Electromyography of symmetrical trunk movements and trunk position sense in chronic stroke patients

Immediate effects of trunk Kinesio Taping® on functional parameters in the acute stage of patients with mild stroke: A randomized controlled trial

BACKGROUND

Improving early trunk control, balance, and sitting activity following acute stroke is critical for functional prognosis.

PURPOSE

To compare the immediate efficacy of Kinesio Taping® (KT) application on anterior and posterior trunk muscles in terms of improving trunk control, balance, and sit-to-stand performance in the acute stage of stroke.

METHODS

Sixty-nine patients with acute mild stroke were allocated to the anterior KT group (AKT) (age = 65.95 ± 9.67; 12 females, 11 males; Modified Rankin Score = 3), posterior KT group (PKT) (age = 65.39 ± 10.39; 10 females, 13 males; Modified Rankin Score = 3), and control group (CG) (age = 65.34 ± 8.91; 11 females, 12 males; Modified Rankin Score = 2). Trunk control, balance, and sit-to-stand performance were assessed at the baseline and after 45 minutes and 48 hours post-KT. Data were analyzed using repeated-measures ANOVA.

RESULTS

All outcome measures scores improved in all groups significantly after 48 hours (p < .001). A significant improvement after 45 minutes was only seen in trunk control compared to the CG (p < .001; d = 1.32 for AKT and p = .038; d = 0.75 for PKT). Trunk control, balance, and sit-to-stand performance improved in both AKT and PKT compared to the CG at 48 hours post-taping. Trunk control (p < .001; d = 0.26) and balance (p < .001; d = 0.72) results were in favor of the AKT, while sit-to-stand performance results did not make a difference between KT groups (p = .335; d = 0.47).

CONCLUSION

KT application on anterior or posterior trunk muscles was effective for improving trunk control, balance, and sit-to-stand performance in acute stage of stroke in the short term. KT application on anterior trunk muscles had the advantage of improving trunk control and balance.

The effects of trunk repositioning errors on trunk and extremity functions in stroke

AIM

The aim of this study was to analyze the TRE in three directions including forward flexion, lateral flexion to the hemiparetic side, and rotation to the hemiparetic side in patients with stroke and to compare the errors with age- and sex-matched healthy subjects. In addition, it was investigated which functional outcomes were explanatory for TRE in patients with stroke.

METHODS

Forty-one patients with subacute/chronic stroke (age 59 ± 14.5 years) and 41 healthy subjects (age 57 ± 12.8 years) were included in the study. Demographic and clinical data were collected. TREs were measured using an inclinometer. The Trunk Impairment Scale (TIS), Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Timed Up and Go Test, and 10-m walk test (10MWT) were also used to assess trunk control, motor impairment, upper extremity function, and lower extremity function, respectively, in patients with stroke.

RESULTS

TRE scores in three directions were higher in patients with stroke than in healthy subjects (p < 0.001). TREs in three directions were significantly strongly correlated with all functional outcomes (ρ > 0.60, r < 0.001). Multiple regression analysis determined 10MWT, WMFT-Performance, TIS, and FMA-Upper Extremity as explanatory factors for TRE.

CONCLUSION

The model presented in this study could help clinicians and researchers to predict the TRE in patients with stroke. Gait speed, upper extremity motor ability, upper extremity motor impairment, and trunk control should be considered for TRE after a stroke.

The Effect on Muscle Activity of Reaching Beyond Arm's Length on a Mobile Seat: A Pilot Study for Trunk Control Training for People After Stroke

Objective

This pilot study compared muscle activity during lateral reaching tasks between mobile and stable sitting using a novel therapy chair in people after stroke and healthy controls.

Design

Observational pilot study.

Setting

This study was conducted in a rehabilitation center for people after stroke and at the university's movement laboratory for healthy participants.

Participants

A total of eleven people after stroke and fifteen healthy people (N=26) took part.

Interventions

Lateral reaching exercises to the ipsilateral and contralateral sides were performed on a mobile and a stable seat.

