Trunk Function Research Articles

P.326 - Investigation of the relation between the trunk and upper limb functions in DMD

P.326 - Investigation of the relation between the trunk and upper limb functions in DMD

The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: a randomized controlled trial

Objective: To examine the effect of core stability exercises on trunk control, dynamic sitting and standing balance, gait, and activities of daily living in subacute stroke patients. Design: A randomized controlled trial. Setting: Inpatient rehabilitation hospital in two centres. Subjects: Eighty patients (mean of 23.25 (±16.7) days post-stroke) were randomly assigned to an experimental group and a control group. Interventions: Both groups underwent conventional therapy for five days/week for five weeks and the experimental group performed core stability exercises for 15 min/day. The patients were assessed before and after intervention. Main measures: The Trunk Impairment Scale (Spanish-Version) and Function in Sitting Test were used to measure the primary outcome of dynamic sitting balance. Secondary outcome measures were standing balance and gait as evaluated via Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Postural Assessment Scale for Stroke (Spanish-Version), and activities of daily living using Barthel Index. Results: The experimental group showed statistically significant differences for all of the total scale scores (P<0.05), except for the sitting section of the Brunel Balance Assessment. The mean (SD) difference between groups in Trunk Impairment Scale total score was 3.40 (±4.12) points, and its subscale dynamic sitting balance was 2.28 (±3.29). The Berg Balance Scale was 14.54 (±18.19) points, and the Barthel Index was 13.17 (±25.27) points. Collectively, these results were in favour of the experimental group. Conclusions: Core stability exercises in addition to conventional therapy improves trunk control, dynamic sitting balance, standing balance, gait and activities of daily living in subacute post-stroke patients.

Trunk Function in Hemiplegic Patients Kinematic Analysis of Trunk Bending and Gait Performance

Background:&nbsp;Trunk function is considered important for stroke patients in rehabilitation, but the significance of this factoris unclear. In this study, we examined trunk function, defined as the ability to keep the trunk stable against gravity during movement. In addition, we aimed to elucidate the relationship between gait performance and trunk function.Methods:&nbsp;The subjects were 14 hemiplegic men and 20 healthy elderly men. Movement was assessed by a three-dimensional motion analysis system focusing on the trunk. The trunk was divided into three parts: the pelvis, the middle trunk, and the upper trunk. The parameters assessed were static standing, anterior tilt of the trunk in the standing position, and gait. We examined the relationship of each of these trunk movement factors with gait speed. All data was analyzed using SPSS program version 21 (p &lt; 0.05).Results:&nbsp;Comparing data of hemiplegic patients to that of normal subjects, during trunk bending, a large rotation angle toward the non-affected side was found and that toward the affected side of the middle trunk at the toe off time of the affected limb during gait was found in hemiplegic patients (p &lt; 0.01). The degrees of both rotation angles were related to the gait performance.Conclusion:&nbsp;The movement of the middle trunk during bending in hemiplegic patients affected gait performance. The results indicated that gravity and movements of lower limbs easily affected the middle trunk. This is an important factor to consider in the rehabilitation of hemiplegic patients.

Motor Function Cutoff Values for Independent Dressing in Stroke Patients.

This study established motor function cutoff values for dressing independence in inpatients with stroke. Ninety-eight first-time inpatients with stroke were divided into groups on the basis of independence level in dressing, and receiver operating characteristic curves were determined for balance, motor function of affected limbs, trunk function, motor function of unaffected upper limb, and cognitive function. Area under the curve for the Berg Balance Scale (BBS) was highest for the different motor functions. In distinguishing independence group and supervision or less level group, the cutoff value for the BBS was 44 points (sensitivity = 85%, specificity = 93%). In distinguishing supervision or higher level group and dependence group, the cutoff value for the BBS was 32 points (sensitivity = 94%, specificity = 79%). Balance was strongly correlated with the level of dressing independence, and cutoff values for the BBS were indicators of the balance required to reach independent and supervision levels of dressing.

