Trunk control ability is an important component of functional independence after the onset of stroke. Recently, it has been reported that robot-assisted functional training is effective for stroke patients. However, most studies on robot-assisted training have been conducted on upper and lower extremities.
OBJECTIVE:
The purpose of this study was to evaluate the effects of robot-assisted trunk control training on trunk postural control and balance ability in stroke patients.
METHODS:
Forty participants with hemiparetic stroke were recruited and randomly divided into two groups: the RT (robot-assisted trunk control training) group ( 20) and the control group ( 20). All participants underwent 40 sessions of conventional trunk stabilization training based on the Bobath concept (for 30 minutes, five-times per week for 8 weeks). After to each training session, 15 minutes of robotassisted trunk control training was given in the RT group, whereas the control group received stretching exercise for the same amount of time. Robot-assisted trunk control training was conducted in three programs: sitting balance, sit-to stand, and standing balance using a robot system specially designed to improve trunk control ability. To measure trunk postural control ability, trunk impairment scale (TIS) was used. Center of pressure (COP) distance, limits of stability (LOS), Berg Balance Scale (BBS) and functional reach test (FRT) were used to analyze balance abilities.
RESULTS:
In TIS, COP distance, LOS, BBS and FRT, there were significant improvements in both groups after intervention. More significant changes were shown in the RT group than the control group ( 0.05).
CONCLUSIONS:
Our findings indicate that robot-assisted trunk control training is beneficial and effective to improve trunk postural control and balance ability in stroke patients. Therefore robot-assisted training may be suggested as an effective intervention to improve trunk control ability in patients with stroke.
VerheydenGNieuwboerAMertinJPregerRKiekensCDe WeerdtW. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil.2004; 18: 326-334.
2.
GoldiePEvansOMatyasT. Performance in the stability limits test during rehabilitation following stroke. Gait Posture.1996; 4: 315-322.
3.
LauferYDicksteinRResnikSMarcovitzE. Weight-bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights. Clin Rehabil.2000; 14: 125-129.
4.
DaultMCde HaartMGeurtsACArtsIMNienhuisB. Effects of visual center of pressure feedback on postural control in young and elderly healthy adults and in stroke patients. Hum Mov Sci.2003; 22: 221-236.
5.
RodeGTiliketCBoissonD. Predominance of postural imbalance in left hemiparetic patients. Scand J Rehabil Med.1997; 29: 11-16.
6.
de HaartMGeurtsACHuidekoperSCFasottiLvan LimbeekJ. Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study. Arch Phys Med Rehabil.2004; 85: 886-895.
7.
BirnbaumMHillKKinsellaRBlackSClarkRBrockK. Comprehensive clinical sitting balance measures for individuals following stroke: a systematic review on the methodological quality. Disabil Rehabil.2016; 40: 616-630.
8.
LisińskiPHuberJGajewskaESzłapińskiP. The body balance training effect on improvement of motor functions in paretic extremities in patients after stroke. A randomized, single blinded trial. Clin Neurol Neurosurg.2012; 114: 31-36.
9.
SrivastavaATalyABGuptaAKumarSMuraliT. Post-stroke balance training: role of force platform with visual feedback technique. J Neurol Sci.2009; 287: 89-93.
10.
SmaniaNPicelliAGandolfiMFiaschiATinazziM. Rehabilitation of sensorimotor integration deficits in balance impairment of patients with stroke hemiparesis: a before/after pilot study. Neurol Sci.2008; 29: 313-319.
11.
HeYYangLZhouJYaoLPangMYC. Dual-task training effects on motor and cognitive functional abilities in individuals with stroke: a systematic review. Clin Rehabil.2018; 32: 865-877.
12.
RienerRLünenburgerLJezernikSAnderschitzMColomboGDietzV. Patient-cooperative strategies for robot-aided treadmill training: first experimental results. IEEE Trans Neural Syst Rehabil Eng.2005; 13: 380-394.
13.
VeerbeekJMLangbroek-AmersfoortACvan WegenEE, et al. Effects of robot-assisted therapy for the upper limb after stroke: a systematic review and meta-analysis. Neurorehabil Neural Repair.2017; 31: 107-121.
14.
VeerbeekJMvan WegenEvan PeppenR, et al. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One.2014; 9: e87987.
15.
BarrecaSWolfSLFasoliS, et al. Treatment interventions for theparetic upper limb of stroke survivors: a critical review. Neurorehabil Neural Repair.2003; 17: 220-226.
16.
FrisoliAProcopioCChisariC, et al. Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke. J Neuroeng Rehabil.2012; 9: 36-52.
17.
MehrholzJHaedrichAPlatzT, et al. Electromechanical and robotassisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev.2012; 6: CD006876.
18.
KwakkelGKollenBJKrebsHI. Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabil Neural Repair.2008; 22: 111-121.
