Effects of rehabilitation training of core muscle stability on stroke patients with hemiplegia

Correlation analysis of the risk of ischemic stroke with related risk factors in a health examination population

Objective

To explore the correlation between the risk of ischemic stroke and related risk factors in a health examination population.

Methods

This was a retrospective study. A total of 300 subjects undergoing health examination in the physical examination center of Baoding NO.1 Central Hospital were selected from January 2023 to December 2023, and divided into the normal group (Group-N) and the risk group according to the criteria of cerebral hemodynamic integral value(CVHI). The risk group was further subdivided into three groups, including the high-risk group(Group-H), the medium-risk population(Group-M), and the low-risk group(Group-L), with 75 subjects in each group. The general data, including BMI, smoking, and the incidence of hypertension, diabetes, and hyperlipidemia, were analyzed and compared between the two groups.

Results

Multivariable logistic regression analysis was conducted using stroke risk factors as the dependent variables after assignment, and it was found that BMI, smoking, hypertension, diabetes, hyperlipidemia, and hyperuricemia were independent risk factors for ischemic stroke (P<0.05); the incidence of obesity and overweight, smoking, hypertension, hyperlipidemia, and hyperuricemia were significantly increased in Group-H compared with those in groups M, L, and N, with statistically significant differences(P<0.05). The chi square test showed statistically significant differences in the stroke risk factors among different age groups (P<0.05).

Conclusion

The incidence of ischemic stroke risk factors varies among different age groups in the health examination population, and is related to poor lifestyle and underlying diseases.

Influence of core stabilization exercise on physical function and muscle thickness in patients with chronic stroke: A randomized controlled clinical trial

BACKGROUND

This study primarily aims to compare the influence of core stabilization exercise and conventional therapy on motor function, functional independence, and balance, secondarily gait ability, quality of life, and sonographically evaluated core muscle thickness in patients with chronic stroke.

METHODS

Participants were randomly allocated into two groups: core stabilization exercise therapy (CSET, n = 25) group received core stability training for 15 min and 30 min of conventional therapy each per day, and conventional exercise therapy (CET, n = 25) group received conventional therapy for 45 min per day, five days per week, for three weeks. Ultrasonography was performed to measure the thickness of the core muscles on both paretic and nonparetic sides. Patients were evaluated at baseline and after three weeks treatment.

RESULTS

Functional Independence Measurement, Berg Balance Scale, 6-Minute Walk Test, Stroke-Specific Quality of Life Scale and core muscles thicknesses improved significantly in both groups except for the internal oblique muscle of CSET group. The nonparetic side multifidus muscle thickness was significantly different in favor of CSET group (p = .033).

CONCLUSIONS

Conventional and core stabilization exercise therapies in patients with chronic stroke have positive effects on functional independence, balance and gait abilities, quality of life and core muscles thicknesses without being superior to each other.

The Safety and Efficacy of Balance Training on Stroke Patients With Reduced Balance Ability: A Meta-Analysis of Randomized Controlled Trials

To investigate the safety and efficacy of balance training for stroke patients with reduced balance ability by performing a meta-analysis of randomized controlled trials. The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to February 2022. Quality assessment was performed using the using the Cochrane risk of bias tool. Studies were included if: 1) patient allocation was randomized; 2) the participant was composed of stroke patients with reduced balance ability (Berg Balance Scale [BBS] ≤ 40, Timed-Up and Go ≥ 14 seconds, or Mini-Balance Evaluation Systems Test ≤ 17.5); and 3) intervention was additional balance training for the experimental group. Six studies including 466 patients were included in the final analysis. The meta-analysis showed a significant improvement in the BBS (mean difference [MD], 8.14; 95% confidence interval [CI], 4.65, 11.64) and Trunk Impairment Scale (MD, 4.71; 95% CI, 3.45, 5.96) after balance training relative to the comparison group. Ambulation function was significantly improved (standardized MD, 0.98; 95% CI, 0.46, 1.49) after balance training. There was one report of a femur fracture among 230 participants in the balance training group. Balance training in addition to conventional rehabilitation program in stroke patients with reduced balance ability appears to be effective and safe.

The effectiveness of core stabilization exercise using ultrasound biofeedback on motor function, balance control, gait speed and activities of daily living in stroke patients

BACKGROUND

Patients with hemiparetic stroke experience diminished motor function, dynamic balance, and gait speed, which influence their activities of daily living (ADL).

OBJECTIVE

This study aimed to determine the therapeutic effects of ultrasound biofeedback core exercise (UBCE) on Fugl-Meyer assessment (FMA), Time up and go (TUG), 10-meter walking test (10MWT) and functional independent measure (FIM) in participants with stroke.

