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Background and Objective: Impaired trunk control and core muscle weakness affect balance capacity after stroke, but confirmatory literature is lacking. The objective was to examine the relationship between trunk control, core muscle strength and self-confidence on balance efficacy in community-dwelling chronic stroke survivors and to identify trunk performance measures for determining balance confidence., Methods: Patients with a median post-stroke duration of 12 (IQR 7-18) months and independent walking ability participated in this cross-sectional study. Trunk control, core muscle strength and balance confidence were measured using trunk impairment scale 2.0 (TIS 2.0), handheld dynamometer and activity-specific balance confidence scale, respectively. Correlation among TIS 2.0, core muscle strength and balance confidence were tested by Pearson's correlation coefficient. Stepwise multivariate linear regression analysis was conducted to examine the most important trunk performance variables determining balance confidence., Results: Of 177 study participants, the median (IQR) score for TIS 2.0 was 10 (7-12) out of 16 and for balance confidence 41 (27-61) out of 100. Trunk control was highly correlated to overall core muscles strength (r = 0.61-0.70, p <.001) and balance confidence (r = 0.66, p <.001). The major trunk determinants of balance confidence were TIS 2.0 total score (partial R 2  = 0.433) and dynamic sitting balance, i.e. trunk lateral flexion (partial R 2  = 0.376) in chronic stroke., Conclusion: A significant and strong positive association exists among trunk control, core muscles strength and balance confidence in community-dwelling patients with chronic stroke, warranting further investigation of the effect of targeted trunk rehabilitation strategies on functional balance.

Background: Impaired sitting balance is common in persons with stroke, affecting postural control in different directions. However, studies seldomly investigate sitting balance in severely affected non-ambulatory persons with stroke and precise assessment including the diagonal directions are scarce., Research Question: Are measurements of maximal voluntary weight-shifts decreased in severely affected persons with stroke in comparison to healthy controls, and is there a relationship with clinical measurements of trunk control, sitting and standing balance?, Methods: 14 Persons with stroke were recruited in the rehabilitation phase along with 32 healthy controls. A clinical pressure platform (RM Ingénierie, France) evaluated the weight-distribution during static sitting and measurements of maximal voluntary weight-shifts, by centre of pressure displacements in six directions. Clinical measurements included Trunk Control Test, Trunk Impairment Scale and Berg Balance Scale., Results: The persons with stroke had a mean (SD) age of 69 (17) years, including 5 females and 9 males and were on average 57 (40) days post stroke. No patient was able to walk without manual support and median (IQR) Berg Balance Scale score was 17 (6-33) out of 56 points. Measurements showed that the centre of pressure distance was significantly smaller in all directions in persons with stroke compared to healthy controls (p < 0.05). The clinical measurements demonstrated moderate to very high correlations with centre of pressure distance in the diagonal forward, diagonal backward and lateral directions (r = 0.54 - 0.89)., Significance: This study reveals that measurements of maximal voluntary weight-shifts are feasible and show clinically relevant deficits in severely affected non-ambulatory persons with stroke. Especially the lateral and diagonal directions can be of interest to investigate further as they are most strongly correlated with clinical measurements of balance. Reaching exercises in these directions could be considered a core element of rehabilitation for this group of patients., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The Trunk Impairment Scale (TIS) is recommended for clinical research use to assess trunk impairment post-stroke. However, it is observer-dependent and neglects the quality of trunk movements. This study proposes an instrumented TIS (iTIS) using the Valedo system, comprising portable inertial sensors, as an objective measure of trunk impairment post-stroke. Objective : This study investigates the concurrent and discriminant ability of the iTIS in chronic stroke participants. Method: Forty participants (20 with chronic stroke, 20 healthy, age-matched) were assessed using the TIS and iTIS simultaneously. A Spearman rank correlation coefficient was used to examine concurrent validity. A ROC curve was used to determine whether the iTIS could distinguish between stroke participants with and without trunk impairment. Results: A moderate relationship was found between the observed iTIS parameters and the clinical scores, supporting the concurrent validity of the iTIS. The small sample size meant definitive conclusions could not be drawn about the parameter differences between stroke groups (participants scoring zero and one on the clinical TIS) and the parameter cut-off points. Conclusion: The iTIS can detect small changes in trunk ROM that cannot be observed clinically. The iTIS has important implications for objective assessments of trunk impairment in clinical practice.

Turning round is a routine everyday activity that can often lead to instability. The purpose of this study was to investigate abnormalities of turning among people with Parkinson's disease (PwPD) through the measurement of sequence of body segments and latency response. Participants were asked to turn 180° and whole-body movements were recorded using CODAmotion and Visio Fast eye tracking equipment. Thirty-one independently mobile PwPD and 15 age-matched healthy controls participated in the study. We found that contrary to common belief, the head preceded movement of all other body segments (eyes, shoulders, pelvis, first and second foot). We also found interaction between group and body segment (P=0.005), indicating that overall, PwPD took longer to move from head to second foot than age-matched healthy controls. For PwPD only, interactions were found between disease severity and body segment (P<0.0001), between age group and body segment (P<0.0001) and between gender and body segments (P<0.0001). For each interaction, longer time periods were noted between moving the first foot after the pelvis, and moving the second foot after the first, and this was noted for PwPD in Hoehn and Yahr stage III-IV (in comparison to Hoehn and Yahr stage I-II); for PwPD who were under 70 years (in comparison with 70 years or over); and for ladies (in comparison with men). Our results indicate that in PwPD and healthy elderly, turning-on-the-spot might not follow the top-to-bottom approach we know from previous research., (Copyright © 2013. Published by Elsevier B.V.)

