Best Core Stabilization for Anticipatory Postural Adjustment and Falls in Hemiparetic Stroke.

OBJECTIVES: To compare the effects of conventional core stabilization and dynamic neuromuscular stabilization (DNS) on anticipatory postural adjustment (APA) time, balance performance, and fear of falls in chronic hemiparetic stroke. DESIGN: Two-group randomized controlled trial with pretest-posttest design. SETTING: Hospital rehabilitation center. PARTICIPANTS: Adults with chronic hemiparetic stroke (N=28). INTERVENTIONS: Participants were randomly divided into either conventional core stabilization (n=14) or DNS (n=14) groups. Both groups received a total of 20 sessions of conventional core stabilization or DNS training for 30 minutes per session 5 times a week during the 4-week period. MAIN OUTCOME MEASURES: Electromyography was used to measure the APA time for bilateral external oblique (EO), transverse abdominis (TrA)/internal oblique (IO), and erector spinae (ES) activation during rapid shoulder flexion. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), and Falls Efficacy Scale (FES) were used to measure trunk movement control, balance performance, and fear of falling. RESULTS: Baseline APA times were delayed and fear of falling was moderately high in both the conventional core stabilization and DNS groups. After the interventions, the APA times for EO, TrA/IO, and ES were shorter in the DNS group than in the conventional core stabilization group (P<.008). The BBS and TIS scores (P<.008) and the FES score (P<.003) were improved compared with baseline in both groups, but FES remained stable through the 2-year follow-up period only in the DNS group (P<.003). CONCLUSIONS: This is the first clinical evidence highlighting the importance of core stabilization exercises for improving APA control, balance, and fear of falls in individuals with hemiparetic stroke.

EMG and kinematics analysis of the trunk and lower extremity during the sit-to-stand task while wearing shoes with different heel heights in healthy young women.

This study investigated the EMG characteristics and the kinematics of the trunk and lower extremity during the sit-to-stand (STS) task while wearing 1-, 4-, and 8-cm high-heeled shoes. We examined differences in the EMG data of the internal oblique, erector spinae, medial hamstring, and rectus femoris muscles during the STS task. The motion of the hip joint during an STS task was measured with a NorAngle Electrogoniometer System. Twelve young healthy women were recruited to this study. EMG characteristics and the hip joint angle were recorded during the performance of an STS task by subjects wearing high-heeled shoes of three different heel heights. The muscle onset time and EMG activity during this task were analyzed. In 8-cm high-heeled shoes, the onset time for the erector spinae muscle was significantly delayed, and the onset latency for the medial hamstring and the rectus femoris was significantly decreased. There was increased activity in the erector spinae and rectus femoris muscle during this task when wearing 8-cm high-heeled shoes. The initial hip flexion angle at the start point of the STS task did not differ among the 1-, 4-, and 8-cm heel-height conditions, but the trunk flexion angle, corresponding to the displacement between the peak hip flexion and initial hip flexion, was significantly larger in the 8-cm heel-height condition than in the 1- and 4-cm heel-height conditions. The findings suggest that excessive heel height has the potential to induce muscle imbalance during the STS task.