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Li M, Huang Y, Chen H, Wang S, Zhou Y, Zhang Y. Relationship between motor dysfunction, the respiratory muscles and pulmonary function in stroke patients with hemiplegia: a retrospective study. BMC Geriatr 2024; 24:59. [PMID: 38218756 PMCID: PMC10787470 DOI: 10.1186/s12877-023-04647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND The interaction between motor dysfunction and respiratory functions in stroke patients with hemiplegia are not fully understood, particularly with regard to the relationship between changes in trunk control, balance, and daily activities, and changes in respiratory muscle strength and pulmonary volume. Investigating this relationship will facilitate the optimization of stroke rehabilitation strategies. METHODS Clinical history data were collected from 134 patients to analyze the relationship between motor function scales scores and spirometric data. The data from 60 patients' data were used to evaluate the relationship between motor function scales scores and spirometric data at baseline and after 3-weeks rehabilitation. RESULTS (1) Patients with lower scores on Trunk impairment Scale (TIS), Berg Balance Scale (BBS) and Barthel Index (BI) had weaker respiratory muscle strength and pulmonary function. (2) Stroke patients' BBS and BI scores showed differences between normal and unnormal maximal inspiratory pressure (MIP), but not in TIS. (3) Improvements in motor function led to promotion of enhanced respiratory function. Patient exhibited less MIP improvement at the severe level of TIS and BBS. CONCLUSIONS Patients with hemiplegia exhibited diminished respiratory muscle strength and pulmonary function at a more severe motor dysfunction level. Impaired inspiratory muscle strength was associated with reduced balance ability and limitations in activities required for daily living. Enhanced motor function improved respiration and rehabilitation programs should prioritize the activation of diaphragm function to improve overall outcomes.
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Affiliation(s)
- Meng Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Ying Huang
- Department of Pneumology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - HaiYun Chen
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - ShuoShuo Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Ying Zhou
- Department of Geriatrics, Shanghai Xuhui Central Hospital, Shanghai, China.
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China.
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2
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Bozkurt YE, Abit Kocaman A, Kaşıkcı Çavdar M, Keskin ED. A new instrument to assess physical function in stroke patients: the Dubousset function test and its validity, reliability, responsiveness. Neurol Res 2023; 45:1127-1135. [PMID: 37733422 DOI: 10.1080/01616412.2023.2257439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/05/2023] [Indexed: 09/22/2023]
Abstract
AIM The Dubousset Functional Test (DFT) ia a practical four-component assessment test to assess the physical function and balance capacities. The study aimed to examine the reliability, validity, responsiveness of the DFT in stroke survivors. METHODS This study included a total of 57 post-stroke patients (age 60.16 ± 15.08 years). The participants were divided into two groups according to the duration of stroke (6-12 months, 12 months and more). Reliability of DFT test was evaluated with Intraclass Correlation Coefficient (ICC). The correlation between the DFT and The Timed Up and Go test (TUG), dual-task TUG, Functional Reach Test (FRT), 3-meter backward walk test (3MBWT), Tinetti Performance Oriented Mobility Assessment (POMA) was used for the validity. RESULTS For total post-stroke patients, ICC values were between 0.899 and 0.984 (excellent agreement). For stroke patients have 6-12 months stroke duration ICC values were between 0.831 and 0.988 (excellent agreement). For post-stroke patients have 6-12 months stroke duration ICC values were between 0.858 and 0.992 (excellent agreement). For total stroke post-patients the correlation with four component of DFT and TUG, dual-task TUG, FRT, 3MBWT and POMA was found to be statistically significant (p < 0.001). CONCLUSION The DFT has excellent reliability and validity in post-stroke patients. Therefore, it may be a clinically suitable test for detecting balance and physical function.
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Affiliation(s)
- Yusuf Emre Bozkurt
- Department of Physiotherapy and Rehabilitation, Samsun Physical Medicine and Rehabilitation Diseases Hospital, Samsun, Turkey
| | - Ayşe Abit Kocaman
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
| | - Merve Kaşıkcı Çavdar
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E Dilek Keskin
- Faculty of Medical Sciences, Department of Physical Medicine and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
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Thijs L, Voets E, Denissen S, Mehrholz J, Elsner B, Lemmens R, Verheyden GS. Trunk training following stroke. Cochrane Database Syst Rev 2023; 3:CD013712. [PMID: 36864008 PMCID: PMC9987175 DOI: 10.1002/14651858.cd013712.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
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.
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Affiliation(s)
- Liselot Thijs
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Eline Voets
- Department of Neurorehabilitation, KU Leuven, Leuven, Belgium
| | - Stijn Denissen
- AIMS lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- icometrix, Leuven, Belgium
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Bernhard Elsner
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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Pellicciari L, Sodero A, Campagnini S, Guolo E, Basagni B, Castagnoli C, Hochleitner I, Paperini A, Gnetti B, Avila L, Romano E, Grippo A, Hakiki B, Carrozza MC, Mannini A, Macchi C, Cecchi F. Factors influencing trunk control recovery after intensive rehabilitation in post-stroke patients: a multicentre prospective study. Top Stroke Rehabil 2023; 30:109-118. [PMID: 34994302 DOI: 10.1080/10749357.2021.2016099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trunk control plays a crucial role in the stroke rehabilitation, but it is unclear which factors could influence the trunk control after an intensive rehabilitation treatment. OBJECTIVES To study which demographic, clinical and functional variables could predict the recovery of trunk control after intensive post-stroke inpatient rehabilitation. METHODS Subjects with acute, first-ever stroke were enrolled and clinical and data were collected at admission and discharge. The primary outcome was considered the trunk control measured by the Trunk Control Test (TCT). The data were analyzed by a univariate and multivariate logistic regressions. RESULTS Two hundred forty-one post-stroke patients were included. All baseline variables significantly associated to TCT at discharge in the univariate analysis (i.e. gender, NIHSS neglect item at admission, presence of several complexity markers, TCT total score at admission, NIHSS total score, pre-stroke modified Rankin Scale, Fugl-Meyer Assessment motor and sensitivity score) were entered in the multivariate analysis. The multivariate regression showed that age (p = .003), admission NIHSS total score (p = .001), admission TCT total score (p < .001) and presence of depression (p = .027) independently influenced the TCT total score at discharge (R2 = 61.2%). CONCLUSIONS Age, admission neurological impairment (NIHSS total score), trunk control at the admission (TCT total score), and presence of depression independently influenced the TCT at discharge. These factors should be carefully assessed at the baseline to plan a tailoring rehabilitation treatment achieving the best trunk control performance at discharge.
