Search Results (40)

Background and Objectives: Cerebral palsy (CP) is a non-progressive neurological disorder characterized by motor impairments such as spasticity and poor postural control. Among these, trunk control plays a critical role in maintaining balance and enabling functional mobility. Since spasticity is known to interfere with motor coordination and posture, evaluating its response to trunk-focused interventions may offer additional clinical insights. This systematic review and meta-analysis evaluated the effectiveness of trunk-focused interventions on trunk control, gross motor function, balance, and spasticity. Materials and Methods: A systematic search was conducted in PubMed, Embase, Web of Science, MEDLINE, and CINAHL for randomized controlled trials (RCTs) published in the last 10 years up to 11 April 2023. Studies targeting trunk-specific interventions in children with CP were included. Meta-analyses were performed using RevMan 5.3, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study quality was assessed using the PEDro scale. Results: Fifteen RCTs involving 454 children were included. Trunk control improved significantly (SMD = 3.67; 95% CI: 3.10–4.25; I² = 0%). Gross motor function showed a small but significant improvement (SMD = 0.49; 95% CI: 0.06–0.92; I² = 44%). Balance exhibited a large, though not statistically significant, effect (SMD = 0.90; 95% CI: −0.00 to 1.79; I² = 81%). Subgroup analysis indicated that interventions performed more than four times per week produced a significant effect on balance (SMD = 0.54; 95% CI: 0.08–1.01). Only one study assessed spasticity and found no group difference. Conclusions: Trunk-based interventions significantly improve trunk control and gross motor function in children with CP. While improvements in balance were inconsistent, higher-frequency interventions yielded more favorable results. Further research is warranted to clarify effects on spasticity and optimize intervention protocols for clinical application. Full article

Background: The present study aimed to determine whether the protocolized use of pneumatic splints within neurodevelopmental therapeutic approaches produces a positive effect on sensorimotor impairments of the hemiplegic upper extremity in patients. Methods: A randomized clinical single-blind trial was conducted. Stroke patients were recruited and randomized into an experimental group, which completed a treatment protocol of splinting plus physiotherapy for 45 min per session, two sessions per week for four weeks; or a control group, which received the same type of conventional physiotherapy treatment for the same period of time. The patients were evaluated by Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) and the Trunk Control Scale. Secondary variables were Mini-BEStest, the modified Ashworth scale for ankle flexors, and computerized measurements of upper limb functional parameters performed by Armeo Spring^® robotic systems and Amadeo^®. All variables were measured pre- and post-treatment. Results: Twenty stroke patients with subacute and chronic stroke completed the protocol. Mann–Whitney U tests showed statistically significant differences between groups for the FM sensation variable (Z = −2.19; p = 0.03). The rest of the variables studied in the comparison between the two study groups did not present statistically significant differences (p > 0.05). Conclusions: The use of air splints in combination with physiotherapy treatment produced improvements in exteroceptive and proprioceptive sensitivity in post-stroke adult patients in the subacute and chronic phases. Full article

This study investigated the effects of virtual reality (VR)-based training combined with preliminary trunk stabilization education on postural control and balance in stroke patients. A single-blind randomized controlled trial enrolled 30 participants, randomly divided into a trunk stabilization group (n = 15) and a control group (n = 15). The trunk stabilization group engaged in 10 min of trunk stabilization education followed by 20 min of VR-based training, three times weekly for three weeks. The control group participated only in VR-based training. Outcomes were assessed using the Korean Trunk Impairment Scale (K-TIS), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), limit of stability (LOS), and center of pressure (COP) measurements. Both groups significantly improved in all measured outcomes post-intervention (p < 0.05). Notably, the trunk stabilization group exhibited significantly superior improvements in the K-TIS, PASS, BBS, LOS, and COP path length compared to the control group (p < 0.05). These results highlight the enhanced effectiveness of integrating trunk stabilization education with VR-based training, suggesting that it not only yields statistically significant improvements but also provides clinically meaningful benefits for functional postural control and balance recovery in stroke rehabilitation. Full article

