Effects of neuromuscular electrical stimulation and core muscle strengthening on trunk instability following stroke

Background: Postural instability leads to balance dysfunction in stroke subjects, which always increase the risk of fall. This study aimed to compare the effect of neuromuscular electrical stimulation and core muscle strengthening on trunk balance following stroke.Methods: Forty five stroke subjects were participated and assigned randomly into three groups; all groups received standard rehabilitation program; and core group received additional core strengthening, neuromuscular electrical stimulation (NMES) group received added electrical stimulation over paraspinal region and combination group received core muscle strengthening and NMES along with standard rehabilitation protocol. After four weeks of the interventions, primary and secondary outcome measures are evaluated. Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PASS), Trunk Impairment Scale (TIS) and Barthel Index (BI) were evaluated before and after the intervention.Results: All the three (core MS, NMES and combination) groups showed significant improvement after the intervention (BBS 10.07, 15.54 and 18.27, PASS 6.54, 13.06 and 14.00, TIS 0.25, 0.25 and 0.51, BI 16.40, 29.93 and 36.53). The combination group (NMES and core muscle strengthening) showed better improvement than other two groups. TIS and BI total score showed positive (0.849) correlation.Conclusions: Addition of NMES along with core muscle strengthening for stroke rehabilitation will improve trunk stability, balance and ADLs.

Temporal virtual reality-guided, dual-task, body trunk-balance training in a sitting position improved persistent postural-perceptual dizziness: proof of concept

BackgroundPersistent postural-perceptual dizziness (PPPD) is a newly defined disorder of functional dizziness. Due to its recent discovery, definitive treatment for PPPD has not been established; therefore, this study aimed to measure the effectiveness of virtual reality (VR)-guided, dual-task, body trunk balance training using the mediVR KAGURA system for the treatment of PPPD.MethodsData from patients with PPPD collected from January 1, 2021 to February 28, 2021 were reviewed. Additionally, healthy people were included as controls. VR-guided training was performed using 100 tasks for 10 min. Equilibrium tests were performed at baseline and immediately after VR-guided training to examine the effectiveness of static and dynamic balance ability. Additionally, assessments of clinical questionnaire-based surveys of balance disorders were performed at baseline and 1 week after VR-guided training to examine the effects on the symptoms related to balance disorders. The primary outcome was the usefulness of static and dynamic body balance and NPQ scores.ResultsVR-guided training using mediVR KAGURA improved objective symptoms, including static and dynamic postural stability (relating to somatosensory and visual weighting, respectively) even when the training was conducted once for 10 min. Additionally, VR-guided training improved the Hospital Anxiety and Depression Scale score and the Niigata PPPD Questionnaire score, 1 week after a 10-min training session. ConclusionVR-guided training was found to be a viable method in managing the balancing ability, anxiety, and symptoms of patients with PPPD. VR-guided training offers safety and reduction of human resources; however, its clinical efficiency warrants further evaluation in prospective studies.Trial registrationInstitutional Ethics Committee of Kitano Hospital, approval number: 1911003. Registered 18 December 2019, https://kitano.bvits.com/rinri/publish_document.aspx?ID=426

Efficacy Of Core Strengthening Exercises On Swissball Versus Conventional Exercises For Improving Trunk Balance In Hemiplegic Patients Following Stroke

In stroke, there is paralysis or weakness of one side of the body including upper limb, trunk and lower limb leading to the disturbances in the trunk muscles. Trunk is often neglected part in the stroke rehabilitation, trunk training exercises and Swiss ball exercises results in better recruitment of trunk muscles thus improving sitting balance. To compare the effect of core strengthening exercises on Swiss ball and Conventional exercise, to improve trunk balance in hemiplegic patients following stroke. A total number of 70 subjects were screened as per inclusion and exclusion criteria. The subjects were divided into two groups, Group-A received core strengthening exercises on Swiss ball along with conventional treatment and Group-B received core strengthening exercises along with conventional treatment. Subjects showed improvement in trunk balance following 6 weeks of core strengthening exercises.Post-intervention the TIS, BBA and MBI score of both groups improved but the Group-A improved more significantly than Group-B. The level of significance was P<0. 0001. This study concluded that both the interventions have improved the trunk balance and activity of daily living by making the patient functionally independent.

