Evaluating User Perceptions of a Vibrotactile Feedback System in Trunk Stabilization Exercises: A Feasibility Study.

Low back pain patients often have deficits in trunk stability. For this reason, many patients receive physiotherapy treatment, which represents an enormous socio-economic burden. Training at home could reduce these costs. The problem here is the lack of correction of the exercise execution. Therefore, this feasibility study investigates the applicability of a vibrotactile-controlled feedback system for trunk stabilisation exercises. A sample of 13 healthy adults performed three trunk stabilisation exercises. Exercise performance was corrected by physiotherapists using vibrotactile feedback. The NASA TLX questionnaire was used to assess the practicability of the vibrotactile feedback. The NASA TLX questionnaire shows a very low global workload 40.2 [29.3; 46.5]. The quality of feedback perception was perceived as good by the subjects, varying between 69.2% (anterior hip) and 92.3% (lower back). 80.8% rated the feedback as helpful for their training. On the expert side, the results show a high rating of movement quality. The positive evaluations of the physiotherapists and the participants on using the vibrotactile feedback system indicate that such a system can reduce the trainees fear of independent training and support the users in their training. This could increase training adherence and long-term success.

Relationship between Female Sexual Dysfunction and Trunk Stability Post-Stroke: A Cross-Sectional Study.

Background and Objectives: Stroke can lead to a variety of consequences, the severity and nature of which are contingent upon the affected brain region or lesion type. These consequences manifest with distinct clinical presentations and recovery trajectories. This study aims to investigate the potential correlation between feminine sexual dysfunction and trunk stability among stroke survivors. Materials and Methods: Thirty-eight women (stroke group n = 19 and control group n = 19) were recruited. A cross-sectional observational study was designed. Outcome measures were recorded using the Feminine Sexual Function Index, the National Institute of Health Stroke Score, the Newcastle Stroke-specific Quality of Life Measure Beck Depression Index, the Barthel Index, the Urge-urinary Distress Inventory, and the Trunk Impairment Scale. Spearman's correlation was tested between different factors influencing feminine sexual dysfunction and trunk stability. Results: Statistically significant differences were found in sexual function between the stroke group versus the control group (Z = 88; p = 0.007; rb = 0.51). The correlation showed a relationship between feminine sexual dysfunction and trunk stability (p < 0.05). A relationship between quality of life and sexual dysfunction was also found (p < 0.05). There were no statistically significant results for the association between dependency, severity of stroke, time after stroke type of stroke, and sexual dysfunction (p = 0.378). Conclusions: The results of this study support the existence of a correlation between feminine sexual dysfunction and trunk stability, probably due to trunk and pelvic floor muscle synergy. Multidisciplinary teams assessing sexual dysfunction after stroke should include a physical therapist to assess the physical components that may interfere with feminine sexual health post-stroke.

Virtual Reality-Based Assessment for Rehabilitation of the Upper Limb in Patients with Parkinson's Disease: A Pilot Cross-Sectional Study.

Background and Objectives: This study aimed to examine the responsiveness and concurrent validity of a serious game and its correlation between the use of serious games and upper limbs (UL) performance in Parkinson's Disease (PD) patients. Materials and Methods: Twenty-four consecutive upper limbs (14 males, 8 females, age: 55-83 years) of PD patients were assessed. The clinical assessment included: the Box and Block test (BBT), Nine-Hole Peg test (9HPT), and sub-scores of the Unified Parkinson's Disease Rating-Scale Motor section (UPDRS-M) to assess UL disability. Performance scores obtained in two different tests (Ex. A and Ex. B, respectively, the Trolley test and Mushrooms test) based on leap motion (LM) sensors were used to study the correlations with clinical scores. Results: The subjective fatigue experienced during LM tests was measured by the Borg Rating of Perceived Exertion (RPE, 0-10); the BBT and 9HPT showed the highest correlation coefficients with UPDRS-M scores (ICCs: -0.652 and 0.712, p < 0.05). Exercise A (Trolley test) correlated with UPDRS-M (ICC: 0.31, p < 0.05), but not with the 9HPT and BBT tests (ICCs: -0.447 and 0.390, p < 0.05), while Exercise B (Mushroom test) correlated with UPDRS-M (ICC: -0.40, p < 0.05), as did these last two tests (ICCs: -0.225 and 0.272, p < 0.05). The mean RPE during LM tests was 3.4 ± 3.2. The evaluation of upper limb performance is feasible and does not induce relevant fatigue. Conclusions: The analysis of the ICC supports the use of Test B to evaluate UL disability and performance in PD patients, while Test A is mostly correlated with disability. Specifically designed serious games on LM can serve as a method of impairment in the PD population.

