Effect Of "Taking The Waist As Axis" Therapy On Trunk Postural Control Disorders In Stroke Patients With Hemiplegia

Purpose: The purpose of this study is to investigate the effectiveness of the "Taking the Waist as the Axis" Therapy based on the Tai Chi compared with the Trunk Selective Activity Therapy based on the Bobath concept in the clinical treatment of post-stroke patients with trunk posture control disorders,to provide a new practical treatment option for post-stroke rehabilitation,and to promote the application of traditional fitness in the field of stroke rehabilitationMethods: The subjects were recruited from February 2021 to March 2022 in the Department of Rehabilitation of Shanghai Xuhui Central Hospital.43 subjects were recruited according to the inclusion and exclusion criteria,and subjects were randomly grouped based on a random number table generated by IBM SPSS Statistics ver.26.0 software.The treatment group used the "Taking the Waist as the Axis" Therapy plus conventional rehabilitation,and the control group used the Bobath Trunk Selective Activity Therapy plus conventional rehabilitation.Conventional rehabilitation therapy was carried out according to the patients’ daily rehabilitation treatment schedule,such as postural transfer training,regular functional walking training,and in-bar training,et al.The duration of intervention in each group was 50 min for each session,with either the "Taking the Waist as the Axis" Therapy or the Bobath Trunk Selective Activity Therapy lasting 30 min,followed by conventional rehabilitation therapy for 20 min.All therapies conducted 5 times per week for 3 weeks.The Trunk Impairment Scale(TIS)was used as the primary outcome measure to observe the effect of both therapies on trunk postural control.The Fugl-Meyer assessment(FMA),change in intra-abdominal pressure,static stability assessment,Berg Balance Scale(BBS),Modified Barthel Index(MBI)and Rapid ventilation lung function test were used as secondary outcome measures to evaluate the effects of the two therapies on limb motor function,balance function,respiratory function and the ability of activities of daily living.The functional assessments of the primary and secondary outcome measures were performed before and after 3-week intervention,respectively.Results:1.Comparison of the Trunk Impairment Scale(TIS)After a 3-week intervention,significant improvements in TIS were observed within both groups(P<0.05).Compared with control group,the experimental group showed a statistically significant difference in improving TIS scores after 3 weeks of treatment.(P=0.03).2.Comparison of Fugl-Meyer Assessment Scale(FMA)After the 3-week intervention,intra-group comparison showed that FMA scores,FMA-upper extremity and FMA-lower extremity subscale scores were significantly improved in both groups after interventions(P<0.05).Compared with control group,the experimental group showed statistically significant improvement in the FMA scores,FMA-upper extremity and FMA-lower extremity subscale scores after 3weeks of treatment(FMA: P=0.001;FMA-upper limb: P=0.002;FMA-lower limb:P=0.009).3.Comparison of the change of Intra-abdominal pressureAfter 3 weeks of intervention,intra-group comparison showed that the experimental group obtained statistically significant improvement in the change of Intra-abdominal pressure change before and after the intervention(P<0.01),while no significant difference was found in the control group(P>0.05).After 3 weeks of treatment,the difference was statistically significant in the experimental group compared to the control group(P=0.011).4.Comparison of Static balance ability assessment4.1 Static stability assessment in sitting positionAfter the 3-week intervention,both groups achieved improvements in the central of pressure(COP)area and the COP trajectory in the sitting position with eyes open and closed.Specifically,in the experimental group,the significant improvements were observed both in sitting eyes-open COP area and sitting eyes-closed COP trajectory after intervention(P<0.05).And in the control group,the COP area and trajectory with eyes open and closed all got significant improvement(P<0.05).After 3 weeks of intervention,no statistically significant difference was found between two groups in terms of the COP area or COP trajectory in the sitting position with eyes open or eyes closed(P>0.05).4.2 Static stability assessment in standing positionAfter 3 weeks of intervention,significant differences were observed in COP area both in eyes open and closed within experimental group(P<0.05).However,no significant difference was observed in control group(P>0.05).After 3 weeks of intervention,there was no significant difference between two groups(P>0.05).5.Comparison of Berg Balance Scale(BBS)and Modified Barthel Index(MBI)After 3 weeks of intervention,the scores of BBS and MBI in the two groups were improved,and the differences were statistically significant within both groups(P<0.01).However,there was no significant difference in the improvement of BBS and MBI between groups(P> 0.05).6.Comparison of Rapid ventilation lung function testAfter the 3-week intervention,there was a statistically significant difference in forced vital capacity(FVC)within the experimental group(P=0.02),while no significant difference was found within control group.There was no statistical difference between the two groups(P> 0.05).Conclusions: Compared with Trunk Selective Activity Therapy based on Bobath concept,the “Taking the Waist as Axis” Therapy can effectively improve the ability of trunk postural control,limb function and forced vital capacity,supporting its effectiveness and feasibility in trunk rehabilitation.Therefore,the “Taking the Waist as Axis” Therapy based on the Tai Chi’s movement mode can be used as another treatment option in clinical trunk rehabilitation.