Balance training following stroke: effects of task-oriented exercises with and without altered sensory input The measure of balance in sitting in stroke rehabilitation prognosis. Muscle strength of trunk flexion-extension in post-stroke hemiplegic patients. Rehabilitation of postural stability in ataxic/hemiplegic patients after stroke Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: a randomized, controlled trial. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Comparison of physio ball and plinth trunk exercises regimens on trunk control and functional balance in patients with acute stroke: a pilot randomized controlled trial Trunk Control as an Early Predictor of Comprehensive Activities of Daily Living Function in Stroke Patients Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. Additional Exercises Improve Trunk Performance After Stroke: A Pilot Randomized Controlled Trial Trunk control test as a functional predictor in stroke patients. Trunk Muscle Strength in Relation to Balance and Functional Disability in Unihemispheric Stroke Patients Training symmetry of weight distribution after stroke: a randomized controlled pilot study comparing task-related reach, Bo bath and feedback training approaches Effect of 6 weeks wobble board exercises on static and dynamic balance of stroke survivors. Sitting balance: its relation to function in individuals with hemiparesis. Trunk rotatory muscle performance in post-stroke hemiplegic patients. Effects of balance training on hemiplegic stroke patients. Balance disability after stroke. Reliability of the PEDro scale for rating quality of randomized controlled trials. Feasibility and Effectiveness of Circuit Training in Acute Stroke Rehabilitation Lateral weight transference exercises following acute stroke: a preliminary study of clinical effectiveness Rehabilitation of sensorimotor integration deficits in balance impairment of patients with stroke hemiparesis: a before/after pilot study A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. Effects of a program on symmetrical posture in patients with hemiplegia: A single-subject design. Discriminant ability of the Trunk Impairment Scale: A comparison between stroke patients and healthy individuals The effect of independent practice of motor tasks by stroke patients: a pilot randomized controlled trial Randomized Controlled Trial of Truncal Exercises Early After Stroke to Improve Balance and Mobility
The purpose of this study was to compare the effects of a task-oriented exercise program with and without altered sensory input on postural stability in subjects with stroke . Sixteen hemiparetic subjects , at least 6 months post-stroke , were r and omly assigned to the experimental or control group , and participated in an 8-week task-oriented exercise program focusing on balance and mobility exercises . Exercises were performed under normal conditions by the control group , and under conditions of vision and surface manipulation by the experimental group . Pre- and post-test assessment s involved the measurement of the center of pressure ( COP ) displacement during double-legged stance and sit-to-st and under four sensory conditions : ( 1 ) eyes open , normal surface ; ( 2 ) eyes open , soft surface ; ( 3 ) eyes closed , normal surface ; and ( 4 ) eyes closed , soft surface , as well as the 10-m walking test . Results showed significant improvements ( P<0.05 ) in COP displacement under sensory conditions ( 1 ) and ( 2 ) for the experimental group only , and limited changes for the sit-to-st and in both groups after training . Significant improvements ( P<0.05 ) were also found in both groups for the walking test . It is concluded that a task-oriented exercise program , assisted by sensory manipulation , is more effective at improving the st and ing balance of stroke subjects than a conventional task-oriented program . Die vorliegende Studie vergleicht die Wirkung eines anforderungsspezifischen Übungsprogramms mit und ohne Sinnesreizänderung auf die posturale Stabilität von Schlaganfallpatienten . Insgesamt 16 Hemiparetiker wurden mindestens sechs Monate nach dem Schlaganfall r and omisiert der Versuchs- oder der Kontrollgruppe zugeordnet , innerhalb derer sie acht Wochen an einem anforderungsspezifischen Programm mit speziellen Gleichgewichts- und Mobilitätsübungen teilnahmen . Die Kontrollgruppe führte die Übungen unter normalen Bedingungen durch , die Versuchsgruppe dagegen unter Manipulation der Aspekte Sicht und Gehflächen . Bei den Bewertungen vor und nach dem Test wurde die Verlagerung des Druckmittelpunkts ( COP ) während der zweibeinigen Haltung und der Aufstehübung anh and von vier Sinneszuständen gemessen : ( 1 ) offene Augen , normale Fläche , ( 2 ) offene Augen , weiche Fläche , ( 3 ) geschlossene Augen , normale Fläche und ( 4 ) geschlossene Augen , weiche Fläche sowie anh and des 10 m Gehtests . Die Ergebnisse wiesen nur bei der Versuchsgruppe bei der COP-Verlagerung unter den Sinneszuständen ( 1 ) und ( 2 ) beachtliche Verbesserungen ( P<0,05 ) auf und bei beiden Gruppen in beschränktem Maß Veränderungen bei der Aufstehübung . Bei beiden Gruppen wurden auch signifikante Verbesserungen ( P<0,05 ) beim Gehtest beobachtet . Daraus schließt sich , dass ein anforderungsspezifisches Übungsprogramm mit begleitender Sinnesmanipulation das Gleichgewicht von Schlaganfallpatienten bei aufrechter Körperhaltung effektiver verbessert als ein herkömmliches anforderungsspezifisches Programm . El propósito de este estudio fue comparar los efectos de un programa de ejercicios dirigidos , con estimulación sensorial alterada o sin ella , sobre la estabilidad postural de sujetos con accidente vascular cerebral . Dieciséis sujetos hemiparéticos que habían sufrido un accidente vascular cerebral hacía al menos 6 meses , fueron distribuidos al azar en dos grupos : uno experimental y uno control . Los mismos participaron durante 8 