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Affiliation(s)
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Erika Guolo
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | - Lucia Avila
- Fondazione Don Carlo Gnocchi, Marina di Massa, Italy
| | | | - Antonello Grippo
- SOD Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Choi W, Lee J, Lee S. Effects of lumbar joint mobilization on trunk function, postural balance, and gait in patients with chronic stroke: A randomized pilot study. J Back Musculoskelet Rehabil 2023; 36:79-86. [PMID: 35938238 DOI: 10.3233/bmr-200046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Wonjae Choi
- Department of Physical Therapy, Joongbu University, Geumsan-gun, Chungcheongnam-do, Korea
| | - Jieun Lee
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, Korea
| | - Seungwon Lee
- Department of Physical Therapy, Joongbu University, Geumsan-gun, Chungcheongnam-do, Korea.,Department of Physical Therapy, Sahmyook University, Seoul, Korea
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Effectiveness of the Pelvic Clock and Static Bicycle Exercises on Wisconsin Gait Scale and Trunk Impairment Scale in Chronic Ambulatory Hemiplegic Patients: A Single Group Pre-Post Design. Healthcare (Basel) 2023; 11:healthcare11020279. [PMID: 36673647 PMCID: PMC9859298 DOI: 10.3390/healthcare11020279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Most Hemiplegic patients achieve ambulatory function during the sub-acute stage of stroke. Though ambulatory, they still perform an unpleasant awkward gait with remarkable compensations requiring more energy expenditure. Fatigue arises at an early duration as a result of increased energy expenditure. The walking pattern becomes circumduction, featured by asymmetry with an extensor synergy of the lower limb. Each step is rotated away from the body then towards the body, forming a semicircle. This leads to changes in various parameters of gait (spatiotemporal, kinematic, and kinetic) in hemiparetic patients. PURPOSE Many studies reveal the effectiveness of various therapeutic techniques in managing hemiplegic circumduction gait. Pelvic clock exercises aid in improving pelvic rotation components and cause dissociation in impaired pelvic mobility due to spasticity. A static bicycle helps in enhancing proper control between the hamstrings and quadriceps. It also helps in improving knee flexion range. As the patient places the foot in the cycle's petals, it helps to enhance dorsiflexion and eversion functions as well. As the lower body is exercised, there could be relative changes in the upper body, i.e., the trunk. Thus, this study aimed to determine the changes in gait functions and trunk performance of chronic ambulatory hemiplegic patients in response to the above therapies for four weeks. METHOD Twenty-five subjects (post-stroke duration (2.8 ± 0.6) years) who could walk 10 m independently without assistance or support of aid participated in a pelvic clock and static bicycle exercise intervention. The session duration was 30 min a day, and therapy was delivered six days a week and continued for four weeks. The entire program was carried out in an outpatient neurorehabilitation center. RESULTS After the intervention with pelvic clock and static bicycle exercises, there was a remarkable change in gait and trunk functions in chronic hemiplegic patients. CONCLUSION The exercises comprising pelvic clock and static bicycle showed positive differences in gait and trunk functions in chronic stage hemiplegic patients. Later, randomized controlled studies involving larger sample sizes, advanced activation techniques, and increased intervention duration will explore in-depth information on their effectiveness and clinical significance.
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Ademoyegun AB, Mbada CE, Sonuga OA, Malomo OE, Fatai WA, Aghedo IA. Does grip strength of the less-affected side of ischemic stroke survivors influences performance of self-care activities? BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-022-00090-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and aim
Adequate grip strength is needed to execute various self-care activities. This study was aimed to assess the influence of grip strength of the less-affected side of ischemic stroke survivors on performance of self-care activities, and also to determine the reference values of less-affected grip strength needed for independent performance of each of the self-care activities.
Methods
Seventy-three consenting patients with ischemic stroke participated in this cross-sectional study. Handheld dynamometer was used to measure grip strength of the less-affected hand, while functional independence measure was used to evaluate self-care activities (eating, grooming, bathing, dressing of upper body, dressing of lower body and toileting) as independent and dependent. Data was analyzed using inferential statistics of Pearson’s correlation, binomial logistic regression, and receiver operating characteristics. Alpha level was set at p < 0.05.
Results
The mean hand grip strength, functional independence measure and trunk control test scores were 23.8 kg, 29.9 kg, and 68.2 kg respectively. Grip strength was significantly associated with independence in all of the self-care activities (p < 0.05). Less-affected grip strength of 19.5 kg (sensitivity, 80.4%; specificity, 80.1%; area under curve, 0.85), 23.7 kg (sensitivity, 79%; specificity, 72.2%; area under curve, 0.79), 24.8 kg (sensitivity, 70.2%; specificity, 65.2%; area under curve, 0.75), 24.7 kg (sensitivity, 82.1%; specificity, 80.1%; area under curve, 0.84), 23.7 kg (sensitivity, 80.1%; specificity, 76.1%; area under curve, 0.84), and 19.9 kg (sensitivity, 76.9%; specificity, 76.2%; area under curve, 0.79) was needed for independent performance in eating, grooming, bathing, dressing of upper body, dressing of lower body, and toileting respectively.
Conclusion
The less-affected grip strength of patients with ischemic stroke influences their ability to independently perform self-care activities. The reference values of less-affected grip strength in association with other stroke-related characteristics may help clinicians to estimate independence in eating, grooming, bathing, dressing of upper body, dressing of lower body, and toileting among patients with ischemic stroke.
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Dinesh M, Thenmozhi P, KalaBarathi S. Proprioceptive Neuromuscular Facilitation Neck Pattern and Trunk Specific Exercise on Trunk Control and Balance—an Experimental Study. Int J Ther Massage Bodywork 2022; 15:9-17. [PMCID: PMC9683997 DOI: 10.3822/ijtmb.v15i4.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Most stroke survivors continue to live with disabilities and may require physical rehabilitation to control the trunk and balance during the post-stroke period. The cause of lack of trunk control and balance among stroke patients is the weakened trunk muscle strength. Purpose To study the effect of proprioceptive neuromuscular facilitation (PNF) neck pattern and trunk-specific exercise on trunk control and balance among stroke patients. Setting The study was conducted at the medical wards of Saveetha Medical College and Hospital, Chennai, India. Participants Sixty patients with stroke who met the inclusion criteria participated in the study. Research Design This is a quasi-experimental study. Intervention PNF trunk-specific exercise was administered to the experimental group for 45 min of 28 sessions, which contained 15 min of stretching exercise and 30 min trunk-specific exercise. The control group received routine hospital care services. Main Outcome Measures The study’s primary outcome was balance and trunk control, measured by the Berg Balance Scale (BBS) and Trunk Impairment Scale (TIS) before the intervention and at the end of the intervention of 28 days. Results Within-group analysis, paired t test showed a significant improvement comparing the trunk control and balance score before (13.40±1.04 & 25.40±1.81) and after (15.03±0.96 & 27.07± 1.48) the intervention in the experimental group (p < .001). Between-group analysis, both the experimental and control group post-test mean score of TIS (15.03±0.96 &13.70±1.15) and BBS (27.07±1.48 & 25.30±1.73) showed significant difference (p < .001). Conclusion PNF neck pattern and trunk-specific exercise used in this study effectively improved balance and trunk control among patients with stroke.
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Affiliation(s)
- Marimuthu Dinesh
- Nursing (NPCC II Year), Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai
| | - Paluchamy Thenmozhi
- Medical Surgical Nursing Department, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai,Corresponding author: Paluchamy Thenmozhi, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai – 602105, Tamilnadu, India,
| | - Selvaraj KalaBarathi
- Obstetrics and Gynecological Nursing Department, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Lee SJ, Lee EC, Kim M, Ko SH, Huh S, Choi W, Shin YI, Min JH. Feasibility of dance therapy using telerehabilitation on trunk control and balance training in patients with stroke: A pilot study. Medicine (Baltimore) 2022; 101:e30286. [PMID: 36107516 PMCID: PMC9439746 DOI: 10.1097/md.0000000000030286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This randomized controlled trial aimed to investigate the effects of dance therapy using telerehabilitation on trunk control and balance training in patients with stroke and compare them with the effects of conventional treatment. METHODS We enrolled 17 patients with subacute or chronic stroke who were randomly assigned to either an experimental or a control group. In addition to conventional physical therapy, the experimental group (n = 9) participated in 40-minute, non-face-to-face, dance-therapy sessions and the control group (n = 8) received conventional physical therapy. The primary outcome measures were the Trunk Impairment Scale (TIS) scores to assess trunk control and balance function between the 2 groups as a measure of change from baseline to after the intervention. RESULTS We found that the TIS scores of the patients in the experimental group significantly improved (P = .017). The TIS results indicated non-inferiority within a predefined margin for dance therapy using telerehabilitation (difference = -0.86, 95% confidence interval [CI] = -2.21 to 0.50). CONCLUSION Dance therapy using telerehabilitation significantly improved the TIS scores in the experimental group and was not inferior to conventional rehabilitation treatment when compared in a non-inferiority test. The remote dance program may therefore have similar effects to those of conventional treatment regarding trunk-control improvement in patients with stroke.
