Abstract
Stroke is a disease with high mortality and morbidity that not only causes weakness in the extremities, loss of balance, and disturbances in trunk and postural control, but also affects respiratory function. The aim of this study was to investigate the relationship between trunk and postural control and pulmonary function in subacute stroke patients. Herein, 32 volunteer patients who were diagnosed with hemiplegia by a competent physician after unilateral hemorrhagic or ischemic stroke and who met the inclusion criteria participated in the study. Functional independence of the participants was evaluated using the Modified Rankin Scale (mRS) and their cognitive function was assessed with the Standardized Mini Mental State Examination. Respiratory function was evaluated with spirometric measurements, inspiratory muscle strength was evaluated with intraoral pressure measurements, trunk control was evaluated using the Trunk Impairment Scale (TIS), postural control was evaluated using the Postural Assessment Scale for Stroke Patients (PASS-T), computerized postural sway evaluation, and static posture analysis. A significant correlation was found between the TIS scores and inspiratory muscle strength (p < 0.05). A significant correlation was also found between the PASS-T scores and inspiratory muscle strength and pulmonary function (p < 0.05). All of the COP parameters measured were significantly correlated with the PEF(L/s) and FEF25–75 (L/s) (p < 0.05). In conclusion, this study showed that trunk and postural control are associated with inspiratory muscle strength and pulmonary function. It is recommended that evaluation of trunk and postural control and respiratory functions, as well as exercise training to improve these parameters, should be included in rehabilitation programs for individuals with stroke.
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This study has a ethical approval numbered 22/144 by the Clinical Research Ethics Committee of our university.
References
Liu K, Yin M, Cai Z (2022) Research and application advances in rehabilitation assessment of stroke. J Zhejiang Univ-SCI B 23(8):625–641. https://doi.org/10.1631/jzus.B2100999
Kuriakose D, Xiao Z (2020) Pathophysiology and treatment of stroke: present status and future perspectives. Int J Mol Sci 21(20):7609. https://doi.org/10.3390/ijms21207609
Seo M, Shin M-J, Park TS, Park J-H (2020) Clinometric gait analysis using smart insoles in patients with hemiplegia after stroke: pilot study. JMIR Mhealth Uhealth 8(9):e22208. https://doi.org/10.2196/22208
Lin Y-N, Huang S-W, Kuan Y-C, Chen H-C, Jian W-S, Lin L-F (2022) Hybrid robot-assisted gait training for motor function in subacute stroke: a single-blind randomized controlled trial. J Neuroeng Rehabil 19(1):1–13. https://doi.org/10.1186/s12984-022-01076-6
Liao W-C, Lai C-L, Hsu P-S, Chen K-C, Wang C-H (2018) Different weight shift trainings can improve the balance performance of patients with a chronic stroke: A randomized controlled trial. Medicine 97(45):e13207. https://doi.org/10.1097/MD.0000000000013207
Karthikbabu S, Chakrapani M, Ganeshan S, Rakshith KC, Nafeez S, Prem V (2012) A review on assessment and treatment of the trunk in stroke: A need or luxury. Neural Regen Res 7(25):1974. https://doi.org/10.3969/j.issn.1673-5374.2012.25.008
Umphred DA (2007) Neurological Rehabilitation. Elsevier, St. Louis: Mosby
Santos RSad, DALL’ALBA SCF, Forgiarini SGI, Rossato D, Dias AS, FORGIARINI LA (2019) Relationship between pulmonary function, functional independence, and trunk control in patients with stroke. Arquivos de Neuro-Psiquiatria 77:387–92. https://doi.org/10.1590/0004-282X20190048