semanas en un programa de ejercicios dirigidos , el cual se centraba en ejercicios de balance y de movilidad . El grupo control realizó los ejercicios en condiciones normales , mientras que el grupo experimental los realizó en condiciones en que la visión y las superficies fueron alteradas . En las evaluaciones realizadas antes y después de los ejercicios se midió la desviación del centro de presión ( CP ) durante la postura de pie utiliz and o ambas piernas , así como en la postura sentada , listo para ponerse de pie , bajo cuatro condiciones sensoriales deferentes : 1 ) ojos abiertos , superficie normal ;  2  ) ojos abiertos , superficie bl and a ;  3  ) ojos cerrados , superficie normal ;  y  4 ) ojos cerrados , superficie bl and a. Se realizó además la prueba de la marcha de los 10 m. Los result ados mostraron mejoras significativas ( P<0,05 ) en la desviación del CP en ambos grupos durante la prueba de la marcha . Se concluyó que un programa de ejercicios dirigidos , en los que se utilicen manipulaciones sensoriales , es más efectivo que un programa convencional de ejercicios dirigidos para mejorar el balance durante la postura de pie en sujetos con accidente vascular cerebral . Le but de cette étude était de comparer les effets d'un programme d'exercices fonctionnels assistés ou non de stimulations sensorielles sur la stabilité posturale de sujets atteints d'un accident vasculaire cérébral ( AVC ) . Seize sujets hémiparétiques atteints d'un AVC depuis au moins 6 mois et répartis de façon aléatoire au sein du groupe expérimental et du groupe témoin ont participé à un programme d'exercices fonctionnels de huit semaines portant sur des exercices d'équilibre et de mobilité . Les exercices étaient exécutés en situation normale par le groupe témoin et en situation de manipulation de la vision et de la surface de support par le groupe expérimental . Les évaluations pré et post exercices ont été effectuées à l'aide de la mesure du déplacement du centre de pression ( CP ) lors du maintien de la position debout en appui bipodal et du transfert assis-debout selon les quatre conditions sensorielles suivantes : yeux ouverts , surface normale ( 1 ) ; yeux ouverts , surface moelleuse ( 2 ) ; yeux fermés , surface normale ( 3 ) ; yeux fermés , surface moelleuse ( 4 ) . Le test de marche de 10 mètres a aussi été inclus dans l'évaluation . Les résultats ont démontré une amélioration significative ( P<0.05 ) du déplacement du CP dans les conditions 1 et 2 pour le groupe expérimental seulement ainsi que des changements limités pour le transfert assis-debout chez les deux groupes de sujets à la suite de l'entraînement . Une amélioration significative ( P<0.05 ) a été observée au niveau du test de marche chez les deux groupes de sujets . Cette étude a démontré qu'un programme d'exercices fonctionnels assistés de stimulations sensorielles est plus efficace pour l'amélioration du maintien de l'équilibre en position debout chez les sujets atteints d'un AVC qu'un programme d'exercices fonctionnels conventionnnel To test the hypothesis that recovering stroke patients with initially good sitting balance or those who develop good sitting balance during rehabilitation have better Barthel Index-based functional assessment outcomes than recovering stroke patients with poor sitting balance , we prospect ively studied 24 of 25 consecutive stroke patients admitted to a tertiary-care hospital rehabilitation unit . Sitting balance , a prerequisite for most functional activities , was scored using a four-point scale evaluating static and dynamic sitting balance on admission to the rehabilitation unit and weekly until discharge . Functional status was assessed using the Barthel Index 4 or 12 weeks after the stroke . We found a strong positive correlation between Barthel Index score and each weekly sitting balance score . Multiple evaluations over time identified those patients whose sitting balance improved during rehabilitation in our unit ; after grouping the patients into those with normal , improved , and poor sitting balance , we found a significant difference in the Barthel Index scores among the three groups . The group of patients whose sitting balance improved had higher Barthel Index scores than the group whose sitting balance did not improve . Ongoing evaluation of sitting balance can be helpful in anticipating functional status at discharge in stroke patients undergoing comprehensive rehabilitation This study was undertaken to determine muscle strength of trunk flexion-extension in hemiplegic patients after stroke compared with that of normal controls . The design consisted of a nonr and omized control trial in a secondary care setting ( a rehabilitation unit at a hospital facility ) . The subjects included 25 post-stroke male hemiplegic patients and 25 male healthy controls . The maximal peak torques of trunk flexion-extension  at angular velocities of 0 degrees ( isometric contraction ) , 60 degrees , 120 degrees , and 150 degrees/s were measured by using an isokinetic dynamometer ( Cybex Trunk Extension-Flexion Unit , Cybex , Ronkonkoma , NY ) . Peak torque of trunk flexion and extension in hemiplegic patients was significantly smaller than that of healthy controls ( P < 0.05 ) , except isometric trunk flexion ( P > 0.05 ) . The weakness of trunk flexion-extension muscles in hemiplegic patients might be accounted for by the bilateral innervation from the motor cortex , the insufficient use of high threshold motor units , and disuse atrophy Purpose . This study assesses the postural stability and the effect of balance training using a force platform visual biofeedback among out patients with postural disturbances following stroke . Method . A tilting multiaxial force platform was used to assess bilateral postural stability in 38 out patients ( mean age 69.50 ± 8.57 years ) with hemiplegia and /or ataxia after stroke .  