The effect of motor imagery training for trunk movements on trunk muscle control and proprioception in stroke patients

Effectiveness of Motor Imagery on Physical Function in Patients With Stroke: A Systematic Review

Over the past two decades, motor imagery (MI) has been used as a supplementary treatment approach to regain physical function in patients with stroke. However, the baseline treatment and the quality of study methodology for new treatment approaches have improved. This systematic review examined the evidence published in the past few decades on the effectiveness of MI on upper- and lower-extremity function and functional performance in patients with stroke. A total of 29 randomized controlled and crossover trials that compared MI with other interventions were analyzed. In addition, the outcomes were grouped into upper-, lower-extremity function, and functional performance for data analysis. More than half of the upper-extremity function studies reported improved performance in Fugl-Meyer assessment, Wolf motor function test, and box and block test in both acute and chronic stages. Lower-extremity function and functional performance were primarily investigated using Fugl-Meyer assessment, gait speed and parameters, activities of daily living, and balance ability. When considering only high-quality studies, six of 15 on upper extremity reported significant effects, whereas five of 15 reported nonsignificant effects. In addition, six of 14 studies on gait and balance reported significant effects. This systematic review suggests that both MI training and conventional rehabilitation programs effectively enhance upper limb functional abilities, including improvements in gait speed and balance, in individuals with acute and chronic stroke. Although the studies published during the past few decades showed heterogeneity in onset after stroke, research protocol, training intensity, and research methodology quality, none of them reported the long-term effects.

Sensory training combined with motor training improves trunk proprioception in stroke patients: a single-blinded randomized controlled trial

OBJECTIVES

Inadequate trunk function is the underlying cause of many problems such as impaired balance and mobility. Although there have been trunk-based physiotherapy approaches in recent years, almost all of these approaches focus on motor problems. This study aims to investigate the effects of sensory training combined with trunk-centered Bobath exercises on trunk control and proprioception, balance, gait, and the activity of daily living (ADL).

MATERIALS AND METHODS

This study is a randomized controlled trial included with twenty-seven stroke patients. Participants were separated into two groups, Group 1; 'sensory training combined with trunk-centered Bobath exercises' and Group 2; 'trunk-centered Bobath exercises'. Trunk-centered Bobath exercises were used for motor training. Sensory training included transcutaneous electric nerve stimulation and a set of exercises that provide tactile and proprioceptive stimulation. Trunk Impairment Scale, Trunk Reposition Error, Berg Balance Scale, 2-minute walk test, and Barthel Index were used to assess trunk control, trunk proprioception, balance, gait, and ADL respectively.

RESULTS

Intra-group analysis results showed that trunk control, trunk proprioception, balance, gait, and ADL improved in both groups after treatment (p < 0.05). The changes in the Trunk Reposition Error values of the participants in Group 1 before and after treatment was found to be significantly higher than Group 2 (p < 0.05).

CONCLUSIONS

The findings indicated that the application of trunk-centered motor training is effective in improving trunk proprioception and trunk control, balance, gait, and ADL in stroke patients. Also, sensory training combined with trunk-centered motor training was found more effective in improving trunk proprioception than solely motor training.

Reliability and validity of the trunk position sense and modified functional reach tests in individuals after stroke

The psychometric qualities of the proprioception and dynamic trunk control tests have rarely been studied in individuals after stroke.

OBJECTIVE

To investigate the reliability and validity of the Trunk Position Sense Test (TPS) and Modified Functional Reach Test (MFRT) in persons after stroke.

METHODS

Thirty-two participants were included. The TPS and MFRT were assessed by two physiotherapists during a first session. After resting, a second session was conducted. The intraclass correlation coefficient (ICC) was calculated to assess the test-retest (ICC3,k) and inter-rater reliability (ICC2,k). Pearson correlations coefficients were calculated between TPS/MFRT performances and clinical tests (trunk strength, Timed Up and Go and Balance Assessment in Sitting and Standing Positions - BASSP).

RESULTS

The TPS inter-rater reliability was good for vertical error (ICC = 0.75 [0.50-0.88]) while it was moderate for horizontal error (ICC = 0.48 [0.10-0.75]) as well as for test-retest reliability (0.39 ≤ ICC ≤ 0.59). As for the MFRT, inter-rater (0.76 ≤ ICC ≤ 0.90) and test-retest reliability (0.71 ≤ ICC ≤ 0.91) were good to excellent for anterior, paretic et non-paretic displacements. Horizontal errors for the TPS (-0.26 ≤ r ≤ -0.36) and anterior MFRT (0.38 ≤ r ≤ 0.64) values correlated moderately with trunk strength.

CONCLUSION

The MFRT is a reliable test for persons after stroke with trunk control impairments. The TPS does not appear to be relevant for post-stroke individuals. This can be explained by the fact that its procedure is not easily applied for individuals after stroke - who may have significant motor and cognitive impairments.