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Affiliation(s)
- So Jung Lee
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Eun Chae Lee
- Gyeongnam Regional Health & Medical Center for Persons with Disabilities, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Muhyun Kim
- Department of Dance, Sejong University, Seoul
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sungchul Huh
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Woosik Choi
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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Luna TD, Santamaria V, Ai X, Agrawal SK. Reactive Postural Control During Sit-to-Stand Motion. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3181351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tatiana D. Luna
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Victor Santamaria
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Xupeng Ai
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Sunil K. Agrawal
- Department of Mechanical Engineering, Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
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Eizad A, Lee H, Pyo S, Oh MK, Lyu SK, Yoon J. Study on the Effects of Different Seat and Leg Support Conditions of a Trunk Rehabilitation Robot. IEEE Trans Neural Syst Rehabil Eng 2022; 30:812-822. [PMID: 35294353 DOI: 10.1109/tnsre.2022.3160188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Performance of trunk rehabilitation exercises while sitting on movable surfaces with feet on the ground can increase trunk and leg muscle activations, and constraining the feet to move with the seat isolates control of the trunk. However, there are no detailed studies on the effects of these different leg supports on the trunk and leg muscle activations under unstable and forcefully perturbed seating conditions. We have recently devised a trunk rehabilitation robot that can generate unstable and forcefully perturbed sitting surfaces, and can be used with ground-mounted or seat-connected footrests. In this study, we have evaluated the differences in balance performance, trunk movement and muscle activation (trunk and legs) of fourteen healthy adults caused by the use of these different footrest configurations under the different seating scenarios. The center of pressure and trunk movement results show that the seat-connected footrest may be a more suitable choice for use in a balance recovery focused rehabilitation protocol, while the ground-mounted footrest may be a more suitable choice for a trunk movement focused rehabilitation protocol. Although it is difficult to make a clear selection between footrests due to the mixed trends observed in the muscle activation results, it appears that the seat-connected footrest may be preferable for use with the unstable seat as it causes greater muscle activations. Furthermore, the results provide limited evidence that targeting of a particular muscle group may be possible through careful selection of the seat and footrest conditions. Therefore, it may be possible to utilize the trunk rehabilitation robot to maximize the training outcomes for a wide range of patients through careful selection of training protocols.
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Immediate Effects of Single-Session High-Velocity Training for Lateral Trunk Movement on Gait Function in Early Postoperative Patients after Total Hip Arthroplasty: A Nonrandomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10020256. [PMID: 35206872 PMCID: PMC8871938 DOI: 10.3390/healthcare10020256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Total Hip Arthroplasty (THA) is an effective method for relieving pain and improving gait function. However, THA patients demonstrate slow gait speed at discharge. Rehabilitation programs after THA require the immediate improvement of gait speed early in the postoperative period. To examine the immediate effects of seated side tapping training (SSTT), which focuses on lateral trunk movement and movement velocity, on gait function in early postoperative THA patients, the methods were as follows: The SSTT group performed five repetitions of a task in which they moved their trunks laterally to alternately touch markers to their left and right side as quickly as possible 10 times in a seated position. One set of SSTT lasted approximately 3 min. The control group rested in a seated position for 10 min. Results: Significant interactions were observed for gait speed, stride time, and stride time coefficient of variability. The SSTT group demonstrated significant pre-post-intervention improvement in gait speed, stride time, and coefficient of variability. Conclusions: SSTT improved both gait speed and gait stability and can be performed easily and safely. Therefore, single-session high-velocity trunk training may be an effective method to improve gait function immediately in early postoperative THA patients.
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Eizad A, Lee H, Lee J, Yoon J. Evaluation of TENS Based Biofeedback and Warning for Improvement of Seated Balance on a Trunk Rehabilitation Robot. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3191269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Amre Eizad
- School of Integrated Technology, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Hosu Lee
- School of Integrated Technology, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Junyeong Lee
- School of Integrated Technology, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Jungwon Yoon
- School of Integrated Technology, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
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Dasoju V, Kovela RK, Tedla JS, Sangadala DR, Reddy RS. Psychometric properties of trunk impairment scale in children with spastic diplegia. Sci Rep 2021; 11:18529. [PMID: 34535713 PMCID: PMC8448770 DOI: 10.1038/s41598-021-98104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022] Open
Abstract
The Trunk Impairment Scale (TIS) is a valid and reliable tool to assess trunk impairment in children with heterogeneous cerebral palsy. The purpose of this study was to determine the reliability and validity of the TIS in assessing children with spastic diplegic cerebral palsy. The sample was a total of 30 subjects (15 = boys, 15 = girls). All subjects underwent an assessment of the sitting component of the Gross Motor Function Measure-88 and TIS by rater 1. Rater one observed video recordings within 24 h and scored TIS for intra-rater reliability, while rater two did likewise after 48 h for inter-rater reliability. The mean and standard deviation of the TIS and sitting components of the Gross Motor Function Measure-88 were 15.66 ± 4.20 and 52.36 ± 6.26, respectively. We established intra-rater and inter-rater reliability of the TIS with Intra Class Correlation Coefficient 0.991 and 0.972, respectively. The concurrent validity of the TIS with the sitting component of the Gross Motor Function Measure-88 was good, with an r-value of 0.844 (p < 0.001). This study showed the excellent intra-rater and inter-rater reliability and high concurrent validity of the TIS in assessing children with spastic diplegic cerebral palsy.
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Affiliation(s)
- Vedasri Dasoju
- Department of Physical Therapy, Krishna Institute of Medical Sciences, Secunderabad, India
| | - Rakesh Krishna Kovela
- Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Devika Rani Sangadala
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
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Calvo MF, Valencia OD, González JP, Palma F, Mella W, Cárcamo M. [Trunk kinematics during walking in stroke patients: A systematic review]. Rehabilitacion (Madr) 2020; 55:218-227. [PMID: 33280836 DOI: 10.1016/j.rh.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022]
Abstract
The trunk and pelvis are affected after stroke, predisposing individuals to falls and dependency. The aim of this review was to describe the lineal and angular kinematics of the trunk and pelvis in patients with post-stroke sequels during walking. We included studies published up to June 2018 using a 2-3 D motion capture system during walking. We searched the Cochrane, Medline, PEDRo, Lilacs, Scielo, EBSCO, ClinicalKey and Elsevier databases. Twelve articles were selected. Linear kinematics showed greater lateral displacement and acceleration in all axes. Angular kinematics in the swing phase of the paretic segment showed the pelvis in posterior rotation, with elevation and lower velocity and the trunk in anterior flexion, with lateral inclination and ipsilateral rotation. The studies showed wide variability, making it impossible to establish of a common effect. However, the results allow description of the movement of the trunk and pelvis.
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Affiliation(s)
- M F Calvo
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - O D Valencia
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - J P González
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Palma
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - W Mella
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Cárcamo
- Departamento de Salud Pública y Epidemiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
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Prat-Luri A, Moreno-Navarro P, García JA, Barbado D, Vera-Garcia FJ, Elvira JL. Do Initial Trunk Impairment, Age, Intervention Onset, and Training Volume Modulate the Effectiveness of Additional Trunk Exercise Programs after Stroke? A Systematic Review with Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8714. [PMID: 33255211 PMCID: PMC7727690 DOI: 10.3390/ijerph17238714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022]
Abstract
The aim of this systematic review is to analyze how, after additional trunk-focused training programs (ATEP), motor recovery after a stroke is modulated by potential effect modifiers. Twenty randomized controlled studies that carried out ATEP were included. Results showed moderate-to-high effects in favor of ATEP for trunk function, balance ability, gait performance, and functional mobility. Studies with a higher initial trunk impairment obtained a higher effect on trunk function and balance; studies with older participants had a higher effect on trunk function, limit of stability, and functional mobility, but not on balance ability. Older and more affected patients were, as well, those who started the intervention earlier, which was also linked with higher effects on trunk function, balance, and gait performance. Longer ATEP found a high effect on trunk function and balance ability. The potential effect modifiers seem to be important in the modulation of the effectiveness of ATEP and should be considered in the design of rehabilitation programs. Thus, since potential effect modifiers seem to modulate ATEP effectiveness, future studies should consider them in their experimental designs to better understand their impact on stroke rehabilitation.