Stability indexes were obtained . Afterwards , a subgroup of 12 patients with the poorest overall stability index ( OASI ) started a balance training programme in the force platform . Postural control training consisted of a 30-min training session once a week for a 15-week period . The test was then repeated . Results . In the 38 out patients sample , the mean OASI was 4.7 ± 2.0 and 42.1 % of the patients used their h and s for support . In the 12 out patients group , the initial OASI was 5.8 ± 2.3 and half of the patients used their h and s for support . The final OASI was 3.3 ± 1.0 ( p = 0.005 ) and only two of the patients used their h and s for support ( p = 0.046 ) . Conclusion . Our results suggest that a training programme using force platform visual biofeedback  improves objective measures of bilateral postural stability in patients with hemiplegia and /or ataxia after stroke OBJECTIVE The purpose of this study was to evaluate the effectiveness of a 12-month community-based intervention on falls and risk factors ( balance , lower extremity strength , and mobility )  in community-living older adults . METHODS Four hundred fifty-three sedentary adults ( 65 years old or older ) were r and omized to either a multifaceted intervention ( 3 times a week group exercise , 6 hours of fall prevention education , comprehensive falls risk assessment results sent to primary health care provider ) or control group ( written material s on falls prevention ) . Primary outcome was fall incidence rates calculated from self-reported falls reported monthly for 12 months . Secondary outcomes were tests of leg strength , balance , and mobility prior to and following the 12-month intervention . RESULTS Twelve-month follow-up was completed on 95 % of participants . Intent-to-treat analysis found that the incidence rate of falls was 25 % lower among those in the intervention group compared with control group ( 1.33 vs 1.77 falls/person-year , rate ratio 0.75 , 95 % confidence interval [ CI ] , 0.52 - 1.09 ) . This difference was not statistically significant . The risk ratio for any fall was 0.96 ( 95 % CI , 0.82 - 1.13 ) . Small but significant improvements were found on the Berg Balance Test ( adjusted mean difference + 1.5 points , 95 % CI , 0.8 - 2.3 ) , the Chair St and Test ( adjusted mean difference + 1.2 , 95 % 0.6 - 1.9 ) , and the Timed Up and Go Test ( adjusted mean difference -0.7 , 95 % CI , -1.2 to -0.2 ) . CONCLUSIONS A community-based multifaceted intervention was effective in improving balance , mobility , and leg strength , all known fall risk factors . Although the incidence of falls was lower , the confidence interval included the possibility of no intervention effect on falls OBJECTIVE To evaluate the impact of a program of muscle strengthening and physical conditioning on  impairment and disability in chronic stroke subjects . DESIGN A r and omized pretest and posttest control group , followed by a single-group pretest and posttest design . SUBJECTS Thirteen community-dwelling stroke survivors of at least 9 months . INTERVENTION A 10-week ( 3 days/week ) program consisting of a warm-up , aerobic exercises , lower extremity muscle strengthening , and a cool-down . MAIN OUTCOME MEASURES Peak isokinetic torque of the major muscle groups of the affected lower limb , quadriceps and ankle plantarflexor spasticity , gait speed , rate of stair climbing , the Human Activity Profile ( HAP ) , and the Nottingham Health Profile ( NHP ) were recorded twice for the treatment group and three times for the control group . RESULTS Significant improvements were found for all the selected outcome measures ( HAP , NHP , and gait speed ) for the treatment group ( p < .001 ) . In terms of overall training effects , the 13 subjects demonstrated increases in strength of the affected major muscle groups , in HAP and NHP profiles , and in gait speed and rate of stair climbing without concomitant increases in either quadriceps or ankle plantarflexor spasticity . CONCLUSIONS The 10-week combined program of muscle strengthening and physical conditioning result ed in gains in all measures of impairment and disability . These gains were not associated with measurable changes of spasticity in either quadriceps or ankle plantarflexors Objective : To examine the effects of trunk exercises performed using the physio ball as against the plinth , on trunk control and functional balance in patients with acute stroke . Design : An observer-blinded pilot r and omized controlled trial . Subjects : Thirty patients with acute stroke ( mean post-stroke duration 12 ( 95 % confidence interval ( CI ) 2–34 ) days ) who had the first onset of unilateral haemorrhagic or ischaemic lesion and an independent ability to sit for 30 seconds . Setting : Inpatient stroke rehabilitation centre . Interventions : The experimental group performed task-specific trunk exercises on an unstable surface ( physio ball ) while the control group performed them on a stable surface ( plinth ) . In addition to regular acute physiotherapy , both the groups underwent 1 hour of trunk exercises a day , four days a week for three weeks . Main measures : Trunk Impairment Scale and Brunel Balance Assessment . Results : The difference between the baseline characteristics of the patients belonging to both groups was not statistically significant . Post-intervention , both the groups improved on trunk control and functional balance but the experimental group improved more significantly than the control group ( change scores of between-group comparison for the total Trunk Impairment Scale 3.06 ( 1.43 ) , dynamic sitting balance 1.47 ( 1.36 ) and coordination 1.3 ( 0.67 ) subscales of Trunk Impairment Scale ; the total Brunel Balance Assessment 1.8 ( 1.4 ) and stepping 1.87 ( 1.6 ) component of Brunel Balance Assessment ) . The level of significance was set at P < 0.05 . Conclusions : The trunk exercises performed on the physio