Effects of robot-assisted arm training on respiratory muscle strength, activities of daily living, and quality of life in patients with stroke: a single-blinded randomized controlled trial

BACKGROUND

Post-stroke clinical changes not only affect extremities and trunk muscles but also the respiratory muscles.

PURPOSE

To determine the effect of robot-assisted arm training with conventional rehabilitation (CombT) on respiratory muscle strength, activities of daily living (ADL), and quality of life in patients with stroke and to compare the results with conventional rehabilitation (CR).

METHODS

It was a two-arm, single-blinded, randomized controlled trial in which 66 patients were randomly allocated to either CombT or CR to receive 30 sessions (5/week) over 6 weeks. The respiratory muscle strength (maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), activities of daily life (ABILHAND questionnaire), and quality of life (Stroke Impact Scale (SIS)) were measured before and 6 weeks after training.

RESULTS

The CombT group showed significantly better MIP, MEP, and performance in ADLs after 6 weeks of training compared to the CR group (p < .01). The effect size was large for MIP (d = 0.9) and MEP (d = 0.9), whereas medium for performance in ADLs (d = 0.62). Also, the SIS-arm strength (p < .01), hand function (p = .04), ADLs (p = .02), and recovery (p = .04) were significantly better in CombT group with a medium (d = 0.6, d = 0.5, d = 0.5, and d = 0.5, respectively) effect size compared with CR group.

CONCLUSIONS

Both CombT and CR groups improved respiratory muscle strength, performance in ADLs, and quality of life in patients with stroke. However, CombT appears to offer more comprehensive benefits, highlighting its valuable role in respiratory and functional recovery after stroke.

Effects of trunk training using motor imagery on trunk control ability and balance function in patients with stroke

OBJECTIVE

To explore the effects of trunk training using motor imagery on trunk control and balance function in patients with stroke.

METHODS

One hundred eligible stroke patients were randomly divided into a control group and trial group. The control group was given routine rehabilitation therapy, while the trial group was given routine rehabilitation therapy and trunk training using motor imagery.

RESULTS

Prior to treatment, there was no significant difference between the two groups (P > 0.05) in Sheikh's trunk control ability, Berg rating scale (BBS), Fugl-Meyer assessment (FMA), movement length, movement area, average front-rear movement speed, average left-right movement speed, and surface electromyography (sEMG) signal of the bilateral erector spinae and rectus abdominis. After treatment, Sheikh's trunk control ability, FMA, and BBS in the two groups were significantly higher than those before treatment (P < 0.05). The movement length, movement area, the average front-rear movement speed, and the average left-right movement speed in the two groups decreased significantly (P < 0.05). The differences of these indicators between the two groups were statistically significant (P < 0.05). After treatment, the rectus abdominis and erector spinae on the affected side of the two groups improved when compared with those before treatment (P < 0.05). The rectus abdominis and erector spinae on the healthy side of the trial group descended after treatment (P < 0.05), while little changes were observed on the healthy side of the control group after treatment (P > 0.05). The rectus abdominis and erector spinae on the affected side of the trial group improved when compared with those in the control group (P < 0.05). There was no significant difference between the two groups in the decline of abdominalis rectus and erector spinal muscle on the healthy side.

CONCLUSION

Trunk training using motor imagery can significantly improve the trunk control ability and balance function of stroke patients and is conducive to promoting the recovery of motor function.

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.

A Literature Review of High-Tech Physiotherapy Interventions in the Elderly with Neurological Disorders

Neurological physiotherapy adopts a problem-based approach for each patient as determined by a thorough evaluation of the patient’s physical and mental well-being. Τhis work aims to provide a literature review of physical therapy interventions in the elderly with neurological diseases (NDs) and discuss physiotherapy procedures and methods that utilize cutting-edge technologies for which clinical studies are available. Hence, the review focuses on acute NDs (stroke), deteriorating NDs (Parkinson’s disease), and age-related cognitive impairment. The most used physiotherapy procedures on which clinical data are available are balance and gait training (robot-assisted or not), occupational therapy, classical physiotherapy, walking and treadmill training, and upper limb robot-assisted therapy. Respectively, the most often-used equipment are types of treadmills, robotic-assisted equipment (Lokomat^® and Gait Trainer GT1), and portable walkway systems (GAITRite^®), along with state-of-the-art technologies of virtual reality, virtual assistants, and smartphones. The findings of this work summarize the core standard tools and procedures, but more importantly, provide a glimpse of the new era in physiotherapy with the utilization of innovative equipment tools for advanced patient monitoring and empowerment.

Effects of whole-body vibration training on lower limb motor function and neural plasticity in patients with stroke: protocol for a randomised controlled clinical trial

INTRODUCTION

Lower limb motor dysfunction is common in patients with stroke, and usually caused by brain neural connectivity disorder. Previous studies have shown that the whole-body vibration training (WBVT) significantly improves the lower limb motor function in patients with stroke and may promote nerve remodelling. The prior purpose of this study is to explore effects of WBVT on lower limb motor function and neuroplasticity in patients with stroke.

