ABSTRACT Purpose: Although proximal stability of the trunk is a prerequisite for balance and gait, to determine the role of trunk rehabilitation on trunk control, balance and gait in patients with chronic stroke is yet unknown. Method: Fifteen sub-jects (post-stroke duration (3.53 ± 2.98) years) who had the ability to walk 10 meters independently with or without a walking aid; scoring ≤ 21 on Trunk Impairment Scale (TIS), participated in a selective trunk muscle exercise regime, consisting of 45 minutes training per day, four days a week, and for four weeks duration in an outpatient stroke reha-bilitation centre. Results: The overall effect size index for trunk rehabilitation was 1.07. This study showed large effect size index for Trunk Impairment Scale (1.75), Berg Balance Scale (1.65) than for gait variables (0.65). After trunk rehabilitation, there was a significant improvement for gait speed (p= 0.015), cadence (p= 0.001) and gait symmetry (p=0.019) in patients with chronic stroke. In addition, all the spatial gait parameters had a significant change post-intervention. There was no significant change in temporal gait parameters with the exception of affected single limb support time. The level of significance was set at p < 0.05. Conclusion: The exercises consisted of selective trunk movement of the upper and the lower part of trunk had shown larger effect size index for trunk control and balance than for gait in patients with chronic stroke. Future randomized controlled studies incorporating large sample size would provide insight into the effectiveness and clinical relevance of this intervention.
Cite this paper
nullS. Karthikbabu, J. Solomon, N. Manikandan, B. Rao, M. Chakrapani and A. Nayak, "Role of Trunk Rehabilitation on Trunk Control, Balance and Gait in Patients with Chronic Stroke: A Pre-Post Design," Neuroscience and Medicine, Vol. 2 No. 2, 2011, pp. 61-67. doi: 10.4236/nm.2011.22009.
 S. Ryerson, N. Byl, D. Brown, R. Wong, and J. Hidler. “Altered Trunk Position Sense and its Relation to Balance Functions in People Post-stroke,” Journal of Neurological Physical Therapy, Vol. 32, No. 1,2008, pp. 14-20.
 M. Karatas, N. Cetin, M. Bayramoglu, and A. Dilek, “Trunk Muscle Strength in Relation to Balance and Functional Disability in Unihemispheric Stroke Patients,” American Journal of Physical Medicine and Rehabilitation, Vol. 83, No. 2, 2004, pp. 81-87.
 T. Fujiwara, S. Sonoda, Y. Okajima, N. and Chino, “The Relationships between Trunk Function and the Findings of Transcranial Magnetic Stimulation among Patients with Stroke,” Journal of Rehabilitation Medicine, Vol. 33, 2001, pp. 249-255.
 T. Tsuji, M. Liu, K. Hase, and N. Chino, “Trunk Muscles in Persons with Hemiparetic Stroke Evaluated with Computed Tomography,” Journal of Rehabilitation Medi- cine, Vol. 35, No. 4, 2003, pp. 184-188.
 S. Tanaka, K. Hachisuka, and H. Ogata, “Muscle Strength of the Trunk Flexion-extension in Post-stroke Hemiplegic Patients,” American Journal of Physical Medicine and Rehabilitation, Vol. 77, No. 4, 1998, pp. 288-290.
 S. Tanaka, K. Hachisuka, and H. Ogata, “Trunk Rotatory Muscle Performance in Post-stroke Hemiplegic Patients,” American Journal of Physical Medicine and Rehabilitation, Vol. 76, No. 5, 1997, pp. 366-369.
 G. Verheyden, A. Nieuwboer, H. Feys, V. Thijs, K. Vaes, and W. De Weerdt, “Discriminant Ability of the Trunk Impairment Scale: A Comparison between Stroke Patients and Healthy Individuals,” Disability Rehabilitation, Vol. 27, No. 17, 2005, pp. 1023-1028.
 P.M. Davis, “Problems Associated with the Loss of Selective Trunk Activity in Hemiplegia,” In: P.M. Davis, Ed, Right in the Middle. Selective Trunk Activity in the Treatment of Adult Hemiplegia, Springer, 1990, pp. 31- 65.