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Affiliation(s)
- Amaya Prat-Luri
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
| | - Pedro Moreno-Navarro
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
| | - Jose A. García
- Infectious Diseases Unit, Hospital General Universitario de Elche, Miguel Hernández University of Elche, 03203 Elche, Spain;
| | - David Barbado
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
| | - Francisco J. Vera-Garcia
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
| | - Jose L.L. Elvira
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.P.-L.); (P.M.-N.); (F.J.V.-G.); (J.L.L.E.)
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Effect of Task-Specific Training on Trunk Control and Balance in Patients with Subacute Stroke. Neurol Res Int 2020; 2020:5090193. [PMID: 33294224 PMCID: PMC7688364 DOI: 10.1155/2020/5090193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Impairment of static and dynamic posture control is common after stroke. It is found to be a predictor and an essential component for balance, walking ability, and activities of daily living (ADL) outcomes. Studies investigating effect of physical therapy techniques with an aim to improve trunk function after stroke are limited. This study aimed at studying the effect of task-specific training on trunk control and balance in patients with subacute stroke. Methods In this randomized controlled trail, thirty-four patients were alienated into two equal groups. The study group (n = 17) received task-specific training, and the control group (n = 17) received conventional physical therapy based on the neurodevelopmental technique. Task-specific training was applied through two phases with criteria of progression based on Chedoke-McMaster Stroke Assessment postural control stages. The interventions were applied in a dosage of 60 min per session, three times a week for ten weeks. Static and dynamic balance were measured by the trunk impairment scale (TIS), postural assessment scale (PAS), and functional reach test (FRT). Laser-guided digital goniometer was used to measure the trunk ranges of motions (ROM) as a secondary outcome. Results Significant differences between the baseline and the follow-up measures including TIS, PAS, FRT, and trunk (ROM) were found in both groups (P ≤ 0.05). In-between group comparison also showed significant differences between the results of both groups indicating more improvements among patients representing the study group. Conclusion Task-specific training may be effective in improving the static and dynamic postural control and trunk ranges of motion among subacute stroke patients.
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Silveira EA, Barbosa LS, Noll M, Pinheiro HA, de Oliveira C. Body fat percentage prediction in older adults: Agreement between anthropometric equations and DXA. Clin Nutr 2020; 40:2091-2099. [PMID: 33071014 DOI: 10.1016/j.clnu.2020.09.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/26/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is difficult to measure body fat percentage in clinical settings. Equations using anthropometric measures are more feasible and can be used to estimate body fat. However, there is a need to analyze their accuracy in older adults. Our study aims to validate the use of anthropometric equations to estimate body fat percentage in older men and women. METHODS This study evaluated data from 127 Brazilian individuals aged between 60 and 91 years. Weight, height, skinfold thickness and waist and hip circumferences were measured. Seventeen anthropometric equations were tested using the crossed validity criteria suggested by Lohman and the graph analysis proposed by Bland and Altman and by Lin was also performed. The gold-standard method for comparing the anthropometric equations was the dual-energy absorptiometry X-ray (DXA). RESULTS The average body fat percentage was 30.2 ± 8.6% in men and 43.4 ± 7.9% in women (p < 0.001). In men, the equations which used skinfold thickness presented amplitude of 11.48%, while in women, amplitude's constant error (CE) was 22.88%. The equations based on circumferences and BMI presented CE variation from -5.3% to 29.68% on the estimation of body fat percentage, which means that a same male individual can have the total body adiposity diagnosed with 34.98% of variation, depending on the selection of the employed equation. For women this CE variation was 12.44%. CONCLUSION Overall, all the equations yielded different results from the DXA. However, the best equations for male were the one of Lean et al. (1996), which uses the waist circumference, and for women the one of Deurenberg et al. (1991), developed from the body mass index. The need of developing specific equations for older adults still remains, since even the two best equations showed considerable limitations on predicating body fat percentage.
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Affiliation(s)
- Erika Aparecida Silveira
- Faculty of Medicine, Health Sciences Graduate Program, Federal University of Goiás, Brazil; Epidemiology & Public Health Department, University College London, England, UK.
| | | | - Matias Noll
- Faculty of Medicine, Health Sciences Graduate Program, Federal University of Goiás, Brazil; Instituto Federal Goiano, Brazil
| | | | - Cesar de Oliveira
- Epidemiology & Public Health Department, University College London, England, UK
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Thijs L, Denissen S, Mehrholz J, Elsner B, Lemmens R, Verheyden GSAF. Trunk training for improving activities in people with stroke. Hippokratia 2020. [DOI: 10.1002/14651858.cd013712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Liselot Thijs
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Stijn Denissen
- AIMS lab, Center for Neurosciences; UZ Brussel, Vrije Universiteit Brussel; Brussels Belgium
- icometrix; Leuven Belgium
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School; Technical University Dresden; Dresden Germany
| | - Bernhard Elsner
- Department of Public Health; Dresden Medical School, Technical University Dresden; Dresden Germany
| | - Robin Lemmens
- Department of Neurosciences, Laboratory for Neurobiology; UZ Leuven; Leuven Belgium
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20
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Walking characteristics including mild motor paralysis and slow walking speed in post-stroke patients. Sci Rep 2020; 10:11819. [PMID: 32678273 PMCID: PMC7366923 DOI: 10.1038/s41598-020-68905-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/30/2020] [Indexed: 11/08/2022] Open
Abstract
Walking speed is strongly influenced by the severity of motor paralysis in post-stroke patients. Nevertheless, some patients with mild motor paralysis still walk slowly. Factors associated with this difference in walking speed have not been elucidated. To confirm walking characteristics of patients with mild motor paralysis and slow walking speed, this study identified patient subgroups based on the association between the severity of motor paralysis and walking speed. Fugl-Meyer assessment synergy score (FMS) and the walking speed were measured (n = 42), and cluster analysis was performed based on the association between FMS and walking speed to identify the subgroups. FMS and walking speed were associated (ρ = 0.50); however, some patients walked slowly despite only mild motor paralysis. Cluster analysis using FMS and walking speed as the main variables classified patients into subgroups. Patients with mild motor paralysis (FMS: 18.4 ± 2.09 points) and slow walking speed (0.28 ± 0.14 m/s) exhibited poorer trunk stability, increased co-contraction of the shank muscle, and increased intramuscular coherence in walking compared to other clusters. This group was identified by their inability to fully utilize the residual potential of motor function. In walking training, intervention in instability and excessive cortical control may be effective.
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Effect of Diagonal Pattern Training on Trunk Function, Balance, and Gait in Stroke Patients. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10134635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Trunk control disability commonly occurs after stroke. This study investigated the effect of diagonal pattern training in the sitting position to improve trunk control ability and gait performance. Method: 46 stroke patients were enrolled in this study. We used single plane training and diagonal pattern training. Additionally, the subjects were randomly assigned to the experiment group (diagonal pattern training) and the control group (single plane training). Diagonal pattern training was modified with proprioceptive neuromuscular facilitation technique’s chopping and lifting pattern to create 10 movements. Results: the trunk impairment scale score, Berg balance scale score, 10 m walking test result, and gait significantly increased in the experiment group compared to the control group. Conclusions: diagonal pattern training can be regarded as a promising method to improve postural control and increase balance and gait in stroke patients
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Jung KM, Joo MC, Jung YJ, Jang WN. The effects of the three-dimensional active trunk training exercise on trunk control ability, trunk muscle strength, and balance ability in sub-acute stroke patients: A randomized controlled pilot study. Technol Health Care 2020; 29:213-222. [PMID: 32568128 DOI: 10.3233/thc-181179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trunk control ability has been identified as an important early predictor of functional recovery after stroke. OBJECTIVE Our study aimed to investigate the effects of three-dimensional active trunk training exercise on trunk control ability, trunk muscle strength, and balance ability in sub-acute stroke patients. METHODS Twenty-four sub-acute stroke patients were randomly assigned to an experimental (n= 12) or control (n= 12) group. The experimental group (EG) performed three-dimensional active trunk training exercises using the Space Balance 3D system, while the control group (CG) performed only general trunk training exercises five times per week, for a total of three weeks. The Trunk Impairment Scale (TIS), trunk muscle strength, balance ability using the Space Balance 3D system, and Brunel Balance Assessment (BBA) scores were assessed before and after the intervention. RESULTS Pre-to-post intervention improvement was noted in all outcome measures for both groups (p< 0.05). Post intervention, the TIS, trunk muscle strength, static balance, and BBA scores were significantly higher in the EG than those in the CG (p< 0.05). CONCLUSION Our study suggests that the three-dimensional active trunk training exercise may be more effective compared to the general trunk training exercise in improving trunk control ability, trunk muscle strength, and balance ability in sub-acute stroke patients.