Pozuelo-Carrascosa DP, Carmona-Torres JM, Laredo-Aguilera JA, Latorre-Román PÁ, Párraga-Montilla JA, Cobo-Cuenca AI (2020) Effectiveness of respiratory muscle training for pulmonary function and walking ability in patients with stroke: a systematic review with meta-analysis. Int J Environ Res Public Health 17(15):5356. https://doi.org/10.3390/ijerph17155356
Lee K, Park D, Lee G (2019) Progressive respiratory muscle training for improving trunk stability in chronic stroke survivors: a pilot randomized controlled trial. J Stroke Cerebrovasc Dis 28(5):1200–1211. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.008
Boz K, Saka S, Çetinkaya İ (2023) The relationship of respiratory functions and respiratory muscle strength with trunk control, functional capacity, and functional independence in post-stroke hemiplegic patients. Physiother Res Int 28(2):e1985. https://doi.org/10.1002/pri.1985
Aydoğan Arslan S, Uğurlu K, Sakizli Erdal E, Keskin ED, Demirgüç A (2022) Effects of inspiratory muscle training on respiratory muscle strength, trunk control, balance and functional capacity in stroke patients: a single-blinded randomized controlled study. Top Stroke Rehabil 29(1):40–48. https://doi.org/10.1080/10749357.2020.1871282
Duray M, Yaşar P (2022) İnmeli Bireylerin Fonksiyonel Durumlarının Bakım Veren Ağrısı Üzerine Etkisi. Turkish J Fam Med Prim Care 16(2):274–285. https://doi.org/10.21763/tjfmpc.994648
Güngen C, Ertan T, Eker E, Yaşar R, Engin F (2002) Standardize mini mental test’in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Turk Psikiyatri Derg 13(4):273–281
Rankin J (1957) Cerebral vascular accidents in patients over the age of 60: II. Prognosis Scottish Med J 2(5):200–215. https://doi.org/10.1177/003693305700200504
Demir N, Serel Arslan S, İnal Ö, Karaduman AA (2016) Reliability and validity of the Turkish eating assessment tool (T-EAT-10). Dysphagia 31:644–649. https://doi.org/10.1007/s00455-016-9723-9
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198. https://doi.org/10.1016/0022-3956(75)90026-6
Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R et al (2005) General considerations for lung function testing. Eur Respir J 26(1):153–161. https://doi.org/10.1183/09031936.05.00034505
Redlich CA, Tarlo SM, Hankinson JL, Townsend MC, Eschenbacher WL, Von Essen SG et al (2014) Official American Thoracic Society technical standards: spirometry in the occupational setting. Am J Respir Crit Care Med 189(8):983–993. https://doi.org/10.1164/rccm.201402-0337ST
(2002) ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 166(4):518-624. https://doi.org/10.1164/rccm.166.4.518
Sag S, Buyukavci R, Sahin F, Sağ MS, Dogu B, Kuran B (2019) Assessing the validity and reliability of the Turkish version of the Trunk Impairment Scale in stroke patients. https://doi.org/10.14744/nci.2018.01069
Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W (2004) The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil 18(3):326–334. https://doi.org/10.1191/0269215504cr733oa
Schlick C, Ernst A, Bötzel K, Plate A, Pelykh O, Ilmberger J (2016) Visual cues combined with treadmill training to improve gait performance in Parkinson’s disease: a pilot randomized controlled trial. Clin Rehabil 30(5):463–471. https://doi.org/10.1177/0269215515588836
Buldt AK, Forghany S, Landorf KB, Murley GS, Levinger P, Menz HB (2018) Centre of pressure characteristics in normal, planus and cavus feet. J Foot Ankle Res 11(1):1–9. https://doi.org/10.1186/s13047-018-0245-6
Plandowska M, Lichota M, Górniak K (2019) Postural stability of 5-year-old girls and boys with different body heights. PLoS ONE 14(12):e0227119. https://doi.org/10.1371/journal.pone.0227119