Trunk exercise using the Swiss ball improves the functional balance and walking of stroke patients in the early stages of recovery

Objective To examine the effects of trunk exercises performed using a Swiss ball on functional balance and walking in the early stage of recovering from a stroke. Methods Sixty hemiplegic stroke patients were randomly assigned to a control group or an experimental group, each of 30. Both groups were treated with routine physical training. Those in the control group did conventional trunk exercises, while the patients in the experimental group were given trunk exercises performed using a Swiss ball. The trunk control test (TCT) and the Berg Balance Scale (BBS) were used to assess the patients' trunk and balance function. Gait and balance function training and assessment apparatus (model AL-080) was used to measure and compare the scope of movement of the patient's center of pressure in static sitting over 30 seconds (LOM), the limits of stability (LOS), velocities and a gait asymmetry index (GAI). Results Significant improvements in TCT, BBS, LOM and LOS were observed in both groups after the training, but all of the measures improved significantly more in the experimental group than in the control group. Conclusions Swiss ball trunk exercise can obviously improve the trunk control, functional balance and walking of stroke patients in the early stages of recovery. Key words: Stroke; Hemiplegia; Swiss ball; Trunk control; Balance; Walking

The effects of Bobath-based trunk exercises on trunk control, functional capacity, balance, and gait: a pilot randomized controlled trial

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.

Cognitive and physical functions related to the level of supervision and dependence in the toileting of stroke patients.

This study aimed to clarify which cognitive and physical factors are associated with the need for toileting assistance in stroke patients and to calculate cut-off values for discriminating between independent supervision and dependent toileting ability. This cross-sectional study included 163 first-stroke patients in nine convalescent rehabilitation wards. Based on their FIMⓇ instrument score for toileting, the patients were divided into an independent-supervision group and a dependent group. Multiple logistic regression analysis and receiver operating characteristic analysis were performed to identify factors related to toileting performance. The Minimental State Examination (MMSE); the Stroke Impairment Assessment Set (SIAS) score for the affected lower limb, speech, and visuospatial functions; and the Functional Assessment for Control of Trunk (FACT) were analyzed as independent variables. The multiple logistic regression analysis showed that the FIMⓇ instrument score for toileting was associated with the SIAS score for the affected lower limb function, MMSE, and FACT. On receiver operating characteristic analysis, the SIAS score for the affected lower limb function cut-off value was 8/7 points, the MMSE cut-off value was 25/24 points, and the FACT cut-off value was 14/13 points. Affected lower limb function, cognitive function, and trunk function were related with the need for toileting assistance. These cut-off values may be useful for judging whether toileting assistance is needed in stroke patients.

The effects of forced breathing exercise on the lumbar stabilization in chronic low back pain patients.

[Purpose] This study was conducted to investigate the effects of forced breathing exercise on the trunk functions of chronic low back pain patients. [Subjects and Methods] Twenty-four patients with chronic low back pain were randomly divided into groups of respiratory effort and trunk stabilization exercises. The exercises were performed for 45 minutes, 3 times per week for 6 weeks. Spinal stabilization was measured as the compensation of thesagittal angle joint in relation to the lumbar external load. [Results] After the intervention, the forced breathing and stabilization exercise groups showed a significant difference in lumbar spine stabilization between the first and second stress tests and the control group also showed a significant difference after the intervention. The M1 and M2 tests of lumbar spine stabilization revealed no significant differences between the groups. [Conclusion] The results of this research demonstrate that forced breathing exercise therapy is effective at improving the trunk stability and daily living activities of chronic low back pain patients.

Trunk Impairment Scale -TIS precise tool for evaluating trunk motor deficit of stroke patients

Abstract Stroke causes impairment of brain function resulting in the disorder of motor control of the trunk. Assessment of the movement of a patient with hemiparesis poses many difficulties and limitations. A standard clinical neurological diagnosis does not provide an accurate assessment in terms of trunk deficit. This is the reason for the relatively small and insufficient monitoring of motor changes in patients. Post stroke assessment of the trunk is still insufficient despite the fact that disorders are a common problem in patients with stroke. Trunk function has been identified as an important early predictor of functional outcome after stroke. Trunk Impairment Scale-TIS is the only well-validated tool to examine a patient with hemiparesis taking into account qualitative and quantitative assessment of the trunk deficit. This scale consists of three subscales: static balance in sitting, dynamic balance sitting and coordination. TIS assesses existing compensation during motor tasks. The scale was translated into Polish and pre-adapted to clinical practice The scale supports clinical reasoning in terms of structure and function, body disorders and activity limitations of patients after stroke It appears that the introduction of scale in the clinical study for patients with stroke hemiplegia may not only affect the expansion of detailed documentation of motor deficits, but to support planning and carrying out appropriate (suitable) physiotherapy strategies.

