S Karthikbabu

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

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 randomized 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.

Relationship between pelvic alignment and weight-bearing asymmetry in community-dwelling chronic stroke survivors

Background and Purpose: Altered pelvic alignment and asymmetrical weight bearing on lower extremities are the most common findings observed in standing and walking after stroke. The purpose of this study was to find the relationship between pelvic alignment and weight-bearing asymmetry (WBA) in community-dwelling chronic stroke survivors. Materials and Methods: This cross-sectional study was conducted in tertiary care rehabilitation centers. In standing, the lateral and anterior pelvic tilt angle of chronic stroke survivors was assessed using palpation (PALM™) meter device. The percentage of WBA was measured with two standard weighing scales. Pearson correlation coefficient (r) was used to study the correlation between pelvic tilt and WBA. Results: Of 112 study participants, the mean (standard deviation) age was 54.7 (11.7) years and the poststroke duration was 14 (11) months. The lateral pelvic tilt on the most affected side and bilateral anterior pelvic tilt were 2.47 (1.8) and 4.4 (1.8) degree, respectively. The percentage of WBA was 23.2 (18.94). There was a high correlation of lateral pelvic tilt with WBA (r = 0.631; P< 0.001) than anterior pelvic tilt (r = 0.44; P< 0.001). Conclusion: Excessive lateral pelvic tilt toward the most affected side in standing may influence the weight-bearing ability of the ipsilateral lower extremity in community-dwelling chronic stroke survivors.

Feasibility of multisensory training and its effects on balance control in school going children with cerebral palsy

Context: Involvement of sensory system affects the motor performance of children with cerebral palsy, and the literature on sensory-based balance training is scarce in such children. Aim: To test the feasibility of administering multisensory training in school going children with cerebral palsy and its effects on balance control as measured by Balance Evaluation - Systems Test (BESTest). Settings and Design: School setting and a baseline-pre-post feasibility trial. Subjects and Methods: Seventeen children with cerebral palsy (gross motor function classification system level 1-3) aged between 6 and 16 years participated in sensory-based balance training encompassing inputs from visual, vestibular, and proprioceptive systems. Children with mental delay, hearing, and visual impairments and those who underwent treatments such as BOTOX, tendon lengthening, derotation surgery, or selective rhizotomy in the past 6 months were excluded. Following 2 months run-in period, each child underwent 45 min of training per session; a total of 18 sessions over 2 months duration. Statistical Analysis and Results: Repeated measures ANOVA and post-hoc test was done to analyze within-subject changes and with respect to time. P Conclusion: Multisensory training is a feasible mode of practice in a school setting and is beneficial in improving balance control in children with cerebral palsy.

Effects of truncal motor imagery practice on trunk performance, functional balance, and daily activities in acute stroke

Background: Motor imagery is beneficial to treat upper and lower limbs motor impairments in stroke patients, but the effects of imagery in the trunk recovery have not been reported. Hence, the aim is to test the effects of truncal motor imagery practice on trunk performance, functional balance, and daily activities in acute stroke patients. Methods: This pilot randomized clinical trial was conducted in acute stroke unit. Acute stroke patients with hemodynamic stability, aged between 30 and 70 years, first time stroke, and scoring <20 on trunk impairment scale (TIS) were included in the study. Patients in the experimental group practiced trunk motor imagery in addition to physical training. Control group was given conventional physical therapy. The treatment intensity was 90 min/day, 6 days a week for 3 weeks duration. Trunk control test, TIS, brunel balance assessment (BBA), and Barthel index (BI) were considered as the outcome measures. Results: Among 23 patients included in the study, 12 and 11 patients, respectively, in the control and experimental groups completed the intervention. Repeated measures ANOVA, i.e., timeFNx01 group factor analysis and effect size showed statistically significant improvements (P = 0.001) in the scores of TIS (1.64), BBA (1.83), and BI (0.67). Conclusion: Motor imagery of trunk in addition to the physical practice showed benefits in improving trunk performance, functional balance, and daily living in acute stroke.