Background/Objectives: Children with diplegic spastic cerebral palsy (CP) often present with impaired postural control, poor balance, and gait abnormalities that negatively affect their functional mobility and independence. Core stability, which is the ability to control the position and movement of the trunk, is considered a critical component in maintaining postural alignment and improving gross motor function. This study aimed to investigate the impact of a structured core stability exercise program on the standing ability, functional balance, and gait parameters of children diagnosed with diplegic spastic CP. Methods: Forty children (28 males, 12 females) aged 4–10 years with a clinical diagnosis of diplegic spastic cerebral palsy were randomly allocated into two groups (n = 20 each). The study group underwent a 12-week core stability exercise program in addition to a standardized physiotherapy regimen, which was conducted three times per week. The control group received the physiotherapy program alone. Functional outcomes were assessed pre- and post-intervention using the Gross Motor Function Classification System (GMFCS), Pediatric Balance Scale, and Kinovea software for gait analysis. Results: Both groups demonstrated statistically significant improvements in all measured variables after the intervention. However, the study group showed significantly greater improvements in standing ability (9%), balance (9%), and gait parameters (p < 0.05), particularly in knee flexion, ankle dorsiflexion, and plantar flexion, during gait cycles. Conclusions: Core stability training resulted in superior enhancements in balance, standing, and gait performance compared with physiotherapy alone in children with diplegic spastic cerebral palsy. Full article

Background and Objectives: Forward head posture (FHP) is associated with reduced stability limits, impaired balance performance, and compromised cervical proprioception. This study investigated the effects of capital flexion exercise (CFE) on the craniovertebral angle (CVA), trunk control, balance, and gait in chronic stroke patients with forward head posture. Materials and Methods: Twenty-six subjects were randomly assigned to the CFE group or the control group (n = 13 each). The CFE group underwent a familiarization process and performed CFE for 9 min per session, 3 times a week for 6 weeks, as well as the existing neurodevelopmental treatment (NDT). The control group received only the existing NDT. Results: The CVA, the Korean version of the Postural Assessment Scale for Stroke (K-PASS), the Berg Balance Scale (BBS), and the Timed Up and Go test (TUG) improved after the intervention in the CFE group (p < 0.05). In the control group, CVA and TUG improved after the intervention (p < 0.05). The CVA (d = 1.34, p = 0.002), K-PASS (d = 1.36, p = 0.000), and BBS (d = 1.68, p = 0.000) values of the CFE group showed statistically significant improvement compared to the control group. Although TUG improved in the CFE group, the between-group difference was not statistically significant (d = −0.28, p = 0.467). Conclusions: This study suggests that capital flexion exercises effectively improve craniovertebral angle, trunk control, and balance in chronic stroke patients with forward head posture. Full article

Postural control arises from the complex interplay of stability, adaptability, and dynamic adjustments, which are disrupted post-stroke, emphasizing the importance of examining these mechanisms during functional tasks. This study aimed to analyze the complexity and variability of postural control in post-stroke individuals during the feedforward phase of gait initiation. A cross-sectional study analyzed 17 post-stroke individuals and 16 matched controls. Participants had a unilateral ischemic stroke in the chronic phase and could walk independently. Exclusions included cognitive impairments, recent surgery, and neurological/orthopedic conditions. Kinematic and kinetic data were collected during 10 self-initiated gait trials to analyze centre of pressure (CoP) dynamics and joint angles (−600 ms to +50 ms). A 12-camera motion capture system (Qualisys, Gothenburg, Sweden) recorded full-body kinematics using 72 reflective markers placed on anatomical landmarks of the lower limbs, pelvis, trunk, and upper limbs. Ground reaction forces were measured via force plates (Bertec, Columbus, OH, USA) to compute CoP variables. Linear (displacement, amplitude, and velocity) and non-linear (Lyapunov exponent—LyE and multiscale entropy—MSE) measures were applied to assess postural control complexity and variability. Mann–Whitney U tests were applied (p < 0.05). The stroke group showed greater CoP displacement (p < 0.05) and reduced velocity (p = 0.021). Non-linear analysis indicated lower LyE values and reduced complexity and adaptability in CoP position and amplitude across scales (p < 0.05). In the sagittal plane, the stroke group had higher displacement and amplitude in the head, trunk, pelvis, and limbs, with reduced LyE and MSE values (p < 0.05). Frontal plane findings showed increased displacement and amplitude in the head, trunk, and ankle, with reduced LyE and MSE (p < 0.05). In the transverse plane, exaggerated rotational patterns were observed with increased displacement and amplitude in the head, trunk, pelvis, and hip, alongside reduced LyE convergence and MSE complexity (p < 0.05). Stroke survivors exhibit increased linear variability, indicating instability, and reduced non-linear complexity, reflecting limited adaptability. These results highlight the need for rehabilitation strategies that address both stability and adaptability across time scales. Full article