Influences of trunk stability on exercise performance of closed kinetic chain of upper and lower limbs.

[Purpose] This study aimed to examine whether trunk stability is related to closed kinetic chain motor performance of the upper and lower limbs. [Participants and Methods] In this study, 27 healthy male university students participated. Trunk stability was measured under two conditions, with and without rhythmic stabilization, as a proprioceptive neuromuscular facilitation procedure. The shortest time required to perform 20 push-ups and lateral step-up/-downs (closed kinetic chain motor performances) immediately after rhythmic stabilization or sitting rest (without rhythmic stabilization) was measured. [Results] Left and right trunk stabilities were significantly higher, and the time required to perform the closed kinetic chain motor task was significantly shorter under the rhythmic stabilization condition than that of the non-rhythmic stabilization condition. Regarding the relationship between the difference between the two trunk stability conditions and difference between upper/lower limbs closed kinetic chain exercise capacity conditions, left trunk stability correlated with each closed kinetic chain movement, whereas right trunk stability did not correlate with either movement. [Conclusion] Trunk stability was shown to improve closed kinetic chain exercise capacity in the upper and lower limbs, and stability of the trunk's dominant side (here, left side) seemed to regulate.

Pelvic Belt Wearing during Exercise Improves Balance of Patients with Stroke: A Randomized, Controlled, Preliminary Trial.

OBJECTIVES: To investigate whether wearing a pelvic belt during a trunk stability exercise program positively affects balance in patients with stroke. MATERIALS AND METHODS: Twenty-four patients with stroke were randomly allocated to the experimental or control group and performed a 60-min general physical therapy and an additional 30-min trunk stability exercise (five times/week for 6 weeks). Those in the experimental and control groups performed the trunk stability exercises with and without wearing the pelvic belt, respectively. RESULTS: The experimental group showed a significantly greater magnitude of improvements in balance than the control group (Postural Assessment Scale for Stroke: +18.3%, F (1, 22)=14.350, p=.001, η2=.395; Berg Balance Scale: +11%, F (1, 22)=19.062, p=.000, η2=.464; Timed Up and Go Test: -10.5%, F (1, 22)=8.562, p=.008, η2=.280; center of pressure path length with eyes open: -15.1%, F (1, 22)=6.770, p=.016, η2=.235; center of pressure path length with eyes closed: -19.5%, F (1, 22)=9.256, p=.006, η2=.296; center of pressure path velocity with eyes open: -22.6%, F (1, 22)=37.747, p=.000, η2=.632; center of pressure path velocity with eyes closed: -13.9%, F (1, 22)=6.511, p=.018, η2=.228, respectively). CONCLUSIONS: Wearing a pelvic belt while performing trunk stability exercise programs could be a more effective approach for improving balance in patients with stroke.

Trunk Postural Control Strategies Among Persons With Lower-Limb Amputation While Walking and Performing a Concurrent Task.

Altered trunk movements during gait in persons with lower-limb amputation are often associated with an increased risk for secondary health conditions; however, the postural control strategies underlying such alterations remain unclear. In this secondary analysis, the authors employed nonlinear measures of triplanar trunk accelerations via short-term Lyapunov exponents to investigate trunk local stability as well as spatiotemporal gait parameters to describe gait mechanics. The authors also evaluated the influence of a concurrent task on trunk local stability and gait mechanics to explore if competition for neuromuscular processing resources can assist in identifying unique strategies to control kinematic variability. Sixteen males with amputation-8 transtibial and 8 transfemoral-and 8 uninjured males (controls) walked on a treadmill at their self-selected speed (mean = 1.2 m/s ±10%) in 5 experimental conditions (8 min each): 4 while performing a concurrent task (2 walking and 2 seated) and 1 with no concurrent task. Individuals with amputation demonstrated significantly smaller Lyapunov exponents than controls in all 3 planes of motion, regardless of concurrent task or level of amputation (P < .0001). Individuals with transfemoral amputation walked with wider strides compared with individuals with transtibial amputation and controls (P < .0001). Individuals with amputation demonstrated more trunk kinematic variability in the presence of wider strides compared with individuals without amputation, and it appears that performing a concurrent cognitive task while walking did not change trunk or gait mechanics.

