The effects of upper extremity task training with symmetric abdominal muscle contraction on trunk stability and balance in chronic stroke patients

Modified-constraint movement induced therapy versus neuro-developmental therapy on reaching capacity in children with hemiplegic cerebral palsy

BACKGROUND AND OBJECTIVE

Upper extremity impairment is one of the complications in hemiplegic children. The purpose of modified constraint-induced movement therapy (mCIMT) is to improve the function of impaired arms and hands in these children. This study compared the efficacy of mCIMT and the approach of neurodevelopmental therapy (NDT) on reaching capacity in children with spastic hemiplegia.

METHODS

Fifty-two spastic hemiplegic children ranging in age from four to 6 years were selected for this study from an outpatient clinic and biomechanical lab (Prince Sattam bin Abdulaziz University, KSA). They were randomly divided into two experimental groups: group I received NDT and group II received mCIMT for the involved upper limb and restriction of the uninvolved arm movements for 12 weeks (three times per week). Both groups received a conventional exercise program in addition to experimental one. Active elbow extension range of motion and three-dimensional motion analysis of the reaching task were measured before and after 3 months of treatment.

RESULTS

Significant enhancement in all pre-treatment and post-treatment outcomes was observed in both groups by a two-way mixed MANOVA; furthermore, Group II (mCIMT) showed the most significant improvement (elbow extension, percentage of reach to peak velocity, movement time and movement units) when comparing the post-treatment outcomes between the two groups (p < 0.001).

IMPLICATION FOR PHYSIOTHERAPY PRACTICE

Addition of mCIMT to a conventional exercise was superior to adding NDT exercise therapy in promoting the performance of reaching pattern in hemiplegic children.

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 lumbar joint mobilization on trunk function, postural balance, and gait in patients with chronic stroke: A randomized pilot study

BACKGROUND

Patients with stroke have hypomobility in the facet joint of affected side. Lumbar joint mobilization could be used to maintain function and mobility of the joints.

OBJECTIVE

This study aimed to investigate the effects of lumbar joint mobilization on trunk function, postural balance, and gait in patients with stroke.

METHODS

Thirty patients with stroke were randomly assigned to two groups. Lumbar joint mobilization was provided for 15 min, 5 times a week for 6 weeks to patients who were allocated into the experimental group. Patients who were allocated into the control group received a sham intervention. Trunk function (trunk impairment scale), postural balance (weight distribution, Berg balance scale, and timed up and go test), and walking (10 m walk test, functional gait assessment, step length, and stride length) were evaluated before and after the experiment for all the patients.

RESULTS

Lumbar joint mobilization significantly improved trunk function, postural balance, and gait compared with pre-test values in the experimental group (P< 0.05). Significant differences were seen in trunk function, postural balance, and walking between the two groups (P< 0.05).

CONCLUSION

Lumbar joint mobilization might be an effective intervention for trunk function, postural balance, and walking in patients with stroke.

Effect of the Trunk and Upper Limb Passive Stabilization on Hand Movements and Grip Strength Following Various Types of Strokes—An Observational Cohort Study

Almost half of the patients surveyed report impaired function of the upper limbx and handx after stroke. The effect of the passive trunk and shoulder stabilization on the recovery of coordinated hand movement is unclear. This study examined whether passive stabilization of the trunk and shoulder could improve the functional state of the hands after various types of strokes. It is an observational prospective cohort study conducted at the Rehabilitation Clinic in two parallel groups of patients with four different types of strokes (hemorrhagic and ischemic of the brain, similar to the cerebellum). A total of 120 patients were analyzed. Patients were examined in various positions: sitting without a backrest with the upper limb adjacent to the body, supine with the upper limb perpendicular to the body, and supine with the arm stabilized in relation to the patient’s body. Hand Tutor devices and a hand dynamometer were used for the measurements. The frequency and maximum range of motion as well as the grip strength were measured in three different positions of the trunk and upper limb. Passive stabilization of the trunk and shoulder showed more statistically significant differences in Group II. In group II, both in patients after hemorrhagic stroke (wrist Hz p = 0.019; wrist ROM p = 0.005; Hz F5 p = 0.021; Hz F4 p = 0.016; Hz F3 p = 0.019; Hz F2 p = 0.021) and ischemic stroke (p = 0.001 for wrist Hz, wrist ROM, Hz F from 5 to F2; and ROM F1; ROM F3 p = 0.009; ROM F2 p = 0.010), and hemorrhagic cerebellum, improvement of parameters was observed. Stabilization of the upper limb and passive stabilization of the trunk improved the frequency and range of movements in the radiocarpal joint and in the fingers of patients after stroke, regardless of the type of stroke.