 S. Ryerson, and K. Levit, “Functional Movement: A Practical Model for Treatment,” In: S. Ryerson, and K. Levit, Ed, Functional Movement Reeducation. A Contemporary Model for Stroke Rehabilitation, Churchill Livingstone, 1997: pp.1-14.
 S. Edwards, “An Analysis of Normal Movement as the Basis for the Development of Treatment Techniques,” In: S. Edwards, Ed, Neurological Physiotherapy. A Problem- Solving Approach, Churchill Livingstone, 1996, pp. 5-40.
 R. Dickstein, S. Shefi, E. Marcovitz, Y. and Villa, “Anticipatory Postural Adjustments in Selected Trunk Muscles in Post-stroke Hemiparetic Patients,” Archives of Physical Medicine and Rehabilitation, Vol. 85, No. 2, 2004, pp. 261-273.
 G. Verheyden, L. Vereeck, S. Truijen, M. Troch, I. Herregodts, C. Lafosse et al, “Trunk Performance after Stroke and Relationship with Balance, Gait and Functional Ability,” Clinical Rehabilitation, Vol. 20, No. 5, 2006, pp. 451-458.
 E. Duarte, E. Marco, J. Muniese, R. Belmonte, P. Diaz, M. Tejero et al, “Trunk Control Test as a Functional Predictor in Stroke,” Journal of Rehabilitation Medicine, Vol. 34, No. 6, 2002, pp. 267-272.
 C.L. Hsieh, C.F. Sheu, I.P. Hsueh, and C.H. Wang, “Trunk Control as an Early Predictor of Comprehensive Activities of Daily Living Function in Stroke Patients,” Stroke, Vol. 33, 2002, pp. 2626-2630.
 G. Verheyden, A. Nieuwboer, L. De Wit, H. Feys, B. Schuback, I. Baert et al. “Trunk Performance after Stroke: An Eye Catching Predictor of Functional Outcome,” Journal of Neurology Neurosurgery and Psychiatry, Vol. 78, No. 7, 2007, pp. 694-698.
 S. Messier, D. Bourbonnais, J. Desrosiers, and Y Roy, “Dynamic Analysis of Trunk Flexion after Stroke,” Archives of Physical Medicine and Reha-bilitation, Vol. 85, No. 10, 2004, pp. 1619-1624.
 G. Verheyden, L. Vereeck, S. Truijen, M. Troch, C. LaFosse, W. Saeys et al, “Additional Exercises Improve Trunk Performance after Stroke: A Pilot Randomized Controlled Trial,” Neurorehabil Neural Repair, Vol. 27, 2008, pp. 1-6.
 M.H. Mudie, U. Winzeler-Mercy, S. Radwan, L. Lee, “Training Symmetry of Weight Distribution after Stroke: A Randomized Controlled Pilot Study Comparing Task-related Reach, Bobath and Feedback Training Approaches,” Clinical Rehabilitation, Vol. 16, No. 6, 2002, pp. 582-592.
 G. Verheyden, A. Nieuwboer, J. Mertin, R. Preger, C. Kiekens, and W. De Weerdt, “The Trunk Impairment Scale: A New Tool to Measure Motor Impairment of the Trunk after Stroke,” Clinical Rehabilitation, Vol. 18, 2004, pp. 326-334.
 G Verheyden, A. Nieuwboer, A. Van de Winckel, and W. De Weerdt, “Clinical Tools to Measure Trunk Performance after Stroke; A Systematic Review of the Literature,” Clinical Rehabilitation, Vol. 21, No. 5, 2007, pp. 387-394.
 K.O. Berg, S.L. Wood Dauphinee, J.I. Williams, and B. Maki, “Measuring Balance in the Elderly: Validation of an Instrument,” Can J Public Health, Vol. 83, No. 2, 1992, pp. S7-11.
 H. Mao, I. Hsueh, P. Tang, C. Sheu, and C. Hsieh, “Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients,” Stroke, Vol. 33, 2002, pp. 1022-1027.