19.
LumPSBurgarCGShorPC, et al. Robot-assisted movement trainingcompared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil.2002; 83: 952-959.
20.
SantamariaVKhanMLunaTKangJDutkowskyJGordonAMAgrawalSK. Promoting functional and independent sitting in chidren with cerebral palsy using the robotic trunk support trainer. IEEE Trans Neural Syst Rehabil Eng.2020; 28: 2995-3004.
21.
LucaADSqueriVBaroneLMMansinHV, et al. Dynamic stability and trunk control improvements following robotic balance and core stability training in chronic stroke survivors: a pilot study. Front Neurol.2020; 11: 494
22.
LatashMLFerreiraSSWieczorekSADuarteM. Movement sway: Changes in postural sway during voluntary shifts of the center of pressure. Exp Brain Res.2003; 150: 314-324.
23.
BlumLKorner-BitenskyN. Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Phys Ther.2008; 88: 559-566.
24.
DuncanPWWeinerDKChandlerJStudenskiS. Functional reach: A new clinical measure of balance. J Gerontol.1990; 45: M192-197.
25.
RyersonSBylNNBrownDA.WongRAHidlerJM. Altered trunk position sense and its relation to balance functions in people post-stroke. J Neurol Phys Ther.2008; 32: 14-20.
26.
KaratasMÇtinNBayramogluMDilekA. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am J Med Rehabil.2004; 83: 81-87.
27.
JungKKimYChungYHwangS. Weight-shift training improves trunk control, proprioception, and balance in patients with chronic hemiparetic stroke. Tohoku J Exp Med.2014; 232: 195-199.
28.
BayoukJFBoucherJPLerouxA. Balance training following stroke: Effects of task-oriented exercises with and without altered sensory input. Int J Rehabil Res.2006; 29: 51-59.
29.
SchillinBKFalvoMJKarlageREWeissLWLohnesCAChiuLZ. Effects of unstable surface training on measures of balance in older adults. J Strength Cond Res.2009; 23: 1211-1216.
30.
MilotMHMarchal-CrespoLBeaulieuLDReinkensmeyerDJCramerSC. Neural circuits activated by error amplification and haptic guidance training techniques during performance of a timingbased motor task by healthy individuals. Express Brain Res.2018; 236: 3085-3099.
31.
BataviaMGianutsosJG and KambourisM. An augmented auditory feedback device. Arch Phys Med Rehabil.1997; 78: 1389-1392.
32.
RoerdinkMGeurtsACde HaartMBeekPJ. On the relative contribution of the paretic leg to the control of posture after stroke. Neurorehabil Neural Repair.2009; 23: 267-274.
33.
Cabanas-Valde’sRCuchiGUBagur-CalafatC. Trunk training exercises approaches for improving trunk performance and functional sitting balance in patients with stroke: a systematic review. NeuroRehabilitation.2013; 33: 575-592.
34.
Vander LindenDWBruntDMcCullochMU. Variant and invariant characteristics of the sit-to-stand task in healthy elderly adults. Arch Phys Med Rehabil.1994; 75: 653-660.
35.
SchenkmanMBergerRARileyPOMannRWHodgeWA. Whole body movements during rising to standing from sitting. PhysTher.1990; 70: 638-51.
36.
LecoursJNadeauSGravelDTeixera-SalmelaL. Interactions between foot placement, trunk frontal position, weight-bearing and knee moment asymmetry at seat-off during rising from a chair in healthy controls and persons with hemiparesis. J Rehabil Med.2008; 40: 200-207.
37.
DuclosCNadeauSLecoursJ. Lateral trunk displacement and stability during sit-to-stand transfer in relation to foot placement in patients with hemiparesis. Neurorehabil Neural Repair.2008; 22: 715-722.
38.
ChengPTLiawMYWongMKTangFTLeeMYLinPS. The sit-to-stand movement in stroke patients and its correlation with falling. Arch PhysMed Rehabil.1998; 67: 1043-1046.
39.
EngardtM. Rising and sitting down in stroke patients. Auditory feedback and dynamic strength training to enhance symmetrical body weight distribution. Scand J Rehabil Med Suppl.1994; 31: 1-57.
40.
EngardtMRibbeTOlssonE. Vertical ground reaction force feedback to enhance stroke patients’ symmetrical body-weight distribution while rising/sitting down. Scand J Rehabil Med.1993; 25: 41-48.
41.
TungFLYangYRLeeCCWangRY. Balance outcomes after additional sit-to-stand training in subjects with stroke: a randomized controlled trial. Clin Rehabil.2010; 24: 533-542.
42.
LiuMChenJFanWMuJZhangJWangLZhuangJNiC. Effects of modified sit-to-stand training on balance control in hemiplegic stroke patients: A randomized controlled trial. Clin Rehabil.2016; 30: 627-636.