METHODS

Twenty-four stroke survivors consistently underwent UBCE or abdominal draw-in maneuver (ADIM) for 30 min/session, 3 days a week for 4 weeks. Clinical outcome measurements - the FMA, TUG, 10MWT, and FIM - were observed pre-and post-intervention.

RESULTS

We detected significant changes in the FMA-lower extremities, TUG, 10MWT, and FIM scores between the UBCE and ADIM groups. UBCE and ADIM showed significant improvements in FMA-lower extremities, TUG, 10MWT, and FIM scores. However, UBCE showed more favorable results than ADIM in patients with stroke.

CONCLUSIONS

Our research provides novel therapeutic suggestion of neurorehabilitation in stroke patients.

Clinical efficacy of breathing training combined with core stability training in chronic nonspecific low back pain

Objective

The study aimed to assess the clinical efficacy of breathing training combined with core stability training in chronic nonspecific low back pain (CNLBP).

Methods

This was a retrospective study. Of 60 included patients with CNLBP admitted by the Sichuan Province Orthopedic Hospital between December 2020 and February 2022. Random number table method was used to divide thirty patients to a control group, and the rest 30 to an observation group. The control group received core stability training, while the observation group underwent breathing training in addition to the exact treatment provided for the control group. To assess the utility of breathing and core stability training for CNLBP treatment, intergroup comparisons were made for clinical outcomes, the VAS, SF- 36, and SCODI scores before treatment and at three and seven weeks post-treatment, and static and dynamic low-back muscular endurance before and after treatment.

Results

The observation group had an overall response rate (ORR) of 96.67%, significantly higher than that (73.33%) of the control group (p< 0.05). Following the intervention, the VAS and SCODI scores declined in both groups; The SF-36 score was elevated in both groups, and likewise. At the end of treatment, both groups exhibited improved static and dynamic muscular endurance of the low back, and the improvement was significantly more distinct in the observation group (p< 0.05).

Conclusion

Compared with core stability training as a sole treatment, breathing training combined with core stability training can yield better outcomes, ameliorate lumbar spine function, relieve pain and enhance low-back muscular endurance in patients with CNLBP.

Effect of Transcranial Direct Current Stimulation Combined with Donepezil on stroke patients with memory impairment

Objective

To investigate the therapeutic effect of transcranial direct current stimulation (TDCS) combined with donepezil on stroke patients with memory impairment.

Methods

The subjects of the study were 120 stroke patients with memory impairment admitted to the Rehabilitation Department of Tianjin Medical University General Hospital from July 2017 to March 2020. Enrolled patients were divided into Group-A (58 cases) and Group-B (62 cases) according to different treatment intervention methods. Patients in Group-A were treated with TDCS and those in Group-B received donepezil on the basis of TDCS. The changes in Montreal Cognitive Assessment (MoCA) memory index score, Barthel Index (MBI) score, cognitive function and cognitive potential were observed and compared between the two groups before and after treatment.

Results

The improvement of total MoCA score, a single score of memory, MBI score, cognitive function and P300 potential index in Group-B was significantly better than that in Group-A (p<0.05).

Conclusion

TDCS combined with donepezil can reduce or delay the cognitive impairment of stroke patients, improve their delayed memory ability, increase the neurotransmitter acetylcholine in the cerebral cortex, and further enhance their neural function. Findings in our study support that the proposed therapeutic method is worthy of clinical application.

Trunk training following stroke

BACKGROUND

Previous systematic reviews and randomised controlled trials have investigated the effect of post-stroke trunk training. Findings suggest that trunk training improves trunk function and activity or the execution of a task or action by an individual. But it is unclear what effect trunk training has on daily life activities, quality of life, and other outcomes.

OBJECTIVES

To assess the effectiveness of trunk training after stroke on activities of daily living (ADL), trunk function, arm-hand function or activity, standing balance, leg function, walking ability, and quality of life when comparing with both dose-matched as non-dose-matched control groups.

SEARCH METHODS

We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, and five other databases to 25 October 2021. We searched trial registries to identify additional relevant published, unpublished, and ongoing trials. We hand searched the bibliographies of included studies.