Different neuromuscular parameters influence dynamic balance in male and female football players.

PURPOSE: To analyse the relationship between several parameters of neuromuscular performance with unilateral dynamic balance measured through the Y-Balance test, as well as to determine the possible sex-related differences. METHODS: The Y-Balance test, isokinetic (concentric and eccentric) knee flexion and extension strength, isometric hip abduction and adduction strength, lower extremity joint range of motion (ROM) (hip, knee and ankle) and core stability were assessed in male (n = 88) and female (n = 44) professional football players. A stepwise multivariate linear least square regression with backward elimination analysis was carried out to identify a group of factors that were independently associated with balance performance in both sexes. RESULTS: Passive hip flexion and ankle dorsiflexion with knee flexed ROM were the main factors that retained a significant association to dominant (R2 = 23.1) and non-dominant (R2 = 33.5) balance scores for males. For females, core stability, hip abduction isometric peak torque, passive hip abduction and ankle dorsiflexion with knee flexed ROM variables retained a significant association with balance scores for both, dominant (R2 = 38.2) and non-dominant (R2 = 46.9) legs. CONCLUSIONS: Training interventions aimed at improving or maintaining unilateral dynamic balance in male football players should include, among other things, stretching exercises for the posterior chain of the lower extremity. However, females should also include exercises for strength and mobility of the hip abductors and core stability (especially in the frontal plane). This knowledge would allow clinicians and sport practitioners to develop more effective and tailored unilateral dynamic balance training interventions in male and female football players, possibly improving performance and reducing the risk of injury. LEVEL OF EVIDENCE: III.

Progressive Respiratory Muscle Training for Improving Trunk Stability in Chronic Stroke Survivors: A Pilot Randomized Controlled Trial.

BACKGROUND: Stroke weakens the respiratory muscles, which in turn may influence the trunk stability; it is unclear whether the progressive respiratory muscle training (RMT) is effective in improving the trunk stability. The aim of this study was to investigate the effects of progressive RMT with trunk stabilization exercise (TSE) on respiratory muscles thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors. METHODS: This is a pilot randomized controlled trial. Chronic stroke survivors (n = 33) who were able to sit independently participated in the tstudy. The participants were allocated into the RMP with TSE group or the TSE group. The respiratory muscle thickness during resting and contraction were measured. Maximal expiratory pressure (MEP), peak expiratory flow (PEF), and forceful expiratory volume at 1 sec (FEV1) for forced expiratory muscle function and maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), and vital capacity (VC) for inspiratory muscle function were examined. Trunk stability was estimated by maximal velocity and path length of the center of pressure (COP) by using a balance board with sitting posture. RESULTS: The respiratory muscle thickness was significantly increased on the affected side in the RMT group than in the TSE group. The MEP, PEF, MIP, and PIF were significantly increased in the RMT group than in the TSE group; however, FEV1 and VC showed no significant differences between the 2 groups. Trunk stability for the maximal velocity of COP of extension and affected side bending was significantly increased in the RMT group than in the TSE group. In addition, the maximal path length of COP of flexion, extension, affected/less affected side bending was significantly increased in the RMT group than in the TSE group. CONCLUSIONS: RMT combined with TSE can be suggested as an effective method to improve the respiratory muscle thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors as opposed to TSE only.

Tests to Measure Core Stability in Laboratory and Field Settings: Reliability and Correlation Analyses.