Diastasis Recti Abdominis in Pregnancy and Postpartum Period. Risk Factors, Functional Implications and Resolution

Diastasis recti abdominis (DRA) or the increased inter rectus distance (IRD) is described as the separation of the rectus abdominis muscles. It can occur during pregnancy and after childbirth. Mota et al. (2015) found DRA may affect up 100% of pregnant women [1], and it may persist separated in the immediate postpartum period in 35% to 60% of women [2]. Reported prevalence of DRA or increased IRD varies and may be inaccurate due to different cut off points for the diagnosis [1-7] and use of different measurement methods. To date limited studies about the normal width of the IRD in postpartum women are available [8, 9], and there is scarce information about risk factors for DRA. There are some theories stating that failure to treat DRA effectively can lead to long term sequelae [10], including abnormal posture [1], lumbo-pelvic pain and cosmetic imperfections [10]. Postnatal women are stimulated to resume abdominal exercises shortly after delivery [3] to improve trunk function and restore abdominal figure and fitness [8]. To date there is scant knowledge on the most effective abdominal exercises both during pregnancy and after childbirth. In particular there is little evidence on which exercises are most efficient in the narrowing of the recti diastasis. The aim of this article is to critically review the literature on the risk factors, functional implications and the effect of exercise on DRA. This information is expected to be relevant for physiotherapists and exercise professionals.

Does training sitting balance on a platform tilted 10° to the weak side improve trunk control in the acute phase after stroke? A randomized, controlled trial

Background: Trunk performance and sitting balance, especially lateral sitting control, are important predictors of functional outcome after stroke. However, no studies have focused only on trunk function in the frontal plane for persons with acute-phase stroke.Objective: To investigate the effects of lateral sitting training on a tilting platform in persons with stroke.Methods: An assessor-blinded, randomized, controlled trial was carried out involving inpatients at a stroke rehabilitation center. Patients were allocated to either an experimental group (n = 15) or a control group (n = 15). The experimental group sat without leg support on a platform tilted 10° to the paretic side in the frontal plane, while the controls sat on a horizontal platform. Both groups were asked to move their trunk laterally from the paretic side to the nonparetic side. In addition to conventional therapy, this training was performed 60 times/session, with 6 sessions/week. Trunk function was assessed using the Trunk Control Test (TCT), and the ability to move the trunk laterally was evaluated kinematically. Measurements were performed at baseline and after training. Two-way repeated measures analysis of variance was used to test the significance between and within treatments for each dependent variable.Results: None of the demographic data differed between the groups. After training, a significant improvement was noted in the experimental group compared to the controls in the TCT and the ability for lateral trunk transference (P < 0.05, 1 − β = 0.98, effect size = 0.4).Conclusion: Lateral sitting training on the tilting platform improved the impaired trunk function of persons with stroke.

Relationship between dressing and motor function in stroke patients: a study with partial correlation analysis

[Purpose] The aim of the present study was to elucidate which motor functions are most or more important for dressing performance before and after rehabilitation. [Subjects] Seventy-nine first episode stroke patients in a hospital convalescent rehabilitation ward. [Methods] The relationships between motor function of the affected upper and lower limbs, unaffected side function, trunk function, balance, cognitive function, and independence level in dressing were examined at admission and discharge using partial correlation analysis. [Results] Independence level of dressing correlated with motor function of the affected upper limb and balance at admission, but correlated only with balance at discharge. [Conclusion] Balance function was strongly associated with level of dressing independence. The effect of gross motor function of the affected upper and lower limbs on the level of independence in dressing may thus be smaller than originally expected. Enhanced balance ability can be important for learning single-handed actions of self-dressing during rehabilitation.

Identification of the affected lower limb and unaffected side motor functions as determinants of activities of daily living performance in stroke patients using partial correlation analysis.