Koçak FA, Kurt EE, Koçak Y, Erdem HR, Tuncay F, Benaim C (2019) Validity and interrater/intrarater reliability of the Turkish version of the postural assessment scale for stroke patients (PASS-Turk). Top Stroke Rehabil 26(5):373–381. https://doi.org/10.1080/10749357.2019.1608699
Jandt SR, da Sil Caballero RM, Junior LAF, Dias AS (2011) Correlation between trunk control, respiratory muscle strength and spirometry in patients with stroke: an observational study. Physiother Res Int 16(4):218–224. https://doi.org/10.1002/pri.495
Roy-O’Reilly M, McCullough LD (2018) Age and sex are critical factors in ischemic stroke pathology. Endocrinology 159(8):3120–31. https://doi.org/10.1210/en.2018-00465
Boz K, Saka S, Çetinkaya I (2022) The relationship of respiratory functions and respiratory muscle strength with trunk control, functional capacity, and functional independence in post-stroke hemiplegic patients. https://doi.org/10.1002/pri.1985
Yalvaç B (2020) Hemiplejik Hastalarda Gövde Kontrolünün Üst Ekstremite Fonksiyonları, Yaşam Kalitesi ve Depresyona Etkisi. Tıp Fakültesi Klinikleri Dergisi 3(1):15–24. https://doi.org/10.17932/IAU.TFK.2018.008/2020.301/tfk_v03i1003
Tovar-Alcaraz A, de Oliveira-Sousa SL, León-Garzón M, González-Carrillo MJ (2021) Efectos del entrenamiento muscular inspiratorio sobre la función respiratoria y el equilibrio en supervivientes de ictus: un ensayo clínico controlado aleatorizado. Rev neurol(Ed impr) 112–20. https://doi.org/10.33588/rn.7204.2020532
Pai H-C, Li C-C (2023) Relationship between trunk control ability and respiratory function in stroke patients: A scoping review and meta-analysis. Asian Nurs Res. https://doi.org/10.1016/j.anr.2023.04.001
Fernandes TG, Goulart AC, Santos-Junior WR, Alencar AP, Benseñor IM, Lotufo PA (2012) Educational levels and the functional dependence of ischemic stroke survivors. Cad Saude Publica 28:1581–1590. https://doi.org/10.1590/s0102-311x2012000800016
Sartor LCA, Luvizutto GJ, de Souza JT, Silva Dalle Molle ER, Modolo GP, da Silva TR, et al (2020) Respiratory function and grip strength in the acute phase of stroke are associated with stroke severity and disability at hospital discharge. Rehab Res Pract https://doi.org/10.1590/0004-282X20190048
Aygün Kesim D (2014) Investigation of the relationship between respiratory functions and clinical parameters of the disease in hemiplegic stroke patients: Institute of Health Sciences. Dicle University. Master’s thesis
Li M, Huang Y, Chen HY, Wang SS, Zhou Y, Zhang Y (2024) Relationship between motor dysfunction, the respiratory muscles and pulmonary function in stroke patients with hemiplegia: a retrospective study. BMC Geriatrics 24:59. https://doi.org/10.1186/s12877-023-04647-x
Martins LG, Molle da Costa RD, Alvarez Sartor LC, Thomaz de Souza J, Winckler FC, Regina da Silva T et al (2021) Clinical factors associated with trunk control after stroke: a prospective study. Topics Stroke Rehab 28(3):181–9. https://doi.org/10.1080/10749357.2020.1805244
Yanartaş G, Karakoyun A (2020) Isokinetic analysis of trunk muscles in stroke patients and its association with functional parameters. J Stroke Cerebrovasc Dis 29(12):105329. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105329
Iso F, Mitsunaga W, Yamaguchi R, Shimizu N, Ito S, Honda Y et al (2022) Relationship among trunk control, activities of daily living, and upper extremity function during the first week after stroke in patients with acute cerebral infarction. J Phys Ther Sci 34(4):315–319. https://doi.org/10.1589/jpts.34.315
Fabero-Garrido R, Del Corral T, Angulo-Díaz-Parreño S, Plaza-Manzano G, Martín-Casas P, Cleland JA et al (2022) Respiratory muscle training improves exercise tolerance and respiratory muscle function/structure post-stroke at short term: A systematic review and meta-analysis. Ann Phys Rehabil Med 65(5):101596. https://doi.org/10.1016/j.rehab.2021.101596