 J.Y. Wee, H. Wong, and A. Palepu, “Validation of the Berg Balance Scale as a Predictor of Length of Stay and Discharge Destination in Stroke Rehabilitation,” Archives of Physical Medicine and Reha-bilitation, Vol. 84, No. 5, 2003, pp. 731-735.
 L. Blum, and N.K. Bitensky, “Usefulness of Berg Balance Scale in Stroke Rehabilitation. A Systematic Review,” Physical Therapy, Vol. 88, No. 5, 2008, pp. 559- 566.
 J. Green, A. Forster, and J. Yong, “Reliability of Gait Speed Measured by a Timed Walking Test in Patients one year after Stroke,” Clinical Rehabilitation, Vol. 16, No. 3, 2002, pp. 306-314.
 L.S. Portney, and M.P. Watkins, “Power and Sample Size,” In: L.S. Portney, and M.P. Watkins, Ed, Foundations of Clinical Research: Applications to Practice, 2nd edition. pp. 705-720.
 L.J. Liaw, C.L. Hsieh, S.K. Lo, H.M. Chen, S. Lee, and J.H. Lin, “The Relative and Absolute Reliability of Two Balance Performance Measures in Chronic Stroke Patients,” Disabilility and Rehabilitation, Vol. 30, No. 9, 2008, pp. 656-661.
 L. Alzayer, M. Beninato, and L.G. Portney, “The Accuracy of Individual Berg Balance Scale Items Compared with the Total Berg Score for Classifying People with Chronic Stroke according to Fall History,” Journal of Neurological Physical Therapy, Vol. 33, 2009, pp. 136-143.
 C.M. Dean, and R.B. Shepherd, “Task Related Training Improves Performance of Seated Reaching Tasks after Stroke,” Stroke, Vol. 28, 1997, pp. 722-728.
 C.M. Dean, E.F. Channon, and J.M. Hall, “Sitting Training early after Stroke Improves Sitting Ability and Quality and Carries over to Standing up but not to Walking: A Randomized Controlled Trial,” Australian Journal of Physiotherapy, Vol. 53, 2007, pp. 97-102.
 J.K. Tilson, K.J. Sullivan, D.K. Cen, C.H. Koradia, S.P. Azen, and P.W. Duncan, “Meaningful Gait Speed Improvement during the first 60 days Poststroke: Mimimal Clinically Important Difference,” Physical Therapy, Vol. 90, No. 2, 2010, pp. 196-208.
 P.A. Goldie, T.A. Matyas, and O.M. Evans, “Gait after Stroke: Initial Deficit and Changes in Temporal Patterns for each Gait Phase,” Archives of Physical Medicine and Rehabilitation, Vol. 82, No. 8, 2001, pp. 1057-1065.
 J.C. Wall, and G.I. Turnbull, “Gait Asymmetries in Residual Hemiplegia,” Archives of Physical Medicine and Reha-bilitation, Vol. 64, 1983, pp. 583-587.
 J.W. Van Nes, B. Nienhuis, H. Latour, and A.C. Geurtus, “Posturographic Assessment of Sitting Balance Recovery in the Sub-acute phase of Stroke,” Gait Posture, Vol. 28, No.3, 2008, pp. 507-512.
 J.S. Chern, C.Y. Lo, C.Y. Wu, C.L. Chen, S. Yang, and F.D. Tang, “Dynamic Postural Control during Trunk Bending and Reaching in Healthy Adults and Stroke Patients,” American Journal of Physical Medicine and Rehabilitation, Vol. 89, No. 3, 2010, pp. 186-197.
 S.F. Tyson, “Trunk Kinematics in Hemiplegic Gait and Effect of Walking Aids,” Clinical Rehabilitation, Vol. 13, No. 4, 1999, pp. 295-300.
 P.R. Trueblood, J.M. Walker, J. Perry, and J.K. Gronley, “Pelvic Exercise and Gait in Hemiplegia,” Physical Therapy, Vol. 69, No.1, 1989, pp. 18-26.