ball are more effective than those performed on the plinth in improving both trunk control and functional balance in acute stroke patients , suggesting a task-specific effect and also a carry-over effect Background and Purpose — Prediction of activities of daily living ( ADL ) functions at an early stage after a stroke is critical because it enables clinicians to set treatment programs and goals . The objective of this study was to assess the relationship between trunk control at an early stage and comprehensive ADL function ( as assessed by combining basic ADL and instrumental ADL [ IADL ] ) in patients at 6 months after stroke . Methods — A total of 169 stroke patients participated in this prospect i ve study . Trunk control  was measured with the use of the  trunk control items of the Postural Assessment Scale for Stroke Patients ( PASS-TC ) . In addition to the PASS-TC score , age , sex , type of stroke , side of hemiparesis , urinary incontinence , limb paresis ( measured by the Fugl-Meyer motor test ) , balance ( measured by the Fugl-Meyer balance test ) , and basic ADL ( measured by the Barthel Index ) were also selected as predictor variables . These variables were assessed at 14 days after stroke or earlier . The Barthel Index and Frenchay Activities Index ( measuring IADL ) were administered at 6 months after stroke . The sum of the st and ardized Barthel Index and st and ardized Frenchay Activities Index scores was used to assess comprehensive ADL function . Results — Multivariable stepwise linear regression analysis showed that PASS-TC score , age , Fugl-Meyer motor test score , and Barthel Index score ( listed by the order of forward selection ) were the strongest predictors of comprehensive ADL function . These results were internally vali date d with the use of the bootstrap resampling technique . The PASS-TC score alone accounted for 45 % of the variance in predicting comprehensive ADL function . Results also indicated that the PASS-TC score had slightly more power in predicting comprehensive ADL function than either the Fugl-Meyer motor test score or Barthel Index score . Conclusions — The findings of this study provide strong evidence of the predictive value of trunk control on comprehensive ADL function in stroke patients . The results imply that early assessment and management of trunk control after stroke should be emphasized OBJECTIVES To determine the effect of two different community-based group exercise programs on functional balance , mobility , postural reflexes , and falls in older adults with chronic stroke . DESIGN A r and omized , clinical trial . SETTING Community center . PARTICIPANTS Sixty-one community-dwelling older adults with chronic stroke . INTERVENTION Participants were r and omly assigned to an agility ( n=30 ) or stretching/weight-shifting ( n=31 ) exercise group . Both groups exercised three times a week for 10 weeks . MEASUREMENTS Participants were assessed before , immediately after , and 1 month after the intervention for Berg Balance , Timed Up and Go , step reaction time , Activities-specific Balance Confidence , and Nottingham Health Profile . Testing of st and ing postural reflexes and induced falls evoked by a translating platform was also performed . In addition , falls in the community were tracked for 1 year from the start of the interventions . RESULTS Although exercise led to improvements in all clinical outcome measures for both groups , the agility group demonstrated greater improvement in step reaction time and paretic rectus femoris postural reflex onset latency than the stretching/weight-shifting group . In addition , the agility group experienced fewer induced falls on the platform . CONCLUSION Group exercise programs that include agility or stretching/weight shifting exercises improve postural reflexes , functional balance , and mobility and may lead to a reduction of falls in older adults with stroke Background . Sitting balance and the ability to perform selective trunk movements are important predictors of functional outcome after stroke . However , studies evaluating the effect of exercises aim ed at improving trunk performance are sparse . Objective . To examine the effect of additional trunk exercises on trunk performance after stroke . Methods . An assessor-blinded r and omized controlled trial was carried out at an inpatient stroke rehabilitation center . In total 33 participants were assigned to an experimental group ( n = 17 ) or a control group ( n = 16 ) . In addition to conventional therapy , the experimental group received 10 hours of individual and supervised trunk exercises ; 30 minutes , 4 times a week , for 5 weeks . Trunk performance was evaluated by the Trunk Impairment Scale ( TIS ) and its subscales of static and dynamic sitting balance and coordination . A general linear repeated measures model was used to analyze the results of our study . Results . No significant differences were found pretreatment between the 2 groups for the collected demographic variables , stroke-related parameters , clinical measures , number of therapy sessions received , and primary outcome measure used . Posttreatment , a significantly better improvement was noted in the experimental group compared to the control group for the dynamic sitting balance subscale only ; measuring selective lateral flexion initiated from the upper and lower part of the trunk , ( P = .002 , post hoc power calculation = .90 , effect size = 1.16 ) . Conclusions . Our results suggest that , in addition to conventional therapy , trunk exercises aim ed at improving sitting balance and selective trunk movements have a beneficial effect on the selective performance of lateral flexion of the trunk after stroke The purpose of this study was to evaluate prospect ively the Trunk Control Test ( TCT ) correlation at admission to rehabilitation with length of stay , functional independence measure ( FIM ) , gait velocity , walking distance and balance measured at discharge in 28 hemiparetic patients .  