Although core stability (CS) has been assessed through many different tests, the relationships among them are currently unknown. The main objective was to analyze the relationship between 5 representative tests used to assess CS in: (1) laboratory settings: Sudden Loading Test (SLT) and Stable and Unstable Sitting Test (SUST) and (2) field settings: Biering-Sørensen Test (BST), 3-Plane Core Strength Test, and Double-Leg Lowering Test. The reliability of these tests was also examined. In total, 33 recreationally active males performed the tests twice. The relationship between all variables was examined using Pearson correlation coefficient in those variables with a good reliability. Only stiffness and angular displacement in the SLT, dynamic unstable tasks in the SUST, and the holding time in the BST showed good reliability (intraclass correlation coefficient: .63-.91, typical error: 9.8%-21.0%). Few and low correlations were observed between the SLT, SUST, and BST. Despite finding several significant correlations among the dynamic unstable tasks of the SUST (r ≥ .807, P < .01), no correlations were found between the loading directions of the SLT. The absence of correlations between these tests suggests that CS measurements are not generalizable, as they probably assess different dimensions of CS, or in the case of the BST, a different capacity (ie, trunk extensor endurance).

Local Stability of the Trunk in Patients with Degenerative Cerebellar Ataxia During Walking.

This study aims to evaluate trunk local stability in a group of patients with degenerative primary cerebellar ataxia and to correlate it with spatio-temporal parameters, clinical variables, and history of falls. Sixteen patients affected by degenerative cerebellar ataxia and 16 gender- and age-matched healthy adults were studied by means of an inertial sensor to measure trunk kinematics and spatio-temporal parameters during over-ground walking. Trunk local dynamic stability was quantified by the maximum Lyapunov exponent with short data series of the acceleration data. According to this index, low values indicate more stable trunk dynamics, while high values denote less stable trunk dynamics. Disease severity was assessed by means of International Cooperative Ataxia Rating Scale (ICARS) according to which higher values correspond to more severe disease, while lower values correspond to less severe disease.Patients displayed a higher short-term maximum Lyapunov exponent than controls in all three spatial planes, which was correlated with the age, onset of the disease, and history of falls. Furthermore, the maximum Lyapunov exponent was negatively correlated with ICARS balance, ICARS posture, and ICARS total scores.These findings indicate that trunk local stability during gait is lower in patients with cerebellar degenerative ataxia than that in healthy controls and that this may increase the risk of falls. Local dynamic stability of the trunk seems to be an important aspect in patients with ataxia and could be a useful tool in the evaluation of rehabilitative and pharmacological treatment outcomes.

Seated limits-of-stability of athletes with disabilities with regard to competitive levels and sport classification.

In this study, we asked whether wheelchair rugby (WR) classification and competitive level influence trunk function of athletes with disabilities, in terms of seated limits-of-stability (LoS). Twenty-eight athletes were recruited from international- and national-level WR teams, with each group exhibiting marked differences in years of sports practice and training volume. Athletes were also distributed into three groups according their classification: low-point (0.5-1.5-point); mid-point (2.0-2.5-point); and high-point (3.0-3.5-point). Athletes were asked to sit on a force platform and to lean the body as far as possible in eight predefined directions. Center of pressure (COP) coordinates were calculated from the ground reaction forces acquired with the force platform. LoS were computed as the area of ellipse adjusted to maximal COP excursion achieved for the eight directions. ANOVAs reveal that LoS were not different when international- and national-level players were compared (P=.744). Nevertheless, LoS were larger in players from the high-point group than from the low-point group (P=.028), with the mid-point group being not different from both (P>.194). In summary, (i) competitive level does not impact LoS measures and (ii) LoS are remarkably distinct when comparing both extremes of the WR classification range. Our results suggest that, as a training-resistant measure, LoS could be a valid assessment of trunk impairment, potentially contributing to the development of an evidence-based WR classification.

The effects of upper extremity task training with symmetric abdominal muscle contraction on trunk stability and balance in chronic stroke patients.