This study aimed to identify clinical characteristics of impaired trunk control in hundred children with spastic CP (mean age 11.4 ± 2.1 years, range 8-15 years). Assessment of trunk control was performed with the Trunk Control Measurement Scale (TCMS). Trunk control was clearly impaired, indicated by a median total TCMS score of 38.5 out of 58 (66%). Median subscale scores were 18 out of 20 (90%) for the subscale static sitting balance, 16 out of 28 (57%) for the subscale selective movement control and 6 out of 10 (60%) for the subscale dynamic reaching. Total TCMS and subscale scores differed significantly between topographies and severity of motor impairment according to the Gross Motor Function Classification System (GMFCS). Children with hemiplegia obtained the highest scores, followed by children with diplegia and children with quadriplegia obtained the lowest scores. TCMS scores significantly decreased with increasing GMFCS level. In conclusion, trunk control is impaired in children with CP to a various extent, depending on the topography and severity of the motor impairment. The findings of this study also provide specific clues for treatment interventions targeting trunk control to improve their functional abilities., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background and Purpose: Healthy individuals have a top-down coordination pattern when turning while walking; they first rotate the head, then the shoulders, the pelvis and, finally, the feet. The aim of this study was to compare spatial and temporal characteristics of head and trunk rotation in sitting between people early after stroke and healthy participants, and investigate change over time., Methods: This was a pilot, quantitative, longitudinal study. We recruited participants from stroke wards and local groups. People with stroke were assessed at 3, 6 and 12 weeks after stroke. Healthy participants were examined with the same weekly intervals. Participants were in a seated position and were asked verbally to rotate their head and look at a visual signal placed at 90° to the left and to the right of the subject. CODAmotion (Charnwood Dynamics Ltd, Rothley, UK) was used for 3-D motion recording and analysis., Results: Healthy participants (two women and four men; mean age 66 years) showed significant rotation of the head before rotation of the shoulders at all three time points; people with stroke (one woman and five men; mean age 71 years) did not show this top-down pattern of movement. There was no significant difference between start times of head and shoulder rotation at 3 (p = 0.167), 6 (p = 0.084) and 12 weeks after stroke (p = 0.062). Conclusions. The results of our pilot study warrant further investigation into the recovery and pattern of axial coordination after stroke. Future studies could provide insight into the mechanisms behind impaired postural control in people after stroke., (Copyright © 2011 John Wiley & Sons, Ltd.)

In this study the psychometric properties of the Trunk Control Measurement Scale (TCMS) in children with cerebral palsy (CP) were examined. Twenty-six children with spastic CP (mean age 11 years 3 months, range 8-15 years; Gross Motor Function Classification System level I n = 11, level II n = 5, level III n = 10) were included in this study. To determine the discriminant ability of the TCMS, 30 typically developing (TD) children (mean age 10 years 6 months, range 8-15 years) were also included. For inter-rater reliability, two testers scored all children simultaneously. To determine test-retest reliability, participants were reassessed on a second test occasion. For construct validity, the Gross Motor Function Measure (GMFM) was administered. Intraclass correlation coefficients (ICC) ranged from 0.91 to 0.99 for inter-rater and test-retest reliability. Kappa and weighted kappa values ranged for all but one item from 0.45 to 1. The standard error of measurement was 2.9% and 3.4%, and the smallest detectable difference for repeated measurements was 8% and 9.43% between raters and test-retest, respectively. Cronbach's alpha coefficients ranged from 0.82 to 0.94. Spearman rank correlation with the GMFM was 0.88 and increasing coefficients were found from dimension B to E. Subscale and total TCMS scores showed significant differences between children with CP and TD children (p < 0.0001). The results support the reliability and validity of the TCMS in children with spastic CP. The scale gives insight into the strengths and weaknesses of the child's trunk performance and therefore can have valuable clinical use., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Sideways reaching with the unaffected arm while seated is a component of everyday activities and can be a challenging task early after stroke. Kinematic analysis of a lateral reach task may provide potential rehabilitation strategies., Objective: The authors examined the difference between people with stroke and healthy controls in the movement sequence of head, trunk, and pelvis, as well as the difference in angle at maximum reach and peak velocity for each body segment during reach and return., Methods: Twenty-four people within 12 weeks of a stroke and 20 healthy subjects performed a standardized lateral reach. Using CODAmotion, movement sequence was determined and angles and peak velocities were calculated., Results: When reaching, people with stroke moved their pelvis first, followed by the trunk and head, whereas healthy controls started with their head and then moved their trunk and pelvis. Patients achieved significantly smaller angles at maximum reach compared with healthy subjects for all body segments and lower peak velocities during the reach (for head, trunk, and pelvis) and the return (for head and trunk)., Conclusions: Lateral reaching to the unaffected side early after stroke revealed a different pattern than normal and patients reached less far and moved at a slower speed. Specific training strategies to improve reaching are needed.