Original Article

The effects of Bobath-based trunk exercises

on trunk control, functional capacity, balance,
and gait: a pilot randomized controlled trial
Muhammed Kılınc , Fatma Avcu, Ozge Onursal, Ender Ayvat,
Cevher Savcun Demirci, Sibel Aksu Yildirim
Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation,
Ankara, Turkey

Objective: The aim of this study was to investigate the effects of Bobath-based individually designed trunk
exercises on trunk control, upper and lower extremity function, and walking and balance in stroke patients.
The main aim of treatment was to eliminate individual trunk impairments during various patient functions.
Methods: The study was planned as an assessor-blinded, randomized controlled trial. A total of 22 patients
volunteered to participate in the study. Trunk function, functional capacity, and gait were assessed with the
Trunk Impairment Scale (TIS), stroke rehabilitation assessment of movement (STREAM), and a 10-m
walking test, respectively. The Berg Balance Test (BBT), functional reach (FR), and timed up-and-go
(TUG) tests were used to evaluate balance. After the initial assessment, the patients were divided
randomly into two groups, the study group (12 patients) and the control group (10 patients). The mean
age of the patients in the study group was 55.91 years (duration of stroke 58.66 months) and that of the
control group was 54.00 years (duration of stroke 67.20 months). Individual training programs were
determined for the patients in the study group, taking into consideration their evaluation results; and
strengthening, stretching, range of motion, and mat exercises were determined for the control group
according to their functional level. The participants in both groups were taken into the physiotherapy
program for 12 weeks, 3 days a week for 1 hour a day.
Results: In group analyses, both groups showed improvement in STREAM, TIS, and TUG tests. Only the
study group produced significant gains in the BBT, FR, and 10 m walking tests (Pv0.05). According to the
pre- and post-treatment results, no significant difference was observed in any of the evaluated parameters
between the two groups (Pw0.05).
Conclusion: Individually developed exercise programs in the Bobath concept improve trunk performance,
balance, and walking ability in stroke patients more than do conventional exercises.
Keywords: Stroke rehabilitation, Trunk training, Bobath concept, Individually designed exercises

Introduction Today, one of the preferred methods of stroke

Trunk control is one of the most important indi-
cators of functional recovery after stroke. There is
a strong correlation between trunk performance
and balance, gait, and functional skills in stroke
patients.1,2 Weakness and/or increased tone in the
trunk muscles, increase in postural sway, failure of
dynamic stability, and difficulties in transferring
weight all negatively affect the activity performance
of patients.3
Correspondence to: Muhammed Kılınc, Hacettepe University, Faculty of
Health Sciences, Department of Physiotherapy and Rehabilitation,
Samanpazari 06100, Ankara, Turkey. Email: muhammedkilinc@yahoo.com
rehabilitation is neurodevelopmental treatment
(NDT), also known as the Bobath concept. The
trunk is at the heart of the treatment program for
hemiplegia using the Bobath concept. With fine
trunk control and proper weight transfer, it is poss-
ible to secure and protect the body in an upright pos-
ture and in the achievement of distal functional
movement3. The most important aspect of the
relationship between trunk control and its function
is the dynamic stabilization of the trunk with
regard to different parts of the body. The quality of
movement in the head and limbs is directly related
to proximal stability.3,4

