Sensory training combined with motor training improves trunk proprioception in stroke patients: a single-blinded randomized controlled trial

Inadequate trunk function is the underlying cause of many problems such as impaired balance and mobility. Although there have been trunk-based physiotherapy approaches in recent years, almost all of these approaches focus on motor problems. This study aims to investigate the effects of sensory training combined with trunk-centered Bobath exercises on trunk control and proprioception, balance, gait, and the activity of daily living (ADL). This study is a randomized controlled trial included with twenty-seven stroke patients. Participants were separated into two groups, Group 1; ‘sensory training combined with trunk-centered Bobath exercises’ and Group 2; ‘trunk-centered Bobath exercises’. Trunk-centered Bobath exercises were used for motor training. Sensory training included transcutaneous electric nerve stimulation and a set of exercises that provide tactile and proprioceptive stimulation. Trunk Impairment Scale, Trunk Reposition Error, Berg Balance Scale, 2-minute walk test, and Barthel Index were used to assess trunk control, trunk proprioception, balance, gait, and ADL respectively. Intra-group analysis results showed that trunk control, trunk proprioception, balance, gait, and ADL improved in both groups after treatment (p < 0.05). The changes in the Trunk Reposition Error values of the participants in Group 1 before and after treatment was found to be significantly higher than Group 2 (p < 0.05). The findings indicated that the application of trunk-centered motor training is effective in improving trunk proprioception and trunk control, balance, gait, and ADL in stroke patients. Also, sensory training combined with trunk-centered motor training was found more effective in improving trunk proprioception than solely motor training.

躯干功能不全是平衡与运动功能受损等诸多临床问题的根本诱因。尽管近年来已有基于躯干的物理治疗方案，但此类方案几乎均聚焦于运动功能障碍。本研究旨在探讨感觉训练联合躯干中心式Bobath训练（trunk-centered Bobath exercises）对脑卒中患者躯干控制能力、本体感觉、平衡功能、步行能力及日常活动能力（Activity of Daily Living, ADL）的影响。本研究为一项纳入27例脑卒中患者的随机对照试验，将受试者分为两组：第1组为「感觉训练联合躯干中心式Bobath训练组」，第2组为「躯干中心式Bobath训练组」。其中，躯干中心式Bobath训练用于运动功能训练；感觉训练则包含经皮神经电刺激（transcutaneous electric nerve stimulation）与一组可提供触觉及本体感觉刺激的训练动作。本研究分别采用躯干功能障碍量表（Trunk Impairment Scale）、躯干复位误差（Trunk Reposition Error）、伯格平衡量表（Berg Balance Scale）、2分钟步行试验（2-minute walk test）及巴氏指数（Barthel Index），对躯干控制能力、躯干本体感觉、平衡功能、步行能力与日常活动能力进行评估。组内分析结果显示，两组患者治疗后的各项指标均得到显著改善（p<0.05）。经对比，第1组受试者治疗前后的躯干复位误差值变化幅度显著高于第2组（p<0.05）。研究结果表明，躯干导向型运动训练可有效改善脑卒中患者的躯干本体感觉、躯干控制能力、平衡功能、步行能力与日常活动能力；且相较于单纯运动训练，联合感觉训练的躯干导向型运动训练在改善躯干本体感觉方面效果更优。