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Affiliation(s)
- Kyeoung-Man Jung
- Department of Physical Therapy, Won-Kwang University Hospital, Iksan, Korea
| | - Min-Cheol Joo
- Department of Rehabilitation Medicine, Won-Kwang University School of Medicine, Iksan, Korea
| | - You-Jin Jung
- Department of Occupational Therapy, Won-Kwang University Hospital, Iksan, Korea
| | - Woo-Nam Jang
- Department of Physical Therapy, College of Health Welfare, Yong-In University, Yongin, Korea
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Cho YH, Cho K, Park SJ. Effects of trunk rehabilitation with kinesio and placebo taping on static and dynamic sitting postural control in individuals with chronic stroke: A randomized controlled trial. Top Stroke Rehabil 2020; 27:610-619. [PMID: 32252619 DOI: 10.1080/10749357.2020.1747672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Impaired trunk postural control is common after stroke. Combining kinesio taping with trunk rehabilitation has been shown to enhance the recovery of postural control ability in patients with stroke.Objective: We investigated whether the combination of kinesio taping with trunk rehabilitation would improve dynamic and static sitting stability after stroke.Methods: Twenty-eight patients with stroke were recruited and randomly assigned to one of the two 8-week trunk rehabilitation programs with kinesio (experimental group) or placebo taping (control group). Outcome measures were dynamic forward, dynamic backward, affected-side, and unaffected-side sway areas, static sway area and length, and the total limit of stability (LOS) area. The variables were measured using the BioRescue analysis system. All outcome measures were assessed at baseline and after 8 weeks of trunk rehabilitation.Results: Significant increases were observed in the dynamic forward, dynamic backward, affected-side, and unaffected-side sway areas, and the total LOS area, in the experimental and control groups, whereas decreases were observed in the static sway area and length. The dynamic forward sway area was significantly higher in the experimental group than in the control group, but there were no significant differences between the groups in the other variables.Conclusions: Trunk rehabilitation is effective for improving dynamic and static sitting stability after stroke. The addition of kinesio taping to the back muscles further increases forward mobility.
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Affiliation(s)
- Yong-Hun Cho
- Department of physical therapy, AVENS Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Kyun Cho
- Department of physical therapy, AVENS Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Shin-Jun Park
- Department of Physical Therapy, Gangdong University, Chungcheongbuk-do, Republic of Korea
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Normann B, Arntzen EC, Sivertsen M. Comprehensive core stability intervention and coordination of care in acute and subacute stroke rehabilitation—a pilot study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1508497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Britt Normann
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Physiotherapy Department, Nordland Hospital Trust, Bodø, Norway
| | - Ellen Christin Arntzen
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Physiotherapy Department, Nordland Hospital Trust, Bodø, Norway
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Titus AW, Hillier S, Louw QA, Inglis-Jassiem G. An analysis of trunk kinematics and gait parameters in people with stroke. Afr J Disabil 2018; 7:310. [PMID: 29707514 PMCID: PMC5913771 DOI: 10.4102/ajod.v7i0.310] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/11/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Approximately two out of three people with stroke experience gait problems. Trunk movement control and symmetry is an important prerequisite for functional walking gait. Movement control, measured objectively as kinematics during walking gait, is rarely investigated. OBJECTIVE To describe the three-dimensional (3D) kinematics of the trunk during gait in people with stroke, including key spatiotemporal characteristics. METHODOLOGY A total of 17 adults with stroke who met the inclusion criteria were selected to participate in this cross-sectional pilot study. An eight-camera T-10 Vicon system with Nexus 1.8 software (Vicon Motion System Limited, Oxford, UK) was used to analyse the 3D kinematics of the trunk during self-selected walking speed. Trunk kinematics throughout the gait cycle and spatiotemporal parameters were extracted using custom-built scripts in MATLAB used at the Stellenbosch University Movement Analysis Laboratory. Stata Version 12.1 software was used to assess differences in trunk kinematics between the affected and unaffected sides during gait using the Sign test (statistical significance level p < 0.05). RESULTS Participants achieved functional gait speeds although they presented with asymmetrical trunk kinematics. During the full gait cycle, there were statistically significant differences of trunk motion between the affected and unaffected sides in the coronal plane (p < 0.001). There were statistically significant differences in the trunk kinematics between the affected side and unaffected sides at initial contact (p < 0.001) and foot off (p < 0.049) in the coronal plane as well as at initial contact (p < 0.000) and foot off (p < 0.013) in the transverse plane. CONCLUSION This pilot study found significant asymmetry in trunk motion between the affected and unaffected sides that varied across the gait cycle. This suggests the trunk may need to be targeted in clinical gait retraining post-stroke.
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Affiliation(s)
- Adnil W Titus
- Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa
| | - Susan Hillier
- Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa
- Sansom Institute For Health Research, University of South Australia, Australia
| | - Quinette A Louw
- Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa
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Lee HJ, Lee KE, Yi TI, Kim HY. Feedback Facility-Assisted Balance Training in a Patient With Multiple System Atrophy: A Case Presentation. PM R 2017; 10:555-559. [PMID: 28943458 DOI: 10.1016/j.pmrj.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/14/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Abstract
Multiple system atrophy is a rare neurodegenerative disease with a poor prognosis. Furthermore, there are no pharmacological or notable rehabilitation strategies available to prevent the worsening of the disease. This case presentation assessed the outcome of feedback facility-assisted balance training in combination with physical therapy in a 61-year-old man. The patient participated in 30 training sessions over 6 weeks for 30 minutes each that involved balance training. His static and dynamic balance abilities were improved on the Berg Balance Scale, Trunk Impairment Scale, Functional Independence Measure, and Functional Reach. Although this patient's gait speed and muscle strength did not show improvement after training, feedback facility-assisted balance training might be a potential strategy to help reduce the rate of symptom deterioration in patients with multiple system atrophy. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Hyo Jeong Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea.,Department of Rehabilitation Medicine, Seoul Chuk Hospital, 8, Dongsomun-ro 47 gil, Seongbuk-gu, Seoul, 02729, Korea
| | - Ko Eun Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea.,Department of Rehabilitation Medicine, Seoul Chuk Hospital, 8, Dongsomun-ro 47 gil, Seongbuk-gu, Seoul, 02729, Korea
| | - Tae Im Yi
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea.,Department of Rehabilitation Medicine, Seoul Chuk Hospital, 8, Dongsomun-ro 47 gil, Seongbuk-gu, Seoul, 02729, Korea
| | - Hyun Young Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea.,Department of Rehabilitation Medicine, Seoul Chuk Hospital, 8, Dongsomun-ro 47 gil, Seongbuk-gu, Seoul, 02729, Korea
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Tanaka H, Yokogawa M, Nakagawa T, Ibune M, Ishiwatari T, Kawakita S. Key function for obstacle crossing in hemiplegic persons with varied degrees of spasticity. J Phys Ther Sci 2017; 29:1381-1386. [PMID: 28878467 PMCID: PMC5574334 DOI: 10.1589/jpts.29.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 05/24/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To evaluate various key functions related to obstacle crossing motions in
hemiplegic people based on the paralysis degree. [Subjects and Methods] Thirty-seven
patients with maintenance-stage hemiplegia who could independently ambulate outdoors were
included. Subjects’ crossing movements were measured using obstacles with heights of 10%,
20%, and 30% of the trochanter length. The relationship among maximal crossing height and
isometric knee extension muscle strength, one leg standing time, Trunk Impairment Scale
score, disease duration, and subject age was examined, as was the target variable of
maximum crossing height and the top four measurement items, to determine the explanatory
variables. The participants were grouped based on Brunnstrom Recovery Stages III–IV
(severe spasticity) and V–VI (mild spasticity). [Results] The explanatory variables were
the Trunk Impairment Scale in the severe spasticity group and unaffected side-knee
extension muscle strength in the mild spasticity group (contribution rates: 75.6% and
21.0%, respectively). [Conclusion] Trunk function in the severe spasticity group majorly
contributed to crossing obstacles. Furthermore, knee extension muscle strength on the
unaffected side in the mild spasticity group moderately contributed to crossing obstacles.