FIM and TCT were registered on admission . Outcome measures at discharge were : FIM , gait velocity , walking distance and balance assessed with the Berg Balance Scale and computerized posturography .  TCT was significantly correlated with length of stay ( r = -0.722 ) , discharge FIM ( r = 0.738 ) , discharge motor FIM ( r = 0.723 ) , gait velocity ( r = 0.654 ) , walking distance ( p = 0.003 ) , centre of gravity symmetry r = 0.601 ) and Berg Balance Scale ( r = 0.755 ) . Initial TCT predicts the 52 % of the variation in length of stay and 54 % in the discharge FIM . The predictive value of a compound variable (  TCT and admission FIM ) reaches 60 % of the variation in length of stay and 66 % in the FIM at discharge Karatas M , Çetin N , Bayramoglu M , Dilek A : Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients . Am J Phys Med Rehabil 2004;83:81–87 . Objective To evaluate trunk muscle strength in unihemispheric stroke patients and to assess how it relates to body balance and functional disability in this patient group . Design This prospect i ve case-comparison study investigated isometric and isokinetic reciprocal trunk flexion and extension strength at angular velocities in 38 unihemispheric stroke patients and 40 healthy volunteers .  The Berg balance scale was used to assess balance and stability , and the  FIM ™ instrument was used to evaluate functional disability in the patient group . Patients were evaluated as soon as they were able to st and long enough for testing . Results Peak torque values for trunk flexion and extension were lower in the stroke patients than in the controls . The differences were significant for trunk flexion and for trunk extension . In both groups , peak torque values for trunk flexors were greater than peak torque values for trunk extensors . There was a significant positive correlation between trunk muscle strength and Berg balance scale score at discharge . Trunk muscle strength was not correlated with FIM total score or FIM motor score , but the locomotion-transfers FIM subscore at discharge was positively correlated with trunk muscle torque values , except for isometric extension . Conclusion The findings indicate trunk flexion and extension muscle weakness in unihemispheric stroke patients , which can interfere with balance , stability , and functional disability Objective : To determine ( 1 ) the most effective of three treatment approaches to retrain seated weight distribution long-term after stroke and ( 2 ) whether improvements could be generalized to weight distribution in st and ing . Setting : Inpatient rehabilitation unit . Design : Forty asymmetrical acute stroke subjects were r and omly allocated to one of four groups in this pilot study . Changes in weight distribution were compared between the 10 subjects of each of three treatment groups ( task-specific reach , Bobath , or Balance Performance Monitor [ BPM ] feedback training ) and a no specific treatment control group . One week of measurement only was followed by two weeks of daily training sessions with the treatment to which the subject was r and omly allocated . Measurements were performed using the BPM daily before treatment sessions , two weeks after cessation of treatment and 12 weeks post study . Weight distribution was calculated in terms of mean balance ( percentage of total body weight ) or the mean of 300 balance points over a 30-s data run . Results : In the short term , the Bobath approach was the most effective treatment for retraining sitting symmetry after stroke ( p = 0.004 ) . Training with the BPM and no training were also significant ( p = 0.038 and p = 0.035 respectively ) and task-specific reach training failed to reach significance ( p = 0.26 ) . At 12 weeks post study 83 % of the BPM training group , 38 % of the task-specific reach group , 29 % of the Bobath group and 0 % of the untrained group were found to be distributing their weight to both sides . Some generalization of symmetry training in sitting to st and ing was noted in the BPM training group which appeared to persist long term . Conclusions : Results should be treated with caution due to the small group sizes . However , these preliminary endings suggest that it might be possible to restore postural symmetry in sitting in the early stages of rehabilitation with therapy that focuses on creating an awareness of body position Balance is a complex motor skill and it is frequently disturbed among stroke survivors . Rehabilitation experts are still facing challenges in achieving good stability . The primary aim of this study was to determine the effect of a wobble board exercise program on static and dynamic balance of hemiplegic subjects . Seventeen ( 17 ) stroke survivors were r and omly selected into two groups . The subjects in the experimental group were trained on wobble board for six weeks while the control group received only the baseline treatment programs . The modified version of the timed balance test was used to assess balance while the foursquare step test was used to assess dynamic balance . Descriptive statistics and Analysis of variance ( ANOVA ) were used to analyze the data obtained . The result showed that there was significant difference in the static balance ( eye closed ) ( F=7.49 , P < 0.05 ) and dynamic balance ( F3.20 , P < 0.05 ) between the groups but there was no significant difference in static balance ( eye opened ) ( F= 1.75 , P > 0.05 ) . The study concluded that wobble board exercise improved both static ( eye closed ) and dynamic balance of stroke survivor used in this study OBJECTIVES To evaluate test-retest reliability of sitting balance measures in healthy subjects and individuals with hemiparesis secondary to stroke , to evaluate the ability of the balance measures and Functional Independence Measure ( FIM ) to document changes over time , and to compare changes in the balance measures and FIM to each other . METHOD Six nonpatient subjects were evaluated for test-retest reliability . Fourteen subjects with hemiparesis were tested every 2 weeks during their hospitalization on their ability to lean to either side , lean forward , and maintain a symmetrical posture . Maximum displacement was recorded using the Balance System .  