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

Pei-Yun Lee, Jhen-Cih Huang, Hui-Yu Tseng, Yi-Ching Yang, Sang-I Lin, Pei-Yun Lee, Jhen-Cih Huang, Hui-Yu Tseng, Yi-Ching Yang, Sang-I Lin

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.

Keywords: standing balance; stroke; trunk performance; trunk training; walking.

Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study.

References

    1. Feigin V.L., Norrving B., Mensah G.A. Global burden of stroke. Circ. Res. 2017;120:439–448. doi: 10.1161/CIRCRESAHA.116.308413.
    1. Scuffham P., Chaplin S., Legood R. Incidence and costs of unintentional falls in older people in the United Kingdom. J. Epidemiol. Community Health. 2003;57:740–744. doi: 10.1136/jech.57.9.740.
    1. Lamb S.E., Ferrucci L., Volapto S., Fried L.P., Guralnik J.M. Risk factors for falling in home-dwelling older women with stroke: The Women’s Health and Aging Study. Stroke. 2003;34:494–501. doi: 10.1161/01.STR.0000053444.00582.B7.
    1. Kwakkel G., Wagenaar R.C., Kollen B.J., Lankhorst G.J. Predicting disability in stroke—A critical review of the literature. Age Ageing. 1996;25:479–489. doi: 10.1093/ageing/25.6.479.
    1. Tyson S.F., Hanley M., Chillala J., Selley A., Tallis R.C. Balance disability after stroke. Phys. Ther. Sport. 2006;86:30–38. doi: 10.1093/ptj/86.1.30.
    1. Vincent-Onabajo G., Musa H.Y., Joseph E. Prevalence of balance impairment among stroke survivors undergoing neurorehabilitation in Nigeria. J. Stroke Cerebrovasc. Dis. 2018;27:3487–3492. doi: 10.1016/j.jstrokecerebrovasdis.2018.08.024.
    1. De Haart M., Geurts A.C., Huidekoper S.C., Fasotti L., van Limbeek J. Recovery of standing balance in postacute stroke patients: A rehabilitation cohort study. Arch. Phys. Med. Rehabil. 2004;85:886–895. doi: 10.1016/j.apmr.2003.05.012.
    1. van Dijk M.M., Meyer S., Sandstad S., Wiskerke E., Thuwis R., Vandekerckhove C. A cross-sectional study comparing lateral and diagonal maximum weight shift in people with stroke and healthy controls and the correlation with balance, gait and fear of falling. PLoS ONE. 2017;12:e0183020. doi: 10.1371/journal.pone.0183020.
    1. McCombe Waller S., Yang C.L., Magder L., Yungher D., Creath R., Gray V., Roger M.W. Impaired motor preparation and execution during standing reach in people with chronic stroke. Neurosci. Lett. 2016;630:38–44. doi: 10.1016/j.neulet.2016.07.010.
    1. Dickstein R., Shefi S., Marcovitz E., Villa Y. Anticipatory postural adjustment in selected trunk muscles in post stroke hemiparetic patients. Arch. Phys. Med. Rehabil. 2004;85:261–267. doi: 10.1016/j.apmr.2003.05.011.
    1. Bohannon R.W., Cassidy D., Walsh S. Trunk muscle strength is impaired multidirectionally after stroke. Clin. Rehabil. 1995;9:47–51. doi: 10.1177/026921559500900107.
    1. Tanaka S., Hachisuka K., Ogata H. Trunk rotatory muscle performance in post-stroke hemiplegic patients. Am. J. Phys. Med. Rehabil. 1997;76:366–369. doi: 10.1097/00002060-199709000-00003.
    1. Tanaka S., Hachisuka K., Ogata H. Muscle strength of trunk flexion-extension in post-stroke hemiplegic patients. Am. J. Phys. Med. Rehabil. 1998;77:288–290. doi: 10.1097/00002060-199807000-00005.
    1. Ryerson S., Byl N.N., Brown D.A., Wong R.A., Hidler J.M. Altered trunk position sense and its relation to balance functions in people post-stroke. J. Neurol. Phys. Ther. 2008;32:14–20. doi: 10.1097/NPT.0b013e3181660f0c.
    1. Karatas M., Çetin N., Bayramoglu M., Dilek A. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am. J. Phys. Med. Rehabil. 2004;83:81–87. doi: 10.1097/01.PHM.0000107486.99756.C7.
    1. Van Criekinge T., Truijen S., Schroder J., Maebe Z., Blanckaert K., van der Waal C., Vink M., Saeys W. The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: A systematic review and meta-analysis. Clin. Rehabil. 2019;33:992–1002. doi: 10.1177/0269215519830159.
    1. Haruyama K., Kawakami M., Otsuka T. Effect of core stability training on trunk function, standing balance, and mobility in stroke patients. Neurorehabil. Neural Repair. 2017;31:240–249. doi: 10.1177/1545968316675431.
    1. Cabanas-Valdes R., Cuchi G.U., Bagur-Calafat C. Trunk training exercises approaches for improving trunk performance and functional sitting balance in patients with stroke: A systematic review. NeuroRehabilitation. 2013;33:575–592. doi: 10.3233/NRE-130996.
    1. Yoon H.S., Cha Y.J., You J.S.H. 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. NeuroRehabilitation. 2020;46:381–389. doi: 10.3233/NRE-192983.
    1. Czaprowski D., Afeltowicz A., Gebicka A., Pawlowska P., Kedra A., Barrios C., Hadala M. Abdominal muscle EMG-activity during bridge exercises on stable and unstable surfaces. Phys. Ther. Sport. 2014;15:162–168. doi: 10.1016/j.ptsp.2013.09.003.