[Purpose] The purpose of this study is to examine the effects of upper extremity task training employing the bracing method on the trunk control and balance of stroke patients. [Subjects and Methods] The subjects were 46 stroke patients whose strokes had occurred six months or more prior to the study. The subjects were divided into two groups. One group underwent upper extremity task training with symmetric abdominal muscle contraction (bracing) applied. The other group simply underwent upper extremity task training, without bracing. [Results] The experimental group's Trunk Impairment Scale (TIS) significantly increased after the intervention, whereas the control group did not see any significant difference. There was significant improvement in balance after the intervention in both the experimental group and the control group. According to the between-group comparisons, the improvements in the experimental group were significantly greater in the control group, except in the Postural Assessment Scale (PASS). [Conclusion] Based on the results of this study, upper extremity task exercises with symmetric abdominal muscle contraction, conducted as part of adult hemiplegic patients' trunk stabilization exercises, can be applied to a diverse range of hemiplegic patients and implemented as an exercise program after discharge from hospital.

Changes in isolation ratios of the trunk muscles during hip adduction.

[Purpose] The purpose of this study was to compare the changes in isolation ratios of the trunk muscles during hip adduction. [Subjects and Methods] In total, 15 males aged 27-35 years were recruited for the present study. Electromyography data of the external oblique, internal oblique, and erector spinae muscles were collected during hip adduction exercise. [Results] With respect to the internal oblique muscles, the isolation ratio during hip adduction was significantly higher than during no adduction. With respect to the external oblique muscles, the isolation ratio during hip adduction was significantly lower than during no adduction. [Conclusion] Therefore, hip adduction would be a proper exercise for isolated training of the internal oblique muscles, rather than the external oblique muscles, for trunk stability.

Effects of trunk stability exercise using proprioceptive neuromuscular facilitation with changes in chair height on the gait of patients who had a stroke.

[Purpose] The purpose of this study was to identify the effects of trunk stability exercise using proprioceptive neuromuscular facilitation with changes in chair heights on the gait of stroke patients. [Subjects and Methods] The subjects of this study were 11 stroke patients. The intervention method was trunk stability exercise using proprioceptive neuromuscular facilitation with different chair heights (50, 60, and 70 cm). These exercises were performed 5 times per week for 6 weeks. Gait velocity, cadence, stride length, gait cycle, and stance phase duration were used to measure gait function. [Results] Significant changes in gait velocity, cadence, and stride length were observed on the affected side. However, no significant changes in gait cycle and stance phase were observed on the affected side. [Conclusion] These results indicate that trunk stability exercise using proprioceptive neuromuscular facilitation with change in chair heights were effective in improving gait velocity, cadence, and stride length on the affected side. However, in this study, no significant changes were observed in gait cycle and stance phase on the affected side. Therefore, various interventions for stroke patients should be investigated in further studies.

Relationship between trunk stability during voluntary limb and trunk movements and clinical measurements of patients with chronic stroke.

[Purpose] The purposes of this study were to investigate differences between patients with chronic stroke and age matched healthy controls in trunk stability, by assessing the kinematics of the center of mass and moving body segments during voluntary limb and trunk movement, and the relationship between trunk stability and clinical measurements. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Each subject performed flexion of the hip and shoulder of the non-paretic or matched side as fast as possible, as well as trunk flexion and extension at a self-selected speed. A Qualisys motion system was employed to track the kinematics of the trunk and limbs. [Results] Patients presented larger mediolateral displacement of the center of mass during all limb and trunk movements, and larger velocity of center of mass during hip flexion movement. Healthy subjects showed greater movement velocity during shoulder flexion, trunk flexion and extension. Patients' clinical measurements only correlated with movement characteristics during voluntary trunk motions. [Conclusion] Trunk stability in patients with chronic stroke was compromised during voluntary trunk as well as non-paretic limb movements, and the voluntary trunk movements reflected the trunk deficits measured using clinical measurements. Rehabilitation of patients with chronic stroke should include programs to improve trunk stability.

Muscle tone changes in the lower limbs of stroke patients induced by trunk stabilization exercises.

bstract. [Purpose] The purpose of this study was to identify the effects of trunk stabilization exercises on the spasticity of the lower limbs in stroke patients. [Subject] The subject of this study was a 38-year-old male patient who experienced a spontaneous intracranial hemorrhage, and had motor paralysis symptoms and spasticity on the left side. [Methods] The Hmax/Mmax ratio was measured before and after the trunk stabilization exercises, by using proprioceptive neuromuscular facilitation techniques. [Results] The Hmax/Mmax ratio changed from 37% to 20%. [Conclusion] Trunk stabilization exercises help control the muscle tone in stroke patients.