Purpose: Impaired balance leads to loss of function, e.g., the inability to walk safely. Therefore, restoring balance is a common goal of rehabilitation after a stroke. An innovative motor imaging and robotic device, the Erigo^®Pro walking table, was used to improve balance in patients who had suffered an acute stroke. Materials and Methods: Sixty-six stroke patients in the acute phase with an average age of 64.85 ± 18.62 years were randomly assigned to one of three groups (22 subjects each) and treated with different therapies (conventional, conventional with Erigo^®Pro, and conventional with Erigo^®Pro enriched with motor imaging). The duration of therapy was two weeks. Patients were assessed before and after completion of therapy. The study used the trunk stability test and the Berg Balance Scale to assess balance, and the Riablo™ device to measure static balance. In addition, an assessment of the superficial tension of the transversus abdominis and multifidus muscles was performed. The clinical trial registration URL unique identifier was NCT06276075. Results: In each of the groups studied, the therapies applied resulted in significant improvement in functional assessment of trunk stability and balance (TCT < 0.001 and BBS < 0.001). The assessment of balance in the frontal (p = 0.023) and sagittal (p = 0.074) planes with the Riablo™ device confirmed the superiority of motor imaging-enhanced therapy at the level of a statistical trend. The tension of the transversus abdominis was higher at the second measurement (M = 14.41; SE = 3.31). Conclusions: Motor imagery-enhanced therapy is most important, both for trunk stability and functional improvement of body balance parameters and for increasing transversus abdominis muscle tension. Full article

Background/Objective: Parkinson’s disease (PD), a prevalent neurodegenerative disorder, leads to motor and non-motor impairments, affecting quality of life. Camptocormia can be one of the motor signs of PD, characterized by a severe and abnormal forward flexion of the thoracolumbar spine that typically occurs when walking or standing. The following study aims to verify whether postural gymnastics can be an effective treatment for trunk control, balance, activities of daily living, and general well-being in patients with early-stage PD and camptocormia. Methods: Nine participants (mean age 67.7 ± 7.8) with early PD (Hoehn and Yahr Scale ≤ 2) received 10 biweekly physiotherapy sessions. Outcomes were measured using the Parkinson’s Disease Questionnaire (PDQ-39) and Berg Balance Scale (BBS) along with trunk mobility and muscle tests according to the Medical Research Council (MRC) scale. Results: Statistically significant results were noted in the PDQ-39 mobility, ADLs and emotional well-being subscales and in the BBS; statistically significant improvements were also seen in trunk mobility and muscle strength. Conclusions: This study shows that the postural gymnastic treatment, according to Souchard, in patients with PD’s camptocormia has obtained good results and has the potential timprove mobility and balance, encouraging and motivating patients in their rehabilitation journeys. Full article

Background and Objectives: Stroke patients often experience changes in their pelvic tilt, trunk impairments and decreased gait and balance. While various therapeutic interventions have been attempted to improve these symptoms, there is a need for interventions that are easy to apply and reduce the physical labor of physical and occupational therapists. We aimed to investigate the immediate effects of two different methods of trunk elastic taping on the pelvic inclination, trunk impairment, balance, and gait in chronic stroke patients. Materials and Methods: We performed a single-blind randomized controlled trial involving 45 patients with chronic stroke. Participants were randomly assigned to one of three groups: forward rotation with posterior pelvic tilt taping (FRPPT, n = 14), backward rotation with posterior pelvic tilt taping (BRPPT, n = 14), or placebo taping (PT = 14). This study was conducted from December 2023 to January 2024. All the measurements were performed twice: before the intervention and immediately after the intervention. The pelvic inclination was assessed using the anterior pelvic tilt angle. The trunk impairment scale (TIS) was used to measure the trunk impairment. The balance and gait were evaluated using a force plate and walkway system. Results: The pelvic inclination was significantly different in the FRPPT and BRPPT groups compared to the PT group (p < 0.05, p < 0.001). The TIS and gait were significantly increased in the FRPPT group compared to the PT group (p < 0.05). The balance significantly improved in the FRPPT and BRPPT within groups (p < 0.05). Conclusions: Two different methods of posterior pelvic tilt taping improved the anterior pelvic tilt in chronic hemiplegic stroke patients compared with PT, and the FRPPT method also improved the trunk impairment and gait. Therefore, posterior pelvic tilt taping can be used as an intervention with immediate effect. Full article