[Purpose] This study aimed to clarify the independent impact of the affected upper and lower limb, trunk, and unaffected side motor functions on activities of daily living in stroke patients using partial correlation analysis. [Subjects and Methods] This retrospective study included 77 stroke patients. Motor functions were assessed using the Stroke Impairment Assessment Set, and the activities of daily living performance was assessed using the Barthel index or Functional Independence Measure. Further, simple and partial correlation analyses were conducted between each motor function and activities of daily living parameter. [Results] Simple correlation analysis identified significant positive correlations for each pair. In contrast, partial correlation analysis only identified significant positive correlations between the affected lower limb or unaffected side functions and the Barthel index or Functional Independence Measure. This discrepancy between the two tests was explained by the significant interaction between the affected upper and lower limb functions and between the trunk and unaffected side functions. [Conclusion] The present study identified the affected lower limb and unaffected side motor functions as the major determinants of activities of daily living performance in stroke patients. These findings suggest that rehabilitation programs can be improved by targeting these areas.

The role of visual feedback in respiratory muscle activation and pulmonary function.

[Purpose] It is well known that visual feedback is an important factor contributing to balance and postural control. Nevertheless, there has been little discussion about the effects of visual feedback on pulmonary function. This study was conducted to investigate the role of visual feedback on respiratory muscle activation and pulmonary function. [Subjects and Methods] The subjects were 37 healthy adults who consented to participate in this study. The study measured the muscular activation of the trunk and pulmonary function according to the absence or presence of visual feedback. [Results] The results revealed significant changes in muscular activation and pulmonary function with the use of visual feedback. [Conclusion] These findings suggest that visual feedback may play a role in increasing respiratory muscle activity and pulmonary function.

人工膝関節全置換術後患者の身体機能と術前および術後の体幹機能の関連性

人工膝関節全置換術後患者の身体機能と術前および術後の体幹機能の関連性

Relation of quality of upper limb to independent gross motor and manual ability function in children with spastic diplegia

Background: Most of the children having spastic diplegia show variability in upper limb and upper trunk functions. Due to this variation in upper limb and upper trunk, the quality of upper limb function may affect and limit the independence of functional activities in these children. Hence, this study aimed to find the relation of the quality of upper limb function to independent gross motor and manual ability function in children with spastic diplegia. Materials and Methods: Overall, 30 children (both girls and boys) who were diagnosed with spastic diplegia (age ranged 4 to 8 years) were included. Children having any musculoskeletal deformity of upper limb or fracture or who had undergone administration of botulinum toxin or soft tissue release surgery in last 6 months or who were unable to follow commands were excluded from this study. Included children were classified in gross motor function classification system (GMFCS) and manual ability classification system (MACS) level. The outcome measures used were quality of upper limb function, which was assessed using quality of upper extremity skills test, and self care was assessed using self care domain of functional skills with its caregiver assistance of pediatric evaluation of disability inventory (PEDI). The data were analyzed. Results: Spearman coefficient of correlation was calculated. The quality was found having moderate correlation with GMFCS (−0.459) and MACS (−0.589), while it strongly correlated with self care domain of functional skills (0.647) and caregiver assistance of PEDI (0.666). Conclusion: The quality of upper limb functions was affected in children with spastic diplegia. This was reflected on self care domain along with caregiver assistance of PEDI.

A novel objective evaluation method for trunk function.

[Purpose] To investigate whether an objective evaluation method for trunk function, namely the “trunk righting test”, is reproducible and reliable by testing on different observers (from experienced to beginners) and by confirming the test-retest reliability. [Subjects] Five healthy subjects were evaluated in this correlation study. [Methods] A handheld dynamometer was used in the assessments. The motor task was a trunk righting motion by moving the part with the sensor pad 10 cm outward from the original position. During measurement, the posture was held at maximum effort for 5 s. Measurement was repeated three times. Interexaminer reproducibility was examined in two physical therapists with 1 year experience and one physical therapist with 7 years of experience. The measured values were evaluated for reliability by using intraclass correlation coefficients (ICC 1.1) and interclass correlation coefficients (ICC 2.1). [Results] The test-retest reliability ICC 1.1 and ICC 2.1 were all high. The ICC 1.1 was >0.90. The ICC 2.1 was 0.93. [Conclusion] We developed the trunk righting test as a novel objective evaluation method for trunk function. As the study included inexperienced therapists, the results suggest that the trunk righting test could be used in the clinic, independent of the experience of the therapists.

Does additional exercise improve trunk function recovery in stroke patients? A meta-analysis.