ß W. S. Maney & Son Ltd 2015

DOI 10.1179/1945511915Y.0000000011 Topics in Stroke Rehabilitation 2015 VOL . 00 NO . 0 1
Kılınc et al. Effects of Bobath-based trunk exercises
In the literature, there is moderate evidence regard-
ing the effectiveness of trunk training in stroke
patients.4 In a study conducted by Mudie et al.,5
the effectiveness of three different physiotherapy
approaches (NDT, specific reaching tasks, and bal-
ance training) were compared and the Bobath
method was reported to be the most effective for
trunk development. However, in another study con-
ducted by Pollock et al.,6 which was similar in
design, trunk training with the Bobath concept was
reported to have no effect on sitting balance. In a
study performed by Verheyden et al.,7 it was stated
that 10 sessions of trunk range of motion exercises
in addition to conventional therapy increased the lat-
eral flexion movements of the trunk, but that func-
tionally based activities are necessary for more
effective trunk control. Karthikbabu et al.8 investi-
gated the effects of both unstable and stable surfaces
on trunk control and observed that unstable surfaces
were more effective in improving control. In another
study by the same researchers, trunk training was
found to improve walking speed, cadence, and gait
symmetry.9 Saeys et al.,10 in a randomized controlled
study in 2012, reported that trunk training in
addition to conventional methods had positive effects
on trunk function, balance, and mobility.
According to the literature, improving muscle
strength and stability, increasing trunk range of
motion, and improving static and dynamic trunk
control form the basis of current post-stroke treat-
ments.4 Although the importance of trunk control
in post-stroke physiotherapy is emphasized in the lit-
erature, the relationship between functional disability
and the trunk muscles has not yet been fully
explained by clinical studies. In other words, if the
question of which trunk muscle or biomechanical
problem is the basis of the affected function could
be clearly answered, trunk muscle interventions
would provide more functional benefits.
The purpose of the present study was to investigate
the effects of the individually designed Bobath-based
trunk training on trunk control, functional skills,
walking, and balance in stroke patients. In this
study, the main aim was to eliminate individual
trunk impairments affecting various functions per-
formed by patients.
Method
This study, in which we evaluated the efficacy of the
Bobath-based trunk training in stroke patients, was
performed at the Physiotherapy and Rehabilitation
Department of Hacettepe University between June
2013 and October 2014. Ethical approval was given
2 Topics in Stroke Rehabilitation 2015 VOL .
by Hacettepe University. All patients diagnosed by
a neurologist as having had a stroke were invited to
participate in the study. The diagnoses were made
based on the patients’ history and signs and con-
firmed by computed tomography (CT) or magnetic
resonance imaging (MRI). The inclusion criteria for
the study were:
N patients in the subacute and chronic stages associ-
ated with stroke hemiparesis (time since stroke
onset v6 months)
N patients with an affected trunk (those who did not
have full points in the Trunk Impairment Scale, TIS)
N adults 18 years or older,
N patients who could sit and walk independently (or
those who used an aid for walking).
Exclusion criteria were:
(1) patients with recurrent strokes
(2) patients with communication problems
(3) patients with orthopedic or neurological disorders
(other than strokes) that might affect their motor
performance.
The study design is shown in Fig. 1. A total of 87
stroke patients were followed up in the outpatient
clinic during the 16-month study period. Of the 32
patients who met the inclusion criteria, 22 volun-
teered to participate in the study.
Design
The study was planned as an assessor-blinded ran-
domized controlled trial. After the initial assessment,
patients were divided randomly into two groups
using a random numbers table. One of the authors
(EA) was made the randomization by using a compu-
ter-generated random number. Blocks were num-
bered, and then a random-number generator
program was used to select numbers that established
the sequence in which blocks were allocated to study
or the control group. There were 12 patients in the
study group and 10 in the control group.
Interventions
First, the demographic and clinical data for both
groups were recorded. Individual training programs
were then created for the patients in the study
group. For this purpose, the functional limitations
of each individual patient were identified, and mul-
tiple hypotheses regarding the potential trunk-associ-
ated causes underlying each limitation were
developed. By analyzing the various deficiencies, the
most important factor responsible for each impair-
ment was detected. Verification tests for each hypoth-
esis were performed on the trunk muscles that were
mainly responsible for the functional limitations,
00 NO . 0

