Reflex-mediated dynamic neuromuscular stabilization in stroke patients: EMG processing and ultrasound imaging

Abstract

Abstract. BACKGROUND:Postural core instability is associated with poor dynamic balance and a high risk of serious falls. Both neurodevelopmental treatment (NDT) and dynamic neuromuscular stabilization (DNS) core stabilization exercises have been used to improve core stability, but the outcomes of these treatments remain unclear. OBJECTIVE: This study was undertaken to examine the therapeutic effects of NDT and DNS core stabilization exercises on muscular activity, core stability, and core muscle thickness. METHODS: Ten participants (5 healthy adults; 5 hemiparetic stroke patients) were recruited. Surface electromyography (EMG) was used to determine core muscle activity of the transversus abdominis/internal oblique (TrA/IO), external oblique (EO), and rectus abdominis (RA) muscles. Ultrasound imaging was used to measure transversus abdominals/internal oblique (TrA/IO) thickness, and a pressure biofeedback unit (PBU) was used to measure core stability during the DNS and NDT core exercise conditions. Data are reported as median and range and were compared using nonparametric Mann -Whitney U test and Wilcoxon signed rank test at p < 0.05. RESULTS: Both healthy and hemiparetic stroke groups showed greater median EMG amplitude in the TrA/IO muscles, core stability, and muscle thickness values during the DNS exercise condition than during the NDT core exercise condition, respectively (p < 0.05). However, the relative changes in the EMG amplitude, core stability, and muscle thickness values were greater during the DNS exercise condition than during the NDT core exercise condition in the hemiparetic stroke patient group (p < 0.05). CONCLUSIONS: Our novel results provide the first clinical evidence that DNS is more effective than NDT in both healthy and hemiparetic stroke subjects to provide superior deep core muscle activation, core stabilization, and muscle thickness. Moreover, such advantageous therapeutic benefits of the DNS core stabilization exercise over the NDT exercise were more apparent in the hemiparetis stroke patients than normal controls.

Best core stabilization exercise to facilitate subcortical neuroplasticity: A functional MRI neuroimaging study

“…In fact, a recent clinical study demonstrated a superior effect of DNS on core muscle activation over the conventional NDT in sub-acute stroke patients. Specifically, transverse abdominal and internal oblique muscles electromyographic activity was significantly greater in the DNS group than the NDT group, supporting the notion that the subconscious core stabilization method is more beneficial for deep core muscle activity control [11].…”

Functional postural-stabilization tests according to Dynamic Neuromuscular Stabilization approach: Proposal of novel examination protocol

“…DNS can also be used to improve neck muscles coordination to treat cervical instability and neck pain (Cha et al, 2018). Furthermore, DNS methods were found to be effective in the rehabilitation of balance, gait, stance and core stabilization in neurological disorders such as cerebral palsy Son et al, 2017) or stroke (Yoon and You, 2017).…”

“…DNS manual treatment makes use of specific functional exercises to improve spinal and joint stability by focusing on the integrated stabilization system (Frank et al, 2013). Although statistical reliability of the DNS tests is limited good effect of DNS therapeutic procedures (Cha et al, 2018;Davidek et al, 2018;Juehring and Barber, 2011;Kim et al, 2017;Kobesova et al, 2018Kobesova et al, , 2015Oppelt et al, 2014;Son et al, 2017;Yoon and You, 2017) suggests clinical utility of the DNS tests since the therapy, training and individual correction of the clients in the studies listed above was always based on DNS functional tests. A study exploring reliability of individual DNS tests has been in process.…”

Abdominal Expansion versus Abdominal Drawing-In Strategy on Thickness and Electromyography of Lumbar Stabilizers in People with Nonspecific Low Back Pain: A Cross-Sectional Study

“…The abdominal expansion (AE) strategy has been increasingly used by a therapeutic approach, dynamic neuromuscular stabilization, prior to purposeful movement during daily activities, and as the essential foundation of their stabilization exercises [ 13 , 14 , 15 ]. In contrast to the AD strategy, the AE strategy involves eccentric contraction of the abdominal muscles accompanied by downward contraction of the diaphragm.…”