Original research| Volume 99, ISSUE 11, P2168-2174, November 2018

Best Core Stabilization for Anticipatory Postural Adjustment and Falls in Hemiparetic Stroke

Published:February 21, 2018DOI:



      To compare the effects of conventional core stabilization and dynamic neuromuscular stabilization (DNS) on anticipatory postural adjustment (APA) time, balance performance, and fear of falls in chronic hemiparetic stroke.


      Two-group randomized controlled trial with pretest-posttest design.


      Hospital rehabilitation center.


      Adults with chronic hemiparetic stroke (N=28).


      Participants were randomly divided into either conventional core stabilization (n=14) or DNS (n=14) groups. Both groups received a total of 20 sessions of conventional core stabilization or DNS training for 30 minutes per session 5 times a week during the 4-week period.

      Main Outcome Measures

      Electromyography was used to measure the APA time for bilateral external oblique (EO), transverse abdominis (TrA)/internal oblique (IO), and erector spinae (ES) activation during rapid shoulder flexion. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), and Falls Efficacy Scale (FES) were used to measure trunk movement control, balance performance, and fear of falling.


      Baseline APA times were delayed and fear of falling was moderately high in both the conventional core stabilization and DNS groups. After the interventions, the APA times for EO, TrA/IO, and ES were shorter in the DNS group than in the conventional core stabilization group (P<.008). The BBS and TIS scores (P<.008) and the FES score (P<.003) were improved compared with baseline in both groups, but FES remained stable through the 2-year follow-up period only in the DNS group (P<.003).


      This is the first clinical evidence highlighting the importance of core stabilization exercises for improving APA control, balance, and fear of falls in individuals with hemiparetic stroke.


      List of abbreviations:

      AD (anterior deltoid), APA (anticipatory postural adjustment), BBS (Berg Balance Scale), DNS (dynamic neuromuscular stabilization), EO (external oblique), ES (erector spinae), FES (Falls Efficacy Scale), IAP (intra-abdominal pressure), IO (internal oblique), MANOVA (multivariate analysis of variance), RA (rectus abdominis), TIS (Trunk Impairment Scale), TrA (transverse abdominis)
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