Effect of Home-based Trunk Training on Reactive Stepping in Individuals with Chronic Stroke: A Single-subject Experimental Study with Two Cases

Abstract

Objectives: Reactive stepping is necessary to prevent falls when a person slips or trips while walking, particularly in outdoor activities. Individuals with stroke usually exhibit reactive balance impairment. Trunk training is effective for improving balance and mobility after stroke; however, its effect on reactive stepping remains unknown. This study aimed to examine the effects of trunk training on reactive stepping in community-dwelling individuals after stroke.

Methods: This study was conducted using an A-B-A single-subject design. Two community-dwelling women with chronic stroke (79 years old, 9 years post-stroke and 83 years old, 17 years post-stroke) participated in this study. The baseline (A) and intervention (B) phases lasted for 6 weeks. Specifically, the participants did not receive any intervention in phase A, whereas they performed home-based trunk training in phase B. Outcome measures included the foot-off time, maximum trunk rotation angular velocity, number of steps during forward reactive stepping following perturbation, and Trunk Impairment Scale (TIS) score.

Results: Decreased trunk rotation and step count corresponding to improved TIS score were observed in one case after the intervention. However, trunk control did not improve in the other case after the intervention, and reactive stepping kinematics remained unchanged.

Conclusions: Enhancing trunk control may improve reactive stepping in individuals with chronic stroke; nevertheless, further evidence is required.