(1) Background. High-level spinal cord injury (SCI) disrupts trunk control, leading to an impaired performance of upright postural tasks in sitting and standing. We previously showed that a novel robotic postural stand training with spinal cord epidural stimulation targeted at facilitating standing (Stand-scES) largely improved standing trunk control in individuals with high-level motor complete SCI. Here, we aimed at assessing the effects of robotic postural stand training with Stand-scES on sitting postural control in the same population. (2) Methods. Individuals with cervical (n = 5) or high-thoracic (n = 1) motor complete SCI underwent approximately 80 sessions (1 h/day; 5 days/week) of robotic postural stand training with Stand-scES, which was performed with free hands (i.e., without using handlebars) and included periods of standing with steady trunk control, self-initiated trunk and arm movements, and trunk perturbations. Sitting postural control was assessed on a standard therapy mat, with and without scES targeted at facilitating sitting (Sit-scES), before and after robotic postural stand training. Independent sit time and trunk center of mass (CM) displacement were assessed during a 5 min time window to evaluate steady sitting control. Self-initiated antero-posterior and medial-lateral trunk movements were also attempted from a sitting position, with the goal of covering the largest distance in the respective cardinal directions. Finally, the four Neuromuscular Recovery Scale items focused on sitting trunk control (Sit, Sit-up, Trunk extension in sitting, Reverse sit-up) were assessed. (3) Results. In summary, neither statistically significant differences nor large Effect Size were promoted by robotic postural stand training for the sitting outcomes considered for analysis. (4) Conclusions. The findings of the present study, together with previous observations, may suggest that robotic postural stand training with Stand-scES promoted trunk motor learning that was posture- and/or task-specific and, by itself, was not sufficient to significantly impact sitting postural control. Full article

Objectives: This study aimed to determine the impacts of upper and lower limb (UL and LL) spasticity and impairment on spinal alignment in chronic post-stroke patients. Methods: A total of 45 consecutive chronic post-stroke patients, 18 women and 27 men, from 18 to 70 years old who presented post-stroke hemiparesis were recruited in this cross-sectional study. The clinical assessment included the Modified Ashworth Scale (UL-MAS and LL-MAS spasticity), Upper Limb Motricity Index (UL-MI), FAST-UL, and Five Times Sit-to-Stand Test (5T-STS); the Associated Reaction Rating Scale was used to measure associated reactions in the hemiparetic UL, the plumb line distance from the spinous process of C7 on the sagittal (PL-C7s) and frontal plane (Pl-C7f), the kyphosis apex (PL-AK), and the spinous process of L3 (PL-L3). Angular measures of spinal alignment were measured by a Bunnell scoliometer™ (angle of trunk rotation—ATR) and a gravity-dependent inclinometer (inclination at C7-T1 and T12-L1). Results: In chronic post-stroke patients, there was found to be an association between the 5T-STS and PL-C7f (β = 0.41, p = 0.05) and the angle of inclination at T12-L1 (β = 0.44, p = 0.01). The FAST-UL correlated with PL-C7f (β = −0.41, p = 0.05), while the UL-MI correlated with this last parameter (β = −0.36, p = 0.04) and the ATR (β = −0.31, p = 0.05). The UL-MAS showed correlation with the ATR (β = 0.38, p = 0.01). Conclusions: The results lead to the possibility that, in chronic post-stroke patients, spinal misalignment on the frontal and sagittal plane is associated both with strength impairment and UL spasticity. The improvement or restoration of spinopelvic parameters can take advantage of therapeutic interventions targeted at motor improvement and spasticity reduction of the hemiparetic side. Full article

Background: The purpose of this study was to investigate the effects of real-time feedback methods on static balance training in stroke patients. There are two types of real-time feedback methods, as follows: one is Knowledge of Result (KR), and the other is Knowledge of Performance (KP). Method: Thirty stroke patients participated in this study and were randomly assigned to the KR group (n = 15) or the KP group (n = 15). All of the groups underwent real-time feedback training for four weeks (30 min per session, five sessions per week). The primary outcomes were sway length, sway velocity, and area 95%, which were assessed before and after the intervention. The secondary outcomes included the Berg Balance Scale, the Fugl Meyer Assessment for Lower Extremity, the Postural Assessment Scale for Stroke Trunk Impairment Scale, and the Fall Efficacy Scale. A group × time interaction was assessed using two-way ANOVA with repeated measures. Result: There was a significant increase over time in all outcomes (p < 0.05). Significant differences were observed for a group × time interaction in sway length and area 95% (p < 0.05). Conclusions: Real-time feedback training for static balance enhanced stroke patients’ static balance abilities, clinical outcome assessments, and promoted self-efficacy against falls. Full article