Main Outcome Measure

Muscular activity of the multifidus, erector spinae and external oblique was measured bilaterally. A within-subject linear mixed model was applied to analyze the effects of seat condition, task, muscle side, and group.

Results

A seat condition effect was found for the multifidus and external oblique that was dependent on the muscle side and task. During ipsilateral reaching, the activity of the multifidi decreased for people after stroke on the mobile seat, while increasing for healthy participants. The erector spinae showed no condition effect. Decreased activity of the external oblique was found for both groups on the mobile seat.

Conclusions

Mobile sitting influences muscular activity. However, these preliminary results should be further investigated in order to generate recommendations for rehabilitation.

Effect of Core Exercises on Motor Function Recovery in Stroke Survivors with Very Severe Motor Impairment

Paresis of the upper and lower limbs is a typical issue in stroke survivors. This study aims to determine whether core exercises help stroke survivors with very severe motor impairment recover their motor function. This study employed a within-subjects design. Eleven hemiparetic stroke patients with very severe motor impairment (FMA score < 35) and ages ranging from 24 to 52 years old were enrolled in this study. All participants engaged in supervised core exercise training twice a week for 12 weeks. The main outcome measures were Fugl-Meyer Assessment Lower Extremity (FMA-LE) and Fugl-Meyer Assessment Upper Extremity (FMA-UE), which were measured before training and at intervals of four weeks during training. Repeated measures ANOVA was used to analyze the effect of core exercises on motor function performance and lower extremity motor function and upper extremity motor function recovery. There were significant differences in the mean scores for motor function performance, lower extremity motor function, and upper extremity motor function throughout the four time points. A post-hoc pairwise comparison using the Bonferroni correction revealed that mean scores significantly increased and were statistically different between the initial assessment and follow-up assessments four, eight, and twelve weeks later. This study suggests that 12 weeks of core exercise training is effective for improving motor function recovery in patients with very severe motor impairment.

A Novel Core Strengthening Intervention for Improving Trunk Function, Balance and Mobility after Stroke

This paper a novel core-strengthening intervention (CSI) delivered using the AllCore360°, a device that targets trunk muscles through a systematic, high-intensity rotating-plank exercise. Three individuals (age: 61.7 ± 3.2 years; range: 58–64 years) with post-stroke hemiplegia participated in 12-sessions of the CSI. The participants completed up to 142 rotating planks at inclination angles (IAs) that ranged from 40° to 65°, over 12 sessions. The interventional effects on the functional outcomes of trunk performance, balance and mobility were assessed using the Trunk Impairment Scale (TIS), the Berg Balance Scale (BBS), the Timed-Up and Go (TUG) test, the 10-m walk test (10MWT), and the 6-min walk test (6MWT). Postural outcomes were assessed using the center of pressure (CoP) data recorded during quiet standing on a balance platform, and neuromuscular outcomes were assessed using electromyography (EMG) during AllCore360° rotations. All participants completed the CSI (minimum of 120 rotations), demonstrating the feasibility of the CSI in chronic stroke. The CoP data suggested improved lateral control of posture during standing across participants (averaging an over 30% reduction in lateral sway), while the EMG data revealed the ability of the CSI to systematically modulate trunk muscle responses. In summary, the current investigation presents the feasibility of a novel delivery method for core strengthening to maximize rehabilitation outcomes in the chronic phase of stroke.

Correlation Between Proprioceptive Impairment and Motor Deficits After Stroke: A Meta-Analysis Review

Introduction: Proprioceptive impairment is a common symptom after stroke. Clarifying how proprioception correlates with motor function after stroke may be helpful in optimizing proprioception-augmented movement training. Previous studies have shown inconsistent findings. A meta-analysis is an optimal method to explore the correlation and identify the factors contributing to these inconsistencies.

Objective: To explore the correlation between proprioception and motor function after stroke through a meta-analysis, taking into account characteristics of the measurements used in these studies.

Methods: We searched multiple databases until November 2021 for eligible studies that measured both proprioception and motor functions in persons with stroke and reported their correlation or data for correlation analysis. A meta-analysis of the correlations was performed. The subgroup analysis and meta-regression were further conducted to investigate potential factors contributing to the heterogeneity of correlation strength, based on the participants' characteristics, proprioception, and motor function measures.

