Ann Rehabil Med.  2016 Feb;40(1):142-151. 10.5535/arm.2016.40.1.142.

The Additive Effects of Core Muscle Strengthening and Trunk NMES on Trunk Balance in Stroke Patients

• Ko EJ
• Chun MH
• Kim DY
• Yi JH
• Kim W
• Hong J

• KMID: 2155177
• DOI: http://doi.org/10.5535/arm.2016.40.1.142

Abstract

OBJECTIVE
To investigate an additive effect of core muscle strengthening (CMS) and trunk neuromuscular electrical stimulation (tNEMS) on trunk balance in stroke patients.
METHODS
Thirty patients with acute or subacute stroke who were unable to maintain static sitting balance for >5 minutes were enrolled and randomly assigned to 3 groups, i.e., patients in the CMS (n=10) group received additional CMS program; the tNMES group (n=10) received additional tNMES over the posterior back muscles; and the combination (CMS and tNMES) group (n=10) received both treatments. Each additional treatment was performed 3 times per week for 20 minutes per day over 3 weeks. Korean version of Berg Balance Scale (K-BBS), total score of postural assessment scale for stroke patients (PASS), Trunk Impairment Scale (TIS), and Korean version of Modified Barthel Index (K-MBI) were evaluated before and after 3 weeks of therapeutic intervention.
RESULTS
All 3 groups showed improvements in K-BBS, PASS, TIS, and K-MBI after therapeutic interventions, with some differences. The combination group showed more improvements in K-BBS and the dynamic sitting balance of TIS, as compared to the CMS group; and more improvement in K-BBS, as compared to the tNMES group.
CONCLUSION
The results indicated an additive effect of CMS and tNMES on the recovery of trunk balance in patients with acute or subacute stroke who have poor sitting balance. Simultaneous application of CMS and tNMES should be considered when designing a rehabilitation program to improve trunk balance in stroke patients.

Keyword

Stroke; Electrical stimulation; Exercise

MeSH Terms

Back Muscles
Electric Stimulation
Humans
Rehabilitation
Stroke*

Figure

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  Fig. 1 Flowchart of the study. CMS group, core muscle strengthening group; tNMES group, trunk neuromuscular electrical stimulation group; Combination group, core muscle strengthening and trunk neuromuscular electrical stimulation group.

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  Fig. 2 Surface electodes were placed at 4 sites. Two were on the thoracic erector spinae, and the other 2 were on the lumbar erector spinae.

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  Fig. 3 The core muscle strengthening (CMS) program consisted of (A) the bridge exercise, (B) segmental rotation, (C) the dead bug exercise, (D) plank exercise, (E) belly blaster, (F) bird dog exercise, (G) side plank exercise, and (H) side bridge exercise.

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  Fig. 4 The comparison of improvements in K-BBS, PASS, TIS, and K-MBI among 3 groups. CMS group, core muscle strengthening group; tNMES group, trunk neuromuscular electrical stimulation group; Combination group, core muscle strengthening and trunk neuromuscular electrical stimulation group; K-BBS, Korean version of Berg Balance Scale; PASS, total score of postural assessment scale for stroke patients; TIS, Trunk Impairment Scale; K-MBI, Korean version of Modified Barthel Index. a)p<0.05 by the Kruskal-Wallis test comparing CMS, tNMES, and combination groups, b)p<0.025 by the Mann-Whitney U-test with the Bonferroni correction to compare CMS and combination group, c)p<0.025 by the Mann-Whitney U-test with the Bonferroni correction to compare tNMES and combination group.

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  Fig. 5 Correlation between ΔK-MBI and (A) ΔK-BBS, (B) ΔPASS, (C) ΔTIS, (D) Δstatic sitting balance subscale of TIS, (E) Δdynamic sitting balance subscale of TIS, and (F) Δcoordination subscale of TIS. K-BBS, Korean version of Berg Balance Scale; PASS, total score of postural assessment scale for stroke patients; TIS, Trunk Impairment Scale; K-MBI, Korean version of Modified Barthel Index.

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