Background and Objectives: Stroke can lead to a variety of consequences, the severity and nature of which are contingent upon the affected brain region or lesion type. These consequences manifest with distinct clinical presentations and recovery trajectories. This study aims to investigate the potential correlation between feminine sexual dysfunction and trunk stability among stroke survivors. Materials and Methods: Thirty-eight women (stroke group n = 19 and control group n = 19) were recruited. A cross-sectional observational study was designed. Outcome measures were recorded using the Feminine Sexual Function Index, the National Institute of Health Stroke Score, the Newcastle Stroke-specific Quality of Life Measure Beck Depression Index, the Barthel Index, the Urge-urinary Distress Inventory, and the Trunk Impairment Scale. Spearman’s correlation was tested between different factors influencing feminine sexual dysfunction and trunk stability. Results: Statistically significant differences were found in sexual function between the stroke group versus the control group (Z = 88; p = 0.007; rb = 0.51). The correlation showed a relationship between feminine sexual dysfunction and trunk stability (p < 0.05). A relationship between quality of life and sexual dysfunction was also found (p < 0.05). There were no statistically significant results for the association between dependency, severity of stroke, time after stroke type of stroke, and sexual dysfunction (p = 0.378). Conclusions: The results of this study support the existence of a correlation between feminine sexual dysfunction and trunk stability, probably due to trunk and pelvic floor muscle synergy. Multidisciplinary teams assessing sexual dysfunction after stroke should include a physical therapist to assess the physical components that may interfere with feminine sexual health post-stroke. Full article

Although the 6-Minute Walk Test (6MWT) is among the recommended clinical tools to assess gait impairments in individuals with Parkinson’s disease (PD), its standard clinical outcome consists only of the distance walked in 6 min. Integrating a single Inertial Measurement Unit (IMU) could provide additional quantitative and objective information about gait quality complementing standard clinical outcome. This study aims to evaluate the test–retest reliability, validity and discriminant ability of gait parameters obtained by a single IMU during the 6MWT in subjects with mild PD. Twenty-two people with mild PD and ten healthy persons performed the 6MWT wearing an IMU placed on the lower trunk. Features belonging to rhythm and pace, variability, regularity, jerkiness, intensity, dynamic instability and symmetry domains were computed. Test–retest reliability was evaluated through the Intraclass Correlation Coefficient (ICC), while concurrent validity was determined by Spearman’s coefficient. Mann–Whitney U test and the Area Under the receiver operating characteristic Curve (AUC) were then applied to assess the discriminant ability of reliable and valid parameters. Results showed an overall high reliability (ICC ≥ 0.75) and multiple significant correlations with clinical scales in all domains. Several features exhibited significant alterations compared to healthy controls. Our findings suggested that the 6MWT instrumented with a single IMU can provide reliable and valid information about gait features in individuals with PD. This offers objective details about gait quality and the possibility of being integrated into clinical evaluations to better define walking rehabilitation strategies in a quick and easy way. Full article

Stroke patients experience impaired sensory and motor functions, which impact their activities of daily living (ADL). The current study was designed to determine the best neurorehabilitation method to improve clinical outcomes, including the trunk-impairment scale (TIS), Berg balance scale (BBS), Fugl-Meyer assessment (FMA), and modified Barthel index (MBI), in stroke patients with impaired sensory function. Forty-four stroke survivors consistently underwent proprioceptive body vibration rehabilitation training (PBVT) or conventional physical therapy (CPT) for 30 min/session, 5 days a week for 8 weeks. Four clinical outcome variables–the FMA, TIS, BBS, and MBI–were examined pre- and post-intervention. We observed significant differences in the FMA, BBS, and MBI scores between the PBVT and CPT groups. PBVT and CPT showed significant improvements in FMA, BBS, TIS, and MBI scores. However, PVBT elicited more favorable results than CPT in patients with stroke and impaired sensory function. Collectively, this study provides the first clinical evidence of optimal neurorehabilitation in stroke patients with impaired sensory function. Full article