METHODS

A single-blind randomised controlled trial will be conducted. Sixty patients with stroke will be recruited and allocated randomly to WBVT, routine rehabilitation training (RRT) and control group (CG). The WBVT and RRT interventions will be implemented as five 25 min sessions weekly for continuous 12 weeks; the CG will remain daily habitual living styles and routine treatments, in community or hospital, and will also receive telephone follow-up and health-related lectures. Transcranial magnetic stimulation will be used to assess neural plasticity while lower limb motor function is assessed using indicators of strength, walking ability and joint activity. The assessments will be conducted at the period of baseline, week 6, week 12 as well as on 4 and 8 weeks, respectively, after intervention completion.

ETHICS AND DISSEMINATION

This study has been approved by the Shanghai University of Sport Research Ethics Committee (102772021RT067) and will provide data on the effects of WBVT relative to RRT in terms of the improvement of stroke patients' lower limb motor function and neural plasticity. The results of this study will be disseminated via publications in peer-reviewed journals and presentations at international conference.

TRIAL REGISTRATION NUMBER

ChiCTR2200055143.

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.

Stroke Severity and Maximum Inspiratory Pressure are Independently Associated with Functional Mobility in Individuals After Stroke

BACKGROUND

Clinical changes after stroke can contribute to reduced mobility and negatively affect the survival of these individuals. The objective of this study was to verify factors associated with functional mobility in stroke individuals.

METHODS

Crosssectional study carried out with stroke individuals in an outpatient clinic. Demographic and clinical data were collected and the following measures were applied: National Institute of Health Stroke Scale (NIHSS), modified Barthel Index, Trunk Impairment Scale, Functional Reach Test, Timed Up and Go Test, and the International Physical Activity Questionnaire. Respiratory muscle strength was assessed by measuring the maximum inspiratory pressure (MIP) and the maximum expiratory pressure (MEP).Variables with p < .05 in univariate logistic regression analysis were included in the multivariate logistic regression model, using the backward stepwise method.

RESULTS

53 individuals were enrolled with a mean age of 55 years (±13.43). 51% were male and the median NIHSS score was 2.25 (0-13). The final multivariate model included NIHSS (OR = 1.872; 95% CI 1.167-3.006; p = 0.009), physical therapy treatment (OR = 15.467; 95% CI 1.838-130.178; p = 0.012) and MIP (OR = 1.078; 95% CI 1.024-1.135; p = 0.004).

CONCLUSION

Stroke severity and inspiratory muscle strength were factros associated with functional mobility in individuals after stroke, regardless stroke time.

The effects of upper and lower limb position on symmetry of vertical ground reaction force during sit-to-stand in chronic stroke subjects

[Purpose] The purpose of this study was to evaluate the influence of arm and leg posture elements on symmetrical weight bearing during Sit to Stand tasks in chronic stroke patients. [Subjects and Methods] The subjects were diagnosed with stroke and 22 patients (15 males and 7 females) participated in this study. All participants performed Sit to Stand tasks on three foot postures and two arm postures. Two force plates were used to measure peak of vertical ground reaction force and symmetrical ratio to peak Fz. The data were analyzed using independent t-test and two-way repeated ANOVA. [Results] The results of this study are as follows: 1) Peak Fz placed more weight in non-paretic leg during Sit to Stand. 2) A symmetrical ratio to Peak Fz indicated significant difference between foot and arm posture, and had non-paretic limb supported on a step and paretic at ground level (STP) and grasped arm posture that lock fingers together with shoulder flexion by 90°(GA) (0.79 ± 0.09). [Conclusion] These results suggest that STP posture of the legs and GA posture of the arms should be able to increase the use of the paretic side during Sit to Stand behavior and induce normal Sit to Stand mechanism through the anterior tilt of the hip in clinical practices, by which loads onto the knee joint and the ankle joint can be reduced, and the trunk righting response can be promoted by making the back fully stretched. The outcome of this study is expected to be a reference for exercise or prognosis of Sit to Stand in stroke patients.

Physical Therapy for Neurological Conditions in Geriatric Populations

With more of the world’s population surviving longer, individuals often face age-related neurology disorders and decline of function that can affect lifestyle and well-being. Despite neurophysiological changes affecting the brain function and structure, the aged brain, in some degree, can learn and relearn due to neuroplasticity. Recent advances in rehabilitation techniques have produced better functional outcomes in age-related neurological conditions. Physical therapy (PT) of the elderly individual focuses in particular on sensory–motor impairments, postural control coordination, and prevention of sarcopenia. Geriatric PT has a significant influence on quality of life, independent living, and life expectancy. However, in many developed and developing countries, the profession of PT is underfunded and understaffed. This article provides a brief overview on (a) age-related disease of central nervous system and (b) the principles, approaches, and doctrines of motor skill learning and point out the most common treatment models that PTs use for neurological patients.