Effects of trunk training using motor imagery on the control ability and balance function of the trunk in stroke patients | BMC Sports sciences, medicine and rehabilitation

General information

Post-stroke patients with motor dysfunction who were hospitalized in the Department of Rehabilitation Medicine of our hospital from January 1, 2020 to January 1, 2022, aged 50 to 70 years old, were selected.

Inclusion criteria: [12] ① The patient met the diagnostic criteria for stroke established at the Fourth National Academic Conference on Cerebrovascular Diseases in 1995, [13, 14] and stroke was diagnosed as the primary disease on CT or MRI. ② The time between disease onset and enrollment ranged from two weeks to three months. ③ The patient’s vital signs were stable and the patient was conscious, able to understand the instructions and cooperate with the rehabilitation training. ④ The patient’s score on the Kinesthetic and Visual Imagery Questionnaire (KVIQ) was ≥ 25 points. ⑤ The patient signed the required informed consent form. ⑥ Age between 50 and 70 years.

Exclusion criteria: [14] ① The patient suffered from severe cardiac, hepatic or renal insufficiency, a malignant tumor, etc. ② The patient suffered from impaired consciousness, aphasia, mental disorder or severe cognitive impairment. ③ The patient has had other craniocerebral diseases or traumatic sequelae in the past. ④ The patient has previous severe osteoarticular disorders causing abnormal trunk function.

Finally, a total of 100 patients with stroke and motor dysfunction were included, and they were divided into a control group and a trial group according to the random number table, with 50 cases in each group. There was no significant difference (P > 0.05) in general data such as gender, age, disease course and KVIQ between the two groups, and they were comparable. See Table 1 for details. This study was approved by the local ethics committee (approval number: 2018-ethical review-189) and conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent.

Treatment methods

The patients in the control group underwent routine rehabilitation therapy and remained in the supine position in the same environment for the same amount of time as the combined trunk motor imagery therapy. Meanwhile, the trial group received both routine rehabilitation therapy and combined trunk motor imagery therapy.

Routine rehabilitation therapy

The training included proper limb positioning, neuromuscular promotion techniques, such as the proprioceptive neuromuscular facilitation technique (PNF), Rood’s approach, motor relearning, occupational therapy, daily living training and traditional therapy. The participants received routine rehabilitation therapy for five hours a day, five times a week, for a period of four weeks.

Motor image therapy

The motor imagery therapy training consisted of six steps: [4, 14] ① Illustration of the task: The therapist first demonstrated and explained the content of the imagery training, asking the patients to carefully observe and identify which part of the limb was ‘active’, what kind of movement was to be performed, and the normal movement to master. feeling. ② Preview: Patients were asked to re-imagine the relevant movements. ③ Motor imagery: Patients listened to the motor imagery instruction tape and practiced the imagery. ④ Rehabilitation training: the patients repeatedly practiced the movements of imagery training. ⑤ Problem solving: The patients learned relevant skills through repeated practice. ⑥ Practical application: the patients convert relevant skills into practical skills. Before the motor images, a video of a normal person’s trunk movements was shown, including stable trunk movements with a Bobath ball, and balance movements while sitting, standing, and reaching to move a water cup. The 10-minute video and audio were shown to patients via a computer in a quiet treatment room. During each training session, patients were instructed to close their eyes and sit on a comfortable chair with their bodies relaxed. The patients then imagined the movement of their body based on the specific motor imagery instructions in the video. During the treatment, the therapist occasionally interrupted the patients to ask questions, to see if they could concentrate on the images of the physical movement. At the end of the session, the patients were asked to refocus their attention on their surroundings, after which they were sent back to their room and asked to feel their physical being. The patients were then asked to pay attention to the environmental sounds. Finally, the narrator counted down from 10 to 1, and the patients were asked to open their eyes when the countdown reached 1. A motor imagery video was shown only during the first treatment, after which the patients underwent motor imagery training according to the motor imagery. guidelines for imagery. The motor imagery therapy sessions were conducted for 30 minutes each, with a frequency of five times per week, for a total of four weeks.

Observation indicators and evaluation methods

The evaluation of the patient’s trunk control was performed before treatment and four weeks after treatment using Sheikh trunk control evaluation. The simple Fugl-Meyer assessment (FMA), the Berg rating scale (BBS), and the balance feedback trainer were used to evaluate the motor and balance functions of the patients. In addition, before and after treatment, the sEMG signals of the bilateral erector spinae and rectus abdominis in the maximum flexion and extension range at a uniform speed under the sitting position were measured by sEMG signals. All evaluations were performed in a blinded manner by the same evaluator.

Sheik Hull Check Evaluation

Sheikh is a scale for evaluating the ability to control the trunk. It involves four movements: turning from the supine position to the hemiplegic side, turning to the healthy side, sitting upright from the supine position and maintaining balance in a sitting position on the bed. The scoring method is: 0 points for non-completion, 12 points for completion but needing some assistance (grasping or leaning on an object), and 25 points for normal completion. A higher total score indicates better trunk control.

BBS rating

The balance function is divided into 14 items, from easy to difficult, and each item is scored based on a five-point scale: 0, 1, 2, 3, and 4. The highest score is 4 points and the lowest score is 0 points. . The highest integral score is 56 points, the lowest is 0 points. The higher the score, the better the balance function.

Evaluation of motor functions

FMA is used to evaluate motor function in patients. The highest score is 100. The higher the score, the better the patients’ motor functioning will be.

Evaluation of balance feedback training equipment

The ProKin 254P (PK-254P) balance feedback training device, manufactured by TecnoBody Ltd., Italy, was used to test the postural stability of the patients. Stability tests were performed in standing position with eyes open using the static mode of the PK-254P balancer. The standard standing posture includes: ① Bilaterally symmetrical standing with A1A5 as central axis. ② The patients raise their heads and look straight ahead. ③ Both upper limbs are naturally placed on either side of the body. ④ The medial edges of both feet are 10 cm apart and the highest point of the bilateral arches is on axis A3A5. Observation parameters are as follows: movement length, movement area, mean front-back movement speed, and mean left-right movement speed.

sEMG signal acquisition

While the patients are seated on a square stool, their trunk is subjected to anterior flexion and posterior extension in the maximum range at uniform velocity. The Shanghai NCC 8-channel sEMG signal acquisition system was used to acquire the bilateral erector spinae and rectus abdominis myoelectric signals. The electrodes were taped to the 3 cm lateral opening on the left and right sides of the L3 spinous process (erector spinae) and the 3 cm lateral opening on the left and right sides 3 cm above the navel (rectus abdominis). The conductive diameter of the electrodes was 1 cm and the distance between the electrodes was 2 cm. Dandruff and oil were removed with a fine gauze and alcohol before testing. The root mean square (RMS) of myoelectric signals was then analyzed. The test was repeated three times with an interval of 30 seconds to obtain the average value. The RMS of the bilateral rectus abdominis and erector spinae of the two groups was evaluated before treatment and four weeks after treatment.

static analysis

SPSS software version 16.0 was used to analyze the data. The measurement data is expressed as (\(\bar x \pm s\)). Parametric statistics were applied when the data collected met the assumptions of homogeneity of variance and normal distribution. When these assumptions were not met, non-parametric statistics were used. The paired sample T-test was used for pre- and post-treatment comparison within the same group, while the independent sample T-test was used for between-group comparison, and P< 0.05 indicated that the difference was statistically significant.