Design and Modeling of a Parallel Continuum Manipulator for Trunk Motion Rehabilitation

The objective of the present work is to develop a device for training the trunk balance and motion during the early stage of rehabilitation of patients who have suffered a stroke. It is coupled to a standing frame and is based on a parallel continuum manipulator where a wearable jacket is moved by four flexible limbs actuated by rotary motors, achieving the translation and rotation required in the trunk to perform a given exercise. The flexible limbs act as a natural mechanical filter in such a way that a smooth physiological motion is achieved, and it feels less intimidating to the patient. After measuring the kinematic requirements, a model has been developed to design the system. A prototype has been built and a preliminary experimental validation has been done where the jacket generates translation coupled to a rotation around the anteroposterior, medio-lateral and longitudinal axis. The measurements of the motors torque and the force sensors located in the flexible limbs have been compared with the simulations from the model. The results prove that the prototype can accomplish the motions required for the rehabilitation task, although further work is still required to control the interaction with the patient and improve the performance of the device.

A Study to Assess the Effects of Proprioceptive Neuromuscular Facilitation of Trunk In Improving Trunk Balance of Patients with Stroke

Stroke is a complex pathology with many clinical presentations with unique impairments and activity limitations. Physiotherapy has a massive impact on quality of life of a stroke survivor. Proprioceptive neuromuscular facilitation (PNF) is a rehabilitation technique used to stimulate the neuromuscular system in an effort to excite proprioceptors (sensory organs in muscles, tendons, bones, and joints) in order to produce a desired movement. It has a greater impact on trunk control. The aim of the study is to evaluate the effect of proprioceptive neuromuscular facilitation of trunk in improving balance of trunk in stroke patients. Twenty stroke patients within the age between 60 to 70 years, were recruited for study. All patients were assigned proprioceptive neuromuscular facilitation of trunk for 4 weeks. Pre and post test scores were analysed. Inclusion criteria are patients with 60-70 years of age of both the genders with stroke duration of at least 6 months. Exclusion criteria are recurrent stroke with severe spasticity, perceptual disorders and uncorrected vision problems, any symptomatic cardiac failure, patients with other neurological disorders or musculoskeletal problems, impaired cognitive function. Both pre-test and post-test measures were analysed statistically using the data analysis computed with SPSS. The outcome measures used is TIS. Statistical analysis showed significant improvement in trunk balance after the treatment of proprioceptive neuromuscular facilitation of trunk for 4 weeks in stroke patients. Result showed significant improvement in the PNF treatment in trunk balance after the treatment of proprioceptive neuromuscular facilitation of trunk. The study concluded that the trunk balance can be improved in stroke patients after performing the proprioceptive neuromuscular facilitation of trunk for 4 weeks.

Surgical correction of trunk balance in spinal deformities and in instability of hip joints

Introduction. Restoration of trunk balance is the basic task in surgical correction of spinal deformities and in hip joint instability of various etiology. Purpose. To analyze and to define the relevance of roentgen-anatomical parameters of spine-pelvis relationships for surgical correction of deformities in the thoracolumbar spine and of hip joint instability of dysplastic and neurogenic etiology. Material and methods. An X-ray analysis of parameters of the frontal and sagittal spine-pelvis balance was performed in 220 patients with dysplastic and neurogenic deformities of the thoracic and lumbar spine (n = 98) and with instability of hip joints (n = 122) but who were able to walk. They were operated in the neuro-orthopedic department with orthopedics in National Medical Research Center for Children’s Health. The reference group included 60 relatively healthy children without any scoliotic deformities of the spine and with stable hip joints. Dynamics of changes in X-ray parameters was analyzed using findings of orthostatic spondylograms from the indicated groups of children. The obtained data were compared with reference values. Results. The trial performed has revealed typical changes in spine-pelvis relationship parameters in patients with hip joint instability and spine deformities and in the reference group . The researchers also found out relations between various parameters of the trunk balance before and after surgical correction. Conclusion. While planning a surgical correction of trunk balance in spinal deformities, one should take into account parameters of spine-pelvis relationships, such as PI, SS, PT, SVA deviation and the mid-sacral line; and in case of hip joint instability - local roentgen-angulometric parameters of the femoral and acetabular components of instability. This is due to the fact that the lower the level of reconstructive surgical manipulation is located, the greater effect it has at the frontal and sagittal balance of the trunk.