Effects of Cervical Mobilization on Balance and Gait Parameters in Individuals With Stroke: A Randomized Controlled Trial.

Stroke is a significant health problem that may result in long-term functional deficits. Balance and walking problems are among the most common post-stroke deficits, and they may negatively affect quality of life. Our aim in this study was to investigate the effects of cervical mobilization on balance and gait parameters after stroke. Participants were 24 adults (aged 30-65 years), who scored 24 or above on the Standardized Mini-Mental State Exam (MMSE) and no more than 3 on the Modified Rankin scale. Participants were randomly assigned to either an experimental Bobath therapy and cervical mobilization group (n = 12) or a control group who received Bobath therapy and a sham application (n = 12). Both groups received 60 minutes of Bobath therapy three times a week for four weeks; additionally, the experimental group received 15 minutes of cervical mobilization in each session, while the control group received 15 minutes of spinal sham mobilization each session. Pre and post treatment, we assessed all participants' demographic characteristics, gait parameters, balance parameters, and forward head posture values using a clinical data assessment form, spatiotemporal gait analysis (LEGSystm), portable computerized kinesthetic balance device (SportKAT 550), and craniovertebral angle (CVA), respectively. The groups showed no significant differences in their initial demographic and clinical characteristics (age, sex, stroke duration and disability levels.). In comparing changes on variables of interest, we observed significant experimental versus control group improvements in balance parameters except for their left side balance score (right side, left side, forward, backward and total balance scores were significant at p = .003, p = .089, p < .001, p = .022, p < .001, respectively), gait parameters (stride number, stride length, stride time, stride velocity, cadance at p = .007, p = .019, p = .013, p = .005, p = .001, respectively) and CVA (p < .001). Also, there were findings in favor of the experimental group on the modified timed up and go test on walk out, mid turn, walk back and total times (p = .028, p = .001, p = .016, and p = .001, respectively),but not for sit-to-stand time or stand-to-sit time. Clinicians involved in stroke rehabilitation should assess and treat the cervical region to enhance rehabilitation effectiveness.

The Effects of Trunk Impairment on Fatigue and Balance in Children with Cerebral Palsy.

Cerebral palsy (CP) involves trunk impairment, leading to decreased postural control that is an important contributor to problems maintaining daily activities without undue fatigue. Our aim in this research was to determine the effects of trunk impairment on fatigue and balance in children with hemiplegic CP. We included 65 ambulatory children with CP in this cross-sectional study, and we grouped them into those with greater trunk impairment (Group 1, n = 33) and lesser trunk impairment (Group 2, n = 32) according to their scores on the Trunk Imparment Scale (TIS). We assessed their fatique level using the Pediatric Quality of Life Inventory™ Version 4.0 Multidimensional Fatigue Scale (PedsQL-MFS), and their balance ability using the Pediatric Balance Scale (PBS). We found that the PedsQL-MFS parameters, except the general and cognitive fatigue scores, were significantly better for participants in Group 2 than in Group 1; however Group 2 showed significantly higher scores for balance ability than did Group 1 (p < .001). All of the TIS parameters were significantly correlated with sleep/rest fatigue, and PBS scores and trunk coordination were also significantly correlated with general fatigue (p = .013) and cognitive fatigue (p = .003) which are subparameters of the PedsQL-MFS and PBS (p < .001). However static balance was highly and negatively correlated with cognitive fatigue (p < .037).Increased trunk impairment contributed to the exacerbation of fatigue and balance problems in children with hemiplegic CP. Inadequate trunk control was associated with poor sleep and poor resting quality rather than perceived general and cognitive fatigue.