Results: In total, 28 studies comprising of 1,829 participants with stroke were included in the meta-analysis. The overall correlation between proprioception and motor function was significant (r = 0.267, p < 0.05), but there was heterogeneity across studies (I² = 45%, p < 0.05). The results of the subgroup analysis showed proprioception of the axial segment in weight-bearing conditions (r = 0.443, p < 0.05) and upper limb without weight-bearing (r = 0.292, p < 0.05) had a stronger correlation with motor function than proprioception of the lower limb without weight-bearing. The proprioception measured through ipsilateral matching (r = 0.412, p < 0.05) showed a stronger correlation with motor function than through contralateral matching. The International Classification of Functioning, Disability, and Health (ICF) domains of motor function, movement function (r = 0.338, p < 0.05), activity performance (r = 0.239, p < 0.05), and independence (r = 0.319, p < 0.05) showed a stronger correlation with proprioception than with other domains.

Conclusion: There is a significant correlation between proprioception and motor dysfunction after stroke. The proprioception measured in the axial segment under weight-bearing conditions or measured with ipsilateral matching, and motor function, specifically in the ICF domains of movement function, activity performance, and independence showed a positive contribution to the association between proprioception and motor function. The correlation does not imply causation and might be underestimated by attributes of current tests for proprioception and motor function. Further studies are needed to clarify the cause-effect relationship.

Trunk Muscle Activation Patterns During Standing Turns in Patients With Stroke: An Electromyographic Analysis

Recent evidence indicates that turning difficulty may correlate with trunk control; however, surface electromyography has not been used to explore trunk muscle activity during turning after stroke. This study investigated trunk muscle activation patterns during standing turns in healthy controls (HCs) and patients with stroke with turning difficulty (TD) and no TD (NTD). The participants with stroke were divided into two groups according to the 180° turning duration and number of steps to determine the presence of TD. The activation patterns of the bilateral external oblique and erector spinae muscles of all the participants were recorded during 90° standing turns. A total of 14 HCs, 14 patients with TD, and 14 patients with NTD were recruited. The duration and number of steps in the turning of the TD group were greater than those of the HCs, independent of the turning direction. However, the NTD group had a significantly longer turning duration than did the HC group only toward the paretic side. Their performance was similar when turning toward the non-paretic side; this result is consistent with electromyographic findings. Both TD and NTD groups demonstrated increased amplitudes of trunk muscles compared with the HC groups. Their trunk muscles failed to maintain consistent amplitudes during the entire movement of standing turns in the direction that they required more time or steps to turn toward (i.e., turning in either direction for the TD group and turning toward the paretic side for the NTD group). Patients with stroke had augmented activation of trunk muscles during turning. When patients with TD turned toward either direction and when patients with NTD turned toward the paretic side, the flexible adaptations and selective actions of trunk muscles observed in the HCs were absent. Such distinct activation patterns during turning may contribute to poor turning performance and elevate the risk of falling. Our findings provide insights into the contribution and importance of trunk muscles during turning and the association with TD after stroke. These findings may help guide the development of more effective rehabilitation therapies that target specific muscles for those with TD.

Electromyographic Analyses of Trunk Musculature after Stroke: An Integrative Review