Figure 1 The study design
and a specific intervention plan for the particular
impairment was identified and implemented. After
this, the hypothesis was verified by observing any
recent functional recovery or, where this could not
be confirmed, a new hypothesis was developed.
These interventions (exercises) were applied to the
patients as a treatment program successfully in
terms of functional performance (details of the devel-
opment of hypotheses are given in Schema 1).
Experienced physiotherapists took part in the identi-
fication of functional limitations and in stroke reha-
bilitation during the development and validation of
the hypotheses (SAY, MK: Course information:
Assessment and treatment of adult hemiplegia –
The Bobath concept. Trainer: Elia Panturin, Senior
Kılınc et al. Effects of Bobath-based trunk exercises
Instructor; International Bobath Instructors Training
Association (April 15–22, 2006 and June 22–28,
2006), School of Physiotherapy and Rehabilitation,
Hacettepe University, Ankara, Turkey). The treat-
ment program was developed taking the functional
limitations of the patients into account, and consisted
of seven trunk exercises according to the Bobath
concept.
These were:
1. stretching of the latissimus dorsi muscle
2. functional use and strengthening of the latissimus
dorsi
3. functional strengthening of abdominal and oblique
abdominal muscles
4. placing exercises in order to facilitate trunk
extension
Topics in Stroke Rehabilitation 2015 VOL . 00 NO . 0 3
Kılınc et al. Effects of Bobath-based trunk exercises
5. rotations and counter-rotations (right and left) of
the hips with the trunk extended
6. training of lumbar spine stabilizers
7. functional reach of shoulder, anterior, right, and left
sides.
In applying the exercises, the physiotherapists acted
in accordance with the fundamental principles of
the Bobath method, such as ensuring the active par-
ticipation of the patient; obtaining high-quality func-
tional movements; abundant repetitions; following a
passive movement with an active movement; and
holding difficult movements in the inner-range
position.
Strengthening (trunk flexion–extension) and
stretching exercises (stretching and elongation), mat
activities (bridging), functional activities (weight
transfer to from anterior to posterior and left to
right), and range of motion exercises (trunk flexion,
extension, left–right rotation, lateral flexion) were
performed by the patients in the control group in
the light of their current assessments.
Participants in both groups were entered into the
physiotherapy program for 12 weeks, 3 days a week
for 1 hour a day, and were assessed at baseline and
in the 12th week of the study.
Balance (Berg Balance Test, BBT)
The Berg Balance Scale is a measurement that
assesses 14 functions including sitting, standing,
and walking, all scored between 0 and 4. Scoring is
based on the quality of the performance, and how
long it takes to complete an activity or sustain a cer-
tain posture.11 The Turkish version of the scale used
in stroke patients was developed by Sahin et al.12
Functional capacity (STREAM)
Stroke rehabilitation assessment of movement
(STREAM) was used to evaluate the functional
capacity of the patients. This is a scale consisting of
30 items in which upper extremity, lower extremity,
and basic mobility activities are represented by 10
items. It is a quality assessment, which determines
not only whether the patients are performing the
actions or not, but also how well they do them.13
During the assessment, limb movements are evalu-
ated over two points and basic mobility movements
over three points. Extremity scoring is shown below.
0 Unable to perform the test movement through any
appreciable range (includes flicker or slight range).
1 a. Able to perform only part of the move-
ment, with marked deviation from the normal pat-
tern (in our study, one point)
4 Topics in Stroke Rehabilitation 2015 VOL .
b. Able to perform only part of the movement
but in a manner that is comparable to the
unaffected side (in our study, two points)
c. Able to complete the movement but only
with a marked deviation from the normal pat-
tern (in our study, three points).
2 Able to complete the movement in a manner
that is comparable to the unaffected side (in our
study, four points).
In addition, we used the scoring system developed by
Wang et al.14 in which voluntary movements of the
limbs are scored on a 3-point scale (0, unable to per-
form the test movement; 1, only partially able to per-
form the test movement; and 2, able to complete the
test movement). Basic mobility items are scored on a
4-point scale similar to that used for limb move-
ments, except that a category has been added to
allow for independence with the help of a mobility
aid. Thus, the maximum raw total STREAM score
is 70, with each of the limb subscales scored out of
20 and the mobility subscale scored out of 30. In
this study, we also gave a detailed table of the
STREAM assessments to indicate the quality
changes.
Trunk Function (TIS)
Trunk function was evaluated with the TIS. This
consists of a total of 17 items: three regarding static
sitting balance, 10 regarding dynamic sitting balance,
and four about coordination. Patients receive a total
of between 0 and 23 points.15 The Turkish version of
this scale was developed by Parlak Demir et al.16
Stability Limits [Functional Reach (FR) Test]
The patient is instructed to progress to the next
activity, positioning the arm that is closest to a wall
in 90uu of shoulder flexion with the fist closed but
not touching the wall. The assessor records the start-
