, https://doi.org/10.1186/s12984-021-00910-7
  8. Efficacy of chest expansion resistance exercise on respiratory function, trunk control and dynamic balance in patients with chronic stroke: A Comparative study. vol.26, pp.1, 2017, https://doi.org/10.1186/s43161-021-00041-z