Effects of a low-center-of-gravity backpack on the trunk stability of mountaineers while ascending and descending.

[Purpose] This study developed a backpack with a low center of gravity (LCG) and investigated the effects of the LCG backpack on the trunk stability of mountaineers while ascending and descending. [Subjects and Methods] Ten males aged 20-32 years were recruited. The subjects ascended and descended a road with an inclination of 30 degrees wearing the standard or LCG backpack, and trunk acceleration was measured using a tri-axial accelerometer. [Results] The anterior-posterior (AP) and medial-lateral (ML) trunk acceleration while ascending and descending with the LCG backpack were significantly lower than those with the standard backpack. [Conclusion] The results suggest that the LCG backpack could prevent falling injuries during mountaineering and mountain-related activities.

The effects of trunk stability exercise and a combined exercise program on pain, flexibility, and static balance in chronic low back pain patients.

[Purpose] The aim of this study was to examine the effect of trunk stability exercise and combined exercise program on pain, flexibility, and static balance in chronic low back pain patients. [Subjects and Methods] Thirty persons diagnosed with chronic low back pain were divided into a trunk stability exercise group and a combined exercise group and then conducted exercise for six weeks. [Results] VAS and sway lengths decreased significantly in both groups. A comparison of sway lengths after the intervention between the two groups revealed that the trunk stability exercise group had a bigger decrease than the combined exercise group. [Conclusion] The results of this study indicated that trunk stability exercise would have bigger effect than combined exercise on the daily activities of chronic low back pain patients as it strengthens deep abdominal muscles and improves flexibility and balancing ability.

A Comparison of Flexi-bar and General Lumbar Stabilizing Exercise Effects on Muscle Activity and Fatigue.

[Purpose] The objective of this study was to compare the effects of flexi-bar training and general lumbar stabilization training on muscle activity and fatigue. [Methods] Twenty normal persons participated in this study. After warm up and a Maximum Voluntary Isomeric Contraction (MVIC) test, participants performed bridging exercise, quadruped lumbar stabilization exercise on quadruped and curl-up, with and without the flexi-bar training, each exercise lasting for 30 seconds. Electromyography was used for the assessment of the muscle activity and fatigue of the rectus abdominis, erector spinae, external oblique and internal oblique muscles. [Results] The bridging and quadruped exercises with the flexi-bar elicited significant increases in the muscle activates of the muscle groups. The curl-up exercise with the flexi-bar showed significant differences in external oblique and internal oblique muscle activities compared to the exercise without the flexi-bar. Muscle fatigue showed different results depending on the exercise. [Conclusion] Generally, flexi-bar exercise induced greater muscle activation and fatigue. However, because there were differences of effect dependent on the posture, we should prescribe the appropriate exercise for the target muscles.

Biofeedback-Based Proprioceptive Training to Improve Functional Prerequisites of Dragon Boating in Breast Cancer Survivors.

Breast cancer (BC)-related sequelae drastically impact the psychophysical functioning and quality of life of affected women. Adapted physical activity (APA) has proved to effectively counteract these impairments in a non-medicalized framework. In particular, dragon boats are able to promote body functionality, social interaction, and quality of life in BC survivors, but the literature on specific motor gestures is scarce and practice is still based more on a re-educative perspective than a performative one. In this context, the present longitudinal study investigated the benefits of an adapted biofeedback-based sensorimotor training intervention on upper body functionality in a team of dragon ladies. The 8-week intervention was conceived as integrated dry workout sessions led by an APA kinesiologist and applied a novel sensorized proprioceptive device, such as a Libra board. Post-protocol evaluation revealed a significant improvement in bilateral upper limb mobility, core endurance, and trunk stability along with a distress decrease and quality of life enhancement through validated assessment tools. Our findings suggest that integrating biofeedback-based workout sessions can effectively promote upper body functionality in BC survivors practicing dragon boating. Furthermore, our innovative approach could help spread methodological hints able to boost exercise adherence in this target population, thus counteracting cancer recurrence while promoting overall well-being.