ing position at the third metacarpal head on a yard-
stick, and the patient is instructed to ‘‘Reach as far
forward as you can without taking a step.’’ The
location of the third metacarpal is then recorded.
Scores are determined by assessing the difference
between the start and end positions, which is the
reach distance. Three trials are done, and the average
of the last two is noted.17
Walking performance (10 m walking test)
The time taken to walk 10 m is recorded in seconds.
At the end of the test, the average of three trials is
taken. During the test, patients are allowed to use
walking aids.18
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Risk of falling (timed up-and-go, TUG)
Subjects are required to stand up from a chair with
armrests, walk 3 m, turn around, return to the
chair, and sit down. The time taken to complete
this task is measured in seconds with a stopwatch.19
Statistical analyses
Statistical analyses of the data were performed with
SPSS 15.00. The quantitative and qualitative data
were expressed as mean+ standard deviation
(x+ SD) and percentages, respectively. Wilcoxon’s
signed ranks tests were used for group analyses,
and the Mann–Whitney U test was used to compare
different groups. The level of significance was set at
Pv0.05.
Results
A total of 22 patients were included in the study, 12
(eight women, four men) in the study group, and 10
(five women, five men) in the control group. In the
study group, one patient’s medical condition wor-
sened, and a second patient failed to give a reason
for not participating in the study; and one patient
in the control group left the treatment in the
second week of the study because of difficulty with
transportation. The initial evaluation of these
patients was included in the analysis. The mean age
of the patients in the study group was
55.9+ 7.9 years and that of the control group was
54.1+ 13.6 years. Six patients in the study group
had hemiparesis due to ischemic stroke and six
because of hemorrhagic stroke; and in the control
group, five patients had hemiparesis due to ischemic
stroke and five because of hemorrhagic stroke.
At the beginning of the study the demographic and
clinical characteristics of the patients (Berg Balance
Test (BBT), timed-up-and go, 10 m walking test,
FR, TIS, and STREAM) were similar in the two
groups (Pw0.05). The demographic and baseline
clinical characteristics of the patients are given in
Table 1. Both groups were included in the 36 phy-
siotherapy sessions over 12 weeks.
When the results of the BBT, FR, and 10 m walk-
ing test were analyzed, a statistical improvement was
observed in the study group (Pv0.05), but no signifi-
cant changes were seen in the control group
(Pw0.05) (Table 2). According to the STREAM,
TIS, and TUG test results, a statistically significant
improvement was observed in both groups
(Pv0.05) (Table 2). According to the TIS test in
both groups, dynamic sitting balance and total TIS
results showed a significant improvement (Pv0.05),
but static sitting balance and the coordination
Kılınc et al. Effects of Bobath-based trunk exercises
subscale did not (Pw0.05) (Table 2). Total
STREAM points and the lower extremity subscale
showed significant improvements in both groups
(Pv0.05); however, mobility and the upper extremity
subscales improved only in the study group (Pv0.05)
(Table 2).
The STREAM results of the patients who partici-
pated in the study are presented in a different table
in order to show changes in quality. In this table,
the STREAM scale items concerning trunk perform-
ance in particular (numbers 4, 5, 6, 8, 9, 15, 21, 22,
23, 26, and 29), were intended to show more accu-
rately and in detail changes in the quality of the
movement before and after the treatment. For
example, whereas item 4 scores (rolling onto side)
showed no change with treatment in seven patients
from the study group, an improvement in the quality
of the movement was observed in three patients after
the treatment. On the other hand, in the control
group, no improvement in the quality of the move-
ment was observed in six patients but was present
in three (Table 3). In item 23 (abducts affected hip
with knee extended), in which the maximum changes
were observed in the study group, the scores of four
patients remained stable after the treatment, whereas
the scores of six patients showed improvement.
A detailed analysis of 11 items is given in Table 3.
There were no significant differences were found
between the two groups according to all evaluated
parameters after treatment (Pw0.05) (Table 4).
Discussion
The results of the present study have shown that
Bobath-based trunk exercises improve trunk function
and have a positive impact on balance and walking
activities. Although there had been significant
advances in the mentioned parameters in the group
where the conventional treatment had been applied,
the gains of treatment were more limited. The pre-
and post-treatment results of the two study groups
showed no difference between them, but an intra-
group assessment showed that the study group had
greater gains.
In the literature, there are many studies of the
Bobath concept in stroke patients. Paci20 stated in
his review that there are 15 well-designed RCT or
CT studies of the Bobath concept, but none of
them investigated trunk function. Additionally,
since 2003, there has only been the study by Verhey-
den,7 which used neurodevelopmental therapy on the
trunk. However, Verheyden used a standard treat-
ment protocol and not an individualized approach.
Topics in Stroke Rehabilitation 2015 VOL . 00 NO . 0 5
Kılınc et al. Effects of Bobath-based trunk exercises