SELECTION CRITERIA

We selected randomised controlled trials comparing trunk training versus non-dose-matched or dose-matched control therapy including adults (18 years or older) with either ischaemic or haemorrhagic stroke. Outcome measures of trials included ADL, trunk function, arm-hand function or activity, standing balance, leg function, walking ability, and quality of life.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Two main analyses were carried out. The first analysis included trials where the therapy duration of control intervention was non-dose-matched with the therapy duration of the experimental group and the second analysis where there was comparison with a dose-matched control intervention (equal therapy duration in both the control as in the experimental group).  MAIN RESULTS: We included 68 trials with a total of 2585 participants. In the analysis of the non-dose-matched groups (pooling of all trials with different training duration in the experimental as in the control intervention), we could see that trunk training had a positive effect on ADL (standardised mean difference (SMD) 0.96; 95% confidence interval (CI) 0.69 to 1.24; P < 0.001; 5 trials; 283 participants; very low-certainty evidence), trunk function (SMD 1.49, 95% CI 1.26 to 1.71; P < 0.001; 14 trials, 466 participants; very low-certainty evidence), arm-hand function (SMD 0.67, 95% CI 0.19 to 1.15; P = 0.006; 2 trials, 74 participants; low-certainty evidence), arm-hand activity (SMD 0.84, 95% CI 0.009 to 1.59; P = 0.03; 1 trial, 30 participants; very low-certainty evidence), standing balance (SMD 0.57, 95% CI 0.35 to 0.79; P < 0.001; 11 trials, 410 participants; very low-certainty evidence), leg function (SMD 1.10, 95% CI 0.57 to 1.63; P < 0.001; 1 trial, 64 participants; very low-certainty evidence), walking ability (SMD 0.73, 95% CI 0.52 to 0.94; P < 0.001; 11 trials, 383 participants; low-certainty evidence) and quality of life (SMD 0.50, 95% CI 0.11 to 0.89; P = 0.01; 2 trials, 108 participants; low-certainty evidence). Non-dose-matched trunk training led to no difference for the outcome serious adverse events (odds ratio: 7.94, 95% CI 0.16 to 400.89; 6 trials, 201 participants; very low-certainty evidence). In the analysis of the dose-matched groups (pooling of all trials with equal training duration in the experimental as in the control intervention), we saw that trunk training had a positive effect on trunk function (SMD 1.03, 95% CI 0.91 to 1.16; P < 0.001; 36 trials, 1217 participants; very low-certainty evidence), standing balance (SMD 1.00, 95% CI 0.86 to 1.15; P < 0.001; 22 trials, 917 participants; very low-certainty evidence), leg function (SMD 1.57, 95% CI 1.28 to 1.87; P < 0.001; 4 trials, 254 participants; very low-certainty evidence), walking ability (SMD 0.69, 95% CI 0.51 to 0.87; P < 0.001; 19 trials, 535 participants; low-certainty evidence) and quality of life (SMD 0.70, 95% CI 0.29 to 1.11; P < 0.001; 2 trials, 111 participants; low-certainty evidence), but not for ADL (SMD 0.10; 95% confidence interval (CI) -0.17 to 0.37; P = 0.48; 9 trials; 229 participants; very low-certainty evidence), arm-hand function (SMD 0.76, 95% CI -0.18 to 1.70; P = 0.11; 1 trial, 19 participants; low-certainty evidence), arm-hand activity (SMD 0.17, 95% CI -0.21 to 0.56; P = 0.38; 3 trials, 112 participants; very low-certainty evidence). Trunk training also led to no difference for the outcome serious adverse events (odds ratio (OR): 7.39, 95% CI 0.15 to 372.38; 10 trials, 381 participants; very low-certainty evidence). Time post stroke led to a significant subgroup difference for standing balance (P < 0.001) in non-dose-matched therapy. In non-dose-matched therapy, different trunk therapy approaches had a significant effect on ADL (< 0.001), trunk function (P < 0.001) and standing balance (< 0.001). When participants received dose-matched therapy, analysis of subgroup differences showed that the trunk therapy approach had a significant effect on ADL (P = 0.001), trunk function (P < 0.001), arm-hand activity (P < 0.001), standing balance (P = 0.002), and leg function (P = 0.002). Also for dose-matched therapy, subgroup analysis for time post stroke resulted in a significant difference for the outcomes standing balance (P < 0.001), walking ability (P = 0.003) and leg function (P < 0.001), time post stroke significantly modified the effect of intervention.  Core-stability trunk (15 trials), selective-trunk (14 trials) and unstable-trunk (16 trials) training approaches were mostly applied in the included trials.

AUTHORS' CONCLUSIONS

There is evidence to suggest that trunk training as part of rehabilitation improves ADL, trunk function, standing balance, walking ability, upper and lower limb function, and quality of life in people after stroke. Core-stability, selective-, and unstable-trunk training were the trunk training approaches mostly applied in the included trials. When considering only trials with a low risk of bias, results were mostly confirmed, with very low to moderate certainty, depending on the outcome.

