Explicit training through neurodevelopmental therapy improves tone and postural control in hemiplegic stroke-A Systematic review protocol

Neurodevelopmental treatment (NDT) and Dynamic neuromuscular stabilization (DNS)-based exercise is effective for improving core stability and postural control in stroke patients. To compare the effects of DNS and conventional NDT exercises on diaphragm movement, abdominal muscle thickness, and postural control in stroke patients. The participants were randomly allocated into DNS (n = 16) and NDT (n = 15) for 30 minutes each per day, 3 days a week for 4 weeks. Diaphragm movement and abdominal muscle thickness were determined using ultrasonography. The trunk impairment scale (TIS) and Berg Balance Scale (BBS) were used to measure postural control. The functional ambulation category (FAC) was used to evaluate gait ability. Analysis of covariance (ANCOVA) was used to evaluate post-test differences in the DNS and NDT exercise groups. ANCOVA revealed the superior effects of DNS in diaphragm movement and abdominal muscle thickness (transversus abdominis, internal oblique), as well as clinical BBS and FAC tests, compared with those of NDT (p < 0.05). This novel clinical trial suggests that DNS training was more effective than NDT training in improving postural movement control and gait ability via a balanced co-activation of the diaphragm and TrA/IO in stroke patients.

Stroke is classified into two main types based on its pathophysiology, namely ischemic stroke and hemorrhagic stroke. Ischemic stroke, also known as non-hemorrhagic stroke, occurs due to reduced blood and oxygen to the brain and often results in motor impairments such as hemiparesis, postural control deficits, abnormal gait patterns, and decreased selective movement ability. Damage to the basal ganglia plays a signicant role in movement coordination disorders following stroke. This study aimed to determina the effectiveness of physiotherapy management using the New Bobath Concept in improving postural control, gait patterns, and selective movement ability in a patient with left hemiparesis caused by ischemic stroke unvolving the right posterior basal ganglia. This study employed a case study design. Physiotherapy intervention was conducted using New Bobath Concept over six therapy session within a four-week period. Postural control was assessed using a postural grid, gait pattern changes were analyzed through gait pattern analysis, and selective movement ability was evaluated using the Modofied Motor Assessment Scale (MMAS). The results demostrated improvements in postural control and gait patterns, indicated by a reduction in circumduction during walking. Associative reaction movement began to decrease, although they were still briefly observed during the stance and swing phase. Selective upper extremity movement abiluty also improved, with MMAS scores increasing from 28 at the initial assessment (T1) to 42 at the final assessment (T6). These findings suggest that physiotherapy intervention using New Bobath Concept is effective in improving postural control, enhancing gait patterns, and increasing selective movement ability in patients with hemiparesis following ischemic stroke. The New Bobath Concept can be considered a relevant therapeutic approach in post-stroke rehabilitation to optimize functional recovery.

Effect of resistance training on balance and postural control in people with Parkinson’s: A systematic review

Dizziness and unsteadiness associated with reports of visual disturbances and loss of balancenare common complaints in those with persistent whiplash associated disorders (WAD). Annumber of causes for these symptoms have been suggested, but it is feasible that dizziness is anconsequence of abnormal afferent input to the postural control system due either to damage tonthe central nervous system, the peripheral vestibular system and or abnormal cervical afferentninput. n The aim of this thesis was to identify, more precisely, the nature and possible aetiology of thensymptoms of dizziness and unsteadiness in subjects with whiplash as well as investigate anynphysical impairments of postural control, particularly with respect to abnormal cervicalnafferent input. A better understanding of the causes and relationships of such persistentnproblems was considered vital to guide physiotherapists towards suitable diagnostic measuresnand relevant rehabilitation.n n The series of studies in this thesis investigated the symptom of dizziness and disturbances tonpostural control in subjects with persistent WAD and for the first time, took into considerationnsuch factors as medication, anxiety, age and compensation status. Three tests which werenlikely to reflect disordered cervical afferent input were examined: cervical joint position errorn(JPE), an eye movement control measure, the smooth pursuit neck torsion test (SPNT) andnmeasurement of dynamic balance control via computerised dynamic posturography.nComparison was made between subjects with whiplash complaining of dizziness and those notncomplaining of these symptoms. Relationships between cervical JPE, balance and SPNT wereninvestigated. A final study was conducted in which subjects with known pure peripheralnunilateral vestibular loss were examined to assess the potential of these tests to differentiatenbetween cervical and vestibular involvement. The results of the studies demonstrated that impairments identified in cervical JPE, balance andnSPNT are common in subjects with persistent WAD who both do, and do not, complain ofnspecific symptoms such as loss of balance or dizziness. Deficits in all three measures were greater in subjects with the symptomatic complaints of dizziness or unsteaduiess. Thencomplaint of dizziness and the deficits in postural control could not be attributed tonmedications, compensation, anxiety or age. Only weak relationships were observed betweenncervical JPE, balance and SPNT, implying a need to assess all three measures to identify andnmanage disturbances in the postural control system in subjects following a whiplash injury.nFurther the SPNT and selected balance tests were shown to effectively differentiate betweennsubjects with whiplash and subjects with discreet unilateral vestibular loss. Tests of cervicalnjoint position error did not differentiate between the groups.n n The results suggest that the reported characteristics of dizziness and causes of postural controlndisturbances in subjects with WAD are different to those with discreet vestibular pathology.nThe most plausible primary cause of the disturbances in subjects with WAD is abnormalncervical afferent to the postural control system.n n This series of studies has been the first comprehensive investigation of factors associated withnthe symptom of dizziness and disturbances to postural control in subjects with persistent WAD.nThis research is a vital step towards early identification of the most appropriate assessment andnmanagement strategies for patients with complaints of dizziness and/or disturbances in posturalncontrol following a whiplash injury. Early recognition of these disturbances may ultimatelynassist in the prevention of some of the persistent complaints and physical impairmentsnfollowing a whiplash injury.n