Table 1 Patient characteristics

Study group (n512) Control group (n510) P value

Age (mean+ SD) (min–max) 55.91+ 7.92 (38–72) 54+ 13.64 (27–73) 0.68
Duration (month) (min–max) 58.66+ 55.68 (9–180) 67.20+ 43.17 (11–144) 0.69
Gender Eight females, four males Five females, five males
Hemi-side Three right, nine left Two right, eight left
Type of stroke Six ischemic, six hemorrhagic Five ischemic, five hemorrhagic
Berg Balance Test 45.33+ 2.23 46.10+ 2.47 0.45
Timed up-and-go 17.59+ 7.29 17.51+ 7.59 0.98
Functional reach 19.98+ 4.41 20.51+ 5.99 0.81
10 m walking test 18.33+ 11.00 14.49+ 5.83 0.33
Trunk Impairment Scale 13.42+ 4.29 14.80+ 5.31 0.50
Static sitting balance 4.67+ 1.50 5.70+ 1.83 0.16
Dynamic sitting balance 6.00+ 2.45 6.50+ 2.80 0.66
Coordination 2.75+ 2.22 2.60+ 2.22 0.87
Stroke rehabilitation assessment of movement 45.08+ 12.60 46.10+ 13.03 0.85
(STREAM)
Upper extremity (0–20) 11.50+ 5.87 11.10+ 6.31 0.87
Lower extremity (0–20) 13.42+ 3.63 14.0+ 3.19 0.60
Mobility (0–30) 20.17+ 5.77 20.80+ 5.53 0.79

The most important feature of our study is that the
trunk training was individually planned and func-
tionally oriented. Multiple hypotheses regarding
functional limitations and trunk impairment were
developed for each patient, tested, and refined, and
eventually a treatment plan focusing on the individ-
ual patient’s needs was developed, taking into
account the principles of the Bobath concept. Exer-
cises were determined according to the functional
expectations of the patient and modified in accord-
ance with their functional level. Each exercise was
combined with functional activity, the goal of
which was to achieve both normal and fine move-
ments. From this perspective, the results of our
study provide more accurate data on the effectiveness
of the Bobath concept in stroke patients. For these
reasons, so far as we are aware, ours is the first orig-
inal study on this subject.
Another factor that makes our results worthwhile
is the evaluation of the quality of movement and
function after the treatment. The results of the
STREAM scale, which is widely used to assess
motor function in stroke patients, are provided to
indicate changes in the quality of activities. Accord-
ing to the Bobath concept, the quality of movement
and function in stroke patients is one of the most
important goals of treatment, and evaluation
approaches should include this parameter. In pre-
vious studies, inadequacies in the reflection of
changes in the quality of movement are outstanding.
Although most studies have stressed that quality is
an important goal of treatment, assessments have
been made by tests such as the Fugl–Meyer, River-
maid, and Frenchay Activity Index, evaluating
whether movements are done or not, or how often,
rather than their quality. However, in our study, 11
items of the STREAM scale, thought to be related
to the trunk, offer a detailed examination opportu-
nity to reflect the quality of changes. According to
the STREAM scale results, in six of the 10 patients
for the item ‘‘abducts affected hip with knee
extended’’ (one patient in the control group), five
patients in the ‘‘flexes hip in sitting’’ item (two
patients in control group), four patients in ‘‘places
hand on sacrum’’ item (one patient in control
group), three patients in ‘‘rises to standing from sit-
ting’’ and ‘‘maintain standing for 20 seconds’’ items
became moving ‘‘compatible with healthy side
level,’’ in other words moved more qualified.
Improvements in the results of the STREAM scale
correlate with those of the Berg Balance Scale, which
also evaluate quality, because the first two items of
the Berg Balance Scale are the same as those assessed
by STREAM, i.e. standing up from sitting and stand-
ing without support. When the results of these two
measures were considered together in the study
group, the improvements were proved statistically
(Berg Balance Scale), and the individual results as
to how much each movement improved were detailed
(STREAM).
There are two studies in the literature on the effects
of trunk exercises on reaching activity.21,22 The
results of the present study indicated significant
improvements in functional reaching after treatment
only in the study group. In this regard, our results
are compatible with those of Thielman and
Dean21,22.
The effects of trunk training on sitting balance and
trunk performance were evaluated by TIS in five pre-
vious studies,2,7,8,10,23 and significant developments in

