Effects of neuromuscular electrical stimulation and core muscle strengthening on trunk instability following stroke


  • Riyas Basheer K. B. Department of Physiotherapy, Tejasvini Physiotherapy College, Kudupu, Mangalore, Karnataka, India
  • Dinesh K. V. Department of Orthopedics, Srinivas Institute of Medical Sciences, Mukka, Surathkal, Mangalore, Karnataka, India
  • Subhashchandra Rai Department of Physiotherapy, Tejasvini Physiotherapy College, Kudupu, Mangalore, Karnataka, India
  • Mohammed Arshak A. T. Department of Physiotherapy, Kenz Rehab Physiotherapy Centre, Koppam, Palakkad, Kerala, India




Stroke, NMES, Core muscle strengthening, BBS, BI, TIS, PASS


Background: Postural instability leads to balance dysfunction in stroke subjects, which always increase the risk of fall. This study aimed to compare the effect of neuromuscular electrical stimulation and core muscle strengthening on trunk balance following stroke.

Methods: Forty five stroke subjects were participated and assigned randomly into three groups; all groups received standard rehabilitation program; and core group received additional core strengthening, neuromuscular electrical stimulation (NMES) group received added electrical stimulation over paraspinal region and combination group received core muscle strengthening and NMES along with standard rehabilitation protocol. After four weeks of the interventions, primary and secondary outcome measures are evaluated. Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PASS), Trunk Impairment Scale (TIS) and Barthel Index (BI) were evaluated before and after the intervention.

Results: All the three (core MS, NMES and combination) groups showed significant improvement after the intervention (BBS 10.07, 15.54 and 18.27, PASS 6.54, 13.06 and 14.00, TIS 0.25, 0.25 and 0.51, BI 16.40, 29.93 and 36.53). The combination group (NMES and core muscle strengthening) showed better improvement than other two groups. TIS and BI total score showed positive (0.849) correlation.

Conclusions: Addition of NMES along with core muscle strengthening for stroke rehabilitation will improve trunk stability, balance and ADLs.


Karatas M, Cetin N, Bayramoglu M, Dilek A. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am J Phys Med Rehabil. 2004;83:81-7.

Perlmutter S, Lin F, Makhsous M. Quantitative analysis of static sitting posture in chronic stroke. Gait Posture. 2010;32:53-6.

Yoo SD, Jeong YS, Kim DH, Lee MA, Noh SG, Shin YW, et al. The efficacy of core strengthening on the trunk balance in patients with subacute stroke. J Korean Acad Rehabil Med. 2010;34:677-82.

Slijper H, Latash ML, Rao N, Aruin AS. Task-specific modulation of anticipatory postural adjustments in individuals with hemiparesis. Clin Neurophysiol. 2002;113:642-55.

Yu SH, Park SD. The effects of core stability strength exercise on muscle activity and trunk impairment scale in stroke patients. J Exerc Rehabil. 2013;9:362-7.

Kim YM, Chun MH, Kang SH, Ahn WH. The effect of neuromuscular electrical stimulation on trunk control in hemiparetic stroke patients. J Korean Acad Rehabil Med. 2009;33:265-70.

Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008;88:559-66.

Benaim C, Perennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke. 1999;30:1862-8.

Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004;18:326-34.

Terence J Quinn, Peter Langhorne. Barthel index for stroke trials; Development, properties and application. Stroke. 2011;42:1146-51.

Verheyden G, Vereeck L, Truijen S, Troch M, Lafosse C, Saeys W, et al. Additional exercises improve trunk performance after stroke: a pilot randomized controlled trial. Neuro Rehabil Neural Repair. 2009;23:281-6.

Basheer RKB, Nair A, Sukumar S, Paul JK, Chandran DS, Jazeel NM, et al. Effects of unstable surface task oriented training and visual deprived balance training in hemiparetic individuals: A comparative study. Int J Multidisciplinary Res Develop. 2018;5(12):1-5.

Kimberley TJ, Lewis SM, Auerbach EJ, Dorsey LL, Lojovich JM, Carey JR. Electrical stimulation driving functional improvements and cortical changes in subjects with stroke. Exp Brain Res. 2004;154:450-60.

Wu CW, van Gelderen P, Hanakawa T, Yaseen Z, Cohen LG. Enduring representational plasticity after somatosensory stimulation. Neuro Image. 2005;27:872-84.

Sheffler LR, Chae J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve. 2007;35:562-90.




How to Cite

K. B., R. B., K. V., D., Rai, S., & A. T., M. A. (2021). Effects of neuromuscular electrical stimulation and core muscle strengthening on trunk instability following stroke. International Journal of Research in Medical Sciences, 9(12), 3596–3601. https://doi.org/10.18203/2320-6012.ijrms20214706



Original Research Articles