FIM scores were obtained for each testing session . RESULTS Test-retest reliability for nonpatient subjects was high and for patients was moderate to high . Leaning forward and to the paretic side showed the greatest number of correlations with the FIM scores . All of the FIM scales and the forward lean measure documented progress . CONCLUSIONS The protocol developed to test sitting balance , using the Balance System , seems appropriate for use with patient population s. The ability to lean maximally to either side or forward or sit symmetrically is not strongly related to function This study was undertaken to determine whether the direction of trunk rotation would have any effect on trunk muscle performance of post-stroke hemiplegic patients . The design consisted of a nonr and omized control trial in a setting of secondary care ( rehabilitation unit at hospital facility ) . The subjects included 65 hemiplegic patients ( 50 males ) and age-matched 80 healthy controls ( 38 females ) .  Isokinetic trunk rotatory muscle performance at angular velocities of 60 , 120 , and 150 degrees per second was measured by using an isokinetic dynamometer ( Cybex Torso Rotation Unit ) . There were no significant differences in the peak torque and best work between the right and left directions of the trunk rotation in the hemiplegic patients or in healthy controls , regardless of the gender of the subjects ( paired t test , P > 0.05 ) . The muscle performance of the hemiplegic patients was significantly lower than that of the controls for both genders ( t test , P < 0.05 ) . In the hemiplegic patients , the direction of trunk rotation does not affect the trunk rotatory muscle performance , although the performance itself was slightly decreased BACKGROUND The purpose of this study was to evaluate the delayed effects of balance training program on hemiplegic stroke patients . METHODS A total of 41 ambulatory hemiplegic stroke patients were recruited into this study and r and omly assigned into two groups , the control group and trained group . Visual feedback balance training with the SMART Balance Master was used in the trained group . Bruunstrom staging of affected limb scores and Functional Independent Measure ( FIM ) scores of each patient were recorded . Quantitative balance function was evaluated using the SMART Balance Master . Data were collected before training and 6 months after completing the training program . RESULTS Significant improvements in dynamic balance function measurements were found for patients in the trained group at 6 months after completing the training program . The ability of self-care and sphincter control also improved for patients in the trained group . On the other h and , no significant differences were found in static balance functions between the trained group and control group at 6 months of follow up . The locomotion and mobility scoring of FIM also revealed no differences between the groups . CONCLUSION Dynamic balance function of patients in the visual feedback training group had significant improvements when compared with the control group . Activities of daily living ( ADL ) function in self-care also had significant improvements at 6 months of follow up in the trained group . The results showed that balance training was beneficial for patients after hemiplegic stroke BACKGROUND AND PURPOSE Balance disability is common after stroke , but there is little detailed information about it . The aims of this study were to investigate the frequency of balance disability ; to characterize different levels of disability ; and to identify demographics , stroke pathology factors , and impairments associated with balance disability . SUBJECTS The subjects studied were 75 people with a first-time anterior circulation stroke ; 37 subjects were men , the mean age was 71.5 years ( SD=12.2 ) , and 46 subjects ( 61 % ) had left hemiplegia . METHODS Prospect i ve  hospital-based cross-sectional surveys were carried out in 2 British National Health Service trusts . The subjects ' stroke pathology , demographics , balance disability , function , and neurologic impairments were recorded in a single testing session 2 to 4 weeks after stroke . RESULTS A total of 83 % of the subjects ( n=62 ) had a balance disability ; of these , 17 ( 27 % ) could sit but not st and , 25 ( 40 % ) could st and but not step , and 20 ( 33 % ) could step and walk but still had limited balance . Subjects with the most severe balance disability had more severe strokes , impairments , and disabilities . Weakness and sensation were associated with balance disability . Subject demographics , stroke pathology , and visuospatial neglect were not associated with balance disability . DISCUSSION AND CONCLUSION Subjects with the most severe balance disability had the most severe strokes , impairments , and disabilities . Subject demographics , stroke pathology , and visuospatial neglect were not associated with balance disability BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Background : Task-specificity , repetition and progression are key variables in the acquisition of motor skill however they have not been consistently implemented in post-stroke rehabilitation . Objective : To evaluate the effectiveness of a stroke rehabilitation plan of care that incorporated task-specific practice , repetition and progression to facilitate functional gain compared to st and ard physical therapy for individuals admitted to an