Jung K-J, Park J-Y, Hwang D-W, Kim J-H, Kim J-H (2014) Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients. Ann Rehabil Med 38(1):29–37. https://doi.org/10.5535/arm.2014.38.1.29
Kim M, Lee K, Cho J, Lee W (2017) Diaphragm thickness and inspiratory muscle functions in chronic stroke patients. Med Sci Monitor: Int Med J Exper Clin Res 23:1247. https://doi.org/10.12659/msm.900529
Ekmekçioğlu Z, Kirmaci ZIK, Ergun N (2023) The Relationship of Trunk Control with Lower Extremity Sense, Balance, and Walking in Individuals with Stroke. Clin Exper Health Sci 13(3):530–536. https://doi.org/10.33808/clinexphealthsci.1094360
Valenza MC, Prados-Roman E, Granados-Santiago M, Torres-Sanchez I, Lopez-Lopez L, Cabrera-Martos I (2020) Respiratory repercussions of neurological diseases and how best to manage them. Expert Rev Respir Med 14(1):89–102. https://doi.org/10.1080/17476348.2020.1689124
Lee K, Cho J-E, Hwang D-Y, Lee W (2018) Decreased respiratory muscle function is associated with impaired trunk balance among chronic stroke patients: a cross-sectional study. Tohoku J Exp Med 245(2):79–88. https://doi.org/10.1620/tjem.245.79
Moisan G, Chayasit P, Boonsinsukh R, Nester CJ, Hollands K (2022) Postural control during quiet standing and voluntary stepping response tasks in individuals post-stroke: a case-control study. Top Stroke Rehabil 29(7):465–472. https://doi.org/10.1080/10749357.2021.1943803
Estrada-Barranco C, Sanz-Esteban I, Giménez-Mestre MJ, Cano-de-la-Cuerda R, Molina-Rueda F (2022) Predictive Validity of the Postural Assessment Scale for Stroke (PASS) to Classify the Functionality in Stroke Patients: A Retrospective Study. J Clin Med 11(13):3771. https://doi.org/10.3390/jcm11133771
Arslan BN (2022) Effect of robot-assisted walking training on balance, trunk control, mobility, spasticity and motor function in hemiplegic individuals: Istanbul Medipol University, Institute of Health Sciences, Master’s thesis
Demirci CS, Arslan SA, Yakut H, Sertel M, Kutluhan S. Kronik İnmede İnmeli Hastalar için Postüral Değerlendirme Ölçeği’nin Psikometrik Özelliklerinin Berg Denge Ölçeği ve Brunel Denge Değerlendirmesi ile Karşılaştırılması. https://doi.org/10.46237/amusbfd.840416
Bedir EE (2023) Investigation of the effects of dance treatment on balance, falling, posture and trunk control in individuals with stroke: Hasan Kalyoncu University Graduate Education Institute Physiotherapy and Rehabilitation
Liu X, Qu Q, Deng P, Zhao Y, Liu C, Fu C et al (2022) Assessment of diaphragm in hemiplegic patients after stroke with ultrasound and its correlation of extremity motor and balance function. Brain Sci 12(7):882. https://doi.org/10.3390/brainsci12070882
Jeong YJ, Kim GS, Jeong YG, Im MH (2020) Can pulmonary function testing predict the functional outcomes of poststroke patients?: an observational study. Am J Phys Med Rehabil 99(12):1145–1149. https://doi.org/10.1097/PHM.0000000000001507
Sawacha Z, Carraro E, Contessa P, Guiotto A, Masiero S, Cobelli C (2013) Relationship between clinical and instrumental balance assessments in chronic post-stroke hemiparesis subjects. J Neuroeng Rehabil 10(1):1–7. https://doi.org/10.1186/1743-0003-10-95
Manor BD, Hu K, Peng C-K, Lipsitz LA, Novak V (2012) Posturo-respiratory synchronization: Effects of aging and stroke. Gait Posture 36(2):254–259. https://doi.org/10.1016/j.gaitpost.2012.03.002
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Ozhan, S., Duruturk, N. Investigating the relationship of trunk and postural control with pulmonary functions in subacute stroke patients. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07750-y
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DOI: https://doi.org/10.1007/s10072-024-07750-y