Selecting and implementing a physical therapy routine that is aimed at improving function,
depending on the severity of paralysis, is necessary.
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Affiliation(s)
- Hideaki Tanaka
- Department of Physical Therapy, Keiju Medical Center, Japan.,Graduate Course of Rehabilitation Science, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Masami Yokogawa
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Takao Nakagawa
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Masahide Ibune
- Department of Physical Therapy, Keiju Medical Center, Japan
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Gonçalves RS, Krebs HI. MIT-Skywalker: considerations on the Design of a Body Weight Support System. J Neuroeng Rehabil 2017; 14:88. [PMID: 28877750 PMCID: PMC5588735 DOI: 10.1186/s12984-017-0302-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 08/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To provide body weight support during walking and balance training, one can employ two distinct embodiments: support through a harness hanging from an overhead system or support through a saddle/seat type. This paper presents a comparison of these two approaches. Ultimately, this comparison determined our selection of the body weight support system employed in the MIT-Skywalker, a robotic device developed for the rehabilitation/habilitation of gait and balance after a neurological injury. METHOD Here we will summarize our results with eight healthy subjects walking on the treadmill without any support, with 30% unloading supported by a harness hanging from an overhead system, and with a saddle/seat-like support system. We compared the center of mass as well as vertical and mediolateral trunk displacements across different walking speeds and support. RESULTS The bicycle/saddle system had the highest values for the mediolateral inclination, while the overhead harness body weight support showed the lowest values at all speeds. The differences were statistically significant. CONCLUSION We selected the bicycle/saddle system for the MIT-Skywalker. It allows faster don-and-doff, better centers the patient to the split treadmill, and allows all forms of training. The overhead harness body weight support might be adequate for rhythmic walking training but limits any potential for balance training.
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Affiliation(s)
- Rogério Sales Gonçalves
- Federal University of Uberlândia/Brazil, School of Mechanical Engineering, Av. João Naves de Ávila 2121 Campus Santa Monica CX 593, Uberlândia, MG CEP 38408-100 Brazil
- Mechanical Engineering Department, The Eric P. and Evelyn E. Newman Laboratory for Biomechanics and Human Rehabilitation, Massachusetts Institute of Technology – MIT, Boston, USA
| | - Hermano Igo Krebs
- Mechanical Engineering Department, Principal Research Scientist & Lecturer MIT, Room 3-137 Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139-4307 USA
- Neurology Department, University of Maryland, School of Medicine, Baltimore, USA
- Mechanical Science and Bioengineering Department, Osaka University, Suita, Japan
- Fujita Health University, School of Medicine, Toyoake, Japan
- Newcastle University, Institute of Neuroscience, Newcastle, UK
- Loughborough University, The Wolfson School of Engineering, Loughborough, UK
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Sá CDSCD, Fávero FM, Voos MC, Choren F, Carvalho RDP. Versão brasileira da Segmental Assessment of Trunk Control (SATCo). FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/16955824012017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RESUMO Traduziu-se e adaptou-se para o português do Brasil o teste Segmental Assessment of Trunk Control (SATCo). Dois profissionais proficientes na língua inglesa traduziram, independentemente, a escala original para o português do Brasil (T1 e T2). Em seguida, gerou-se a versão traduzida de consenso (TU). Dois tradutores realizaram duas versões em inglês (RT1 e RT2) da versão TU. Um novo processo de consenso entre tradutores e pesquisadores resultou em uma versão em inglês (RTfinal), que foi comparada com a versão original, com vistas a possíveis diferenças semânticas. A versão do instrumento em português do Brasil (TU), denominada “Avaliação Segmentar do Controle de Tronco”, foi revisada pela comissão de especialistas, composta por três fisioterapeutas, para verificação do conteúdo e gerou a segunda versão de concordância (Tfinal). Tfinal foi encaminhada a uma das autoras da escala original para verificar o entendimento da versão em português do Brasil. Após essa etapa, 20 fisioterapeutas aplicaram a escala em crianças com paralisia cerebral. Parte dos fisioterapeutas indica a necessidade de complementação de informação na descrição das instruções e na descrição da pontuação.
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An SH, Park DS. The Effects of Trunk Exercise on Mobility, Balance and Trunk Control of Stroke Patients. ACTA ACUST UNITED AC 2017. [DOI: 10.13066/kspm.2017.12.1.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seung-Heon An
- Dept. of Physical Therapy, National Rehabilitation Hospital
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31
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Wahsh HA, Shoukry KE, Mohamed NE. Effect of trunk belt on function in children with diplegia. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2016. [DOI: 10.4103/1110-6611.196777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Haruyama K, Kawakami M, Otsuka T. Effect of Core Stability Training on Trunk Function, Standing Balance, and Mobility in Stroke Patients. Neurorehabil Neural Repair 2016; 31:240-249. [PMID: 27821673 DOI: 10.1177/1545968316675431] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trunk function is important for standing balance, mobility, and functional outcome after stroke, but few studies have evaluated the effects of exercises aimed at improving core stability in stroke patients. OBJECTIVE To investigate the effectiveness of core stability training on trunk function, standing balance, and mobility in stroke patients. METHODS An assessor-blinded, randomized controlled trial was undertaken in a stroke rehabilitation ward, with 32 participants randomly assigned to an experimental group or a control group (n = 16 each). The experimental group received 400 minutes of core stability training in place of conventional programs within total training time, while the control group received only conventional programs. Primary outcome measures were evaluated using the Trunk Impairment Scale (TIS), which reflects trunk function. Secondary outcome measures were evaluated by pelvic tilt active range of motion in the sagittal plane, the Balance Evaluation Systems Test-brief version (Brief-BESTest), Functional Reach test, Timed Up-and-Go test (TUG), and Functional Ambulation Categories (FAC). A general linear repeated-measures model was used to analyze the results. RESULTS A treatment effect was found for the experimental group on the dynamic balance subscale and total score of the TIS ( P = .002 and P < .001, respectively), pelvic tilt active range of motion ( P < .001), Brief-BESTest ( P < .001), TUG ( P = .008), and FAC ( P = .022). CONCLUSIONS Core stability training has beneficial effects on trunk function, standing balance, and mobility in stroke patients. Our findings might provide support for introducing core stability training in stroke rehabilitation.
