The effect of trunk exercises on the perception of verticality after stroke: A pilot study

摘要

Ten to 40 % of stroke patients exhibit severe balance impairments known as pusher behaviour. Patients with pusher behaviour often have a contralesional pelvic tilt suggesting an over activity within trunk muscles. As pusher behaviour is also highly correlated with misperception of verticality, the question arises whether trunk exercises can improve perception of verticality after stroke. This pilot study is an assessor blinded, randomized, controlled trial with a control group receiving conventional treatment with additional passive mobilizations of the hemiplegic upper limb while supine. The experimental group received conventional treatment with additional trunk exercises with an emphasis on trunk muscle strength, coordination, symmetry, axial extension and selective movements of the trunk. To assess perception of verticality, the subjective visual (SVV) and subjective postural vertical (SPV) test were administered together with the Trunk Impairment Scale to measure trunk performance. In total, 39 patients participated in this study of which 6 patients showed pusher behaviour. Trunk exercises showed no interaction effect on the SVV and SPV in the non-pusher group.The interaction effect in the pusher group could not be analysed because of the small amount of patients showing pusher behaviour. However, all pushers improved significantly over time on the SPV. Yet, the experimental group improved significantly more on the TIS than the control group. This indicates that the trunk training was effective, even though it did not affect verticality perception. As a result, it seems that no general relationship between trunk instability and verticality perception can be observed in stroke patients. However, this could be different for patients with pusher behaviour which justifies further research within this subject.