6 Topics in Stroke Rehabilitation 2015 VOL . 00 NO . 0

 Table 2 Pre- and post-treatment values of the Berg Balance Test, timed up-and-go, functional reach, 10 m walking, Trunk Impairment Scale, and stroke rehabilitation assessment of
movement (STREAM) scales for the study and control group patients

Study group (n510) Control group (n59)

95% CI 95% CI

Pre-treatment Post-treatment Lower Upper P Pre-treatment Post-treatment Lower Upper P value

Berg balance (0–56) 45.40+ 2.46 45.80+ 2.53 {0.77 {0.03 0.037* 46.44+ 2.35 46.67+ 2.60 {0.56 0.12 0.169
Timed up-and-go (seconds) 18.80+ 7.41 16.12+ 5.32 0.41 4.95 0.026* 18.38+ 7.49 16.18+ 6.15 0.82 3.59 0.006*
Functional reach (cm) 18.63+ 3.30 21.84+ 4.23 {6.35 {0.06 0.047* 21.20+ 5.92 22.00+ 4.50 {2.37 0.78 0.277
10 m walking test (seconds) 19.93+ 11.40 14.25+ 5.72 1.14 10.23 0.02* 14.95+ 5.99 14.24+ 5.40 {0.78 2.22 0.302
Trunk impairment (0–23) 13.50+ 3.41 15.60+ 4.14 {3.02 {1.18 0.001* 15.89+ 4.28 16.56+ 4.16 {1.33 0.00 0.05*
Static sitting balance 4.70+ 1.49 5.30+ 1.64 {1.29 0.09 0.081 6.00+ 1.66 6.00+ 1.66 1
Dynamic sitting balance 6.30+ 2.00 7.40+ 2.22 {1.73 {0.47 0.003* 7.11+ 2.15 7.78+ 2.17 {1.33 0.00 0.05*
Coordination 2.50+ 2.17 2.90+ 2.23 {1.00 0.20 0.168 2.77+ 2.28 2.77+ 2.28 1
STREAM (0{–70) 43.90+ 11.89 53.70+ 11.20 {14.74 {4.86 0.002* 46.00+ 13.82 48.44+ 14.49 {3.73 {1.16 0.002*
Upper extremity (0–20) 10.90+ 5.74 13.90+ 6.37 {4.91 {1.09 0.006* 11.67+ 6.42 12.00+ 6.50 {1.19 0.53 0.397
Lower extremity (0–20) 13.40+ 3.41 16.70+ 3.53 {5.02 {1.58 0.002* 14.00+ 3.32 15.56+ 4.07 {2.23 {0.88 0.001*
Mobility (0–30) 19.60+ 5.91 23.10+ 4.61 {6.33 {0.67 0.021* 20.33+ 5.66 20.89+ 5.67 {1.23 0.12 0.95

Evaluated by Wilcoxon’s signed ranks test; *pv0.05.

Table 3 Patient improvement according to the stroke rehabilitation assessment of movement (STREAM) scores

Study group (no. of patients) Control group (no. of patients)

Did not 0 to 1a to 1a to 1b to 1a/b/c 2 to Did not 0 to 1a to 1a to 1b to 1a/b/c 2 to

Items change 1a/b/c 1b 1c 1c to 2 3 change 1a/b/c 1b 1c 1c to 2 3

N4 Rolls onto side 7 – – – 1 2 6 – – – – 2 1

N5 Raises hips off bed in crook lying 8 – – – – 2 8 – – – – 1 –
(Bridging)
N6 Moves from lying supine to sitting 6 – 1 – 1 1 1 8 – – – – 1 –
N8 Raises hand to touch top of head 8 – – – – 1 1 9 – – – – – –
Kılınc et al.