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Affiliation(s)
- Koshiro Haruyama
- 1 Department of Rehabilitation Medicine, Higashisaitama National Hospital, Saitama, Japan
| | - Michiyuki Kawakami
- 2 Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomoyoshi Otsuka
- 1 Department of Rehabilitation Medicine, Higashisaitama National Hospital, Saitama, Japan
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Kim JS, Oh DW. Real-time ultrasound imaging biofeedback training is diaphragmatic function in nontraumatic cervical spinal cord injury: a single-subject experimental study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.1080/21679169.2016.1247909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ji-Seon Kim
- Department of Physical Therapy, College of Health and Welfare, Kyungwoon University, Gumi-si, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health Science, Cheongju University, Cheongju-si, Republic of Korea
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Learman KE, Benedict JA, Ellis AR, Neal AR, Wright JA, Landgraff NC. An exploration of trunk reposition error in subjects with acute stroke: An observational design. Top Stroke Rehabil 2016; 23:200-7. [PMID: 27077979 DOI: 10.1080/10749357.2016.1138671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND & OBJECTIVE Trunk reposition error (TRE) is a component of trunk control, yet has not been reported in acute stroke. The purpose of this study was to quantify TRE in acute stroke and report this with related rehabilitation outcomes. METHODS Sixty subjects, 30 with acute stroke and 30 healthy controls, completed this study. Subjects with acute stroke were measured before and after an in-patient acute rehabilitation stay. MEASURES TRE using an electromagnetic tracking device, Berg Balance Scale, Postural Assessment Scale for Stroke, and Functional Independence Measures. Pre-post measures were analyzed with paired t-tests. Between-group measures were analyzed with independent w-tests. RESULTS There were significant between group differences (acute stroke vs. controls) for all functional outcome measures (P < 0.001) and for three-dimensional TRE (P = 0.001). There were significant improvements in all functional outcome measures following an in-patient rehabilitation stay (P < 0.001). All measures of TRE reduced but did not achieve significance. CONCLUSION TRE was not as severely impaired as anticipated and was variable based on plane of measure. Time in a rehabilitation setting produced significant improvements in functional outcomes but TRE improvements were not as robust. These results indicate a need for further investigation of the strength of the interrelationship between TRE and function.
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Affiliation(s)
- Kenneth E Learman
- a Department of Physical Therapy , Youngstown State University , Youngstown , OH , USA
| | - James A Benedict
- a Department of Physical Therapy , Youngstown State University , Youngstown , OH , USA
| | - Alyson R Ellis
- b Texas Physical Therapy Specialists , New Braunfels , TX , USA
| | - Ashley R Neal
- c Centers for Rehabilitation Services , University of Pittsburgh Medical Center , Shadyside , PA , USA
| | | | - Nancy C Landgraff
- a Department of Physical Therapy , Youngstown State University , Youngstown , OH , USA
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Jung KS, Cho HY, In TS. Trunk exercises performed on an unstable surface improve trunk muscle activation, postural control, and gait speed in patients with stroke. J Phys Ther Sci 2016; 28:940-4. [PMID: 27134389 PMCID: PMC4842470 DOI: 10.1589/jpts.28.940] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study examined the effects of trunk exercises performed on an unstable
surface on trunk muscle activation, postural control, and gait speed in stroke patients.
[Subjects] Twenty-four participants with stroke were recruited in this study and randomly
distributed into experimental (n = 12) and control groups (n = 12). [Methods] Subjects in
the experimental group participated in trunk exercises on the balance pad for 30 min, five
times a week for 4 weeks; those in the control group performed trunk exercises on a stable
surface for 30 min, five times a week for 4 weeks. Trunk muscle activation was measured by
using surface electromyography, and trunk control was evaluated with the Trunk Impairment
Scale (TIS). Gait speed was measured with the 10-Meter Walk Test. [Results] Activity of
the external and internal oblique muscles in the experimental group was significantly
higher than that in the control group. The TIS score of the experimental group showed
significantly greater improvement than did that of the control group. The 10-Meter Walk
Test (10MWT) score also significantly improved in the experimental group. [Conclusion]
Trunk exercises on an unstable surface improve trunk muscle activation, postural control,
and gait speed in patients with hemiparetic stroke.
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Affiliation(s)
- Kyoung-Sim Jung
- Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Republic of Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, College of Health Science, Gachon University: 191 Hambangmoe-ro, Yeonsu-gu, Incheon 406-799, Republic of Korea
| | - Tae-Sung In
- Department of Physical Therapy, Shin-Hwa Rehabilitation Hospital, Republic of Korea
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Vadas D, Kalichman L. Post-stroke hip fracture in older people: A narrative review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.2.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: A hip fracture is a serious and common complication after stroke. Individuals often experience particular gait problems post-stroke and may have difficulty with everyday activities such as walking. Therefore, the interventions for falls prevention in older patients should be re-examined when applied to the post-stroke population. This study reviews the risk factors for falls and hip fractures that are specific to the post-stroke population and the measures that may be taken to prevent hip fractures and/or falls in this patient group. Method: A narrative review of articles written in English in the scientific literature on the risk factors, natural history and prevention of hip fractures in post-stroke patients. Results: The interventions that were reviewed showed some benefit to post-stroke patients. These included interventions designed to increase physical activity, water-based exercise, general falls prevention programmes, and the use of force platforms and body weight supported treadmills. More solid evidence was found to support strategies such as the symmetrical use of limbs, which provides appropriate support and an environment where an individual can regain more normal movement patterns. This can be achieved by training in a low-gravity environment using water-based exercises or a body-weight supported treadmill. To perform more symmetrical movements, biofeedback (visual feedback) or a force platform can be used in addition to symmetrical exercises. Conclusions: In a post-stroke population, it is better to pay special attention to the prevention of falls and hip fracture than to rehabilitate after a fracture has occurred. Evaluation and management of the risk factors that contribute to falls should be a priority in post-stroke rehabilitation, focusing on as many risk factors as possible in hip fracture prevention programmes. A variety of techniques should be used to facilitate functional recovery, emphasising symmetry and optimal movement patterns.
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Affiliation(s)
- Dor Vadas
- Israeli Center for Rehabilitation of Stroke and Traumatic Brain Injury Patients, Rehovot, Israel
| | - Leonid Kalichman
- Senior lecturer, Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Kılınç M, Avcu F, Onursal O, Ayvat E, Savcun Demirci C, Aksu Yildirim S. The effects of Bobath-based trunk exercises on trunk control, functional capacity, balance, and gait: a pilot randomized controlled trial. Top Stroke Rehabil 2015; 23:50-8. [PMID: 26260878 DOI: 10.1179/1945511915y.0000000011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of Bobath-based individually designed trunk exercises on trunk control, upper and lower extremity function, and walking and balance in stroke patients. The main aim of treatment was to eliminate individual trunk impairments during various patient functions. METHODS The study was planned as an assessor-blinded, randomized controlled trial. A total of 22 patients volunteered to participate in the study. Trunk function, functional capacity, and gait were assessed with the Trunk Impairment Scale (TIS), stroke rehabilitation assessment of movement (STREAM), and a 10-m walking test, respectively. The Berg Balance Test (BBT), functional reach (FR), and timed up-and-go (TUG) tests were used to evaluate balance. After the initial assessment, the patients were divided randomly into two groups, the study group (12 patients) and the control group (10 patients). The mean age of the patients in the study group was 55.91 years (duration of stroke 58.66 months) and that of the control group was 54.00 years (duration of stroke 67.20 months). Individual training programs were determined for the patients in the study group, taking into consideration their evaluation results; and strengthening, stretching, range of motion, and mat exercises were determined for the control group according to their functional level. The participants in both groups were taken into the physiotherapy program for 12 weeks, 3 days a week for 1 hour a day. RESULTS In group analyses, both groups showed improvement in STREAM, TIS, and TUG tests. Only the study group produced significant gains in the BBT, FR, and 10 m walking tests (P < 0.05). According to the pre- and post-treatment results, no significant difference was observed in any of the evaluated parameters between the two groups (P>0.05). CONCLUSION Individually developed exercise programs in the Bobath concept improve trunk performance, balance, and walking ability in stroke patients more than do conventional exercises.
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Affiliation(s)
- Muhammed Kılınç
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Ankara, Turkey
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Kong SW, Jeong YW, Kim JY. Correlation between balance and gait according to pelvic displacement in stroke patients. J Phys Ther Sci 2015; 27:2171-4. [PMID: 26311948 PMCID: PMC4540843 DOI: 10.1589/jpts.27.2171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/03/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the correlations of balance and
gait according to pelvic displacement in stroke patients. [Subjects] The subjects of this
study were 58 stroke patients who had been admitted to a hospital. [Methods] A Global
Postural System was used to measure pelvic displacement. To measure the balance ability, a
Tetrax balance system was used to measure the weight distribution index and stability
index. Gait ability was measured during the 10-Meter Walking Test and Figure-of-8 Walk
Test. [Results] The results of this study showed that was significant positive correlation
between the anterior superior iliac spine height difference in pelvic displacement and the
weight distribution index and significant positive correlation between the posterior
superior iliac spine height difference and the stability index in the normal position with
the eyes closed. Statistically significant positive correlation also was found between the
anterior superior iliac spine height difference and the straight and curved gait ability.
