The Impact of Targeted trunk training on bed mobility in stroke patients

Stroke is classically characterized as a neurological deficit attributed to an acute focal injury of the central nervous system by a vascular cause, including cerebral infarction, intra cerebral hemorrhage ,and subarachnoid hemorrhage and is a major cause of disability and death worldwide. People with stroke present with a combination of sensory, motor and cognitive impairments. In 70–80% of stroke patients, sensory, and motor impairments are associated to postural deficits involving balance and trunk control. Stroke generally results in unilateral motor deficit in upper and lower extremity. However, its impact on trunk muscle is extensive due to its architecture. Two main muscle groups are involved in trunk movement: the back extensors and abdominal muscles. Most of the abdominal muscles are attached to an aponeurosis that is connected to Linea Alba. So, the muscles on one side of abdomen rely on stability provided by muscles on other side, especially for trunk rotation. This causes compromise of trunk muscles on nonparetic side also leading to impaired movement.

Patricia M. Davies advocates that trunk is a core component to control upper and lower extremities. Without proper trunk control, movements of limbs can only be performed in primitive and stereotyped manner. Improving trunk control in lying position promotes bed mobility in early stage and also contributes to improved balance, gait and ADL in later stages. Trunk control is essential for movement control and postural balance during functional activities.

Trunk performance is an important predictor of functional outcome after stroke. Trunk function is associated with balance and walking ability in stroke patients, and has also been found to offer a useful predictor of balance and walking ability and activities of daily living (ADL) outcomes. There are several studies showing strong evidence that trunk training is able to improve trunk control, sitting and standing balance, gait and ADL activities. Trunk muscles also contribute for bed mobility like turning in bed and moving in bed.

Bed mobility is one of the basic functions which have to be achieved before progressing to other functions. It is the first step in making the patient independent by enabling them to move on their own to prevent complications like pressure sores or joint stiffness. Patients who reposition themselves require less assistance from caregivers which enables them to concentrate on other aspects of patient’s care. Improvement in bed mobility gives the patient a sense of accomplishment and a positive mindset during the recovery process. Bed mobility is a component assessed in various stroke outcome measures. However, intervention with focus to improve bed mobility using trunk training is hard to find in the literature.

We design this study with this focused training to improve bed mobility in stroke patients. This could show significant improvement in bed mobility when compared to other trunk training protocols and conventional physiotherapy