The restoration of trunk function following stroke is a key component of rehabilitation, however there is limited evidence of the efficacy of additional trunk training. To evaluate the efficacy of trunk exercises added to conventional rehabilitation on functional outcomes. Relevant randomised controlled trials (RCTs), published up to July 2012, evaluating the effect of the addition of trunk exercises to conventional rehabilitation on functional outcomes were identified in Medline, Cinahl, Embase, Pubmed, PEDro, Web of Science and Scopus databases. Findings were summarised across studies as mean or standardised mean differences (MD or SMD) with 95% confidence intervals. Six RCTs with 155 participants and a mean PEDro score of 6.5 (range 6 to 8) were included. Data from two to five studies were pooled in meta-analyses that showed a moderate, non-significant effect of additional trunk exercise on trunk performance, (SMD = 0.50; 95% CI -0.25, 1.25; P = 0.19); large effects on standing balance, SMD = 0.72 (95% CI -0.01, 1.45 P = 0.05); and walking ability, (SMD = 0.81; 95% CI 0.30, 1.33. P = 0.002) and a small, non-significant effect, MD = 10.03 (95% CI -15.70, 35.75. P = 0.44) on functional independence. There is moderate evidence that the addition of specific trunk exercise to conventional early stroke rehabilitation significantly improve standing balance and mobility after stroke; however the evidence was weak for the effect of additional trunk exercise on trunk performance and in functional independence.

Trunk strength and function using the multidirectional reach distance in individuals with non-traumatic spinal cord injury

ContextTrunk control is essential to engage in activities of daily living. Measuring trunk strength and function in persons with spinal cord injury (SCI) is difficult. Trunk function has not been studied in non-traumatic SCI (NTSCI).ObjectivesTo characterize changes in trunk strength and seated functional reach in individuals with NTSCI during inpatient rehabilitation. To determine if trunk strength and seated reach differ between walkers and wheelchair users. To explore relationships between trunk and hip strength and seated functional reach.DesignObservational study.SettingTwo SCI rehabilitation facilities.Participants32 subacute inpatients (mean age 48.0 ± 15.4 years).Outcome measuresIsometric strength of trunk and hip and function (Multidirectional Reach Test: MDRT) were assessed at admission and within 2 weeks of discharge. Analysis of variance was conducted for admission measures (MDRT, hip and trunk strength) between walkers and wheelchair users. Changes in MDRT, hip and trunk strength were evaluated using parametric and non-parametric statistics. The level of association between changes in values of MRDT and strength was also examined.ResultsSignificant differences between walkers and wheelchair users were found for strength measures (P < 0.05) but not for MDRT. Left- and right-sided reaches increased in wheelchair users only (P < 0.05). Associations between changes in hip strength, trunk strength, and reach distance were found (R = 0.67–0.73).ConclusionIn clinical settings, it is feasible and relevant to assess trunk, hip strength, and MRDT. Future studies require strategies to increase the number of participants assessed, in order to inform clinicians about relevant rehabilitation interventions.

Contralateral C7 Nerve Transfer with Direct Coaptation to Restore Lower Trunk Function After Traumatic Brachial Plexus Avulsion Injuries: Surgical Technique

BJS Essential Surgical Techniques (JBJS EST) is the premier journal describing how to perform orthopaedic surgical procedures, verified by evidence-based outcomes, vetted by peer review, while utilizing online delivery, imagery and video to optimize the educational experience, thereby enhancing patient care. WHAT MAKES JBJS ESSENTIAL SURGICAL TECHNIQUES ESSENTIAL READING? Edited by Edward Cheng, MD, JBJS EST is an online journal for orthopaedic surgeons, from seasoned veterans to those just starting out in this field. It offers readers a continuously expanding online library of thoroughly vetted surgical procedures. Easy to Read, Easy to Absorb: Each surgical procedure is described step by step and illustrated extensively with images to encourage greater understanding of the procedure and concepts. Video excerpts are frequent features. Indications, contraindications, pitfalls, and challenges are clearly highlighted. Peer reviewed and derived from a top-quality published clinical article: Readers can be confident that these procedures are based on solid scientific concepts, because all articles contain outcomes that have been reported on in previously published peer-reviewed publications. JBJS EST articles are subjected to the same rigorous editorial, peer-review, and copyediting process that has established The Journal of Bone & Joint Surgery's reputation for excellence. Contributions to JBJS EST are welcomed from anywhere in the world and are considered on their merits. Articles must be written in English and should be submitted as outlined in the Instructions to Authors. All authors must abide by the JBJS Ethics Policies.