Immediate effects of lateral truncal tilt balance training with and without a wedge on subjective postural vertical and sitting balance in patients with subacute stroke: a randomised crossover trial

Abstract

Background/Aims The subjective postural vertical is an important factor in maintaining sitting balance. However, specific training to improve verticality and sitting balance has yet to be established. The aim of this study was to clarify the effectiveness of lateral truncal tilt training, using a wedge, on subjective postural vertical, subjective postural vertical with eyes open and sitting balance in patients with subacute stroke. Methods In this randomised crossover trial, the immediate effects of lateral truncal tilt training were examined. Participants were allocated to one of two groups (group 1 and group 2). In group 1, after placing an inclined 10° tilt wedge on the participants' affected side, the participants moved their trunk laterally as far as possible toward the wedge side 60 times within 2 minutes. The participants in group 2 performed the same movement but without the wedge. This was performed once. The participants' subjective postural vertical, subjective postural vertical with eyes open and sitting pressure while they were tilted toward the frontal plane were measured at baseline, after the first intervention and after the second intervention. Following a 1-hour break, the groups crossed over. Repetition analysis was used at baseline and after both groups had competed the intervention both with and without the wedge. Results In total, 18 patients (mean age 68.7 years) participated in this study. Variabilities in subjective postural vertical with eyes open indicated a greater decrease in group 1 than group 2 (P<0.01). A significantly larger improvement in the balancing capabilities in the subjective postural vertical and sitting pressure was observed (P<0.01). The sitting pressure on the affected side in the subjective postural vertical with eyes open and subjective postural vertical showed a pre- and post-training interaction (P<0.01). Conclusions Lateral truncal tilt balance training using a wedge can improve postural verticality and improve sitting balance in people who have had a stroke. Implications for practice Stroke rehabilitation programmes can include wedge training to improve posture and sitting balance in people who have had a stroke, which can help these individuals to complete activities of daily living.