[Conclusion] The increased pelvic displacement in stroke patients results in a decrease in
balance ability and gait speed. This suggests that control of pelvic displacement is
necessary before functional training for patients with stroke.
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Affiliation(s)
- Seon Woong Kong
- Department of Physical Therapy, Saemirae Hospital, Republic of Korea
| | - Yeon Woo Jeong
- Department of Physical Therapy, Kwangju Women's University, Republic of Korea
| | - Jin Young Kim
- Department of Occupational Therapy, Howon University, Republic of Korea
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Jung K, Kim Y, Chung Y, Hwang S. Weight-shift training improves trunk control, proprioception, and balance in patients with chronic hemiparetic stroke. TOHOKU J EXP MED 2014; 232:195-9. [PMID: 24646921 DOI: 10.1620/tjem.232.195] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Trunk instability is one of main problems in survivors following stroke. We investigated the effects of weight-shift training (WST) on an unstable surface in sitting position on trunk control, proprioception, and balance in individuals with chronic hemiparetic stroke. Eighteen participants with chronic hemiparetic stroke were recruited and were allocated to either WST or control group. The WST group received a weight-shift training program for 30 min and then received a conventional exercise program for 30 min, while the control group received conventional exercise program for 60 min, five times a week for four weeks for both groups. In this randomized control study, we used three outcome measures: trunk reposition error (TRE), Trunk Impairment Scale (TIS), and Timed Up and Go (TUG) test. TRE was measured by each participant's reposition error to the target angle during his/her active trunk movement. TIS and TUG were examined for trunk control abilities and dynamic balance abilities, respectively. After training, TRE showed significantly greater improvement in the WST group (mean change, 1.67 ± 1.45˚) than the control group (mean change, 0.08 ± 1.05˚). The TIS score was significantly higher in the WST group (mean change, 2.33 ± 1.50) than the control group (mean change, 0.13 ± 0.83). The TUG test also showed a significant improvement in the WST group (mean change, 5.03 ± 1.88 sec) than the control group (mean change, 2.59 ± 1.86 sec). Our findings indicate that weight-shift training is beneficial for improving trunk control and proprioception in patients with chronic hemiparetic stroke.
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Affiliation(s)
- Kyoungsim Jung
- Department of Physical Therapy, The Graduate School, Sahmyook University
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Deep abdominal muscle activity following supratentorial stroke. J Electromyogr Kinesiol 2013; 23:985-90. [DOI: 10.1016/j.jelekin.2013.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 11/18/2022] Open
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Bae SH, Lee HG, Kim YE, Kim GY, Jung HW, Kim KY. Effects of Trunk Stabilization Exercises on Different Support Surfaces on the Cross-sectional Area of the Trunk Muscles and Balance Ability. J Phys Ther Sci 2013; 25:741-5. [PMID: 24259843 PMCID: PMC3805005 DOI: 10.1589/jpts.25.741] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/15/2013] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effects on stroke patients of
trunk stabilization exercise on different support surfaces. [Subjects and Methods] Sixteen
stroke patients with onset of stroke six months earlier or longer were randomly and
equally assigned to group I (exercise performed on a stable support surface) and group II
(exercise performed on an unstable support surface). The two groups conducted the trunk
stabilization exercises on the respective support surfaces, in addition to existing
rehabilitation exercises five times per week for 12 weeks. Changes in the cross-sectional
area (CSA) of the muscles were examined using computed tomography (CT), and changes in the
balance ability were assessed using a measuring system and the trunk impairment scale
(TIS). [Results] In group I, there was a significant increase in the CSA of the mulifidus
muscle on the side contralateral to the brain lesion and in the paravertebral and
multifidus muscles on the side ipsilateral to the brain lesion. In group II, there was a
significant increase in the CSA of the paravertebral and multifidus muscles on the side
contralateral to the brain lesion and on the side ipsilateral to the brain lesion. In
terms of changes in balance ability, the sway path (SP) and TIS significantly improved in
group I, and the SP, sway area (SA), and TIS significantly improved in group II .
[Conclusion] Exercise on the unstable support surface enhanced the size of the
cross-sectional area of the trunk muscles and balance ability significantly more than
exercise on the stable support surface.
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Affiliation(s)
- Sea Hyun Bae
- Department of Physical Therapy, Gwangju Heemang Hospital
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Souza LACE, Martins JC, Teixeira-Salmela LF, Godoy MR, Aguiar LT, Faria CDCDM. Avaliação da força muscular pelo teste do esfigmomanômetro modificado: uma revisão da literatura. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000200021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O Teste do esfigmomanômetro modificado (TEM) tem potencial de ampla aplicação clínica para mensuração da força muscular. OBJETIVO: Realizar uma ampla revisão da literatura para descrever como o TEM vem sendo utilizado para avaliação da força muscular, bem como suas propriedades de medida. MATERIAIS E MÉTODOS: Foram realizadas buscas nas bases de dados MEDLINE/LILACS/SciELO/PEDro com combinação de termos específicos, sem restrições quanto ao idioma e publicados até novembro/2011, seguida de busca manual ativa. Todos os estudos encontrados foram analisados por dois examinadores independentes. RESULTADOS: Dos 24 estudos incluídos, 11 investigaram alguma propriedade psicométrica (validade de critério concorrente e confiabilidade) e reportaram resultados adequados. O TEM já foi utilizado para avaliação da força muscular de crianças, adultos e idosos, saudáveis ou acometidos por alguma condição de saúde; doenças reumáticas e dor lombar foram as mais comuns. Já foi utilizado para avaliação dos músculos do tronco e membros; os membros superiores foram os mais avaliados (79,16%), principalmente os preensores palmares. Todos realizaram adaptação no esfigmomanômetro, a maioria utilizou contração muscular por 5 segundos, pré-insuflação do equipamento de 20 mmHg e não foi reportado o tempo de repouso nem o número de repetições. CONSIDERAÇÕES FINAIS: Apesar de apresentar adequadas propriedades de medida e ampla aplicabilidade clínica, o TEM ainda é pouco utilizado para avaliação da força muscular e não foi empregado em estudos com indivíduos em que este desfecho é comumente avaliado. A falta de padronização e/ou descrição dos procedimentos adotados dificulta a replicação dos métodos para utilização do TEM na prática clínica.
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Lacerda NND, Gomes ÉB, Pinheiro HA. Efeitos da facilitação neuromuscular proprioceptiva na estabilidade postural e risco de quedas em pacientes com sequela de acidente vascular encefálico: estudo piloto. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000100007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O controle do tronco é uma habilidade motora básica necessária para executar diversas tarefas funcionais, e é deficiente em pacientes que sofreram acidente vascular encefálico (AVE). Objetivo: Avaliar o efeito do método facilitação neuromuscular proprioceptiva (PNF) na estabilidade postural e risco de quedas em pacientes com sequela de AVE. Metodologia: Foi realizado estudo de intervenção que consistiu em treinamento da estabilidade postural por meio de um protocolo fixo constituído por 5 exercícios utilizando o método PNF, onde foram realizados 10 atendimentos com frequência de três vezes por semana e duração em média de 45 minutos, e para a avaliação dos desfechos, utilizou-se a escala de equilíbrio de Berg (EEB). Resultados: Foram atendidos 12 homens com hemiparesia à esquerda e no mínimo seis meses de evolução e observou-se diferença altamente significativa entre os valores pré e pós teste por meio da EEB (p<0,01). Conclusão: O PNF teve efeitos benéficos na estabilidade postural e em repercussões no risco de quedas em indivíduos com hemiparesia à esquerda.
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