    1. Vera-Garcia F.J., Grenier S.G., McGill S.M. Abdominal muscle response during curl-ups on both stable and labile surfaces. Phys. Ther. 2000;80:564–569. doi: 10.1093/ptj/80.6.564.
    1. Marshall P.W., Desai I. Electromyographic analysis of upper body, lower body, and abdominal muscles during advanced Swiss ball exercises. J. Strength Cond. Res. 2010;24:1537–1545. doi: 10.1519/JSC.0b013e3181dc4440.
    1. Behm D.G., Anderson K., Curnew R.S. Muscle force and activation under stable and unstable conditions. J. Strength. Cond. Res. 2002;16:416–422.
    1. Lam H.S., Lau F.W., Chan G.K., Sykes K. The validity and reliability of a 6-Metre Timed Walk for the functional assessment of patients with stroke. Physiother. Theory Pract. 2010;26:251–255. doi: 10.3109/09593980903015235.
    1. Behm D.G., Drinkwater E.J., Willardson J.M., Cowley P.M. The use of instability to train the core musculature. Appl. Physiol. Nutr. Metab. 2010;35:91–108. doi: 10.1139/H09-127.
    1. Teasell R., Hussein N. Evidence Based Review of Stroke Rehabilitation [Internet] EBTSR; London, ON, Canada: 2019. [(accessed on 11 April 2020)]. Background Concepts in Stroke Rehabilitation. Available online: .
    1. Van Criekinge T., Saeys W., Vereeck L., De Hertogh W., Truijen S. Are unstable support surfaces superior to stable support surfaces during trunk rehabilitation after stroke? A systematic review. Disabil. Rehabil. 2018;17:1981–1988. doi: 10.1080/09638288.2017.1323030.
    1. Horak F.B., Esselman P., Anderson M.E., Lynch M.K. The effects of movement velocity, mass displaced, and task certainty on associated postural adjustments made by normal and hemiplegic individuals. J. Neurol. Neurosurg. Psychiatry. 1984;47:1020–1028. doi: 10.1136/jnnp.47.9.1020.
    1. Garland S.J., Stevenson T.J., Ivanova T. Postural responses to unilateral arm perturbation in young, elderly, and hemiplegic subjects. Arch. Phys. Med. Rehabil. 1997;78:1072–1077. doi: 10.1016/S0003-9993(97)90130-1.
    1. Milosevic M., Masani K., Kuipers M.J., Rahouni H., Verrier M.C., McConville K.M., Popovic M.R. Trunk control impairment is responsible for postural instability during quiet sitting in individuals with cervical spinal cord injury. Clin. Biomech. 2015;30:507–512. doi: 10.1016/j.clinbiomech.2015.03.002.
    1. Verheyden G., Vereeck L., Truijen S., Troch M., Lafosse C., Saeys W., Leenaerts E., Palinckx A., De Weerdt W. Additional exercises improve trunk performance after stroke: A pilot randomized controlled trial. Neurorehabil. Neural Repair. 2009;23:281–286. doi: 10.1177/1545968308321776.
    1. Saeys W., Vereeck L., Truijen S., Lafosse C., Wuyts F.P., Heyning P.V. Randomized controlled trial of truncal exercises early after stroke to improve balance and mobility. Neurorehabil. Neural Repair. 2012;26:231–238. doi: 10.1177/1545968311416822.
    1. Dean C., Shepherd R., Adams R. Sitting balance I: Trunk-arm coordination and the contribution of the lower limbs during self-paced reaching in sitting. Gait Posture. 1999;10:135–146. doi: 10.1016/S0966-6362(99)00026-0.
    1. Yoo S.D., Jeong Y.S., Kim D.H., Lee M.A., Noh S.G., Shin Y.W., Kim S.H., Kim H.S. The Efficacy of Core Strengthening on the Trunk Balance in Patients with Subacute Stroke. Ann. Rehabil. Med. 2010;34:677–682.
    1. Cabanas-Valdes R., Bagur-Calafat C., Girabent-Farres M., Caballero-Gomez F.M., Hernandez-Valino M., Urrutia Cuchi G. The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: A randomized controlled trial. Clin. Rehabil. 2016;30:1024–1033. doi: 10.1177/0269215515609414.
    1. Patla A.E., Ishac M.G., Winter D.A. Anticipatory control of center of mass and joint stability during voluntary arm movement from a standing posture: Interplay between active and passive control. Exp. Brain Res. 2002;143:318–327. doi: 10.1007/s00221-001-0968-6.
    1. Lee W.A. Anticipatory control of postural and task muscles during rapid arm flexion. J. Mot. Behav. 1980;12:185–196. doi: 10.1080/00222895.1980.10735219.
    1. Cordo P.J., Nashner L.M. Properties of postural adjustments associated with rapid arm movements. J. Neurophysiol. 1982;47:287–302. doi: 10.1152/jn.1982.47.2.287.
    1. Bazalgette D., Zattara M., Bathien N., Bouisset S., Rondot P. Postural adjustments associated with rapid voluntary arm movements in patients with Parkinson’s disease. Adv. Neurol. 1986;45:371–374.
    1. Babu K., Nayak A. Additional trunk training improves sitting balance following acute stroke: A pilot randomized controlled trial. Int. J. Curr. Res. Rev. 2011;2:26–43.

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