inpatient stroke unit . Methods : Individuals participated in either a circuit training ( CTPT ) model ( n = 72 ) or a st and ard ( SPT ) model ( n = 108 ) of physical therapy , 5 days/week . Each 60 minute circuit training session , delivered according to severity level , consisted of four functional mobility tasks . Daily exercise logs documented both task repetition and progression . Results : The CTPT model was successfully implemented in an acute rehabilitation setting . The CTPT group showed a significantly greater improved change in gait speed from hospital admission to discharge than the SPT group ( 0.21± 0.25 m/sec vs. 0.13± 0.22 m/sec ; p = 0.03 ) . The difference between groups occurred primarily among those who were ambulatory upon admission . There were no significant differences between the two cohorts at 90 days post-stroke as measured by the FONE-FIM , SF-36 and living location . Conclusions : Therapy focused on systematic ally progressed functional tasks can be successfully implemented in an inpatient rehabilitation stroke program . This circuit-training model result ed in greater gains in gait velocity over the course of inpatient rehabilitation compared to the st and ard model of care . Community-based services following hospital discharge to maintain these gains should be included in the continuum of post-stroke care Objectives : To evaluate a training programme aim ed at improving lateral weight transference in patients following acute stroke to determine main treatment effects , if any , to inform the design of future studies . Design : A single-blind r and omized controlled trial . Setting : The Stroke Unit at The James Cook University Hospital , Middlesbrough , UK . Subjects : Thirty-five patients with an acute stroke . Interventions : All subjects received their usual care , including physiotherapy . The treatment group ( n / 17 ) received 12 additional therapy sessions ( over four weeks ) comprising exercises aim ed at improving lateral weight transference in sitting delivered by trained physiotherapy assistants . Main outcome measures : Measures of dynamic reaching , sitting and st and ing , and static st and ing balance were undertaken by a blind independent observer . Results : Specific measures of weight displacement in st and ing and reaching , and timed st and ing up and sitting down did not detect any differences over time regardless of group . Neither were there any significant changes over time , except for sway during static st and ing ( p B=0.01 ) and time to return to their original position during dynamic reaching ( p / 0.01 ) . Conclusions : A training programme aim ed at improving lateral weight transference did not appear to enhance the rehabilitation of acute stroke patients . Improvements observed in postural control in st and ing and sitting may be attributable to usual care or natural recovery Balance impairment in patients with stroke hemiparesis is frequently related to deficits of central integration of afferent inputs ( somatosensory , visual , vestibular ) . Our aim was to evaluate whether balance exercises performed under various sensory input manipulations can improve postural stability and /or walking ability in patients with stroke . Seven chronic hemiparetic subjects were recruited . Patient performance was assessed before , immediately after and one week after treatment ( consisting of 20 one-hour daily sessions of several balance exercises ) by means of the  Sensory Organization Balance Test  and the  Ten Metre Walking Test .  Before treatment , all patients showed balance impairment with difficulty integrating somatosensory information from the lower extremities and excessive reliance upon visual input in st and ing balance control . After treatment , balance and walking speed significantly increased and this improvement was maintained for one week . These findings indicate that rehabilitation of sensorimotor integration deficits can improve balance in patients with stroke hemiparesis OBJECTIVES To examine the effects of a community-based group exercise program for older individuals with chronic stroke . DESIGN Prospect i ve , single-blind , r and omized , controlled intervention trial . SETTING Intervention was community-based . Data collection was performed in a research laboratory located in a rehabilitation hospital . PARTICIPANTS Sixty-three older individuals ( aged > or = 50 ) with chronic stroke ( poststroke duration > or = 1 year ) who were living in the community . INTERVENTION Participants were r and omized into intervention group ( n=32 ) or control group ( n=31 ) . The intervention group underwent a fitness and mobility exercise ( FAME ) program design ed to improve cardiorespiratory fitness , mobility , leg muscle strength , balance , and hip bone mineral density ( BMD ) ( 1-hour sessions , three sessions/week , for 19 weeks ) . The control group underwent a seated upper extremity program . MEASUREMENTS Cardiorespiratory fitness ( maximal oxygen consumption ) , mobility ( 6-minute walk test ) , leg muscle strength ( isometric knee extension ) , balance ( Berg Balance Scale ) , activity and participation ( Physical Activity Scale for Individuals with Physical Disabilities ) , and femoral neck BMD ( using dual-energy x-ray absorptiometry ) . RESULTS The intervention group had significantly more gains in cardiorespiratory fitness , mobility , and paretic leg muscle strength than controls . Femoral neck BMD of the paretic leg was maintained in the intervention group , whereas a significant decline of the same occurred in controls . There was no significant time-by-group interaction for balance , activity and participation , nonparetic leg muscle strength , or nonparetic femoral neck BMD . CONCLUSION The FAME program is feasible and beneficial for improving some of the secondary complications result ing from physical inactivity in older adults living with stroke . It may serve as a good model of a community-based fitness program for preventing secondary diseases in older adults living with chronic conditions OBJECTIVES Asymmetrical posture during static stance has been identified as a common problem in persons with hemiplegia . This study examined the effect of an activity-based therapy regimen on symmetric weight bearing and midline position of center of gravity ( COG ) in three adult subjects with hemiplegia . METHOD An ABAB single-subject design was used . The intervention program , including s and ing in front of a st and ing table and play a bean bag game , was introduced for 30 min each day during each intervention phase . Quantitative measurements of the weight distribution and the midline position of COG were taken with the Balance Master System ( version 2.20 ) . RESULTS Visual inspection and statistical analysis of the data revealed a significant improvement in symmetric weight distribution and midline position of COG . The study suggests that this program may be a promising alternative to a variety of postural rehabilitation programs for persons with hemiplegia . CONCLUSION Insecurity caused by poor stabilization and abnormal reactions to body weight bearing in an antigravity position might contribute to asymmetric postures . Results of this study suggest that an activity-oriented program can be effective in helping the persons with hemiplegia achieve symmetric stances Purpose . The  Trunk Impairment Scale ( TIS ) is a st and ardized scale to evaluate the trunk function in stroke patients . It was the aim of this study to determine the discriminant ability of the TIS by comparing stroke patients with healthy individuals . Further , the variables that had an influence on obtaining a high score on the TIS in healthy subjects were examined . Method . Forty stroke patients and 40 age- and sex-matched healthy individuals were included in the study .  TIS scores from the stroke patients and healthy individuals were compared using the Wilcoxon ranked sum test . Results . Sub-scale and total TIS scores showed significant differences between stroke patients and healthy individuals ( P < 0.0001 ) . Univariate analysis and logistic regression analysis further revealed that younger persons , women and people who are more active in daily life have a higher chance of obtaining a high score on the TIS . Conclusions . The TIS discriminates between stroke patients and healthy individuals . A submaximal score on the TIS was found in 45 % of the healthy subjects suggesting that a lower score on the TIS still indicates normal trunk function and full participation in daily life Objective : To investigate the effect of independent practice of sitting balance as an addition to st and ard physiotherapy treatment for patients with stroke . Design : R and omized controlled trial , using blocked r and omization procedure with 2:1 ratio . Subjects : In patients with diagnosis of stroke , having achieved one minute of independent sitting balance but not yet achieved 10 independent steps , and with no known previous disabilities , pathology or neurological de”cit affecting mobility prior to stroke . Intervention : A four-week regime of independent practice aim ed at improving aspects of balance , as an addition to st and ard physiotherapy treatment based on the Bobath Approach . Main outcome measure : Proportion of patients achieving ‘ normal ’ symmetry of weight distribution during sitting , st and ing , rising to st and , sitting down , and reaching . Results : Nineteen subjects were r and omized to the control group ; nine to the intervention group . There were no clinical ly signi”cant differences in measured outcome between the groups . Conclusions : The regime of independent practice had no measured bene”cial effect on the balance ability of patients with recently acquired stroke Background . Sitting balance and the ability to perform selective truncal movements are important predictors of functional outcome after stroke . However , few clinical trials have evaluated the effect of truncal exercises . Objective . The authors assessed the effect of additional truncal exercises on truncal function , st and ing balance , and mobility . Methods . An assessor-blinded r and omized controlled trial was carried out at a stroke rehabilitation hospital . A total of 33 participants ( mean 35 days post onset ) were r and omly assigned to an experimental group ( n = 18 ) or a  control group ( n = 15 ) . In addition to conventional therapy , the experimental group received 16 hours of truncal exercises . The control group received 16 hours of sham treatment .  Truncal function was evaluated by the Trunk Impairment Scale ( TIS ) and st and ing balance and mobility by the Tinetti Test . The Romberg with eyes open and eyes closed , Four Test Balance Scale ( FTBS ) , Berg Balance Scale ( BBS ) , Rivermead Motor Assessment Battery ( RMAB ) , Functional Ambulation Categories , and Dynamic Gait Index ( DGI ) were performed to eluci date the findings of the primary outcome measures . Results . A treatment effect was found for the experimental group on the TIS ( P < .001 ) , Tinetti Test ( P < .001 ) , FTBS ( P = .014 ) , BBS ( P = .007 ) , RMAB ( P < .001 ) , and DGI ( P = .006 ) . Conclusions . In addition to conventional therapy , truncal exercises have a beneficial effect on truncal function , st and ing balance , and mobility in people after stroke
BACKGROUND Trunk control has been identified as an important early predictor of functional outcome after stroke but there is insufficient evidence that proximal stability of the trunk is a pre-requisite for sitting and st and ing balance , walking , and functional activities .
OBJECTIVE We systematic ally review ed the literature on trunk training exercises ( TTE ) in adult patients with stroke .
To establish if TTE can improve trunk performance and sitting balance .