Purpose The purpose of this singlecase study was to investigate the effects of trunk stabilization based on the Bobath concept on balance in a patient with cerebellar stroke. The intervention aimed to improve postural control by enhancing trunk stability and extensor muscle activation, which are essential components of the Bobath approach to neurorehabilitation. Methods A 76yearold female patient with cerebellar stroke participated in this case study. The intervention consisted of five sessions over a threeweek period, with each session lasting approximately one hour. The treatment included targeted therapeutic approaches designed to enhance trunk stability and extensor muscle activation Results Following the intervention, notable improvements were observed in the patient's postural alignment while standing against gravity. The Trunk Impairment Scale (TIS) score increased by 3 points, the Berg Balance Scale (BBS) score increased by 10 points, and the Functional Reach Test (FRT) showed a 10 cm improvement. Conclusion A threeweek intervention applying Bobathbased trunk stabilization techniques led to measurable improvements in balance in a patient with cerebellar stroke. These findings support the potential effectiveness of the Bobath concept in enhancing trunk control and balance safety in individuals with cerebellar dysfunction.

Apathy exacerbates postural control impairments in stroke survivors: The potential effects of cognitive dual-task for improving postural control

Introduction: Cerebral palsy (CP) is a major cause of motor dysfunction in children, often requiring comprehensive and long-term rehabilitation. Neurodevelopmental Treatment (NDT) is a commonly applied intervention designed to improve motor control, posture, and functional abilities. This review aims to examine how the frequency of NDT therapy affects functional outcomes in children with CP. Methods: A systematic literature review was conducted using PubMed, ProQuest, Scopus, and Google Scholar. Six peer-reviewed articles published between 2013 and 2023 were selected based on inclusion criteria: studies involving children with CP who received NDT therapy and assessed outcomes such as gross motor function, balance, postural control, or occupational performance. Keywords used included "Neurodevelopmental Treatment," "cerebral palsy," "therapy frequency," and "functional ability." Results: The findings indicate that a higher frequency of NDT therapy (three to five sessions per week) is associated with more significant improvements in gross motor skills, postural control, and balance. However, lower-frequency therapy (twice weekly) also produced positive outcomes when delivered consistently. Four of the six studies showed greater benefits with high-frequency sessions, while the remaining two reported notable improvements at lower frequencies. Moreover, combining NDT with complementary approaches such as the CO-OP method or Bobath therapy enhanced functional performance and parent-reported satisfaction. Conclusion: Therapy frequency plays a crucial role in determining the functional outcomes of children with CP undergoing NDT. While high-frequency therapy offers optimal benefits, consistent low-frequency sessions can still be effective. Clinicians should individualize therapy plans based on each child's needs to achieve the best possible rehabilitation outcomes.