The Use of Armeo®Spring Device to Assess the Effect of Trunk Stabilization Exercises on the Functional Capabilities of the Upper Limb-An Observational Study of Patients after Stroke

Almost half of stroke patients report impaired function of the upper limb and hand. Stability of the trunk is required for the proper movement of the body, including the legs and arms. The aim of the study was to analyze the effect of trunk stabilization exercises on coordinated movement of the affected upper limb in patients after stroke, using an Armoe®Spring device and the “wall” and “abacus” functional tests. Materials and methods: This is a randomized, double-blinded study. The research was carried out in the Rehabilitation Clinic on a group of 60 stroke patients who were randomly assigned to groups differing in the rehabilitation program. The study group had physiotherapy based on the NDT Bobath concept and the control group used classic exercises. The importance of the trunk for upper limb coordination was assessed on the Armeo®Spring device using three evaluation programs, “perpendicular fishing”; “horizontal fishing”; “reaction time”, and two proprietary tests, “wall” and “abacus”. Results: The post-treatment analysis showed significantly better results in the study group for the abacus (p < 0.001), wall (p = 0.003) tests, and a significantly higher percentage of task completion in the vertical fishing (p = 0.036) and reaction time (p = 0.009) tests. Conclusions: Physiotherapy including exercises to stabilize the trunk had a significant effect on increasing the functional efficiency of the affected upper limb and on improving the handgrip strength. The Armeo®Spring device is a good device for the functional assessment of the upper limb before and after therapy.

Importance of core stability for coordinated movement of the human body in stroke rehabilitation

OBJECTIVES

To examine the effect of core stability on parameters of coordinated movement of the trunk and lower extremities in post-stroke rehabilitation.

METHODS

A total of 55 subjects (mean age, 58 years) were included in the study: 33 patients after stroke (17 with ischemic cerebral stroke and 16 with cerebellar) and 22 neurologically healthy subjects with lower back pain. Participation was voluntary. All subjects were asked to complete two exercises: a dynamic movement in the seated position (leaning forward and back) and a march-in-place exercise with a high elevation of the knees. The two exercises were performed with and without contraction of the abdominal muscles. The frontal and sagittal inclination of the trunk during movement, gait speed, elevation of the feet, and muscle tension was recorded. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT04886466.

RESULTS

Core stability (abdominal contraction) was associated with more precise trunk movement in the frontal and sagittal plane, as well as higher elevation of the feet and a faster gait. This occurred in both post-stroke patients and neurologically healthy subjects with lower back pain.

DISCUSSION

Muscle tensions were generally lower in post-stroke patients compared to those with lower back pain syndrome but active abdominal tension muscles caused the increase of core stability and alter the trunk movement path, and improves gait and range of movement. Core stability training during stroke rehabilitation may help patients to achieve a higher level of coordinated movement.

Could Self-Control and Emotion Influence Physical Ability and Functional Recovery after Stroke?

Background and Objectives: This study was conducted to determine whether self-control and emotions could influence patients' physical ability and functional recovery after stroke. Materials and Methods: Twenty-four patients within eight weeks after a stroke were included in this study (age: 54.04 ± 10.31; days after stroke: 42.66 ± 8.84). The subjects participated in tests at the baseline, four weeks later, and eight weeks later. Subjects were asked to complete the following: (1) self-control level test, (2) positive and negative emotion test, (3) knee muscle strength testing, (4) static balance test, (5) gait measurement, and (6) activities of daily living evaluation. Results: The muscle strength of the knee, static balance, gait ability, and the Functional Independence Measure score increased significantly in the stroke patients over time. A significant correlation was noted between the emotion and physical variables in stroke patients. The self-control level was significantly associated with the change in the physical variables in stroke patients over time. Conclusions: The self-control level was positively related to the increases in functional recovery of stroke patients with time, while the emotions were related more to the physical abilities.