Background: Observational and intervention studies examining trunk electromyographic (EMG) activity following stroke are underpowered and fail criteria for systematic reviews of randomized control trials. Objective: To systematically evaluate and summarize evidence about trunk muscle activation after stroke during ADL and with diagnostic and therapeutic interventions.Methods: Search databases were Medline Complete, CINAHL and Health Sources: Nursing Academic Edition. Studies written in English after 1989 included these search terms: stroke, muscle activity, and trunk including abdominal or back muscles. Systematic reviews, single case studies, dissertations, or letters to the editor were excluded. Reviewers used Covidence to screen relevant research and extract information after title, abstract, and full-text screening. Information extracted related to stroke severity, time since onset, specific muscles and EMG analysis technique, and study limitations. Articles were classified as observational, intervention or device-related.Results: The electronic search yielded 188 articles and a hand search found 3. Title and abstract screening yielded 102 articles for full text screening. Ultimately, 45 articles were extracted. Trunk muscle recruitment during function and movement demonstrated significant differences in trunk EMG recruitment timing, magnitude, and symmetry after stroke when compared with healthy participants. Individuals with stroke demonstrated significant differences when comparing paretic to non-paretic side trunk EMG measures. Intervention studies showed some effect on improving trunk muscle activation but they had small sample sizes and methodological issues.Conclusions: Trunk muscle activation after stroke can be monitored with EMG during rehabilitation programs which challenge functional recovery.

Assessment of trunk flexion in arm reaching tasks with electromyography and smartphone accelerometry in healthy human subjects

Trunk stability is essential to maintain upright posture and support functional movements. In this study, we aimed to characterize the muscle activity and movement patterns of trunk flexion during an arm reaching task in sitting healthy subjects and investigate whether trunk stability is affected by a startling acoustic stimulus (SAS). For these purposes, we calculated the electromyographic (EMG) onset latencies and amplitude parameters in 8 trunk, neck, and shoulder muscles, and the tilt angle and movement features from smartphone accelerometer signals recorded during trunk bending in 33 healthy volunteers. Two-way repeated measures ANOVAs were applied to examine the effects of SAS and target distance (15 cm vs 30 cm). We found that SAS markedly reduced the response time and EMG onset latencies of all muscles, without changing neither movement duration nor muscle recruitment pattern. Longer durations, higher tilt angles, and higher EMG amplitudes were observed at 30 cm compared to 15 cm. The accelerometer signals had a higher frequency content in SAS trials, suggesting reduced movement control. The proposed measures have helped to establish the trunk flexion pattern in arm reaching in healthy subjects, which could be useful for future objective assessment of trunk stability in patients with neurological affections.

Perception of trunk inclination during sitting with feet in contact with the floor

[Purpose] To clarify the sitting postural control, the influences of several reference sitting positions on the perception of the trunk position while sitting with the feet in contact with the floor and keeping the eyes closed were investigated. [Participants and Methods] Fifteen young healthy volunteers participated in the present study. The perception of the trunk position was evaluated by calculating the absolute error (error magnitude) and constant error (error direction) between the reference trunk position (which the subjects memorized; the reference position) and the position that they adopted when reproducing the reference position (the reproduced position). Eight reference positions were set at 5° increments (from 15° backward inclination [−] to 20° forward inclination [+]). [Results] The reference positions had a significant effect on the absolute error, and the absolute error values at −15° and −10° were significantly smaller than at 20°. However, the reference positions had no effect on the constant error. [Conclusion] The present study revealed that the perception of the trunk position while sitting with the feet in contact with the floor is better when inclining backward than when inclining forward. The perception of the trunk position may be higher in a low-stability position and lower in a high-stability position.

Anteroposterior perception of the trunk position while seated without the feet touching the floor

[Purpose] The purpose of this study was to investigate the trunk position perception in the anteroposterior direction in young participants sitting without their feet touching the floor to avoid the influence of the hamstrings tension and the feet pressure on the perception. [Subjects and Methods] Fourteen healthy volunteers were seated on a chair fitted with an original manual goniometer. There were 7 reference positions set at 5° increments, from −15° to 15°, and reproductions of each position were conducted 5 times. Trunk position perception was evaluated by the absolute error between the reproduced trunk angle and the reference position angle. [Results] The results revealed a significant effect of reference position on the absolute error. The absolute error at the −5° reference position was significantly larger than at the −15° and 15° positions, and the absolute error at the 0° position was significantly larger than at the −15°, 10°, and 15° positions. [Conclusion] These results suggest that the perception of extreme forward- and backward-leaning trunk positions while sitting without the feet touching the floor would be higher than in a neutral sitting position. The relationship between the stability of the posture and the perception may be involved in the sitting position.