Trunk stability has been identified as an important prerequisite of functional movement. To investigate the effectiveness of core muscle contraction training on abdominal muscle thickness, balance, and gait ability in stroke patients. Thirty patients with stroke were randomly assigned to two experimental groups and a control group. All groups received conventional therapeutic exercise program for six weeks. The experimental groups additionally trained trunk stability exercise with abdominal hollowing or bracing maneuvers within training time. Primary outcome measures were evaluated abdominal muscle thickness using the sonography. Secondary outcome measures were evaluated by the Functional Reach Test (FRT), Berg Balance Scale (BBS), 10-meter walk test (10MWT), and Timed Up and Go test (TUG). Compared with the control group, the effect of trunk stability training for the experimental groups on the abdominal muscles thickness change was observed (p < 0.05). The values in balance and gait measures, BBS, FRT, 10MWT, and TUG, showed significant improvement after the intervention periods (p < 0.05), although no significant differences were found in scores of gait and balance scales among groups. Trunk stability training with selective abdominal muscles activation has beneficial effects on abdominal muscles, balance, and mobility in stroke patients. Our findings might provide support for introducing stroke rehabilitation.

Partial or total unilateral vestibular loss is the third most common cause of peripheral vestibular dysfunction. Dysfunction of one or both of the vestibular mechanisms can manifest physically as abnormalities of posture, balance, and/or visual acuity. This case report describes physical therapy examination and individualized intervention with vestibular rehabilitation for a patient with unilateral vestibular hypofunction. The patient was an 80-year-old male with electronystamographically confirmed unilateral vestibular loss of 98.3%. He demonstrated altered balance and gaze stability classifying him as having an increased risk for falling. After 5 weeks of individualized vestibular rehabilitation, the patient significantly decreased his fall risk from 11 to 20 of 24 on the Dynamic Gait Index. His gaze stability also improved from a 4 to 1 line disparity with dynamic visual acuity testing. The patient also had a decrease in perceived disability on the Dizziness Handicap Inventory from 30/100 at evaluation to 12/100 at discharge. Individualized vestibular rehabilitation decreased fall risk and improved gaze stability for a patient with significant unilateral vestibular hypofunction.

Training allows athletes to acquire different balance control skills based on the discipline practiced. In particular, dance, in the motor field, allows dancers to optimise the coordination skills that can improve balance and postural stability. The present study compared the postural tonic system control abilities of a semi-professional dancer (SD), a competitive judoka (CJ) and a control case (CC), under static equilibrium conditions. The subjects, selected according to homogeneity criteria, were subjected to tests in a bipodal position on a stabilometric platform and evaluated after different stimulations.

Review question/objective The objective of this systematic review is to provide a narrative summary synthesis of the quality of existing Husserlian phenomenological research studies in the health sciences. As a methodological systematic review, only studies that focus on adult patients’ experiences of preventive, screening, diagnosis, treatment or rehabilitation interventions/procedures will be considered to serve as a paradigm “case” of the use of the Husserlian phenomenological approach within the broad field of health. The review question is: What is the quality of existing Husserlian phenomenological research studies in the health sciences? The motivation for this systematic review is not to fault authors of existing Husserlian phenomenological research, but to explore the problems encountered in existing research literature, if any, and to provide guidance to authors for future health research guided by this specific philosophical perspective. In order to avoid repetition, the term ‘Husserlian phenomenological approach’ as used in the text refers to the approach described by Edmund Husserl in English translations of his own published work; or as described in English language commentaries by internationally recognized scholars; or from Husserlian phenomenological scholars including the structured framework presented by Spiegelberg. Each time the ‘content of Husserlian phenomenological research studies’ is used in the text it should be understood to mean ‘content of Husserlian phenomenological research studies as reflected in the stated philosophical perspective, research methodology, data collection methods, data analysis methods, presentation and interpretation of the results, and the conclusions’. Definition of terms: 1. Husserlian phenomenological research studies refers to primary qualitative research studies that are explicitly grounded in the work of Husserl reflected in explicit statements or descriptions by the authors. 2. Quality refers to the extent to which there is congruence between the Husserlian phenomenological approach and the content of Husserlian phenomenological research studies. These stipulative definitions are intended to preclude the need to cite the scientific literature as there is no need to demonstrate their ‘validity’ or ‘acceptability’ by the communities of scholars. TRUNCATED AT 350 WORDS.