N9 Places hand on sacrum 6 1 1 1 – 1 8 – – – – 1 –

Topics in Stroke Rehabilitation

N15 Flexes hip in sitting 5 – 2 1 1 1 7 – – 1 – 1 –
N21 Rises to standing from sitting 7 – – – 1 1 1 7 – – – – – 2
N22 Maintain standing for 20 seconds 7 – – – 1 2 9 – – – – –

2015
N23 Abducts affected hip with knee 4 – – 2 – 4 8 – – – – – 1
extended
N26 Places affected foot on first step 7 – – 1 1 – 1 9 – – – – – –

VOL .
N29 Walks 10 m indoors 6 – 1 – 1 – 2 9 – – – – – –

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Effects of Bobath-based trunk exercises

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Kılınc et al. Effects of Bobath-based trunk exercises

Table 4 Analysis of the study and control groups after treatment

Mean+ SD

Study Control Z P-value

Berg Balance (0–56) 45.80+ 2.53 46.67+ 2.60 {0.74 0.47

Timed up-and-go (seconds) 16.12+ 5.32 16.18+ 6.15 {0.02 0.98
Functional reach (cm) 21.84+ 4.23 22.00+ 4.50 {0.08 0.94
10 m walking test (seconds) 14.25+ 5.72 14.24+ 5.40 0.01 1.00
Trunk impairment (0–23) 15.60+ 4.14 16.56+ 4.16 {0.50 0.62
Static sitting balance 5.30+ 1.64 6.00+ 1.66 {0.93 0.37
Dynamic sitting balance 7.40+ 2.22 7.78+ 2.17 {0.37 0.71
Coordination 2.90+ 2.23 2.78+ 2.28 0.12 0.91
STREAM (0–70) 96.00+ 20.12 91.44+ 25.21 0.44 0.67
Upper extremity (0–20) 24.50+ 13.02 23.81+ 14.18 0.11 0.91
Lower extremity (0–20) 30.00+ 6.20 29.11+ 6.75 0.30 0.77
Mobility (0–30) 41.40+ 6.45 39.89+ 7.04 0.49 0.63

TIS results were shown by all like our results. The
results of another study24 demonstrated that
deficiencies of trunk function in stroke patients had
adverse effects on standing and walking. These
results were interpreted as indicating that improve-
ments in walking cannot be obtained with walking
exercises only, and so trunk exercises must also be
attached to the treatment program. However, in
Dean et al.’s study,21 performed in 2007, the effects
of trunk training on walking were assessed by a 10-
m walking test, but no change was found in walking
performance with the 2-week training program com-
pared with the control group. In our study, at the end
of the 12-week training program, the 10-m walking
activity test showed significant changes in walking
performance in the study group. In Dean’s study,
the lack of significant improvement in walking per-
formance was associated with the baseline differences
in walking speeds of the two groups. Furthermore,
our study was much longer than that of Dean, and
we think this may have influenced our results posi-
tively in favor of the study group.
The most important limitations of the present study
are the absence of a power analysis and the small
number of patients involved. The lack of significant
differences between the groups is believed to be due to
the number of patients included in the study. Moreover,
all participating patients were evaluated and treated
within the study period of 15 months. Therefore, our
results are presented as a pilot study and we have applied
to the ethical committee for permission to extend its
duration and increase the number of patients.
implemented on the base of the Bobath concept. In
addition, performing the trunk exercises not just for
the trunk but also for the upper and lower extremi-
ties, balance, and gait performance to reach a
higher quality of function, makes this study different
from others. In this regard, it can be suggested that
individually developed exercise programs according
to the Bobath concept improve trunk performance,
balance, and walking activities in stroke patients.
Acknowledgements
The authors would like to thank their patients for
volunteering for the study.
Disclaimer Statements
Contributors
MK and SAY planned the study and generated the
multiple hypotheses, and also prepared the phy-
siotherapy program for the two groups of patients.
FA coordinated the treatment of both groups, EA
performed the randomization, and CD and ÖO per-
formed the patient assessments.
Funding
The authors, their immediate family, and any
research foundation with which they are affiliated
have received no financial payments or other benefits
from any commercial entity related to the subject of
this article.
Conflicts of interest
There is no conflict of interest in this study.

Clinical messages Ethical approval

This study is the first randomized controlled study in Ethical approval was received at Hacettepe Univer-
the literature on the trunk training of stroke patients sity, and signed consent form was taken from the
in which individual treatment was planned and participants.

8 Topics in Stroke Rehabilitation 2015 VOL . 00 NO . 0


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