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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- Heart disease and stroke statistics–2016 update: a report from the American Heart Association.Circulation. 2016; 133: e38-e360
- Falls, sway, and symmetry of weight-bearing after stroke.Int Disabil Stud. 1991; 13: 1-4
- Hemiplegic gait: a kinematic analysis using walking speed as a basis.J Biomech. 1992; 25: 1007-1015
- Falls after stroke.Int J Stroke. 2012; 7: 482-490
- Enhancing anticipatory postural adjustments: a novel approach to balance rehabilitation.J Nov Physiother. 2016; 6: 1-5
- Properties of postural adjustments associated with rapid arm movements.J Neurophysiol. 1982; 47: 287-308
- Relationship between limb movement speed and associated contraction of the trunk muscles.Ergonomics. 1997; 40: 1220-1230
- Transversus abdominis and the superficial abdominal muscles are controlled independently in a postural task.Neurosci Lett. 1999; 265: 91-94
- Postural function of the diaphragm in person with and without chronic low back pain.J Orthop Sports Phys Ther. 2012; 42: 352-362
- Task-specific modulation of anticipatory postural adjustments in individuals with hemiparesis.Clin Neurophysiol. 2002; 113: 642-655
- Anticipatory postural adjustment in selected trunk muscles in poststroke hemiparetic patients.Arch Phys Med Rehabil. 2004; 85: 261-267
- Postural responses to unilateral arm perturbation in young, elderly, and hemiplegic subjects.Arch Phys Med Rehabil. 1997; 78: 1072-1077
- Timing, intensity, and duration of rehabilitation for hip fracture and stroke: report of a workshop at the National Center for Medical Rehabilitation Research.Neurorehabil Neural Repair. 2004; 18: 12-28
- Real-time ultrasound feedback and abdominal hollowing exercises for people with low back pain.NZ J Physiotherapy. 2007; 35: 4-11
- The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects.J Orthop Sports Phys Ther. 2005; 6: 338-345
- An MRI investigation into the function of the transverses abdominis muscle during “drawing-in” of the abdominal wall.Spine. 2006; 31: E175-E178
- Dynamic neuromuscular stabilization and sports rehabilitation.Int J Sports Phys Ther. 2013; 8: 62-73
- Dynamic neuromuscular stabilization: developmental kinesiology: breathing stereotypes and postural-locomotion function.in: Chaitow L. Gilbert C. Morrison D. Recognizing and treating breathing disorders. 2nd ed. Churchill Livingstone, Edinburgh2014: 13-16
- Core stabilization exercise with real-time feedback for chronic hemiparetic stroke: a pilot randomized controlled trials.Restor Neurol Neurosci. 2014; 32: 313-321
- The effect of enhanced trunk control on balance and falls through bilateral upper extremity exercises among chronic stroke patients in a standing position.J Phys Ther Sci. 2016; 28: 194-197
- The trunk impairment scale: a new tool to measure motor impairment of the trunk after stroke.Clin Rehabil. 2004; 18: 326-334
- Clinical tools to measure trunk performance after stroke; a systematic review of the literature.Clin Rehabil. 2007; 21: 387-394
- Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke rehabilitation.Arch Phys Med Rehabil. 2003; 84: 731-735
- The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke.Scand J Rehabil Med. 1995; 27: 27-36
- Falls efficacy as a measure of fear of falling.J Gerontol. 1990; 45: 239-243
- Electrode placements.in: Criswell E. Cram's introduction to surface electromyography. 2nd ed. Aspen Publishers, Gaithersburg1998: 257-383
- Abdominal muscle size and symmetry at rest and during abdominal hollowing exercises in healthy control subjects.J Anat. 2008; 213: 173-182
- Novel augmented ADIM training using ultrasound imaging and electromyography in adults with core instability.J Back Musculoskelet Rehabil. 2011; 24: 233-240
- Facilitation of agonist-antagonist co-activation by reflex stimulation methods.in: Liebenson C. Rehabilitation of the spine. 2nd ed. Lippincott/Williams and Wilkins, Baltimore2007: 551-554
- Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values.Chest. 2009; 135: 391-400
- Comparison of changes in abdominal muscle thickness between standing and crook lying during active abdominal hollowing using ultrasound imaging.Man Ther. 2009; 14: 690-695
- Reflex-mediated dynamic neuromuscular stabilization in stroke patients: EMG processing and ultrasound imaging.Technol Health Care. 2017; 25: S99-S106
- Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.J Clin Consult Psychol. 1991; 59: 12-19
- The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: a randomized controlled trial.Clin Rehabil. 2016; 30: 1024-1033
- The effects of core stability strength exercise on muscle activity and trunk impairment scale in stroke patients.J Exerc Rehabil. 2013; 9: 362-367
- The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain.Spine. 2002; 27: 399-405
- Characteristics of motor unit discharge in subjects with hemiparesis.Muscle Nerve. 1995; 18: 1101-1114
Published online: February 21, 2018
Supported by a Brain Korea 21 PLUS Project Grant (grant no. 2016-51-0009) from the Korean Research Foundation.
Clinical Trial Registration No.: KCT0002126 (Clinical Research Information Service, Republic of Korea).
© 2018 by the American Congress of Rehabilitation Medicine