This quantitative observational study with pre-post design aimed to examine joint-specific kinematic adaptations and the relationship between trunk stability and spatiotemporal gait parameters following intensive robotic rehabilitation. A total of 12 neurological patients completed 16 sessions of gait training using the Tecnobody Smart Gravity Walker. Pre- and post-training kinematic data were collected for bilateral hip and knee flexion-extension, trunk flexion-extension, trunk lateral flexion, and center-of-gravity displacement. Waveforms were normalized to 100% stride. Paired t-tests assessed pre-post differences, and correlations examined associations between trunk stability and gait performance. Significant increases were found in right hip flexion-extension (t = 3.44, p < 0.001), trunk flexion-extension (t = 9.49, p < 0.001), and center-of-gravity displacement (t = 15.15, p < 0.001), with reduced trunk lateral flexion (t = -8.64, p < 0.001). Trunk flexion-extension correlated with gait speed (r = 0.74), step length (r = 0.68), and stride length (r = 0.71); trunk lateral flexion correlated with cadence (r = 0.66) and stride length (r = 0.70). Intensive robotic rehabilitation improved trunk and hip kinematics, supporting trunk stability as an important biomechanical correlate of gait recovery. Sensor-derived metrics revealed strong neuromechanical coupling between postural control and locomotion in neurological patients.

Background Static postural control impairments are often identified in people with chronic ankle instability (CAI). Objective To examine the effect of trial duration on the assessment of postural control in people with CAI. Design Cross-sectional. Setting Laboratory. Participants Twenty-five individuals with self-reported CAI (7 Males; age = 23.86 ± 3.90 years; height = 170.33 ± 11.69 cm; body mass = 76.33 ± 15.28 kg) participated. Inclusion criteria included ≥1 previous ankle sprain, ≥2 episodes of “giving way” in the previous three months, and ≤ 24 on the Cumberland Ankle Instability Tool. Interventions Barefoot single-limb stance on a forceplate was used to assess postural control. Three 10-second trials were collected in eyes open and closed conditions. Data collected during each trial were analysed as the initial 2.5 s (2.5 sec), the initial 5 s (5 sec) and 10 s (10 sec). Main outcome measurements Independent variables included vision (open, closed) and duration (2.5 sec, 5 sec, 10 sec). Dependent variables included time-to-boundary (TTB) variables: mean of TTB minima (TTB-mean) and standard deviation of TTB minima (TTB-SD) in the anterior-posterior (AP) and medial-lateral (ML) directions. For each TTB variable, a 2 × 3 ANOVA with Fisher’s LSD post hoc comparisons examined differences between vision and duration. Alpha level was set at p ≤ 0.05. Results Significant vision and duration main effects and vision-by-duration interactions were identified for all TTB variables (p Conclusions Postural control improved with longer trial durations during eyes open conditions but not during eyes closed conditions. This suggests people with CAI may not recover from the perturbation of moving into single-limb stance during eyes closed conditions.

Systematic Reviews in Medical Education.

BackgroundOlder adults with chronic neck pain (CNP) demonstrate impaired postural control. The Balance Evaluation Systems Test (BESTest) is used to assess systems underlying postural control impairments, but its use in CNP has not been reported. This study assessed whether the BESTest can identify postural control impairments in CNP as well as the level of BESTest item difficulty by Rasch analysis.Materials and methodsThis cross-sectional study recruited thirty young adults (YOUNG) aged 20–40 years and eighty older adults aged 60 years or older [without neck pain (OLD) = 60, with chronic neck pain (CNP) = 20]. Questionnaires were administered to collect demographic data, intensity of neck pain (VAS), patient’s self-rated neck pain and disability (NDI), and balance confidence in daily activities (ABC). The BESTest was used to assess postural control.ResultsThe CNP group showed the lowest ABC scores. Compared to the YOUNG group, the BESTest score was significantly lower in the OLD group, while the CNP group showed the lowest score, suggesting that balance control deteriorated from the normal aging process and further declined in the CNP group, especially in biomechanical constraints, transitions–anticipatory postural adjustment, and reactive postural response (p < 0.05). Using scores from these three sections, the BESTest was accurate at the cutoff score of 48.5 out of 51 for differentiating the older adults whose daily life are affected by neck problems (using the NDI as a reference) with a high AUC (0.79), sensitivity (72%), and specificity (69%). The Rasch analysis revealed that the Timed Up and Go with dual task test was the most difficult BESTest item for all groups, whereas 14 items showed more difficulty for the CNP group.ConclusionThe BESTest can be used to identify postural control impairments in CNP patients, even those with moderate pain and mild disability with a high level of physical functioning. The combined score of biomechanical constraints, transitions–anticipatory postural adjustment, and reactive postural response domains was suggested for the detection of older adults whose daily lives are affected by neck problems. This will also help clinicians consider the management of neck pain to prevent falls in CNP.