Objective: To investigate the effectiveness of trunk training on trunk control, sitting and standing balance and mobility. Data sources: PubMed/MEDLINE, Web of Science, Physiotherapy Evidence Database (PEDro), Cochrane Library, Rehab+ and ScienceDirect were searched until January 2019. Review methods: Randomized controlled trials were included if they investigated the effect of trunk exercises on balance and gait after stroke. Four reviewers independently screened and performed data extraction and risk of bias assessment with the PEDro scale. Disagreements were resolved by a fifth independent reviewer. A meta-analysis was performed to quantitatively describe the results. Results: After screening of 1881 studies, 22 studies and 394 participants met the inclusion criteria. Trunk training was executed as core stability, reaching, weight-shift or proprioceptive neuromuscular facilitation exercises. The amount of therapy varied from a total of 3–36 hours between studies. The median PEDro score was 6 out of 10 which corresponds with a low risk of bias. Meta-analysis was performed with a random-effects model due to differences in study population, interventions received and follow-up length. The overall treatment effect was large for trunk control standardized mean differences (SMD) 1.08 (95% confidence interval (CI): 0.96–1.31), standing balance SMD 0.84 (95% CI: 0.04–0.98) and mobility SMD 0.88 (95% CI: 0.67–1.09). Conclusions: In patients suffering from stroke, there is a strong amount of evidence showing that trunk training is able to improve trunk control, sitting and standing balance and mobility.

Combining the benefits of tele-rehabilitation and Virtual Realitybased balance training -a systematic review on feasibility and effectiveness.Purpose: A motivational surrounding is desirable in stroke rehabilitation considering the need to train repetitively to improve balance, even after discharge from rehabilitation facilities. This review aims to investigate if it is feasible to combine VR which allows exercising in game-like environments with tele-rehabilitation in a community-dwelling stroke population.Methods: Literature searches were conducted in five databases, e.g. PubMed and the Cochrane Library. Randomised and non-randomised controlled trials investigating feasibility and effectiveness of VR-based tele-rehabilitation were included. Based on the risk of bias and study design, methodological quality is ranked according to the GRADE guidelines.Results: Seven studies (n=120) were included, of which four are RCTs.Evidence regarding therapy adherence and perceived enjoyment of VR, as well as a cost-benefit of tele-rehabilitation emphasizes feasibility. Equal effects are reported comparing this approach to a therapist-supervised intervention in the clinical setting on balance and functional mobility. Conclusions:Tele-rehabilitation could be a promising tool to overcome burdens that restrict accessibility to rehabilitation in the future. VR can increase motivation allowing longer and more training sessions in communitydwelling stroke survivors. Therefore, combining the benefits of both approaches seems convenient. Although evidence is still sparse, functional improvements seem to be equal compared to a similar intervention with therapist-supervision in the clinic, suggesting that for cost-efficient rehabilitation parts of therapy can be transferred to the homes.

Animal models suggest that rehabilitation provided as repetitive motor training is most effective early after stroke. To investigate whether such a rehabilitation approach can enhance long-term walking recovery in human patients with stroke, this review gathered clinical studies on the effects of repetitive gait training. We found that robots, in particular, provide a substantial, yet feasible, increase in the amount of walking practice in those stroke patients who are unable to walk. This increase in rehabilitation dose improves walking ability in the long-term. However, these effects are inconsistent, rather small, and in contrast with neutral effects on motor functions of the paretic leg. Therefore, the effects of repetitive training in the context of early stroke rehabilitation remain poorly understood and further research is required. Background: Pre-clinical evidence suggests a period early after stroke during which the brain is most receptive to rehabilitation, if it is provided as highdose motor training. Objective: To evaluate the feasibility of repetitive gait training within the first 3 months post-stroke and the effects on gait-specific outcomes. Methods: PubMed, Web of Science, Cochrane Library, Rehab Data and PEDro databases were searched systematically. Randomized controlled trials were included to descriptively analyse the feasibility and quantitatively investigate the effectiveness of repetitive gait training compared with conventional therapy. Results: Fifteen randomized controlled trials were included. Repetitive training can safely be provided through body weight support and locomotor assistance from therapists or a robotic device. No difference in drop-out rates was reported despite the demanding nature of the intervention. The metaanalysis yielded significant, but small, effects on walking independence and endurance. Training with end-effector robots appears most effective. Conclusion: Robots enable a substantial, yet feasible, increase in the quantity of walking practice early post-stroke, which might enhance functional recovery. However, the mechanisms underlying these effects remain poorly understood.

Purpose: The aim of this systematic review was to determine the number of muscle synergies and the distribution of muscle weightings in stroke patients during gait. Material and Methods:This review is registered on PROSPERO (number: CRD42018088701) and is written following the PRISMA guidelines. A systematic search was conducted using following databases: PubMed, Web of Science, Naric, Cochrane and PEDro. Methodological quality was assessed by the Newcastle-Ottawa Scale and data extraction (subject characteristics, outcome measures and walking protocols) was performed by two independent researchers. The amount and structure of the muscle synergies were the two main outcome measures. Results:In total, ten studies were included in this review. While four synergies are common in healthy controls, stroke patients often showed less synergies during gait. Synergies were determined by the number of muscles measured which varied greatly between studies. Only Tibialis Anterior, Soleus, Gastrocnemius and Rectus Femoris were assessed in all studies. Conclusions:A consensus regarding the amount and composition of muscle synergies in stroke patients is difficult. The majority observed three to four muscle synergies. The decrease in amount of synergies can be explained by merging of synergies, often seen in hip/knee extensors with plantar flexors and hip/knee extensors with knee flexors.

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