Effects of core training on trunk function, balance, and gait in stroke patients: A systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) includes determining the effects of core training alone or combined with conventional therapy on trunk function, balance, and gait in stroke patients; analysing these effects considering the stroke stage and the core training type; establishing the methodological quality of the studies published to date; and knowing the best dosage and type of exercise these aspects.

DATA SOURCE

Cochrane Library, Medline, Web of Science, Scopus, and Science Direct were searched from inception to January 2022.

REVIEW METHOD

A review and meta-analysis of RCTs about core intervention effects on trunk function, balance, and gait in stroke patients was carried out following the Preferred Items for Reporting in Systematic Review and Meta-Analyses guidelines. The Cochrane Collaboration tool was used to assess the risk of bias and internal validity of the included studies.

RESULTS

Twenty-nine studies were included (1030 stroke patients). The mean age of the participants was 58.46 ± 9.89 years, and the average time since the stroke incident was 308.64 ± 175.52 days. The meta-analysis results showed significant improvements in core interventions for trunk function (P ≤ 0.008) and balance (P < 0.00001) but not for gait performance (P = 0.11 in chronic and P = 0.06 in pooled cases). In relation to the differential meta-analysis between training performed on stable and unstable surfaces, no significant differences were found in trunk function (P = 0.06) or balance measures (P = 0.05).

CONCLUSION

Core training improves trunk function and balance in acute and chronic patients, but no changes were found in gait performance.

Effect of Hand Intensive Training on Upper Limb Function of Stroke Patients with Hemiplegia

Objective

To analyze the effect of hand intensive training on upper limb function of stroke patients with hemiplegia,

Methods

110 stroke patients were randomly divided into two groups: the reference group and the observation group. 55 patients in the reference group were treated with routine rehabilitation treatment, including routine joint activity training, bed training, exercise therapy, and ADL ability training; 55 cases in the observation group received intensive hand training on the basis of routine rehabilitation treatment, including inducing the patient's five finger extension, forcibly pulling the fingers and wrist joints, and suddenly opening his fist after clenching his fist.

Results

The treatment period of the two groups was 5 weeks. In the comparison results of Fugl-Meyer (FMA), the exercise effect of the observation group with increased hand intensive training was significantly better than that of the control group with stroke hemiplegia treated with conventional methods. The difference was statistically significant, t < 10.000, P < 0.05; In the comparative analysis of upper limb function test (UEFT), the effect of the observation group was significantly higher than that of the reference group treated with routine rehabilitation nursing (all P < 0.05); In the comprehensive comparison of exercise ability results, the observation group was higher than the reference group in the flexibility, fineness, and fineness of activity behavior after treatment.

Conclusion

Strengthening hand intensive training can further improve the upper limb motor function of stroke patients with hemiplegia, reduce the severity of hemiplegia, and improve the recovery effect of stroke patients. It is worthy of clinical promotion and application.

The Effectiveness of Additional Core Stability Exercises in Improving Dynamic Sitting Balance, Gait and Functional Rehabilitation for Subacute Stroke Patients (CORE-Trial): Study Protocol for a Randomized Controlled Trial

Background: Trunk impairment produces disorders of motor control, balance and gait. Core stability exercises (CSE) are a good strategy to improve local strength of trunk, balance and gait. Methods and analysis: This is a single-blind multicenter randomized controlled trial. Two parallel groups are compared, and both perform the same type of therapy. A control group (CG) (n = 110) performs conventional physiotherapy (CP) (1 h per session) focused on improving balance. An experimental group (EG) (n = 110) performs CSE (30 min) in addition to CP (30 min) (1 h/session in total). EG is divided in two subgroups, in which only half of patients (n = 55) perform CSE plus transcutaneous electrical nerve stimulation (TENS). Primary outcome measures are dynamic sitting, assessed by a Spanish version of Trunk Impairment Scale and stepping, assessed by Brunel Balance Assessment. Secondary outcomes are postural control, assessed by Postural Assessment Scale for Stroke patients; standing balance and risk of fall assessed by Berg Balance Scale; gait speed by BTS G-Walk (accelerometer); rate of falls, lower-limb spasticity by Modified Ashworth Scale; activities of daily living by Barthel Index; and quality of life by EQ-5D-5L. These are evaluated at baseline (T0), at three weeks (T1), at five weeks (end of the intervention) (T2), at 17 weeks (T3) and at 29 weeks (T4). Study duration per patient is 29 weeks (a five-week intervention, followed by a 24-week post-intervention).